Syndrome of inappropriate antidiuretic hormone associated with rectal small cell neuroendocrine carcinoma: a case report.

Neuroendocrine tumors can arise from any portion of the gastrointestinal tract including the colon and rectum. In the scope of all colon and rectal malignancies, they are a rare cause of colorectal carcinoma. Relating to their pluripotent neuroendocrine cellular origins these carcinomas can produce a variety of biologically active peptides with several resultant paraneoplastic syndromes. One of these paraneoplastic syndromes is the syndrome of inappropriate antidiuretic hormone (SIADH). In the SIADH, supraphysiologic levels of vasopressin (antidiuretic hormone, AVP) precipitates exorbitant free water retention and resultant electrolyte abnormalities, most notably hyponatremia. Herein we report a rare case of paraneoplastic SIADH from rectal small cell neuroendocrine carcinoma. To our knowledge, SIADH from rectal small cell neuroendocrine carcinoma has been reported only three times.

Isolated perivesicular hematoma after military parachuting.

BACKGROUND: Isolated perivesicular hematomas are uncommonly described and not an injury typically reported in the literature after parachuting or skydiving. CASE REPORT: Herein, we described a series of three patients with isolated perivesicular hematomas sustained after military parachuting. All three patients were managed nonoperatively after a somewhat prolonged hospital course. Despite the lack of orthopedic injuries, all required physical therapy consultation and required an assisting device to aide with ambulation at the time of discharge. For all three individuals, follow-up imaging months after the injury demonstrated a continued presence of the hematoma. Clinically, the patients continued to have ambulatory and urological difficulties for several months after their injury. DISCUSSION: This injury pattern is uncommonly reported in the literature. An appropriate index of suspicion must be maintained or there may be a delay in diagnosis. Management of these injuries requires coordinated care between the trauma service, urology, and physical therapy.

Planned delayed operation for barium extravasation into the peritoneal cavity.

BACKGROUND: Extravasation of barium into the peritoneal cavity occurs rarely but has lethal results. CASE: We describe a case of extravasation from the small bowel that was initially managed medically before a planned, delayed operation. We discuss the benefit/risk of delayed operation and reoperation.

Crohn's disease: presentation and severity compared between black patients and white patients.

PURPOSE: Common belief based on clinical experience suggests that Crohn's disease is more severe among black patients, although little data exists on the effect of race on Crohn's disease. We compared multiple variables among black patients with Crohn's disease requiring surgery to those of white patients presenting to a university colorectal surgery unit during a five-year period. METHODS: A total of 345 patients required surgery for Crohn's disease between June 1998 and September 2003. The following data were abstracted from patient charts and a prospectively maintained database: age at diagnosis; age at first Crohn's disease surgery; presenting symptoms; incidence, number and location of fistulas at presentation; number of Crohn's disease operations; and family history of inflammatory bowel disease. Data regarding medical insurance coverage also were obtained. Complete data were evaluable on 178 patients. Patient variables were analyzed using the chi-squared, Fisher exact, and Student t-tests. RESULTS: Mean age at diagnosis was 28 years for white males, 20 years for black males, 30 years for white females, and 28 years for black females (all p > 0.05). Thirty-seven percent of white females presented with obstructive symptoms vs. 12 percent of black females. (P = 0.011). Sixty-five percent of black females presented with inflammatory symptoms compared with 28 percent of white females (P = 0.001). Of females presenting with fistulas, 15 percent of black patients had a rectovaginal fistula compared with 5 percent of white patients. Seventeen percent of black males and 21 percent of white males had intra-abdominal fistulas. None of these differences were statistically significant. The incidence of fistulas at presentation, mean number of fistulas, total number of operations, and family history of inflammatory bowel disease did not differ. CONCLUSIONS: Contrary to expectations, Crohn's disease does not seem to be more severe among black patients, who had an earlier age of diagnosis, although this was not statistically significant. Overall, there was no difference in disease presentation. White females were more likely to present with obstructive symptoms compared with black females, who more often presented with inflammatory symptoms. Among patients with fistulas, the incidence of rectovaginal fistulas was higher in black females compared with white females, and white males were somewhat more likely to have intra-abdominal fistulas than black males. Although there was no demonstrated difference in incidence and mean number of fistulas at presentation, the number of operations for Crohn's disease, or family history of inflammatory bowel disease among blacks and whites, there are differences in presenting symptoms among these populations.