Recurrence of a solitary fibrous tumor of the pleura: a case report.

We report a case of an 80-year-old female with two prior thoracotomies for benign solitary fibrous tumor of the pleura (SFTP) presenting with a two-month history of shortness of breath. Computed tomography revealed a pleural-based recurrence and operative excision revealed multiple adherent tumors throughout the thoracic cavity. Pathologic examination demonstrated malignant degeneration of this previously benign tumor. We consider the importance of recurrence of benign SFTP and the significance of surgical care and follow up of patients with this rare tumor.

Management of nonhealing perineal wounds.

The manifestations of perianal Crohn's disease vary from primary lesions such as skin tags and fissures, to diffuse septic destruction of tissue and sphincter muscle. These manifestations are often persistent and refractory to surgical treatment; however, a more disappointing scenario is when the treatment itself results in a chronic wound. The ideal approach for management involves basic surgical principles, careful patient selection, and realistic expectations. Choice of appropriate procedure, effective elimination of sepsis, thorough evaluation to rule out concomitant systemic disease, and appropriate use of fecal diversion are each an important principle. If proctectomy is necessary, several strategies such as intersphincteric dissection, avoidance of fecal contamination, and appropriate wound closure, are effective in diminishing the postoperative morbidity of an unhealed perineal wound. When an unhealed perineal wound develops in a patient with Crohn's disease, the initial management is conservative. When surgical treatment is necessary, success depends on careful patient selection, optimizing the patient's condition, elimination of sepsis, and choice of an effective technique for healing.