Condyloma acuminata: a fatal disease?

Condyloma acuminata is a virally mediated epithelial overgrowth caused by the human papilloma virus. Its simplest form is the common wart, which may occur almost anywhere on the body surface. Its papillary lesion forms are commonly seen in the genital, perineal, and anal areas, though it also infects the conjunctiva, nose, mouth, larynx, and tracheo-bronchial tree. Malignant degeneration may occur in any of these areas. Diagnosis is established by clinical impression and biopsy. Immunoassay methods exist but are simply indicative of the presence of infection and are not useful in predicting the course of the disease. Many treatment modalities exist and all work well for minor lesions. For large lesions such as the giant condyloma acuminata, also known as the Buschke-Lowenstein lesion, only radical surgical extirpation is considered to be appropriate treatment. This case report, as well as others referenced in this study, documents the extreme complexity of management of many of these lesions and the fatal outcome of this disease process in a significant number of cases.

Adrenal hemorrhage with incomplete rotation of the colon leading to early duodenal obstruction: case report and review of the literature.

We report the simultaneous occurrence of neonatal adrenal hemorrhage and type IIIB incomplete fixation of the hepatic flexure of the colon producing early complete obstruction of the duodenum. An abdominal ultrasound intravenous pyelogram, and barium contrast gastrointestinal studies were essential in establishing the preoperative diagnosis.

Iatrogenic perforation of the esophagus by a nasogastric tube.

An unusual case of esophageal perforation by nasogastric tube placement has been presented. Clinical suspicion plus radiologic confirmation of esophageal perforation resulted in prompt surgical intervention with drainage of the contaminated area. The best prognosticator for the successful outcome in the treatment of esophageal perforation is early recognition of the problem.

Resection of abdominal aortic aneurysms in the over-80 age group.

We reviewed the risk of resecting an abdominal aortic aneurysm in 38 patients aged 80 years or older. The operative mortality for an elective aneurysm was 5.2%, for symptomatic but nonruptured aneurysm 26.6%, and for ruptured aneurysm 66.7%. The preoperative risk factors were essentially the same for the elective and ruptured group. Several of the patients with ruptured aneurysm had been followed up with their aneurysm for several years by nonsurgeons. To better understand why these patients were not being referred for elective repair, 100 nonsurgeons were sent a questionnaire concerning abdominal aortic aneurysms in octogenarians. The results showed that 81% overestimated the elective operative mortality and as a result did not recommend elective resection.