The surgical management of toxic dilatation of the colon: a report of 28 cases and review of the literature

Experience with 28 patients with toxic dilatation of the colon is reviewed. The operative mortality in this series was 32% (9/28). Eight of the 9 patients who died were found to have colonic perforations at operation; in contrast, the group of patients with no perforations had a mortality rate of only 6%. Colonic perforation and sepsis were the most significant factors contributing to mortality and morbidity in this series. A review of the literature showed an overall operative mortality rate of 19.5% for patients with toxic megacolon; the mortality rate was 41% for patients with perforations and 8.8% for patients without perforations. It appears that the keystone to successful management is the avoidance of colonic perforation and sepsis; protracted medical management of toxic megacolon seems to have been at least partly responsible for these complications. Sixteen of the 18 survivors following subtotal colectomy required removal of the rectum within 9 months because of continued symptoms and disease in the rectal stump.     

The topography of the cecum and proximal loop of the colon in cattle with cecal dilatation

The topography of the cecum and the proximal loop of the colon was studied in 32 cattle of different german breeds, female gender and different age (5.2 +/- 2.0 years), which were surgically treated for cecal dilatation in the Medical and Forensic Veterinary Clinic II of the Justus-Liebig-University in Giessen. In 13 cases (41%) dilatation and dislocation--without or with torsion (along a longitudinal axis, round to the left)--of the cecum, with dilatation of the proximal loop of the colon was diagnosed. In 3 cases (9%) dilatation, dislocation and torsion (along a longitudinal axis, round to the left) of the cecum without dilatation of the proximal loop was found. In 6 cases (19%) dilatation and dislocation of the cecum with dilatation, dislocation and torsion of the proximal loop of the colon (along a longitudinal axis) to the left, and in 10 cases (31%) dilatation and dislocation of the cecum with dilatation, dislocation and torsion of the proximal loop of the colon (along a longitudinal axis) to the right, was observed. By lining up single findings, models are presented how torsion of the cecum to the left, and torsion of the proximal loop of the colon to the left or to the right may develop.     

Cytomegalovirus colitis mimicking colon carcinoma in an HIV-negative patient with chronic renal failure

Cytomegalovirus (CMV) colitis is thought to occur almost exclusively in immunosuppressed persons. Colonoscopy in patients with CMV colitis usually shows diffuse or localized ulceration, although mucosal friability, erosions, hemorrhage, and plaque-like pseudomembranes may be observed. We report on a patient with chronic renal failure undergoing hemodialysis therapy who had abdominal symptoms, including bloody diarrhea, along with colonoscopic findings suggestive of carcinoma of the colon. The patient was not infected with the human immunodeficiency virus and had normal lymphocyte subset numbers. He was subsequently found to have invasive CMV disease of the colon. CMV colitis can occur in persons who are not severely immunosuppressed, and its colonoscopic appearance may mimic that of colon cancer.     

Adenocarcinoma of the colon presenting as anaemia

All patients with adenocarcinoma of the colon treated surgically at the Austin Hospital over a five-year period were reviewed to determine the relevance of anaemia in diagnosis. It was found that one-fifth of the patients presented with symptoms of anaemia to the doctor of first contact, and of these, one-third had an unwarranted delay in diagnosis (mean delay 13 months).     

Synchronous colon primaries have the same prognosis as solitary colon cancers

The production of recombinant baculoviruses usually employs cotransfection of insect tissue-culture cells with viral and transfer-plasmid DNAs. The preparation and storage of viral and plasmid DNAs suitable for optimal transfection of insect cells are discussed. Electroporation, calcium-phosphate, and lipofection transfection techniques are presented with a discussion of their relative advantages. The rates of recombinant virus formation are compared using viral infection/plasmid transfection protocols versus cotransfection of cells with transfer-plasmid and viral DNAs.     

Phthirus pubis as the cause of tubo-ovarian conglomerate tumor

A case of an inflammatory tubo-ovarian tumour is presented. Histology and entomology identified the infectious agent as Phthirus pubis.     

Heterotopic ossification as a complication of toxic epidermal necrolysis

The development of heterotopic ossification (HO) as a complication of toxic epidermal necrolysis (TEN) has not been previously reported. TEN, also known as Lyell's syndrome, is a rare but serious skin disorder that typically occurs after the administration of drugs, especially sulfonamides, barbiturates, phenytoin, and nonsteroidal anti-inflammatory agents. TEN is characterized by the development of large fluid-filled bullae with separation of large sheets of skin. Complications of TEN can include extensive denudation of skin with dehydration and electrolyte abnormalities, gastrointestinal hemorrhage, acute tubular necrosis, secondary infection of denuded skin, pneumonia, bacterial conjunctivitis, keratitis, and septic infarcts of internal organs. We report a case of HO in a patient with TEN after treatment with trimethoprim-sulfamethoxazole. A 49-year-old man developed an erythematous rash, bullae, fever, and extensive skin loss consistent with a diagnosis of TEN. He was intubated for complications of TEN (pneumonia) and maintained on bed rest for several weeks. In addition, he developed HO that resulted in multiple joint contractures. He was treated with aggressive range of motion by physical therapy, surgical resection of the HO followed by radiation to both elbows, right hip, and right knee. Postoperative outpatient rehabilitation enabled improved function in his mobility and activities of daily living. HO is known to occur after spinal cord and brain injuries and burns. It has not been reported to occur after TEN. Our experience with this case suggests that HO may merit inclusion into the list of complications of TEN.     

