Large intestine obstruction complicated with perforation: a rare manifestation of Schistosoma mansoni infection

The authors report a case of a 25 year old Brazilian man with a history of crampy abdominal pain in the left iliac fossa for 2 weeks, abdominal distention, mucous diarrhea and anorexia. The patient presented signs of hemodynamic instability and a hard mass palpated in the left iliac fossa presented peritoneal irritation. At laparotomy, fecal peritonitis and a punched-out perforation of the midsigmoid colon were found. A left hemicolectomy was performed with terminal colostomy. Specimen examination revealed a thickened rectosigmoid wall, narrow lumen and multiple mucosal polyps. Microscopically, chronic granulomatous colitis with Schistosoma mansoni eggs confirmed the etiology. To the authors' knowledge, this is the first case of obstruction complicated with perforation due to mansoni schistosomiasis reported in the literature.     

Plague that never was: a review of the alleged plague outbreaks in India in 1994

Judging by WHO criteria, there was not a single case in India in 1994 that could be taken as a confirmed case of plague. Both clinical and epidemiological features of the illness alleged to be plague were not at all compatible with those of plague-both bubonic and pneumonic types. The bacteriologic and serological evidence was limited to a few cases, and doubtful. PCR is a highly sensitive test, but the specificity of PCR for plague was not verified under field conditions in India. Just by the demonstration of the presence of a causative organism in the environment or in the body tissue, one cannot substantiate occurrence of an infection or disease in man. In view of the assessment and review presented in this paper, one can conclude that the outbreaks of illness that resembled plague during late 1994 in Beed District and Surat were certainly not due to plague. If the Mamla outbreak had not been declared to be plague, the probability of the Surat illness being labeled as plague was negligible. Whatever happened provides a very important lesson of the harm that can occur nationally and globally from decisions based on inadequate or incorrect information.     

Lifetime diagnosis of major depression as a multivariate predictor of treatment outcome for inpatients with substance use disorders from abstinence-based programs

A multisite, longitudinal study of patients undergoing inpatient alcohol and drug dependence treatment was conducted in private inpatient facilities, consisting of 4339 subjects from 38 independent programs enrolled in a national addiction treatment outcomes registry. Structured interviews were conducted upon admission, including documentation of current alcohol/drug disorder (DSM-III-R) and lifetime diagnosis of major depressive syndrome; structured interviews were conducted prospectively at 6- and 12-month follow-up periods. The prevalence rate of lifetime diagnosis of major depression in the sample was 39%. Comorbidity varied according to gender and substance of choice. Lifetime depressive symptoms did not correlate with differential length-of-stay, treatment completion, or follow-up consent and, at best, were very weakly associated with follow-up contact. Patients diagnosed with lifetime depression showed the same frequency of participation in posttreatment continuing care: they also showed statistically significant reductions in job absenteeism, inpatient hospitalizations, and arrest rates pre- vs. posttreatment comparable to those of patients without lifetime depression diagnosis. Lifetime major depressive syndrome was not a predictor of outcome in response to abstinence-based treatment. Involvement in posttreatment continuing care accounted for far greater outcome variance. Posttreatment vs. pretreatment factors may be more decisive in influencing risk for relapse.     

CT and MRI features of cavernous haemangioma of internal auditory canal

A left internal auditory canal (IAC) cavernous haemangioma is reported in a 45-year-old Saudi male. The lesion was associated with rapidly deteriorating hearing loss and facial nerve dysfunction. CT showed a calcified enhanced IAC lesion while T1 weighted MRI showed an isointense contrast enhancing lesion bulging into the porus acousticus. The imaging features of the three usual IAC lesions--meningioma, acoustic neuroma and cavernous haemangioma--were compared. Calcification/ossification appear more commonly in cavernous haemangioma than in the other two lesions while facial nerve dysfunction is a clinical hallmark of IAC cavernous haemangioma.