Crohn’s disease of the terminal ileum: a cheap diagnosis

Background  A 29-year-old man was admitted with a 7-day history of progressive non-specific abdominal pain that progressed to small bowel obstruction following ingestion of a 20-pence coin 4-months previously. Colonoscopic retrieval was unsuccessful. A subsequent laparotomy revealed a chronically inflamed thickened terminal ileum with mesenteric fat encroachment necessitating a right hemicolectomy. Histopathological analysis confirmed Crohn’s disease with impaction of the 20-pence coin in a distal terminal ileum stricture near the ileo-caecal valve. Learning point  Gastrointestinal foreign body retention should alert the clinician to the presence of an undiagnosed bowel abnormality. Furthermore, failed endoscopic retrieval should be considered as a marker for potential underlying gastrointestinal pathology and a requirement for operative intervention. Conclusion  This case describes a rare presentation of Crohn’s disease and highlights the need to consider underlying gastrointestinal pathology in patients presenting with a deteriorating clinical condition in the presence of an incidental foreign body.     

Laparoscopic assisted surgery for Crohn’s disease an initial experience and results

Summary The inflammatory process associated with Crohn’s disease often makes dissection difficult, even in open surgery. The aim of this study was to assess the technical feasibility, safety and indication of laparoscopic assisted procedures performed in patients with Crohn’s disease. Records of patients undergoing surgical operation for Crohn’s disease from 1993 to 1998 at our hospital were reviewed. Intestinal resection was performed laparoscopically in 24 patients (LAP) and by open technique in 23 patients (OPEN). No significant differences existed as to age, gender, body-mass-index and previous surgery. In the laparoscopic group, seven operations (CON) were converted to open laparotomy (29 %) because of large inflammatory mass and/or fistula. The mean intraoperative blood loss was significantly higher in CON- and OPEN-groups than in LAP-group (P < 0. 01). Major complications occurred only in one patient who underwent laparoscopic assisted high anterior resection. Patients who underwent laparoscopic operation tolerated p. o. liquids sooner than patients who underwent open surgery (median; 2 vs. 5 day,P < 0. 05). Compared with the CON- and OPEN-groups, patients in LAP-group had lower analgesic requirements (median: 3 vs. 6 and 5 day,P < 0. 01). The median postoperative length of stay was significantly shorter in LAP-group than in OPEN-group (median: 11 vs. 14 day,P < 0. 05). Our study showed that LAP is technically feasible for Crohn’s disease. The preoperative correct diagnosis and selection of indications are very important, because the laparoscopic mobilization and resection may be difficult or impossible in patients with large fixed masses, multiple complx fistulas, or recurrent Crohn’sdisease.     

Caffey’s disease: an unusual cause for concern

Background  Caffey’s disease or infantile cortical hyperostosis is a rare cause of irritability, bone pain, soft tissue swelling and fever in the infant. Aims  To review the presentation and diagnosis of an 8-week old infant with focal tenderness of the tibia. Methods  The symptoms, signs, laboratory work-up and radiology are reviewed. Results  The child presented with focal bony tenderness and pyrexia. Laboratory work-up was inconclusive. The diagnosis of Caffey’s disease was made following a skeletal survey to outrule non-accidental injury, which showed similar changes of cortical thickening in the mandible as well as the affected tibia. Conclusions  With our increasing immigrant population, an increasing number of differential diagnoses must be considered when evaluating patients presenting to our emergency rooms. Caffey’s disease is an unusual cause of bone pain in the infant. Symptoms and signs are subtle and the diagnosis is generally made with plain X-rays.     

