Pleural flap for delayed presentation of intrathoracic esophageal perforation

The authors report 2 cases of large intrathoracic esophageal perforation, as a complication of foreign body in 2 boys, 4 and 9-years-old. The delay in diagnosis was more than 36 hours in both cases that were treated successfully by a large pleural flap. Postoperatively, solid oral feeding was initiated after 2 weeks. Although gastrostomy was not performed on both patients, in cases of large esophageal perforation, it is recommended to establish early feeding and prevent aggressive vomiting.     

Ramadan fasting: relation to atherogenic risk among obese Muslims

Increased platelet aggregation as well as changes in coagulation factors have an important effect on the occurrence of atherogenicity and cardiovascular diseases. Fasting in general has been used in medicine for medical purposes when other measures fail. Since Ramadan fasting is different from total fasting, the present work was conducted to study the effect of Ramadan fasting on lipid pattern, some blood coagulation parameters, blood pressure and body mass index (BMI)--as atherosclerotic risk factors--in one hundred and three apparently healthy obese volunteers (15 men and 88 women) aged 15-52 years. The study comprised an initial visit for assessment V1 (before Ramadan) and three other follow up visits: V2 (at the end of Ramadan), V3 (4 weeks after Ramadan) and V4 (8 weeks after Ramadan), Targets were subjected to an interview questionnaire, complete physical and clinical examination, anthropometric measurements, dietary profile, and laboratory assay of complete blood picture (CBC), fasting serum glucose level (FSG), serum lipid pattern: total cholesterol (TC), triglycerides (TG), high density lipoproteins (HDL-c) and low density lipoprotein (LDL-c), lipoprotein a Lp (a), apolipoprotein A1 (APA), and apolipoprotein B (APB) levels; bleeding (BT) and clotting time (CT), prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen and plasma factor VII activity. Statistical analysis was performed using Chi squared, Fisher exact, Student t test, paired t test and Pearson's correlation coefficient. Statistical significance was defined at P < 0.05. The study showed that by the end of Ramadan fasting, there was a significant improvement in the mean levels of hemoglobin (Hb), TC, TG, HDL-c, LDL-c, TC/HDL, LDL/HDL, Lp (a), APA, APB, PT and systolic (SBP) and diastolic blood pressure (DBP) that persisted for four weeks after fasting (P < 0.05). Ramadan fasting has not adversely affected leucocytic count or coagulation parameters (P > 0.05). There was also a significant association between dietary intake, SBP, DBP, weight, BMI, percent body fat and waist, fibrinogen and factor VII activity and TC, TG, HDL-c, LDL-c, LDL/HDL, Lp (a) and APB (P < 0.05). The model of Ramadan fasting could be followed as a behavior modification program to control or prevent atherogenicity because of its positive impact on the lipid pattern, blood count and coagulation parameters.     

Large sphenoid wing meningiomas involving the cavernous sinus: conservative surgical strategies for better functional outcomes

OBJECTIVE: The ability to resect meningiomas that involve the medial and anterior compartments of the cavernous sinus has been refuted. In this retrospective study, we determined the efficacy of total resection of meningiomas that invade the cavernous sinus but are restricted to the lateral compartment. METHODS: We reviewed the charts of 38 consecutive patients with sphenocavernous, clinoidocavernous, and sphenoclinoidocavernous meningiomas who underwent surgical treatment. We assessed early and late cranial nerve morbidity, extent of resection, and long-term outcome (mean, 96 mo). RESULTS: In all patients, tumors exceeded 3 cm diameter. In 22 of 24 patients, total microscopic excision was achieved in tumors that involved only the lateral compartment of the cavernous sinus and touched or partially encased the cavernous internal carotid artery (i.e., modified Hirsch Grades 0 and 1, respectively). In 2 of 24 patients, remaining tumor infiltrated the superior orbital fissure. All 14 patients who had tumors that encased (with or without narrowing) the cavernous segment of the internal carotid artery (Hirsch Grades 2-4) underwent incomplete resection. Among 38 patients, mortality was 0%, late cranial nerve deficits remained in 6 (16%), and late Karnofsky Performance Scale scores exceeded 90 in 34 patients (90%). Four patients (10.5%) developed a recurrence or regrowth. Of 20 patients who were treated with either linear accelerator-based stereotactic radiosurgery or fractionated conformal radiotherapy, 11 had residual tumor and a moderate to high proliferative index, 4 had atypical tumors and 1 had angioblastic meningioma after total excision, 2 had regrowth, and 2 had recurrent tumors. In 18 (90%) of the 20 patients who underwent radiation, tumor size was reduced or controlled. CONCLUSION: On the basis of this study and a review of the literature, we demonstrate that sphenocavernous, clinoidocavernous, and sphenoclinoidocavernous meningiomas of Hirsch Grades 0 and 1 can be excised from the lateral compartment of the cavernous sinus without postoperative mortality and with acceptable rates of morbidity. Residual tumor in the medial compartment (Hirsch Grades 2-4) may be treated with some form of radiation therapy or observation.     

Gastrointestinal malformations in two infants born to women with hyperthyroidism untreated in the first trimester

We report two infants with gastrointestinal anomalies: one with esophageal atresia and tracheo-esophageal fistula and the other with biliary tree atresia, born to hyperthyroid women diagnosed and treated with methimazole after 14 weeks' gestation. Euthyroidism was documented in both infants. These cases raise the issue of whether untreated hyperthyroidism and not methimazole intake is the teratogen.