The key to the diagnosis of pheochromocytoma is a high index of suspicion on the part of the clinician. Confirmation of the diagnosis and localization of the tumor have been rendered relatively straightforward by advances in biochemistry, nuclear medicine, and radiology. Close cooperation and team effort between a physician, anesthetist, and surgeon possessing expertise in this field will ensure optimal preoperative, operative, and postoperative care, particularly for the small group of patients seriously ill with “acute” catecholamine excess.
Toxic megacolon is a rare complication of ulcerative colitis; this report describes 8 patients, 4 of whom died. The high mortality was attributable to prolonged medical treatment, delay in recognising the need to undertake surgery and colonic perforation. Our findings suggest that steroids have no place in the management of this condition; rather the occurrence of toxic megacolon should be regarded as an absolute indication for surgery with patients being selected for either total colectomy or pan-proctocolectomy.
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