Severe haemorrhage in neurofibromatoma: a lesson.

Neurofibromatosis is a relatively common inherited disease of the nervous system, with a frequency of almost 1 in 3000. It is associated with a wide range of vascular abnormalities. A 62-year-old man with neurofibromatosis presented to us with a sacral haematoma. This was due to spontaneous rupture of a pre-existing neurofibromata. Upon admission the patient was in hypovolaemic shock and required aggressive resuscitation prior to surgery. Haemorrhage following trauma or spontaneous rupture is an uncommon complication of neurofibromatosis. The management is discussed with emphasis on the cause and control of bleeding from these lesions.

A case report of osteochondroma of the frontotemporosphenoidal suture.

Osteochondroma, also known as osteocartilaginous exostosis, is the most frequent benign bone tumour of the skeletal system. Despite its preference for long bones (tibia and femur), osteochondroma may occur in some short bones developing endochondral ossification. Seventy-five percent of the patients present only with a single lesion, whereas 25% have multiple lesions; this last clinical condition, defined as osteochondromatosis (disorder of autosomal dominant inheritance) shows a high risk of malignant transformation (about 11%). In the craniofacial area this tumour is very rare. The sites of predilection are the coronoid process and mandibular condyle, even though osteochondromas arising from the base of the skull, maxillary sinus and zygomatic arch have been previously described. However, an osteochondroma originating from the frontotemporosphenoidal suture has not been reported before in the literature. We present a unique case of osteochondroma of the frontotemporosphenoidal suture. Moreover, the relevant international literature has been reviewed and all diagnostic and surgical matters have been discussed.

Unexplained groin pain: safety and reliability of herniography for the diagnosis of occult hernias.

A retrospective study of our initial experience of herniography in a district general hospital is presented. A total of 43 herniograms were performed in 41 patients (median age 57, range 16-77, 27 males, 14 females) over a two year period. Four herniograms were unsuccessful due to failed intraperitoneal contrast injection, of which two were repeated (success rate 90.5%). A total of 25 groin hernias were identified radiologically (two on the asymptomatic side). Twenty one patients underwent surgery and a hernia was confirmed in 19 (true positive rate 90.5%). Sixteen herniograms were considered negative and after a median follow up of 28 months (range 16-42 months), none of these patients have developed a hernia. There were no major complications. It is concluded that herniography is a safe and reliable method of determining or excluding the presence of an occult groin hernia.

Diffusion of nonoxynol-9 into human semen in vitro.

The diffusion of [125I]-nonoxynol-9 into human semen was investigated in vitro before and after liquefaction. No significant difference was found in the distribution of [125I]-nonoxynol-9 within columns of preliquefied semen, liquefied semen, seminal plasma, or water after < or = 120 minutes of diffusion; however, significantly more nonoxynol-9 entered preliquefied semen. The concentration of nonoxynol-9 that entered semen in vitro was greater than its ED100 and the bioavailability was confirmed by demonstration of the retention of spermicidal action. These results indicate that the gel state of preliquefied semen does not inhibit the entry or action of nonoxynol-9 and, consequently, sperm would be exposed to it immediately when it is used in vivo as a vaginal spermicide.

PIP: To investigate factors associated with the relatively low contraceptive efficacy of vaginal spermicides, the diffusion of nonoxynol-9 into human semen in which liquefaction had been prevented was compared with entry into liquefied semen, sperm-free seminal plasma, and water. In 30 minutes, only 6.5% of the mass of the coagulated semen passed through a mesh screen at 4 degrees Celsius, while all the ejaculate passed through at 25 degrees Celsius. In all cases, there was a significant decrease in the concentration of radiolabeled nonoxynol-9 as a function of the depth of diffusion into the solution being tested. The concentration of nonoxynol-9 was significantly greater in coagulated semen than in liquefied semen, seminal plasma, or water. After 2 hours of contact, nonoxynol-9 entry was almost wholly restricted to the first 5 mm in all three fluids. The concentration of nonoxynol-9 that entered semen in vitro was greater than its depth of entry, indicating the spermicide was fully bioavailable. These results suggest that nonoxynol-9 moves quickly to permeate the first 5 mm of semen, cervical mucus, or water, but does not progress further. The slower entry of nonoxynol-9 in vivo may be a factor in the low contraceptive efficacy of this compound. If the entry of nonoxynol-9 into semen before liquefaction is restricted, the spermicidal action will be diminished as viable sperm from inner parts of the coagulated semen escape into the cervical mucus.