No abstract

Splenic tumors are uncommon lesions that can be divided into two main categories: nonlymphoid and lymphoid. The most common nonlymphoid tumors are the vascular tumors, which include benign and malignant hemangiomas, lymphangiomas, and hemangioendotheliomas. The remaining nonlymphoid tumors, such as fibrosarcoma and lipoma, are so uncommon as to be only anecdotally reported. Of the lymphoid tumors, Hodgkin's lymphoma may rarely occur as a primary splenic tumor, but more commonly is seen as part of disseminated disease. The same is true of histiocytic lymphoma and plasmacytoma. Rare benign lymphoid lesions may simulate lymphoid tumors. Of the metastatic tumors to the spleen, melanoma, breast, and lung are the principal lesions, but metastases from many other neoplasms occur. Metastases to spleen are less common than to other parenchymatous organs for reasons yet unknown. The surgical approach to splenic tumors should conform to the principles of good tumor surgery with good access, extirpation without rupture, and correct handling of tissue for study. Partial splenectomy is an acceptable procedure for benign splenic cysts, and possibly for polar hamartomas.

To determine the efficacy of azathioprine in the treatment of Crohn's disease, a 26-week double-blind trial was performed. 20 patients with Crohn's disease, requiring at least 10 mg of prednisone/day over the 3 months prior to entering the study were randomized into placebo (10 patients) and major criterion of success in the trial. There were 7 relapses in the placebo group (5 patients) and 2 relapses in the azathioprine group (2 patients). Complications including fistulae were not affected by the medications. The mean reduction in steriod dosage in the azathioprine group at the end of the trial (-15.5 mg) was greater than in the placebo group (-6.1 mg). These results suggest that azathioprine may permit reduction or discontinuation of steroids without the worsening of symptoms in some patients who appear to require steroids for control of their symptoms. The clinical features of this "AZA-responsive subgroup" remain to be defined.

No abstract

The descending part of duodenum is the principal site for an intraluminally projecting mucosal pouch or diverticulum, but this unusual lesion may also occur elsewhere in the upper gastrointestinal tract. We report three patients in whom a large intraluminal duodenal diverticulum (IDD) was diagnosed radiographically at the ages of 15, 27, and 68 years, respectively. Fiberoptic duodenoscopy was performed in the two symptomatic cases for the removal of impacted food from IDD or dilatation of its outflow aperture. Guidelines for the diagnosis and treatment of IDD are provided based on our experience and review of the pertinent literature.