A case series of two glomus tumors of the gastrointestinal tract.

Two recent cases of glomus tumors (GTs) of the gastrointestinal tract presented with symptoms of GI bleeding. GTs, typically benign lesions of mesenchymal origin, are rarely seen in the GI tract, and most commonly involve the distal appendages. This case series discusses the tumor biology, presentation, imaging, endoscopic findings, pathology and management of GTs. While diagnosis of GTs is typically made on final surgical pathology, there are defining characteristics that can separate a GT from a gastrointestinal stromal tumor on endoscopic ultrasound (EUS) and CT imaging. The classic pathological findings are discussed, and surgical decision-making is reviewed. New developments in the form of EUS-guided biopsy and endoscopic submucosal dissection present new avenues for diagnosis and treatment of submucosal lesions of the GI tract, including GTs. While typically a benign tumor requiring no adjuvant therapy, this study discusses some very rare cases of metastatic GT in the literature.

Comorbidity is a major determinant of severity in acute diverticulitis.

BACKGROUND: Acute colonic diverticulitis may be simple or very complicated. Not much is understood about what factors determine severity. Answering this question may have therapeutic implications. METHODS: A retrospective review was performed consisting of teaching hospital admissions for simple or complicated acute diverticulitis. The intent was to identify characteristics of and differences between the 2 groups. The Charlson index was used to assess states of preexisting health (comorbidity). RESULTS: In multivariate analysis, the presence of a major degree of comorbidity (Charlson score 3 or greater) was strongly associated with complicated disease (P = 0.02) as was the use of nonsteroidal anti-inflammatory drugs (P = .01). Deaths were not seen below age 50, and high Charlson score also strongly predicted mortality (P < .0001). CONCLUSIONS: There are significant differences between patients presenting with simple and complicated diverticulitis, and the amount of associated comorbidity (as measured by Charlson score) appears to be a major one. Because of the high mortality seen in patients with Charlson scores 3 or greater and complicated diverticulitis, we believe that an early surgical approach should be considered for them, particularly if they are 50 or older.

Curved paths in raptor flight: Deterministic models.

Two deterministic models for flight of Peregrine Falcons and possibly other raptors as they approach their prey are examined mathematically. Both models make two assumptions. The first, applicable to both models, is that the angle of sight between falcon and prey is constant, consistent with observations that the falcon keeps its head straight during flight and keeps on course by use of the deep foveal region in its eye which allows maximum acuity at an angle of sight of about 45 degrees . The second assumption for the first model (conical spiral), is that the initial direction of flight determines the overall path. For the second model (flight constrained to a tilted plane), a parameter that fixes the orientation of the plane is required. A variational calculation also shows that the tilted plane flight path is the shortest total path, and, consequently, the conical spiral is another shortest total path. Numerical calculations indicate that the flight paths for the two models are very similar for the experimental conditions under which observations have been made. However, the angles of flight and bank differ significantly. More observations are needed to investigate the applicability of the two models.

Results of cholecystectomy without intraoperative cholangiography.

BACKGROUND: To determine if cholecystectomy can be performed satisfactorily without the use of adjunctive intraoperative cholangiography (IOC), we planned a retrospective analysis at a Canadian university teaching hospital. METHODS: General operative morbidity and mortality (in particular, occurrences and complications of missed choledocholithiasis and reoperations for same, and occurrences of bile duct injuries and bile leaks) were noted and analyzed for a consecutive series of cholecystectomies from a single practice, carried out without IOC. MAIN RESULTS: In general, choledocholithiasis could be identified and treated before the operation; missed cases were infrequent and were treatable without reoperation. No major injuries to the bile duct were encountered. CONCLUSIONS: IOC appears to be optional with cholecystectomy; cholecystectomy can be performed without IOC safely in the defined setting, without related major complications from missed choledocholithiasis or excess occurrence of bile-duct injury.

Isolated blunt splenic injury: do we transfuse more in an attempt to operate less?

OBJECTIVE: To determine if blood transfusion requirements in patients with isolated blunt splenic injury (BSI) are greater if they are managed nonoperatively, we did a retrospective case study of patients with isolated BSI who were seen at a Canadian university teaching hospital over a 10-year period. METHOD: Data such as number of units of packed erythrocytes transfused and mortality in the 75 patients with isolated BSI seen from 1992 to 2002 were separated into operative and nonoperative management groups. RESULTS: In the operative management group (n = 10), patients received more transfused erythrocytes (3.0 v. 0.7 units), and a higher proportion of patients were transfused (80% v. 20%). There were no deaths in either group. CONCLUSION: In the management of isolated BSI, initial nonoperative management does not increase patients' requirements for blood transfusion.