ABSTRACT
Carcinoma arising in a chronic anorectal fistula in Crohn's disease is rare, but the association has been reported in the literature. In most cases, it concerns a colloid carcinoma. Probably chronic irritation at either end of a fistula can trigger the degeneration of scar tissue into cancer. The diagnosis is difficult, due to lack of specificity of symptoms and signs, and is often delayed, resulting in a poor prognosis. A 70-year-old female, diagnosed with Crohn's disease at the age of 45, developed a pararectal colloid carcinoma in an anorectal fistula that had existed for years. She was treated with an abdominoperineal resection and adjuvant chemotherapy (5-fluorouracil and levofolinate) but died. A high index of suspicion and regular surveillance is recommended in chronic anorectal fistulas in Crohn's disease. In case of doubt, repeated biopsies should be performed to rule out malignancy.
Subject(s)
Anus Diseases/complications , Carcinoma/etiology , Crohn Disease/complications , Rectal Fistula/complications , Rectal Neoplasms/etiology , Aged , Fatal Outcome , Female , HumansABSTRACT
Personal experience and reports of colleagues made the authors aware of a possible problem of carbon monoxide exposure in indoor carting arenas. Symptoms such as nausea, headache and altered coordination are not uncommon. This prompted us to register carbon monoxide levels in 15 healthy volunteers in a recreational carting event in a random arena. After two sessions of 10 min and a finale of 20 min we measured a clear increase in carboxyhaemoglobin levels, up to a 16.5-fold increase. The mean rise in the carboxyhaemoglobin level (expressed as a percentage) was 2.06 (mean start carboxyhaemoglobin 0.49%, mean end carboxyhaemoglobin 2.55%). Nausea was noted in 53% of the drivers, headache and altered coordination in 33%, and 13% had a vague abdominal pain. The effects of carbon monoxide exposure during indoor carting should thus not be underestimated, and healthcare workers should be aware of the possible risks.
Subject(s)
Air Pollution, Indoor , Carbon Monoxide/blood , Recreation , Adult , Air Pollution, Indoor/analysis , Carboxyhemoglobin/analysis , Female , Humans , Male , Middle Aged , SportsSubject(s)
Gastrointestinal Hemorrhage/etiology , Hamartoma/complications , Jejunal Diseases/complications , Aged , Humans , MaleSubject(s)
Abdominal Injuries/diagnostic imaging , Wounds, Nonpenetrating/diagnostic imaging , Abdominal Injuries/surgery , Child , Duodenum/injuries , Female , Humans , Liver/injuries , Pancreas/injuries , Rupture , Splenic Rupture/diagnostic imaging , Tomography, X-Ray Computed , Wounds, Nonpenetrating/surgeryABSTRACT
Starting from a case report of a six-month-old boy with a hepatoblastoma, we discuss this topic. New virologic and cytogenetic findings in hepatoma are mentioned in the chapter "epidemiology". In "diagnosis" we focus on history, physical examination, echography, conventional RX, the role of CT-scan of abdomen and thorax, of fine needle aspiration, arteriography and magnetic resonance. In "therapy" we emphasize the new therapeutical means: chemotherapy, orthotopic liver transplantation, resection of pulmonary metastases, as well as radiotherapy and immunotargeting chemotherapy. We conclude that surgery still is the cornerstone of treatment, but the new therapeutical means create hopeful perspectives in outcome.
