[Crohn's disease of small bowel manifested by obstructive carcinoma].

In ulcerative colitis the incidence of adenocarcinoma of the small bowel is higher than in the general population. More than 100 cases of carcinoma of the small bowel have been reported in patients with Crohn's disease of the same segment. However, obstructive carcinoma of the small bowel as the first manifestation of Crohn's disease has seldom been reported. We present such a case in which the first manifestation of otherwise silent Crohn's disease was intestinal obstruction by adenocarcinoma of the same segment.

[Congenital granular cell epulis].

Congenital granular cell epulis is an uncommon pedunculated tumor of the upper alveolar mucosa found only in newborns. The lesion is not usually associated with other congenital deformities, but presents a major esthetic problem and interferes with nursing. We present a case of a double epulis, 7 cm in diameter, in a 2-day-old girl. Treatment is simple excision, and no recurrences have been reported. The lesion must be differentiated from granular cell myoblastoma.

The coracohumeral ligament. Anatomy of a substantial but neglected structure.

We dissected 60 shoulders to demonstrate the anatomy of the coracohumeral ligament. The role of this structure in clinical problems of the shoulder is discussed.

[Multiple enteral fistulas in peritoneal tuberculosis].

A 40-year-old Ethiopian man had abdominal pain for a year and a half, diarrhea and weight loss. Multiple enteral fistulas were diagnosed by X-ray and colonoscopy. During investigation, the differential diagnosis was between Crohn's disease, intestinal lymphoma and intestinal tuberculosis. Therapeutic trial with corticosteroids was unsuccessful. At operation peritoneal tuberculosis was diagnosed and several entero-enteric fistulas were found, but there were no other intestinal lesions nor other foci of tuberculosis. Intestinal fistulas complicating peritoneal tuberculosis are rare in comparison with enteral tuberculosis, lymphoma or Crohn's disease. After the fistulas were closed surgically and antitubercular treatment given, the patient recovered, returned to his normal weight, and had no complaints.

Advanced papillary adenocarcinoma of unknown origin as tumor previa during late pregnancy.

A 41-year-old woman with advanced abdominal adenocarcinoma presented at term pregnancy. The tumor was presented as previa and obstructed the delivery. A cesarean section was performed and a healthy child was born. At surgery diffuse metastatic disease was detected throughout the pelvis and abdomen and was partially resected. Combined chemotherapy consisting of cis-platinum, adriamycin and cytoxan was administered for 5 months. At second-look laparotomy no residual disease was found. We present an unusual presentation of metastatic abdominal undifferentiated carcinoma treated as ovarian cancer.

Histological response to carbon fibre.

The soft tissue response to carbon fibre was studied histologically one and a half years after being used to reconstruct the lateral collateral ligament of the human knee. A remarkably consistent pattern was seen in the induced ligament. The basic pattern was a "composite unit", consisting of a core of carbon fibre enveloped in a concentric manner by coherent layers of fibroblasts and collagen fibres. This new structure seemed to have been induced by continuous irritation caused by the physical structure of the carbon fibres; it is unlikely ever to acquire the structure of a natural ligament. However, it is biologically compatible and is biomechanically sufficient as long as the entire tow of carbon fibres is preserved.

Histologic pattern of biomechanic properties of the carbon fiber-augmented ligament tendon. A laboratory and clinical study.

Implantation of carbon fiber tow (CFT) for ligament and tendon augmentation was investigated in ten dogs and 45 patients. CFT produced a new structure with a remarkably consistent structural pattern. The basic pattern of the CFT-augmented unit consisted of a core of carbon fiber surround by concentric layers of fibroblasts and collagen fibers. This unit structure was developed from continuous irritation of physical structure of the carbon fiber. In dogs, ultimate tensile strength of the augmented tendon one year after surgery averaged 88% of natural tendon. Digestion of the connective tissue component of the CFT unit exposed the original carbon fiber tow. The connective tissue-free CFT maintained its original tensile strength. The continuous production of collagenous tissue surrounding carbon fibers produced a ligamentous structure that was physiologically compatible and biomechanically sufficient.

Eosinophilic granuloma of the temporal bone.

Involvement of the temporal bone by eosinophilic granuloma is rare. Four cases are presented here and the pertinant literature is reviewed. This disease must be kept in mind by the otolaryngologist because of the diagnostic and therapeutic problems that may arise. Direct injection of methyl-prednisolone sodium succinate is suggested as a treatment of eosinophilic granuloma in the temporal bone.

Massive thrombosis as a result of triple infestation of the pulmonary arterial circulation by Ascaris, Candida, and Mucor.

A 35-year-old man with a brief history of dyspnea and fever experienced rapid progressive respiratory distress and died shortly after being hospitalized. Postmortem examination revealed thrombotic occlusion of the pulmonary tree; the thrombotic material showed Ascaris lumbricoides, Candida albicans, and Mucor. This rare coincidence is an unexpected complication of ascariasis that has not been described previously.

Lymphomatoid granulomatosis of the lung in a patient with agnogenic myeloid metaplasia. Report of a case.

A patient with agnogenic myeloid metaplasia, who developed lymphomatoid granulomatosis of the lung is reported. The unusual combination of these myelo- and lymphoproliferative diseases is discussed.

Congenital cardiac fibroma associated with fetal arrhythmia.

A congenital cardiac fibroma presented itself, antenatally by bursts of extrasystoles which were detected by the cardiotocograph during labor. Congenital cardiac tumors are extremely rare. The symptomatology of such tumors consists mainly of hemodynamic disturbances and various arrhythmias. Most of the reported cases were diagnosed in neonates or infants, usually in autopsies, none were diagnosed in utero. It seems logical to assume that some of the arrhythmias may have been present but not diagnosed antepartum. To the best of our knowledge the association of congenital cardiac tumor and fetal arrhythmia (FA) has not been reported yet.

Linitis plastica infiltrating the entire gut.

A case of extensive spread of linitis plastica, involving the entire gastrointestinal tract, is reported. The tumor probably originated in the stomach. Because the mucosal and serosal layers remained intact, diagnosis was markedly delayed, as is commonly seen in scirrhous carcinoma. The method of spread of the tumor (mainly through the submucosal layer) is unusual, and is probably related to the histological type of carcinoma.

Upper gastrointestinal bleeding, aneurismatic dilatation of the thoracic aorta and filling defect on the esophagogram: a diagnostic triad suggesting aortoesophageal fistula.

A patient is described with an aneurysm of the thoracic aorta, which has ruptured into the esophagus. An esophageal X-ray contrast study has revealed a filling defect at the contact site of the esophagus and the aortic aneurysm. The filling defect was due to a clot protruding from the aorta into the esophagus. This unique case calls attention to a diagnostic triad: upper gastrointestinal bleeding, aneurysm of the thoracic aorta, and filling defect in the esophagus at its site of contact with the enlarged aorta. This triad suggested aortoesophageal fistula (AEF) in the patient and could help in the diagnosis of atypical cases of AEF, where thoracic aortography has not been performed initially.