1/4. Recanalization of a fallopian tube after detorsion of twisted adnexa: report of a case with follow-up by repeat hysterosalpingography.BACKGROUND: Detorsion and cystectomy of twisted adnexa have been performed in young women. However, identification was incomplete, and the function of the affected tube was not investigated. CASE: A 23-year-old, nulligravid woman with an acute abdomen was diagnosed with adnexal torsion. An emergency laparotomy revealed that both ovaries were 12x9x9 cm. the right adnexa were twisted and bluish black. Detorsion of the twisted lesion and ipsilateral fallopian tube was performed, with subsequent cystectomy of both lesions. hysterosalpingography on the 14th postoperative day showed right tubal obstruction; 6 months postoperatively, repeat hysterosalpingography revealed patency of the right tube. CONCLUSION: At least several months may be required for functional recovery of an untwisted tube. For that reason, postoperative repeat hysterosalpingography is a useful method for follow-up of function in an untwisted tube.- - - - - - - - - - ranking = 1keywords = black (Clic here for more details about this article) |
2/4. Gastrointestinal mucormycosis causing an acute abdomen in the immunocompromised pediatric patient--three cases.mucormycosis is an infection caused by a ubiquitous fungus in immunocompromised individuals. Typically, it invades blood vessels, producing thrombosis and tissue infarction. This infection spans all pediatric age groups and can lead to hollow viscus perforation and bowel obstruction. A 30-month old male with large cell anaplastic lymphoma had a bowel obstruction. During emergency laparotomy, an ileoileal intussusception was identified, which required resection and anastomosis. In the pathological specimen, fungi of the mucorales order were found to be associated with tissue necrosis. On the eighth day of life, a premature infant had abdominal distension secondary to bowel perforation. Partial gastric resection and multiple intestinal stomas were performed. death occurred soon after, secondary to multiorgan failure. The autopsy and surgical specimens showed widespread mucormycosis. An adolescent had meningococcemia-induced septic shock. During recovery, hemorrhagic colitis developed, which led to perforation. The subtotal colectomy specimen showed widespread mucormycosis. The laparotomy findings are typical (black necrotic tissue involving the bowel), and when seen in the immunocompromised patient, should make one suspect gastrointestinal mucormycosis. Aggressive surgical debridement of devitalized tissue augmented by intravenous antifungal medication is the mainstay of treatment.- - - - - - - - - - ranking = 1keywords = black (Clic here for more details about this article) |
3/4. Small bowel intussusception and brown bowel syndrome in association with severe malnutrition.Brown bowel syndrome is a rare condition characterized by deposition of lipofuscin in the smooth muscle cells of the gastrointestinal tract. The number of reported cases is small, but all are associated with malabsorptive states. Despite these small numbers, there is considerable evidence that vitamin e deficiency is important etiologically. We report here the case of a severely malnourished [body mass index 11.7 kg/m (2): normal range 20-25 kg/m (2)] 31-yr-old black male with a longstanding history of alcohol abuse, who was on anti-tuberculosis therapy. The patient presented with an acute abdomen and was found, at operation, to have a mid-ileal intussusception. Histological examination of the resected specimen demonstrated lipofuscin accumulation consistent with brown bowel syndrome, but no tumor. Subsequent investigations revealed no significant quantities of vitamin E in the blood and pancreatic steatorrhea. However, deficiency of other fat-soluble (vitamin a and D) and water-soluble vitamins (vitamin C and thiamine) also were detected. This report supports the association of brown bowel syndrome with vitamin e deficiency but cannot exclude the compounding effects of protein calorie malnutrition, multiple vitamin deficiencies, and chronic alcohol toxicity.- - - - - - - - - - ranking = 1keywords = black (Clic here for more details about this article) |
4/4. black widow spider bite in a child.An 8-year-old boy who was bitten by a black widow spider was seen in the emergency department twice, as well as by his private family physician, within a 24-hour period of time before being admitted to the hospital. This patient should have been observed for a longer period of time in the emergency department or admitted to the hospital on the day of presentation for observation with conservative management. The current literature is reviewed with special emphasis on the pediatric patient, and management guidelines are recommended.- - - - - - - - - - ranking = 1keywords = black (Clic here for more details about this article) |