Neuirofibroma of penis

We report a case of an isolated neurofibroma of the penis in a child with the stigmata of systemic neurofibromatosis (von Recklinghausen's disease).     

Noninfectious ascitic fluid leukocytosis associated with penetrating duodenal ulcer

Summary Ascitic fluid leukocytosis occurring in the cirrhotic patient in the absence of positive peritoneal cultures is often difficult to explain. A unique case of a patient with alcoholic cirrhosis, sterile ascites, and ascitic fluid leukocytosis demonstrated prior to the perforation of a duodenal ulcer has been presented. Based on the patient's clinical course and the pathological events in peptic ulceration of the stomach and duodenum, it is possible to postulate an explanation for the sterile ascitic fluid leukocytosis observed in this patient.     

Anatomic correction of the congenitally corrected transposition of the great vessels by the first successful "double switch" operation in Hungary

Congenitally corrected transposition of the great arteries is a rare defect characterized by discordant atrioventricular and ventriculoarterial connections. Symptoms result from one or a combination of associated cardiovascular malformations, including ventricular septal defect, pulmonary stenosis or atresia, tricuspid valve dysfunction, dextrocardia, hypoplastic left or right ventricle. Correcting exclusively the associated defects, leaving the morphologic right ventricle in systemic position, will determine the patient's life-long prognosis. Anatomic repair by double switch technique may improve survival of patients with congenitally corrected transposition of the great arteries by establishing the morphologic left ventricle in the systemic circulation. A 3-year-old girl with congenitally corrected transposition of the great arteries, ventricular septal defect, hypoplastic right ventricle, and previous palliative procedure was corrected by double switch technique and patch closure of ventricular septal defect. The authors prefer the double switch procedure inspite of its many surgical challenges because it has very good long-term outcome. The more simple surgery namely the operation of only associated cardiac defects will involve the possibility of deterioration of right ventricular function.     

Enterocutaneous fistula: are treatments improving?

BACKGROUND: We studied the etiology, treatment, and outcome of enterocutaneous fistulas in 106 patients to evaluate our current practice and the impact of newer therapies-octreotide, wound vacuum-assisted closure (VAC), and fibrin glue-on clinical outcomes. Review of the literature and our own 1990 study indicate a mortality rate of 5% to 20% for enterocutaneous fistula, and a healing rate of 75% to 85% after definitive surgery. METHODS: We reviewed all cases of gastrointestinal-cutaneous fistula from 1997 to 2005 at 2 large teaching hospitals. We identified 106 patients with enterocutaneous fistula; patients with irritable bowel disease and anorectal fistulas were excluded. RESULTS: The origin of the fistula was the small bowel in 67 patients, colon in 26, stomach in 8, and duodenum in 5. The etiology of the fistula was previous operation in 81 patients, trauma in 15, hernia mesh erosion in 6, diverticulitis in 2, and radiation in 2. Of the 106 patients in the study, 31 had a high output fistula (greater than 200 mL/day), 44 had a low output fistula, and, in 31 patients, the fistula output was low but there was no record of volume. Initial treatment was nonoperative except for patients with an abscess who needed urgent drainage. In 24 patients, the effect of octreotide was monitored: in 8 patients, fistula output declined; in 16 patients, octreotide was of no benefit. Fibrin glue was used in 8 patients and was of benefit to 1. The wound VAC was used in 13 patients: 12 patients still required operative repair of the fistula, whereas the fistula was healed in 1 patient. The main benefit of the VAC system was improved wound care in all patients before definitive surgery. Total parenteral nutrition was used in most patients to provide nutritional support. Operative repair was performed in 77 patients and was successful in 69 (89%), failing in 6 patients with persistent cancer or infection. Nonoperative treatment was used in 29 patients and resulted in healing in 60%. Of 106 patients, 7 (7%) died of fistula complications. The cause of death was persistence or recurrence of cancer in 4 patients and persistent sepsis in 3. CONCLUSION: Enterocutaneous fistula continues to be a serious surgical problem. The wound VAC and fibrin glue had anecdotal successes (n = 2), and one-third of patients responded to octreotide. We believe that octreotide should be tried in most patients and that the wound VAC has a role in selected patients. Although 7% overall mortality is lower than in previous studies, the number managed without operation (27%) remains the same. In addition to early control of sepsis, nutritional support, and wound care, a well-timed operation was the most effective treatment.     

Effects of calcium on cholinergic-stimulated gastrin release in the rat

The effects of alterations in availability and access of extracellular media calcium on antral gastrin release were examined in the basal state and in response to cholinergic stimulation in rat antral organ culture experiments. In the presence of either divalent cationic chelator (EGTA) or calcium channel blocker (verapamil, nifedipine), carbachol-stimulated gastrin release was inhibited completely to values that were not significantly different from non-stimulated control. In the absence of added calcium chloride, carbachol stimulated gastrin release during the initial 30 min of culture but not at 60 and 120 min of culture. Inhibition by EGTA and verapamil of carbachol-stimulated gastrin release during the initial 30 min of culture suggests, but does not prove, that these agents may also affect intracellular availability and movement of calcium. Cholinergic stimulation of gastrin release demonstrated a concentration-dependent relationship with extracellular calcium: optimal culture media calcium concentration was 1 mM. In conclusion, these studies indicate that cholinergic stimulation of the gastrin cell requires availability of extracellular calcium.