Segmental dilatation of the ileum

Three new cases of congenital segmental dilatation of the ileum are presented and added to 12 cases of segmental dilatation found in the literature. The aspect of the condition which is of particular interest is the presence in 3 of the dilated segments of heteroplastic foregut derivatives of unusual varieties. The etiology of the condition is discussed; it does not appear to be a single distinct pathological entity.     

Middle-ear lipoma as a cause of otomastoiditis

We present a case report which describes a rare cause of a common clinical problem; eustachian tube dysfunction. A seven-year-old child presented with a history of chronic draining ears, despite rigorous medical therapy and multiple ventilation tubes. At myringotomy a mass was noted in the middle ear, and she was taken to the operating room for exploration. The patient was found to have a pedunculated lipoma arising from the anterior medial aspect of the middle-ear cleft producing intermittent obstruction of the eustachian tube orifice. This case represents the fourth case of a middle-ear lipoma in the world literature. We present a review of the literature and an exploration of possible aetiologies of this unusual entity in the differential diagnosis of eustachian tube dysfunction.     

Sacral haemangioma as a cause of coccydynia

We report a 55-year-old woman with coccydynia due to a sacral mass. The histological diagnosis was haemangioma. The MRI findings and the unusual location of this lesion are discussed.     

Luteal defect in pregnancy as the cause of habitual abortion

About 15 of all women in the reproductive age are involved by recurrent abortions. The pathophysiology is different; chromosomal, infectious, immunologic and endocrine reasons and anomalities of the uterine cave are discussed. Though there is a discrepancy between the regular secretory phase needed for implantation and low progestins in early pregnancy inducing abortion, the theory of recurrent abortions induced by ovarian malfunction is critically discussed in literature. Basing on the knowledge of the regulation of ovarian function and a delayed pregnancy without ovarian function in early pregnancy in a patient with recurrent abortions, a defect of the corpus luteum-rescue is the most probable explanation. This defect characterized by regular beta-HCG- and pathological decreased progestin and estradiol levels should be treated by substitution of progestin and estradiol. Though a defect of the HCG-receptor is possible a HCG-substitution seems to be an inadequate therapy.     

Systemic mastocytosis as a cause of osteoporosis

Out of 21 male patients with osteoporosis who visited an outpatient clinic for endocrine diseases in two years (1994-1995), three had systemic mastocytosis as diagnosed histopathologically. Two of these had characteristic features of urticaria pigmentosa, consisting of multiple brown nodules on the skin of trunk and extremities, and a positive Darier sign. In all of them the excretion of the histamine metabolites methylhistamine and methylimidazoleacetic acid in a 24-hour urine specimen was increased. When osteoporosis is diagnosed in men or premenopausal women, underlying pathology could be considered. Cautious investigation of signs and symptoms of systemic mastocytosis in such patients might prove this disease be less rare than is often assumed.     

Subglottic hemangioma as the cause of laryngostenosis in young children

The amount of plasma cells synthesizing different class immunoglobulins in the gallbladder wall in 9 practically healthy people and in 19 patients with different forms of cholecystitis was studied by a complex of histological, histochemical and immunofluorescent methods. It was established that catarrhal cholecystitis was accompanied by activated production of immunoglobulins of all classes by plasmocytes of the gallbladder wall. In patients with destructive forms of cholecystitis the level of secretory immunoglobulin A was substantially decreased as well as the amount of plasmocytes synthesizing IgA. The amount of immunocytes producing IgM and IgG became disproportionally greater, there appeared immune IgM complexes and IgG and IgG in the wall of blood vessels and perivascular stroma. The author considers that local immune reactions play an important role in protection of the gallbladder mucosa and pathomorphogenesis of cholecystitis.     

Sialidosis and galactosialidosis as the cause of non-immunologic hydrops fetalis

Two cases of non-immunological hydrops fetalis (NIHF) presenting with massive ascites are reported; in both patients an oligosaccharid-pattern in the urine typical for sialidosis resp. galactosialidosis was found. The cerebral sonography of both patients showed streaky echo enhancement in the region of the thalamostriatal vessels, which was interpreted as calcification of the vessels. The courses of the patients were characterised by recurrent infections, hepatosplenomegaly and myoclonus. Relevant literature reports on a large variability in the clinical appearance of oligosaccharidoses. The diagnosis of sialidosis is confirmed in cultured fibroblasts by the deficiency of alpha-N-acetylneuraminidase and, in case of galactosialidosis by the additional lack of beta-galactosidase. The precise diagnosis in NIHF is of increasing interest for prenatal diagnostic as well as for neonatological management.