MECKEL'S DIVERTICULUM – REVISITED

Twenty five cases of Meckel''s diverticulum were studied between 1985-1995. Eight of these were symptomatic and in the remaining 17 it was an incidental finding. The symptomatic patients presented with intestinal obstruction (5 cases), perforated peritonitis (2 cases) and intussusception (1 case). All cases of acute appendicitis were also subjected to a search for Meckel''s diverticulum. Of the 25 Meckel''s diverticuli encountered, 22 were resected and in 3 patients it was left in situ. Both the patients with perforated Meckel''s diverticulum showed ectopic gastric mucosa. Complications occurred only after surgery for symptomatic Meckel''s diverticulum. All patients undergoing incidental diverticulectomy had a smooth and uncomplicated recovery.KEYWORDS: Incidental diverticulectomy, Meckel''s diverticulum     

Crohn’s disease in Dublin in the latter half of the nineteenth century

AT least 29 patients with Crohn’s disease were seen in hospitals in Dublin in the latter half of the last century. This retrospective study is additional epidemiological evidence that Crohn’s disease was present but unrecognised prior to this century and not as has been suggested a ‘new’ disease of this century.     

Small bowel obstruction secondary to a giant enterolith complicating Crohn’s disease

Background  

Enterolith formation associated with Crohn’s disease is a very uncommon clinical entity.     

The occurrence of hypothyroidism following radioactive iodine treatment of toxic nodular goiter is related to the TSH level

Background  Strategies to increase frequency of euthyroidism following radioactive (RAI) treatment of hyperthyroidism are required. Aims  To examine the role of TSH in development of hypothyroidism post RAI treatment in patients with Graves’ disease (N = 98) or toxic nodular goiter, TNG (N = 88). Design  This retrospective study examined thyroid status over a mean of 3.7 years post-RAI. Results  Although RAI dose was significantly higher in TNG group, hypothyroidism occurred more frequently in Graves’ disease (71.4 and 22.7%) P < 0.001. The TSH levels at the time of RAI treatment were lower in TNG patients who remained euthyroid, (0.4±0.1 vs. 1.2±0.5 mU/l, P < 0.0022). Conclusions  A higher frequency of euthyroidism occurs in patients with TNG than with Graves’ disease following RAI, particularly when suppressed TSH levels were suppressed at time of RAI-treatment.     

Clinics in diagnostic imaging (162). Meckel’s diverticulum

A 28-year-old Chinese man presented with acute bleeding per rectum. Computed tomography showed a posterior outpouching arising from the distal ileum. The outpouching had hyperaemic walls, but no active contrast extravasation was detected. Technetium-99m pertechnetate scintigraphy showed focal areas of abnormal uptake in the right side of the pelvis, superior and posterior to the urinary bladder. These areas of uptake appeared simultaneously with the gastric uptake and demonstrated gradual increase in intensity on subsequent images. The diagnosis of Meckel’s diverticulum was confirmed on surgery and the lesion was resected. The clinical and imaging features of Meckel’s diverticulum are discussed.     

不同类型急性阑尾炎CT征象比较

目的探讨不同类型急性阑尾炎CT征象及意义。方法选取2010年12月至2018年12月于我院进行手术治疗并病理结果确诊为穿孔急性阑尾炎患者36例与非穿孔急性阑尾炎患者49例,对其CT征象差异进行比较分析、采用Logistic回归分析差异征象与穿孔急性阑尾炎的相关性。结果穿孔与非穿孔急性阑尾炎患者阑尾增大(88.89%vs 91.84,P=0.933)、阑尾壁增厚(83.33%vs 81.61%,P=0.839)、阑尾壁强化(80.56%vs 87.76%,P=0.362)及阑尾周围脂肪内条纹(86.61%vs 89.80%,P=0.857)的出现率均高于81%;穿孔急性阑尾炎组阑尾壁强化缺损、阑尾腔外积气、蜂窝织炎以及脓肿出现率均高于非穿孔组(55.56%vs 2.04%,P<0.05;25.00%vs 4.08%,P<0.05;25.00%vs6.12%,P<0.05;75.00%vs 10.20%,P<0.05);Logistic回归分析结果显示阑尾壁强化缺损、阑尾腔外积气、蜂窝织炎以及脓肿与穿孔急性阑尾的相关性分别是为(waldχ2=4.254,P=0.040;waldχ2=3.36,P=0.067;waldχ2=4.445,P=0.036;waldχ2=4.087,P=0.044)。结论 CT征象可以较准确反应穿孔、非穿孔急性阑尾炎的特点,可以为临床判定给予可靠的影像信息。     

