CALCULI IN A MECKEL'S DIVERTICULUM: A CASE REPORT AND A REVIEW

A case is reported of multiple calculi occurring in a Meckel's diverticulum which caused chronic abdominal pain in a 48-year-old man. The problem was diagnosed before operation by radiological studies. The features of this condition are well illustrated in this patient. The published literature is reviewed.     

A case of type A botulism

The neurotoxin produced by Clostridium botulinum, is responsible for botulism. The clinical signs are digestive disorders, pupillar alterations, and peripheral muscular weakness. The failure of thoracic muscles is responsible for the severity of botulism. We describe a case of a 74 year old woman who presented a severe form of botulism, requiring a prolonged intensive care unit stay.     

A LONG CONTINENT ILEOVESICOSTOMY USING A SINGLE PIECE OF BOWEL

PURPOSE: In 1981 Mitrofanoff presented a procedure to create a continent urinary stoma for intermittent catheterization. Since then, several other methods have been introduced, including the Yang-Monti ileovesicostomy. The length of these ileovesicostomies is limited by the circumference of the bowel segment used, which is inadequate in some cases. We developed a procedure to double the length of the Yang-Monti ileovesicostomy using a single section of bowel. MATERIALS AND METHODS: A 3.5 cm. section of ileum is isolated on its mesentery. The bowel is divided into 2 segments for 80% of its circumference, leaving the bowel intact over the mesentery. Each ring of bowel is then divided adjacent to the mesentery but on opposite sides, allowing the bowel to be unfolded and reconfigured in a single long strip that may then be tubularized. The blood supply to the tube is excellent and it is in the center of the reconfigured ileum. The ends may be trimmed or widely spatulated as necessary. RESULTS: We have performed this procedure in 8 patients. The resulting ileovesicostomy created from a 3.5 cm. section ofileum is 10 to 14 cm. long and accepts a 12F catheter. A larger tube may be created from a longer piece of ileum. All patients are dry and they perform catheterization easily. CONCLUSIONS: This form of ileovesicostomy allows the creation of a long bowel tube that is easily catheterized. The longer length of the tube increases application of the continent stoma principle to more patients and enables reconstruction to be performed with optimal placement and without tension.     

A new laryngoscope

This is a report of a modification to one design of laryngoscope to increase the angle between blade and handle, to facilitate intubation in cases of difficult access, such as in obstetric practice or in patients in whom neck flexion is limited, for example by skull traction. The modification offers the unique advantage of two useful blade angles in one instrument. The first type described would be suitable for use in small units where it is thought that a laryngoscope solely for use in rare cases of difficult access would not be justified. It would also be suitable for inclusion in resuscitation kits for use both within and outside hospital. The second type would be more suitable for the maternity or spinal injuries unit, or the difficult intubation box of a general operating theatre suite.     

MANAGEMENT OF A PHAEOCHROMOCYTOMA IN A CHILD

The management of a case of phaeochromocytoma in a child usingalpha and beta receptor blocking drugs is described. This reportconfirms that estimations of plasma catecholamine concentrationsand direct measurement of arterial pressure are of considerablevalue. Methoxyflurane would appear to be a most suitable anaestheticfor patients with this condition.     

A SAFE,NEW APPROACH TO ESTABLISHING A PNEUMOPERITONEUM AT LAPAROSCOPY

The traditional method of establishing a pneumoperitoneum before laparoscopic surgery is via a Verres needle inserted in the midline below the umbilicus while tenting the abdominal wall with the hand. A new approach is described in which preliminary surgical exposure and tenting of the linea alba immediately above the umbilicus is achieved before needle insertion through the superior margin of the umbilical ring. The advantages of this new technique over the conventional method are discussed. Further technical features important in the safe formation of the pneumoperitoneum are emphasized.     

