Idiopathic jejunal intussusception in an adult.

BACKGROUND: Intussusception is a common surgical diagnosis in the paediatric population and is most commonly idiopathic. In adults a substantial proportion of patients have a malignant leading cause and surgical intervention is mandatory. Intussusception involving the small bowel is thought to be more likely benign in nature and is frequently reduced before the leading cause is excised. AIM: Review of the literature to determine the incidence of malignancy in small bowel intussusceptions and discussion of the optimal operative strategy. METHODS: We describe an unusual case of adult idiopathic jejunal intussusception, which was treated with excision without reduction and present the results of a relevant literature search. RESULTS: A number of reports have confirmed a high incidence of malignancy in small bowel intussusceptions and consequently excision without reduction should be undertaken. CONCLUSION: It is in the authors' view that excision without reduction should be the treatment of choice in small bowel intussusception unless preoperative imaging delineates benign leading pathology and in the rare occasion of a shortened gut.

Occult congenital anomaly of the atlas presenting in the setting of acute trauma.

Congenital absence of the posterior arch of the atlas is rare. Its detection in the setting of acute trauma may be confusing and mimic a fracture. This case serves to highlight the adjunctive use of computed tomography in equivocal cases. Most patients can be managed conservatively, however operative treatment should be reserved for patients in whom atlanto-axial instability has been shown.

Bilateral primary renal lymphoma.

BACKGROUND: Primary renal lymphoma is rare with no well-defined diagnostic criteria. AIM: To describe the first reported case of bilateral and primary renal lymphoma and describe diagnostic criteria. RESULT AND CONCLUSION: If a diagnosis of primary renal lymphoma is to be considered, then specific diagnostic criteria (as outlined) must first be satisfied.

Interspecies variation in axon-myelin relationships.

The primary objective of this paper was to determine the extent and nature of interspecies differences in axon calibre and myelin sheath thickness and in the various relationships between these. Morphometric analysis of the axon perimeter-myelin sheath thickness relationship was performed on an equivalent nerve fibre population in a mammal, the rat, a bird, the chicken, an amphibian, the frog, a bony fish, the trout, and a cartilaginous fish, the dogfish. The abducent nerve was studied. It is especially suitable for this purpose because its fibres are closely similar in type and in peripheral distribution across the species studied. The relationship differed substantially between species. Differences were present in its setting, as described by the positions of the scatterplots, in the g ratio and in the regression and correlation data relating the parameters. Both parameters were markedly larger in the fish species than in all of the others. In addition, in rat, chicken, frog and trout, where large and small fibre classes could be differentiated clearly, the setting of the relationship between the two parameters was different for the two classes. In the main, variation in each of the parameters was greater between than within species. The larger fibres in the fish species were closely similar in axon perimeter and sheath thickness despite their long evolutionary separation. From this study and from others in the series, it may be concluded that there is no fixed or constant relationship between axon calibre and the thickness of the surrounding myelin sheath. Each nerve tends to have its own particular relationship and this differs between species.