Hematological abnormalities in adult patients with Down’s syndrome

Background  There is a paucity of data regarding hematological abnormalities in adults with Down’s syndrome (DS). Aims  We aimed to characterize hematological abnormalities in adult patients with DS and determine their long-term significance. Methods  We retrospectively studied a cohort of nine DS patients referred to the adult hematology service in our institution between May 2001 and April 2008. Data collected were: full blood count (FBC), comorbidities, investigations performed, duration of follow-up and outcome to most recent follow-up. Results  Median follow-up was 26 months (9–71). Of the nine patients, two had myelodysplastic syndrome (MDS) at presentation. Of these, one progressed, with increasing marrow failure, and requiring support with transfusions and gCSF. The remaining eight patients, with a variety of hematological abnormalities including leukopenia, macrocytosis, and thrombocytopenia, had persistently abnormal FBCs. However there was no evidence of progression, and no patient has evolved to acute myeloid leukemia (AML). Conclusions  MDS is a complication of DS and may require supportive therapy. However, minor hematological abnormalities are common in adult DS patients, and may not signify underlying marrow disease.     

Hippocrates’ counselling with regard to physical exercise, gymnastics, dietetics and health

The aim of this study is the investigation of Hippocrates’ consultative theory with regard to man’s physical exercise, gymnastics, diet and health, on the basis of his work “Regimen” and his other works. The aforementioned issues are thematised in the works in question. By means of this thematisation, a medical counselling is formed, according to which exercise, gymnastics and diet aim at the maintenance and restoration of man’s health; dietetics, maintenance of well-being, recovery and amelioration of man’s health are involved in this thematisation. Hippocrates’ views on the aforementioned issues constitute a basis for the discussion and pedagogical exploitation of them in contemporary education and, particularly, in sports education and physical exercise.

Perforated retrocaecal appendix presenting as right lumbar abscess

Background  Acute appendicitis is common in older patients, however, the presentation may differ from the younger population and it is often complicated by coexistent disease and delays in presentation. Aims  This case report describes an unusual presentation of acute appendicitis in an elderly patient and also demonstrates a unique anatomical pathway of disease extension. In addition, this case report highlights the advantages of CT in preoperative evaluation and subsequent management of these protean presentations of acute appendicitis. Methods  This report describes a case of an asymptomatic retrocaecal perforated appendicitis which presented clinically as a right lumbar abscess with surrounding cellulitis, and was further complicated by a concomitant new diagnosis of type 2 diabetes mellitus in a 66-year-old male. Conclusion  Elderly or immunocompromised patients presenting with cellulitis or a cutaneous abscess of the abdominal wall or lumbar region may benefit from an abdominal CT to demonstrate an intraperitoneal source of sepsis.     

Enterocutaneous fistula: A reconstructive dilemma

Summary  Surgical repair of enterocutaneous fistulae in Crohn’s disease may result in large skin defects of the anterior abdominal wall. We present a case in which a large defect was managed with reconstruction using a pedicled rectus abdominis mycocutaneous flap in a single procedure. The case highlights the technical challenge of such a case and the value of a joint surgical approach between plastic and colorectal services.     

Moxibustion treatment restoring the intestinal epithelium barrier in rats with Crohn’s disease by down-regulating tumor necrosis factor alpha, tumor necrosis factor receptor 1, and tumor necrosis factor receptor 2

Objective  

To investigate whether moxibustion regulates tumor necrosis factor alpha (TNF-α), tumor necrosis factor receptor 1 (TNFR1), and TNFR2 in the intestinal mucosa and to explore whether moxibustion could be used by means of this mechanism, to repair the intestinal epithelium barrier disruption in Crohn’s disease (CD).     