A TECHNIQUE OF PULMONARY VENTILATION WITH A NASOTRACHEAL TUBE

A modified naso-endotracheal tube is described which facilitatesprolonged intermittent positive pressure ventilation of thelungs in infants and children. A crosspiece allows connectionwith the inspiratory and expiratory tubes of a circle-type mechanicalventilator. The technique of intubation and of securing thenasal tube to the patient is described in detaiL The tube hasbeen used in 126 patients for periods of up to three months.Subglottic stenosis developed in two patients. It is provisionallyrecommended that the duration of intubation should not exceedthree weeks. ^* Present address: Department of Anaesthetics, Hospital forSick Children, Toronto, Ontario, Canada.     

A case of acquired hemophilia A with massive hemothorax

Acquired hemophilia A (AHA) is an uncommon but potentially life-threatening hemorrhagic disorder caused by the development of an inhibitor against coagulation factor VIII (FVIII). AHA is very rare, affecting approximately 1 in 1 million individuals. However, the incidence may actually be higher, because diagnosis is difficult and the disease can be overlooked. We report a case of an 80-year-old man who presented with sudden onset of severe hemothorax. The patient was diagnosed with presumed AHA based on acute onset of bleeding symptoms and unexplained isolated prolonged activated partial thromboplastin time. Diagnosis was definitely established by demonstrating a decrease in FVIII activity, presence of FVIII inhibitor activity, and normal von Willebrand factor. The patient was successfully treated with recombinant activated coagulation factor VII and transcatheter artery embolization of the intercostal arteries.     

A DENTAL PROTECTOR

A device is described for the protection of fragile or looseteeth, or dental protheses, during endotracheal intubation.The principle is that pressure on the incisors is avoided byplacing a bridge between the bicuspids of both sides, thus providinga harmless rest for the laryngoscope plate. The device can beused when one or both bicuspids are missing. Its use does notlead to difficulty in visualizing the larynx or introducingthe tube.     

A lower trapezius myocutaneous free flap in facial reconstruction: A case report

The free transfer of a myocutaneous flap is the procedure of choice in the reconstruction of facial defects. A case is reported in which a lower trapezius myocutaneous free flap was successfully transferred with microneurovascular anastomoses to repair a facial defect. The advantages of the lower trapezius myocutaneous flap also are discussed.     

A new method of fixation in osteoporotic bone. A preliminary report

Over-tightening of cortical bone screws in osteoporotic bone results in weak fixation. Once a screw is over-tightened and the bone thread form is stripped, there are limited means at the surgeon's disposal to rescue the situation, none of them entirely satisfactory. We describe a simple device that is specifically designed to resolve this problem. It consists of a nylon cavity plug and applicator. The plug is inserted into the stripped hole and the screw re-applied and tightened in the normal manner. The plug expands and forms a load-bearing region on the inner face of the bone. Tests on osteoporotic cadavaric bone have shown that the plug effectively re-establishes screw fixation. When compared to an over-tightened screw, the plug is at least twice as resistant to loads acting to pull the screw out of the surrounding bone.     

A Rare Manifestation of Herpes Zoster: A Case Report

Herpes zoster has an incidence of 350,000 cases per year in the United States. The involvement of the foot and ankle is rare. Most surgeons are not aware of this disease as a cause of extremity pain, its manifestation, and the treatment options. Post-herpetic neuralgia is a common sequela of herpes zoster and can be prevented with prompt treatment. In this article, we present a case of a 53-year-old female with right heel pain secondary to herpes zoster.     

A COMPUTER-CONTROLLED SYRINGE DRIVER FOR USE DURING ANAESTHESIA: A Modification of the Graseby MS16A

The requirements of a drug infusion device for use in theatreare discussed. A modification of the Graseby MS16A syringe pumpand an interface circuit permitting its remote control by micro-computerare described. The pump is controlled via a standard computerinterface (RS232) which makes it a unique and powerful researchtool. Aspects of safety are considered.     

Insulated arm pilomatrixoma: A rare localization. A case report

Pilomatrixoma also known as calcified epithelioma of Malherbe, is a rare benign cutaneous tumor. It is most commonly seen in the head and neck areas, during the first two decades of life. We report a 30-year-old female patient with a rare localisation of pilomatrixoma in the right arm. The pilomatrixoma was excised and at one year follow-up there has been no evidence of recurrence.     

