ABSTRACT
We have previously described the protective effect of a lipoidal splenic factor (SF) against lethal endotoxemia in mice. Since this protective effect is also accompanied by significant antithrombotic changes, and since burn injury causes thrombosis and consumptive coagulopathy, it was postulated that SF decreased the severity of the burn wound. Swiss white mice were anesthetized with pentobarbital sodium and then burned on a depilated area of the lower back with a 2-cm diameter stainless steel weight at 95 degrees for 10 sec. SF (10 mg/kg) (n = 20) or an equal volume of saline (controls) (n = 13) was administered within 1 hour after thermal injury. Severity of burn injury was assessed by examination of hematoxylin and eosin-stained biopsies obtained 24 hours postburn by a grading scale of 0 (normal) to 4 (severe) depending on the degree of epidermal loss, coagulation necrosis, and inflammatory cell infiltrate. Average degree of burn severity was 1.10 +/- 0.20 for SF recipients and 2.85 +/- 0.27 for the controls (p less than 0.001).
Subject(s)
Blood Coagulation Disorders/prevention & control , Burns/complications , Spleen , Tissue Extracts/therapeutic use , Animals , Blood Coagulation Disorders/etiology , Disseminated Intravascular Coagulation/prevention & control , Mice , Sepsis/prevention & control , Thrombosis/prevention & control , Wound Infection/prevention & controlABSTRACT
Tuberculosis of the distal colon occurring in the absence of ileocecal or pulmonary involvement is often mistaken for neoplasm or Crohn's disease. In spite of various studies, including colonoscopy and brushings with biopsy, the diagnosis might still be in doubt at the time of operation. The combined approach of surgery and chemotherapy appears to be the treatment of choice, especially in those patients who have bleeding and/or obstruction in whom the diagnosis cannot be made by other modalities.
Subject(s)
Colonic Diseases/diagnosis , Colonic Neoplasms/diagnosis , Tuberculosis, Gastrointestinal/diagnosis , Adult , Diagnosis, Differential , Endoscopy , Humans , MaleABSTRACT
An unusual case of traumatic hemobilia in which blood reached the bile duct through transhepatic penetration of the gallbladder is reported. The salient features of this variant of traumatic hemobilia are described: antecedent subcapsular liver injury; variant time interval to GI hemorrhage and episodic hemorrhage; and necrosis or hematoma at the bleeding site.
Subject(s)
Bile Ducts , Gallbladder/injuries , Hematocele/etiology , Hemorrhage/etiology , Liver/injuries , Wounds, Stab/complications , Adult , Biliary Tract Diseases/etiology , Humans , MaleABSTRACT
A patient had obstruction of the right and left hepatic ducts secondary to perforate diaphragms at the junction with the common hepatic duct. Transhepatic cholangiograms of both the right and left lobes were required to define the presence of diaphragms at the junctions of right, left, and common hepatic ducts. Excision of the diaphragms relieved the obstruction. A distinction should be made between congenital nonobstructive and congenital obstructive cystic dilation of intrahepatic biliary radicals.
Subject(s)
Hepatic Duct, Common/abnormalities , Adult , Hepatic Duct, Common/diagnostic imaging , Hepatic Duct, Common/embryology , Humans , Male , RadiographyABSTRACT
We present a case of a patient who ingested 648 metallic objects that formed an intertwining mass within the stomach, requiring operative removal. Of interest was the absence of symptoms and complications after 11 years of continual ingestion. To our knowledge, this is the second heaviest accumulation of metallic foreign objects removed from the stomach of a living patient.
Subject(s)
Foreign Bodies , Metals , Stomach , Adult , Bezoars/diagnosis , Bezoars/surgery , Foreign Bodies/surgery , Humans , Male , Stomach/surgeryABSTRACT
During 1968-1973, 122 patients with 126 arterial injuries were treated. In 94 instances (90 patients), these injuries involved extremities. Systolic blood pressure was below 90 mm Hg upon admission in 55.6% of all patients and 37.7% of those with injuries to arteries of the extremities. The decision for operative exploration and repair of arteries of extremities was based largely on clinical grounds (shock, loss of pulse). Preoperative arteriography was needed infrequently, while operative angiography was nearly routine. Although several cases of late revascularization or traumatic thrombosis of renal artery have been reported, hypertension complicates the postoperative period, and early, aggressive approach is essential. Mortality was 10.6%, from aortic injuries. There were no deaths among patients with arterial injuries distal to inguinal ligament or thoracic outlet. The amputation rate from reconstruction failure was 1.1%, none occurring in the last 3 years of the series. The high patency rate and lack of evidence of pulmonary embolization suggest that associated venous injuries be repaired routinely. Arterial injuries represent ideal lesions (normal arterial wall with excellent run-in and run-off). Prompt treatment of shock and early, proper management of patients' mechanical disruptions will salvage many lives and most limbs.
