High-pressure water-gun injection injuries to the extremities. A report of six cases

High-pressure water-gun injection injuries are different from injection injuries that are caused by other agents, in that they are associated with extensive subcutaneous emphysema but only slight soft-tissue inflammation or destruction. The cases of six patients who had such an injury were reviewed. It was found that local irrigation and débridement, together with a short course of penicillin or a broad-spectrum cephalosporin, resulted in complete recovery from this relatively benign variant of high-pressure injection injury.     

Schistosomal cholecystitis: report of six cases

Six cases of schistosomal cholecystitis are reported; five also had calculi. Histopathological studies revealed extensive fibrocalcific reaction of the walls and around the cystic ducts. We hypothesise that this fibrosis produced strictures of the cystic duct and stagnation of bile, predisposing to cholelithiasis. Surgeons practising in endemic areas should be aware of this rare complication of chronic schistosomiasis.     

Penile agenesis: a report of six cases

Agenesis of the penis is an extremely rare anomaly, occurring only once in 30 million births. This low incidence is responsible for the limited experience with this anomaly. There are only about 70 published cases, most reports being of one or two patients. This complex malformation requires urgent assessment at birth for several reasons: Female sex assignment is required early. Gonadectomy should be performed in the first few days of life to prevent male gender sex marking from the testosterone surge occurring between the tenth and the 60th day of life. Early gonadectomy and genital reconstruction helps the family to accept the child's altered gender and to reduce psychological problems.     

Renal granulomatous sarcoidosis: report of six cases

Six cases of chronic renal failure related to granulomatous renal sarcoidosis are reported and compared with data in the literature. The particular features of sarcoidosis granulomatous interstitial nephritis should be emphasised because presentation may be misleading. Renal failure usually presents with a rapidly progressive course, either isolated or associated with mild proteinuria and sterile leukocyturia, while extrarenal localisations may be absent. Diagnosis should be suspected on the basis of elevated or paradoxically normal serum calcium concentrations, due to increased plasma concentrations of calcitriol, while immunoreactive circulating parathormone concentrations are depressed. Calcitriol as well as angiotensin-converting enzyme could represent unregulated secretion products from granulomatous tissue and their plasma concentrations may roughly reflect activity of the disease. Early corticosteroid treatment dramatically improves renal function but long-term renal prognosis may be oblitered due to progressive chronic renal failure related to fibrosis scarring.     

Combined heart-kidney transplantation: report on six cases

Background: Combined heart-kidney transplantation has become a new therapeutic solution for patients with coexisting, irreversible heart and kidney failure. Though this combined approach has several theoretical advantages over sequential transplantation, it has yet to be established that it does not jeopardize patient and graft outcomes. We here report our experience with six cases of combined heart-kidney transplantation from single donors and review the literature in order to clarify this issue. Methods: Four patients were kidney-transplant candidates with severe heart failure and two were heart-transplant candidates with independent chronic renal failure. Donors were selected on the basis of weight and size matching, ABO compatibility, and negative T-cell cross-matching. Results: The heart was always grafted first. The surgical procedure was uneventful in all cases. Heart and kidney function recovered quickly in all patients. Two patients died, one at day 45 from heart subacute rejection and the other one at day 157 from cerebral haemorrhage. The four remaining patients are alive 23-84 months after transplantation (2-year survival rate: 67%) and have well-functioning kidneys (creatinine clearance 31-83 ml/min) and hearts (left ventricular ejection fraction 53-83%). Remarkably, four of six patients had no acute rejection episode of either organ. These patient and graft outcomes are in agreement with previous reports and compare favourably with the results of isolated heart and kidney transplantation. Conclusions: Combined heart-kidney transplantation from the same donor should be proposed to patients who would qualify for transplantation of each organ within a few years. Key words: combined transplantation; heart failure; heart rejection; heart transplantation; kidney rejection; kidney transplantation; renal failure; transplantation outcome      

Articular cartilage injuries of the capitellum interposed in radial head fractures: a report of ten cases

Ten cases of Mason type I and type II isolated radial head fractures are reported, in which an unexpected cartilaginous fragment of the capitellum trapped within the radial head fracture was identified at the time of surgery. In no case was this injury pattern identified on preoperative imaging, including computed tomography in 2 cases. Five patients did have preoperative mechanical findings with forearm rotation. At surgery, all capitellar fragments were found to originate from the posterolateral capitellum. Excision of the capitellar fragment and internal fixation of the radial head fracture were performed in all cases. No sequelae were identified on short-term follow-up. This series highlights an injury pattern that should be considered in isolated nondisplaced and minimally displaced fractures of the radial head. The natural history of this finding, when treated conservatively, is unknown.     

