Cytosolic free Ca2+ concentration in canine aortic endothelial cells lining the polyester arterial prosthesis.

A rise in baseline cytosolic free Ca2+ in canine vascular endothelial-like cells (VEC) lining the luminal surface of the polyester arterial prosthesis is described. In one, three and six month implantation experiments we employed six adult mongrel dogs, polyester arterial prostheses Arteknit Ra K, fluorescent Ca2+ indicator Fura-2 and digital imaging microscopy to study cytosolic free Ca2+ in cultured VEC. The electron microscopy scanning of the luminal surface in different regions of the graft were also performed. A rise in cytosolic free Ca2+ in the VEC lining the luminal surface of the prosthesis is probably the result of the immunologic reaction and mechanical stress which stimulate the proliferation activity of the endothelial cells. It seems that the baseline cytosolic free Ca2+ reflects the course of the endothelization process on the polyester arterial prosthesis.

A simple, inexpensive, life-saving way to perform iterative laparotomy in patients with severe intra-abdominal sepsis.

Between 1 June 1993 and 31 December 1998, 17 patients underwent temporary abdominal closure with 3L urological irrigation bags, because in most cases, there was massive sepsis leading to the conclusion that primary closure was not advisable. Indicative of the seriousness of these conditions, Apache score averaged 19 (range 10-30). The technique consisted of suturing a double thickness of irrigation bags to each side of the wound, and joining the two bags in the midline with running sutures. Abdominal lavage with large quantities of fluid was performed every other day. This type of closure was used for a mean duration of 15 days. Mean length of hospitalization was 60 days. There were only three deaths (17.6%). No incisional hernia occurred after the iterative laparotomies. Deleting patients with acute pancreatitis would have reduced the death rate to only 7%. A 3L urological irrigation bag costs pound 11.60 (24.40 dollars CAN) while a Marlex mesh costs pound 81.40 (171.00 dollars CAN). We conclude that the usage of 3L urological plastic bags is a simple, safe and efficient method for temporary closure of the abdomen.

Pancreatic inflammation, apoptosis, and growth: sequential events after partial pancreatectomy in pigs.

Positive signs of pancreas regeneration were observed in rats after induced pancreatitis and partial pancreatectomy (1,2). Although the human pancreas did not regenerate after partial anatomic resection (3), the pig pancreas exhibited growth responses to bombesin after partial pancreatectomy (4). This study was undertaken to establish the time course of pancreatic inflammation, apoptosis, and hypertrophy and/or hyperplasia after partial pancreatectomy in pigs.

[Pancreatic pseudocyst: Evolution of therapeutic concepts]. / Pseudokyste du pancréas: évolution des concepts thérapeutiques.

OBJECTIVE: To reassess the therapeutic options for pancreatic pseudocysts, resulting from the refinement of imaging techniques of the pancreas over the past 15 years. DATA SOURCES: An extensive review of the literature for the period 1970 to 1994. When pertinent, the authors' experience with 45 patients was added to the literature data. STUDY CRITERIA: In the literature review the following selection criteria were used: diagnostic modalities (clinical, endoscopic and radiologic); clinical context (etiology and clinical presentation); and therapeutic modalities (observation and drainage). DATA EXTRACTION AND SYNTHESIS: Data collection was retrospective in most series. Whenever possible data collected before 1980 were differentiated from those collected after 1980 because diagnostic modalities were quite different in these two periods. CONCLUSIONS: Pancreatic pseudocysts are now diagnosed with more certainty and followed with more precision. Long-term observation is a safe and valuable approach. In symptomatic patients, some form of drainage should be considered. In an elective situation, internal drainage (endoscopic or surgical) is favoured. Cystogastrostomy should not be associated with an increased risk of bleeding.

UVAL-MED a universal visual associative language for medicine.

We describe UVAL-MED, a Universal visual associative language for medicine, and propose its use in combination with diagnostic reasoning and decision support systems. When fully developed, our system will automatically translate SNOMED terms to UVAL-MED terms. Grammar and syntax for UVAL-MED are defined and its features as a language-independent tool are discussed. The perceived advantages of our graphical language for rapid integration of knowledge and the assessment of developing situations could thus facilitate decision making.