A versatile hand splint

Splintage plays a major part in the management and rehabilitation of the hand following injury, infection and operation. It is essential to have a simple, comfortable, and firm but flexible splint. This should be available "off the shelf", but be acceptable to the patient and to the treating clinician. This paper will describe a splint which not only has these qualities, but is cheap and is re-usable after washing. The splint is made of high density Plastazote and is available in two sizes for each hand. It is moulded into the shape of the functional position of the hand and can easily be trimmed with bandage scissors to give a precise fitting. The splint has been evaluated following surgery on fifty hands. Its fabrication, use and simplicity are discussed.     

A case report of thoracic endometriosis – A rare cause of haemothorax

IntroductionThe presence of endometrial tissue in airways, pleura and lung parenchyma is called thoracic endometriosis syndrome (TES). It is a rare pathology, and typically consists of catamenial pneumothorax, haemothorax, haemoptysis, and pulmonary nodules. We report a case of a 36-year-old woman with thoracic endometriosis causing catamenial haemothorax.ConclusionsThe diagnosis of thoracic endometriosis is complicated and often delayed. TES should be suspected in a reproductive age woman with exacerbating symptoms during the menstruation.Treatment may be medical and surgical.     

CHOOSING A PULMONARY VENTILATOR

The author presents an approach to the selection of an automaticpulmonary ventilator. The indications for automatic ventilatorsare set out and a guide to choice is then suggested on physiologicaland practical considerations. Many features of machines arediscussed briefly and a rather high standard is put forward.The underlying emphasis throughout is that the clinician shouldbe fully aware of his requirements and the limitations of apparatus,and that he makes his selection in this frame of mind.     

A missense mutation in NR5A1 causing female to male sex reversal: A case report

Testicular disorder of sex development (TDSD) is a rare condition, characterised by a female karyotype, male phenotype, small testes and cryptorchidism. Only a few studies have investigated the genetic causes of male sex reversal. This is the clinical report of an Iranian 46,XX patient presented with TDSD and associated with hypospadias. Whole-exome sequencing (WES) of the patient ascertained the heterozygous missense variant (c.274C>T) in the NR5A1 gene, resulting in a substitution of arginine with tryptophan. The arginine 92 residue was located in a highly conserved region of steroidogenic factor 1 (SF1), which is crucial for its interaction with DNA. Our finding is in line with previous reports, which highlighted the role of p.(Arg92Trp) variant in TDSD individuals. As far as we are aware, this is the first report of TDSD with p.(Arg92Trp) variant in the Iranian population.     

A Carcinoid Saga

The case is reported of a patient who developed the carcinoid syndrome when metastases appeared in the liver after resection of the primary ileal tumour. A right hepatic lobectomy was followed by complete remission of symptoms for 15 months, even though local removal of further liver metastases became necessary because of biochemical evidence of recurrence. Finally, systemic spread of the tumour became apparent. Two years after the original resection the patient appeared to be in the terminal phase of the disease. The protean manifestations of the carcinoid syndrome are reviewed, and the conclusion is reached that surgical removal of liver metastases can produce worth-while palliation even in the presence of advanced disease. The importance of proper operative management, including anaesthesia, is stressed. More long-term study and the publication of complete case reports seem necessary to delineate the prognosis of the carcinoid syndrome when this is treated surgically.     

A local adhesive finger splint

A new design of a local static finger splint is proposed. The splint is made by enveloping a length of wire into double-sided adhesive tape. The skin of the region to be immobilized is covered with an adhesive skin dressing, to which the splint is then adhered. This method of attachment gives more freedom in choosing a site of splint application and prevents access obstruction to the wound, blocking of tactile areas, and circulation impairment. The splint is light, low profile, and malleable at ambient temperature. The adhesive splint was used in 5 patients to maintain the first web space open or to immobilize stiff interphalangeal joints in flexion overnight.