[Topical steroids in the treatment of phimosis in children]. / Lokal steroidapplikation i behandlingen af phimosis hos børn.

The aim of this study was to evaluate the efficacy of steroid application in the treatment of childhood phimosis. In a consecutive study 91 boys were treated with application of topical betamethason 0.05% cream twice daily. The foreskin was treated for one month, with an attempt at foreskin retraction after fourteen days. Treatment was controlled after one month and six months. Sixty boys achieved full retraction of the foreskin and nine had partial retraction and relief of symptoms. Twenty-two boys had unsatisfactory response and had an operation. Forty-five boys were controlled after six months, 13 had recurrence, of these nine were satisfied and free of symptoms, two had a new steroid treatment with full success, and two wanted a circumcision. A total of 74% did not need an operation after topical steroid treatment. No side-effects or complications were registered. Childhood phimosis can be successfully treated with steroid application, and the treatment should be offered prior to an operation.

Late progress of radiation-induced proctitis.

Sixty-five patients with late radiation-induced proctitis who presented after a median latency of 13 months (range 6 months to 43 years) were studied retrospectively. As a result of progression new colorectal injuries had occurred in 53 patients (82%): stricture (n = 33), fistula (n = 19) and perforation (n = 1). Fourty-one patients had progression of their lesions to the small bowel or urinary tract. Only seven patients had no progression of their radiation injuries after the initial episode proctitis. Surgery was required in 15 patients with strictures, in 18 patients with fistulas, and in one patient with perforation. Thirty-two patients were managed conservatively. Fifteen patients died, given an overall radiation induced mortality of 23%. Factors significantly influencing mortality were coexisting injuries of the small bowel or urinary tract. Age, stage of primary malignant disease, and previous laparotomy did not influence outcome. After a median observation period of 11 years, 35 patients were alive, of whom 18 (51%) had a fair outcome; 12 continued to have slight or moderate symptoms (34%) and five disabling symptoms (14%). Ten patients had died from unrelated causes, and five from recurrent cancer. Because radiation-induced proctitis is likely progresses, it can not be characterised as a harmless manifestation of late radiation injuries.

Histamine release from gut mast cells from patients with inflammatory bowel diseases.

Inflammatory mediators from intestinal mast cells may serve as initiators of acute and delayed inflammation. Mast cell histamine release was measured in 19 patients with inflammatory bowel diseases using gut mast cells from enzymatically dispersed endoscopic forceps biopsy specimens of macroscopically inflamed and normal tissue. Mast cells and corresponding basophils were challenged with anti-IgE, anti-IgG, subclass anti-IgG4, and formyl-methionyl-leucyl-phenylalanine (FMLP) and results were compared with those from nine patient control subjects. The mast cell count in patients with ulcerative colitis was increased compared with that in control subjects and patients with Crohn's disease, and the mast cell count obtained from inflamed tissue was greater than that of normal tissue. The study also shows the heterogeneity of the responsiveness of the histamine releasing cells to various secretagogues. Thus, mast cells released 0.4 (0.0-2.0) (median (range)) ng histamine per sample at anti-IgE challenge, and basophils were also anti-IgE responsive. In contrast, mast cells did not respond to FMLP but the corresponding basophils did. Gut mast cells released 0.3 (0.0-1.0) (median (range)) ng histamine per sample at anti-IgG4 challenge; however, the corresponding basophils did not respond to anti-IgG4. In addition, the anti-IgG4 mediated histamine release was primarily confined to patients with inflammatory bowel disease. This study substantiates previous histopathological findings that mast cells may play a functional role in the inflammatory process of inflammatory bowel diseases and provides evidence for a possible role of subclass IgG4 as a reaginic antibody.

Late radiation injury of the colon and rectum. Surgical management and outcome.

After a median latency of 2 years, the initial late colorectal radiation injuries in 182 patients were: stricture (37 percent), minor lesions (36 percent), rectovaginal fistula (22 percent), and gangrene or other fistulas (5 percent). Due to progression, new colorectal injuries, primarily stricture (55 percent) and fistula (42 percent), occurred in 68 patients (37 percent). Resection provided the best results. However, the resectability rate was low (46 percent) and resection was primarily performed in patients with a circumscript well-defined stricture of the proximal rectum or sigmoid colon with an anastomotic leakage rate of 5 percent. The prevailing management of 78 patients with fistula or stricture with synchronous fistula was defunctioning colostomy, primarily end-sigmoidostomy, providing fair results in half of the patients. Stomal complications occurred in 15 percent. The radiation-induced colorectal mortality was 8 percent. Colorectal fistula and associated radiation injuries of the urinary tract, and especially of the small bowel, were the major determinants of fatal outcome, yielding an overall radiation-induced mortality of 25 percent. After a median observation time of 13 years, half of the patients were alive at follow-up; 56 percent of these had a fair outcome whereas the remaining patients continued to have mild symptoms responding to conservative measures (34 percent) or disabling symptoms (10 percent).

Late radiation injuries of the small intestine--management and outcome.

A series of 86 patients with late radiation-induced lesions, mainly stricture, of the small bowel is reviewed. The median interval from radiotherapy to manifestation of enteropathy was 2 (1/4 to 43) years. Progression of the lesions necessitated further treatment in 35 of the 70 patients who survived the initial attack. Bowel resection was followed by leakage from 12% of ileo-ileal and ileo-colic anastomoses. Mortality was 34% from the enteropathy and 8% from coexisting damage to the rectum or urinary tract. Factors significantly influencing mortality were pre-irradiation laparotomy, emergency surgery, and surgery to deal with a segment of irradiated intestine left in situ at initial operation. Age, stage of primary malignancy and coexisting rectal or urinary tract lesions did not significantly influence the outcome. After a median of 10 years' observation the outcome was classified as favourable in only 28% of cases, while 30% had slight to moderate symptoms or had died of unrelated causes. When surgery is required for radiation-related lesions of the small intestine, the aim should be a one-stage definitive procedure, as management of subsequently progressing lesions is associated with substantially increased mortality.