Laparoscopic management of Crohn's disease-related complex enterovesical, enterocutaneous and enteroenteric fistula: A case report.

The management of Crohn's disease is medical, with surgery reserved for emergencies and complications. Fistulizing Crohn's disease can present with either an internal or external fistula. Internal fistulae are common in patients with ileocolonic disease. Enterovesical fistulae form a very small part of these internal fistulae. An ileovesical fistula with other concomitant internal or external fistulae is a complex fistula. A patient with an ileovesical fistula further compounded by an enteroenteric fistula and an enterocutaneous fistula is a difficult surgical patient to manage because of the resultant dense inflammation. Here we report a case of complex ileovesical fistula (concomitant enterocutaneous fistula and enteroenteric fistula) managed by a laparoscopic approach.

Exposure to 4,4'-methylene bis (2-chloroaniline) (MbOCA) in New South Wales, Australia.

OBJECTIVES: This study was conducted to determine the level of exposure of 4,4'-methylene bis (2-chloroaniline) (MbOCA) in New South Wales (NSW), Australia. METHODS: An integrated occupational hygiene and biological monitoring program were used to assess the workers' exposure to MbOCA via inhalation, ingestion and dermal contact. This was conducted by personal air monitoring, static air monitoring and surface contamination monitoring of the work environment and biological monitoring of the workers' exposure to MbOCA at nine workplaces in NSW. RESULTS: The air monitoring results for MbOCA gave a geometric mean (GM) of 0.06 µg/m3 and a geometric standard deviation (GSD) of 2.70 and a 95% confidence interval of 0.29 µg/m3. The surface contamination in the main work area showed the highest contamination with a GM of 74 ng/cm2 and a GSD of 17 and a 95% confidence interval of 7,751 ng/cm2. Biological monitoring showed a GM of 0.89 µmol/mol cr and a GSD of 11.9 and a 95% confidence interval of 52 µmol/mol cr. This indicated that 13% of the workers were over the SafeWork NSW Biological Occupational Exposure Limit of 15 µmol/mol cr. CONCLUSIONS: Workers' exposure through inhalation was minimal; however, evidence from biological monitoring of MbOCA suggested that the main contributing factor to exposure was skin absorption. This was attributed to poor housekeeping and inadequate personal protection. Improvements in these areas were recommended, and it was also recommended to improve the awareness of the workers to the adverse effects to their health of exposure to this carcinogen.

Seminoma of undescended testis with urinary bladder metastasis: A case report with review of literature.

Cryptorchidism is the most common predisposing factor in the development of testicular germ cell tumors. Seminoma is the most common malignancy developing in a cryptorchid testis, usually has lymphatic but rarely hematogenous metastasis. The Urinary Bladder is an extremely rare site of metastasis of seminoma metastasis. A 29-year-old male patient presented to us with a history of infertility and an intra-abdominal mass. He was investigated and treated and was found to have an intra-abdominal seminoma with synchronous urinary bladder metastasis. He was treated with appropriate chemotherapy and continues to be in good health.

Sarcomatoid Carcinoma of the Penis.

Sarcomatoid carcinomas are biphasic tumours, which occur at any site in the human body. It rarely affects the penis, with only 38 cases being reported in literature. It may be considered as a variant of squamous cell carcinoma or a dedifferentiated tumour. We report a 60-year old gentleman who presented with a swelling in the glans penis. He underwent a partial penectomy. Histopathology revealed sarcomatoid carcinoma of the penis, which was confirmed by immunohistochemistry. The rarity of this clinical entity makes its diagnosis difficult.

Renal Cell Carcinoma with Unusual Skeletal Metastasis to Tibia and Ankle: A Case Report and Review of Literature.

Renal Cell Carcinoma (RCC) accounts for 5% of the epithelial malignancies worldwide with clear cell carcinoma accounting for 85% of these malignancies. One third of these patients experience synchronous metastatic disease and 20-30% of the remaining patients experience metachronous metastatic RCC. Bony metastasis accounts for 20% of metastatic RCC. They most commonly affect the axial skeleton and rarely the long bones or the small bones of the hands and feet. Bone metastases from RCC are predominantly osteolytic in nature, leading to significant patient morbidity due to the associated Skeletal Related Events (SRE). SREs may significantly decrease patient quality of life. Bone pain is most common SRE and radiotherapy is most common form of treatment. Only 2% of the patients require surgery. Here we present a case of advanced RCC with tibial and ankle metastasis who presented to us after one year of radical nephrectomy with severe pain and inability to walk and underwent above knee amputation.