Chronic venous leg ulcers are a common ailment with no ideal treatment. Recent reports have shown granulocyte- macrophage colony stimulating factor to be of use in the healing of these chronic wounds. Therefore, we conducted a double-blind, randomized, placebo-controlled study which enrolled 60 patients with chronic venous leg ulcers, whom we treated with placebo or with 200 or 400 microg of granulocyte-macrophage colony stimulating factor by perilesional injections of the drug in four weekly treatment episodes. Observations were conducted at each treatment visit, at weeks 5, 9, 13, and six months after the inclusion in the protocol. The number of healed wounds in the placebo and the treated arms were significantly different (p = 0.05), with 4 of 21 (19%) in the first group having healed at week 13, as compared to 12 of 21 (57%) and 11 of 18 (61%), in the 200 microg and the 400 microg groups, respectively. There were only minor side-effects attributable to the treatment, and the reobservation at 6 months showed that none of the treated ulcers recurred during that period. We conclude that granulocyte-macrophage colony stimulating factor injected perilesionally may be a useful drug for the treatment of chronic venous leg ulcers.
Splenic rupture is a rare but serious complication after colonoscopy, with high global mortality (5%). Diagnosis requires a high index of suspicion because presentation can be subtle, nonspecific, and delayed from hours to days and then not easily attributed to a recent endoscopy. Urgent splenectomy is the most common treatment option. A 73-year-old woman was admitted to the emergency department 8 h following a diagnostic colonoscopy. She presented abdominal pain and syncope. The diagnosis of splenic rupture was made and a splenectomy was urgently performed. The patient's postoperative recovery was uneventful. Splenic rupture is a rare complication of colonoscopy which cannot be underestimated in the differential diagnosis of abdominal pain after this procedure. Splenic injuries may occur in apparently uncomplicated, easy colonoscopies performed by experienced endoscopists, with no risk factors identified, as in this case.
Polyorchidism is a rare congenital anomaly characterized by the presence of more than two testes. Triorchidism is the most common variant. Polyorchidism has been reported in around two hundred cases in the world to date. It is usually diagnosed incidentally in routine exams or surgery. It can be associated with undescended testis (40%), hernia (30%), and torsion (15%), among others. Given how rare it is, polyorchidism requires a high degree of suspicion. The exact aetiology of polyorchidism is unknown. The preservation of supernumerary testis has been controversial. Today, in the absence of pain, conservative management with a strict ultrasound and magnetic resonance imaging (MRI) follow-up is the most widely used approach. We present a case of a 48-year-old man who had a personal history of left cryptorchidism and came to our appointment with a bilateral inguinal hernia. During surgery for hernia repair, we found a supernumerary testis located on the left inguinal region with no epididymis or vas deferens. We opted for orchidopexy. In the other left testis, we did an orchidectomy due to the presence of a suspicious nodule. The histology was negative for neoplasia.
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