Milton A. Gumbs

Kimura's disease : A case report and literature review

Kimuras disease, which occurs endemically in the Far East and sporadically in the West, has so far eluded efforts to determine its exact pathogenesis. It presents as solitary or multiple benign swellings of the skin, has a predilection for the periauricular and scalp regions, and often is associated with regional lymphadenopathy. Morphologically, the lesions are characterized by proliferating blood vessels with rich eosinophilic infiltrate. Peripheral blood eosinophilia and raised serum IgE levels are signature features of the condition. The overall prognosis is good. When surgery is not possible, conservative treatment with either corticosteroids or radiation often can produce a favorable response. Complete surgical excision whenever feasible is the preferred treatment despite a high recurrence rate. Based on a recent case of Kimuras disease in a 55‐year‐old black woman, we discuss the pitfalls in the diagnosis of this chronic inflammatory disorder. J. Surg. Oncol. 1999;70:190–193.

Histoplasmosis of the small bowel in patients with AIDS.

Two cases of jejunal strictures caused byHistoplasma capsulatum in AIDS patients are presented. Both patients were intravenous drug abusers. One patient, who was being treated for Pneumocystis carnii pneumonia, presented with jejunal perforation and the other presented with lower gastrointestinal bleeding and intestinal obstruction. On exploration, both patients were found to have jejunal strictures; one had intestinal perforation, and the other had intestinal obstruction with ulcers and strictures resulting in gastrointestinal bleeding. In areas where it is endemic, histoplasmosis is rarely disseminated. Dissemination is most commonly seen in immunosuppressed patients. Dissemination and extrapulmonary histoplasmosis is now included in the case definition of AIDS.

Volvulus of the transverse colon: Reports of cases and review of the literature

Volvulus of the transverse colon is rare. Sixty-six cases have been reported in the English medical literature, and three new cases are presented herein. The causative factors, classical clinical presentation, radiologic findings, and management have been addressed. It is believed that colonoscopy will have an increasing role in the diagnosis and treatment of this condition in the future.

Gunshot Wound of the Left Chest and Bochdalek Hernia

A 16-year-old male presented with a hemopneumothorax following a gunshot wound to the left chest. He was treated effectively with closed suction drainage for 48 hours when he suddenly complained of severe left chest pain. Preoperative diagnosis was suggestive of a traumatic diaphragmatic hernia but operative findings were confirmatory of a rare hernia through the foramen of Bochdalek. Chest X-ray showing a gas-filled viscus above the diaphragm is diagnostic. Increased abdominal pressure generated when he was first hit by the bullet and aggravated by increased negative intrapleural pressure resulting from suction drainage of the hemothorax is the probable mechanism of the herniation.

Ultrasound as an aid in the diagnosis of acute appendicitis

This 1-year prospective study used high-resolution ultrasound at 5 MHz to assess 79 patients admitted with a possible diagnosis of acute appendicitis. The sonographic criterion used to diagnose acute appendicitis was visualization of a noncompressible appendiceal shadow having a diameter of 5 mm or more. Ultrasound examination proved to be a valuable tool in the differential diagnosis of acute appendicitis in all patients who had equivocal symptoms and signs. Ultrasound was particularly useful when applied to female patients of childbearing age.

Actinomycosis: A Rare Cause of Perianal Disease

We present the case of a patient with perianal actinomycosis. Although actinomycosis that is primarily perianal is rare, is should be suspected in patients who present with recurrent perianal abscesse

Granular Cell Tumor of the Biliary Tree: A Rare Cause of Limy Bile

A 41-year-old black man presented a clinical picture of acute cholecystitis. At surgery, a histologically proven granular cell tumor was found to be occluding the cystic duct. This case is reported be