Primary aortoenteric fistula: report of six new cases

Primary aortoenteric fistula (PAEF) is defined as a communication between the native aorta and the gastrointestinal tract, in contrast to secondary fistulas, which arise between a suture line of a vascular graft and the intestine. Arteriosclerosis is the predominant cause of PAEF and accounts for more than two-thirds of the cases reported. The pathogenesis is usually based on direct adhesion of a segment of the gastrointestinal tract to an aortic aneurysm, followed by progressive erosion through the bowel wall. The clinical presentation is usually one of intermittent gastrointestinal haemorrhage resulting in lethal exsanguination. Pain in the abdomen, a pulsatile abdominal mass or fever may be present. The choice of various diagnostic procedures is often decided by the clinical presentation. Esophagogastroduodenoscopy, ultrasound and CT scan may be useful in the evaluation of these patients. Current recommendations for repair include debridement of the aneurysmal aorta, repair with an in situ graft and primary repair of the gastrointestinal tract, followed by aggressive antimicrobial therapy. We present six cases of PAEF surgically treated at the St. Radboud Hospital, the Canisius Wilhelmina Hospital in Nijmegen and the Lukas Hospital in Apeldoorn over a period of 15 years.     

Collagenous gastritis: a report of six cases.

Collagenous gastritis is an exceptional entity with eight cases documented to date characterized by the presence of a thick subepithelial collagen band associated with an inflammatory infiltrate of the gastric mucosa. The aim of our study was to describe the clinical and histologic characteristics of six new cases of collagenous gastritis. All cases showed a subepithelial collagen band that averaged 30 microm but often measured up to 120 microm. This finding was almost always accompanied by mixed chronic inflammation in the lamina propria and by surface epithelial damage of varying severity. Our study seems to delineate two subsets in patients with collagenous gastritis: 1) collagenous gastritis occurring in children and young adults presenting with severe anemia, a nodular pattern on endoscopy, and a disease limited to the gastric mucosa without evidence of colonic involvement, and 2) collagenous gastritis associated with collagenous colitis occurring in adult patients presenting with chronic watery diarrhea. These findings highlight the fact that subepithelial collagen deposition may be a generalized disease affecting the entire gastrointestinal tract.     

Acute mercury vapour intoxication: report of six cases

In a group of six workers acutely exposed to metallic mercury vapour in a confined space, one patient had acute renal and respiratory failure which required daily haemodialysis and mechanical ventilation, another had acute bilateral pneumonitis with respiratory insufficiency, and the other four had corrosive oropharyngeal mucositis with a 'flu-like syndrome. Serum and urinary mercury showed an obvious correlation with the clinical picture. After removal from the source of exposure and the institution support measures (including chelant therapy in the first two patients), all recovered without evidence of residual damage.     

Primary malignant paratesticular tumors: report of six cases

The authors report six cases of primary malignant paratesticular tumors. They reexamine the literature and emphasize the influence of the histopathological type of these tumors on the prognosis. Survival of the patients is better when tumors are differentiated and detected early.     

颅脑损伤死亡病例临床分析

目的 总结颅脑损伤死亡病例的特点及相应的救治经验。方法 回顾性分析２６４例颅脑损伤死亡病人资料，结果 颅脑损伤的主要死亡原因是严重的脑损伤及颅内血肿，各种原因的延误以及严重的合并症、并发症等，但在伤后不同时期残废原因的分布有明显的差别。结论 院前急救、尽早发现并清除颅内血肿、防治并发症及营养支持是降低颅脑损伤死亡率的重要措施。     

Footballer's hip a report of six cases

We have reviewed a consecutive series of six professional footballers who presented with intractable hip pain which was attributed at arthroscopy, to an anterior acetabular labral tear with adjacent chondral damage. The location and type of labral tear were identical for each patient. There was no evidence of acetabular dysplasia. A variable area of chondral damage was associated with the labral tear. All unstable tissue was resected. Five returned to professional football at the highest level. Acetabular labral pathology should be included in the differential diagnosis of footballers with hip or groin pain. Arthroscopy of the hip is an appropriate method of diagnosis and treatment and minimises the length of rehabilitation required.