True caecal diverticulitis.

Nine patients (six females and three males), median age = 27.5 years (range 13-36) with caecal diverticulitis are presented. All underwent surgery with a suspected diagnosis of acute appendicitis. Per-operative diagnosis was possible in five cases, two cases were thought to have other benign pathology, but malignancy could not be excluded in the remaining two cases. Local excision was carried out in five cases, a right hemicolectomy was performed in the rest. Histology showed true diverticuli in eight cases, severity of the inflammation made it difficult to comment on the ninth case. Postoperative barium enema was carried out in six cases, which showed no further diverticuli in the colon. We conclude that preoperative diagnosis of caecal diverticulitis is difficult, and that true solitary caecal diverticuli present in a younger age group than the false caecal and ascending colon diverticuli and that they are probably congenital in origin.

Volvulus of the sigmoid colon in Jordan.

This report discusses 27 patients with sigmoid volvulus treated at Jordan University Hospital (JUH) during a 15-year period. These patients represented 4.7 percent of adult patients treated for intestinal obstruction in the same period. The average age was 54.5 years, and none of the patients was institutionalized. Twenty-five patients presented with acute symptoms, and two had chronic symptoms. Sigmoidoscopic detorsion was achieved in 15 patients. Emergency resection was required in two of these patients: for the development of gangrene a few hours after detorsion in one patient and for recurrence within 24 hours in the other despite the presence of a rectal tube. Early recurrence occurred in two other patients and was managed endoscopically. Emergency surgery was performed in 10 other patients: for a failed endoscopic detorsion in three patients, for ulcerated and bleeding mucosa forecasting gangrene in another, and as a primary treatment in six patients who were either misdiagnosed or suspected to have gangrenous bowel. Elective resection was performed in 13 patients. The mortality rate was 15 percent (4/27) for the whole series and 33.3 percent (1/3) for those with gangrenous bowel.

Adrenal cysts: diagnosis and management.

We present 7 patients (5 adult females and 2 neonate males) with adrenal cysts. The cysts included 1 hydatid, 1 lymphatic and 5 pseudocysts. Three cysts were diagnosed preoperatively and all were resected surgically. The existence of true epithelial cysts of the adrenal gland is doubted by many authors; the present series includes most types of adrenal cyst.

Massive bleeding in neurofibromatosis associated with congenital hypofibrinogenaemia: a case report.

A 22 year old male who bled profusely at operation for excision of an extensive scalp and facial neurofibromata is reported. He was found to have congenital hypofibrinogenaemia. It is suggested that hypofibrinogenaemia should be considered as a cause of excessive bleeding in cases of Von Recklinghausen's neurofibromatosis.

Tumores rari et inusitati. Chordoma in a lumbar vertebral transverse process: a case report and review of the literature.

Chordoma is a rare tumour of the skeleton that develops from notochordal elements. It occurs in the midline of the body particularly at the upper and lower ends of the vertebral columns. This paper reports a case of chordoma of unusual localization in the transverse process of a lumbar vertebra in a 30-year-old man with review of the literature. The early confinement of the tumour to a vertebral transverse process has never been reported. The scarcity with which chordoma is diagnosed in Jordan and the clinical presentation of the case reported are discussed.

Clear cell sarcoma: report of two cases with ultrastructural observations and review of the literature.

Two cases of clear cell sarcoma of tendons and aponeuroses, one with prominent melanogenesis, are reported. One tumour arose in the left buttock of a young male and the other in the left fourth toe of a young female. Both had a rapid fatal course with local and distant metastases. Electron microscopy shows melanosomes in one case, suggesting a melanotic origin.

Rectal vesico-urethroplasty updated with ten years' evaluation.

A new operation--rectal vesico-urethroplasty--has been designed to reproduce the normal anatomy and physiology of the lower urinary tract after total cystectomy. This is achieved by using the rectum with its intact nerve supply to replace the bladder and posterior urethra, thereby ensuring the known requirements for normal bladder function, viz, an adequately contractile reservoir with a sphincteric outlet and an intact corticospinal nerve tract. The operation has been carried out on 126 patients, 114 males and 12 females. It has been performed as an immediate sequel to cystectomy in 111 cases and as a secondary reconstruction after previous cystectomy and diversion in 15 cases. The results are greatly superior to colocystoplasty: most patients enjoy practically normal continence and voiding and are not threatened by subsequent complications. The postoperative mortality rate of 17% in the present series is largely due to avoidable factors and has markedly reduced in the last group of cases.