Point mutation in the parkin gene on patients with Parkinson’s disease

Summary To investigate the distribution of possible novel mutations from parkin gene in variant subset of patients with Parkinson’s disease (PD) in China and explore whether parkin gene plays an important role in the pathogenesis of PD, 70 patients were divided into early-onset group and late-onset group; 70 healthy subjects were included as controls. Genomic DNA from 70 normal controls and from those of PD patients were extracted from peripheral blood leukocytes by using standard procedures. Mutations of parkin gene (exon 1–12) in all the subjects were screened by PCR-single strand conformation polymorphism (SSCP), and further sequencing was performed in the samples with abnormal SSCP results, in order to confirm the mutation and its location. A new missense mutation Gly284Arg in a patient and 3 abnormal bands in SSCP electrophoresis from samples of another 3 patients were found. All the DNA variants were sourced from the samples of the patients with early-onset PD. It was concluded that Parkin point mutation also partially contributes to the development of early-onset Parkinson’s disease in Chinese. WANG Tao, male, born in 1961, Associate Professor This work was supported by grants from the key program of the special scientific project of Scientific & Technologic Agency of Hubei Province (Serial No. 2001AA308B01) and the Hygienic Research Project of Hygienic Agency of Hubei province (Serial No. WJ 01529).     

Studies on structural changes of the inner ear caused by experimental round window membrane rupture

Summary This paper is a report on the histopathological changes of the inner ear following artificial rupture of the left round window membrane observed in 19 experimental guinea pigs. We found that the artificially perforated round window membrane could heal spontaneously, that no noticeable morphological changes took place in Corti’s organ within 2 weeks postoperatively and that if the round window membrane rupture failed to heal 2.5 months postoperatively, the Corti’s organ in the basic turn would be the chief part to be damaged, as a result of which the high frequency hearing ability might be impaired. These findings call the clinicians’ attention to the fact that if the hearing of patients who are suspected of labyrinthine window membrane rupture does not improve distinctly 2 weeks after the appearance of the symptoms, operations must be performed immediately for exploration and repair.     

Appendectomy at the time of cesarean section

The current world literature estimates the incidence of appendicitis in pregnancy at approximately 1 case per 1500 normal deliveries. Observations of one physician and review of records from Saint Anthony Hospital in Oklahoma City have suggested potential benefit to routine examination of the appendix at the time of cesarean section and removal if it appears pathologic. The medical literature was reviewed regarding appendicitis in pregnancy and incidental or indicated appendectomy at the time of cesarean section. Many authors have described difficulties with diagnosis, as well as potential complications of appendicitis in pregnancy. Studies have confirmed the safety of performing incidental appendectomy at the time of cesarean section. The authors, therefore, propose that clinicians visualize and palpate the appendix at all cesarean sections, and remove those with evidence of inflammation or disease.     

Otitis externa: quality of life assessment

Introduction  Otitis externa (OE) is an extremely common dermatological condition that can affect social life and employment, but formal studies of its general health impact are lacking. Objective  The aims of this study were two-folded, first to assess the impact of OE on various health determinants as measured by the Finlay’s dermatological quality of life index (DLQI) and second to see if there was any difference on quality of life (QoL) of patients with acute and chronic OE. Methods  A prospective questionnaire study was carried out. The study included 85 consecutive adult patients with both acute and chronic OE attending the casualty department of a regional otolaryngology unit. Results  Both groups of patients reported a significantly poor QoL, particularly patients with acute OE, whom were significantly affected by the condition. Conclusion  We concluded that OE has a significant impact on the QoL particularly in patients with acute and chronic OE. This paper was presented at The Royal Academy of Medicine meeting in Fota Island, Cork, Ireland on the 24th April 2007.