An intelligent interactive simulator of clinical reasoning in general surgery.

We introduce an interactive computer environment for teaching in general surgery and for diagnostic assistance. The environment consists of a knowledge-based system coupled with an intelligent interface that allows users to acquire conceptual knowledge and clinical reasoning techniques. Knowledge is represented internally within a probabilistic framework and externally through a interface inspired by Concept Graphics. Given a set of symptoms, the internal knowledge framework computes the most probable set of diseases as well as best alternatives. The interface displays CGs illustrating the results and prompting essential facts of a medical situation or a process. The system is then ready to receive additional information or to suggest further investigation. Based on the new information, the system will narrow the solutions with increased belief coefficients.

Concept graphics: a language for medical knowledge.

This paper makes a case for Concept Graphics, a novel form of medical knowledge representation. Concept Graphics are assemblies of icons each of which has a precise meaning. Individual icons are metaphors of the object or process they represent. Concept Graphics are analogs of pathological situations, their symptoms, signs and other relevant components necessary for a diagnosis. We propose three principal areas of application for Concept Graphics: medical education, medical records management and research based on medical records. Our earlier work in medical education showed a clear advantage in using Concept Graphics in parallel with text of equivalent information content, over text alone. A Concept Graphics based intelligent tutoring systems (ITS) is being developed. In the area of medical records management we are developing a system for the rapid identification of relevant records based on rapid visual screening. The Concept Graphics based system can reveal properties common to specific groups of records. As such the graphics are a research tool.

Moxalactam as single-agent prophylaxis in the prevention of wound infection following colon surgery.

A single agent systemic antibiotic (moxalactam) when used prophylactically in patients undergoing colon surgery was associated with a wound infection rate comparable to that achieved by a combination of oral neomycin and intravenous metronidazole. The data obtained demonstrated that the reduced infection rate was not the result of a reduction in the bacterial content of the colon alone but due to the prophylactic agents used for elective colon surgery.

Traumatic aneurysms of the descending thoracic aorta.

From July 1979 to December 1985 we observed 51 patients with traumatic lesions of the descending thoracic aorta. Twenty-nine had acute ruptures, mostly accompanied by multiple injuries, and 27 had to be operated upon immediately. Twenty-two patients (19 males, 3 females) had chronic traumatic aneurysms of the descending thoracic aorta (more than six weeks after trauma). Mean age at the time of trauma was 24 years. Mean age at time of surgery was 36.5 years. Twelve patients were symptomatic. All were treated surgically. At surgery, complete aortic disruption was found in 15 patients and partial rupture in seven. We did not use aortic shunting of any kind, only aortic cross-clamping. Hypertension was controlled by intravenous drug infusion. The ruptured aortic segment was replaced in all cases by prosthetic Dacron graft. There were no operative deaths. One patient (age 77) died 11 weeks after surgery from multiple organ failure. One case of postoperative paraplegia was observed. This patient recovered almost completely from his neurological deficit.

[Colonothoracic fistulas: presentation of 2 cases]. / Fistules colo-thoraciques: présentation de deux cas.

Two cases of colothoracic fistulae are reported. The first one is secondary to pulmonary actinomycosis, the second to complicated colic diverticulitis. The etiologies of colothoracic fistulae are multiple and can be divided in intrathoracic or intraabdominal origin. The treatment includes: effective intravenous antibiotherapy, colic resection of the concerned portion and thoracic drainage.

[Infectious mononucleosis and splenic pseudocyst: presentation of a case]. / Mononucléose infectieuse et pseudokyste splénique: présentation d'un cas.

The authors report the clinical case of an 18-year-old patient who presented with a symptomatic mass in the left upper quadrant 6 months after having infectious mononucleosis. The preoperative investigation consisted principally of echography and computerized axial tomography of the abdomen, which demonstrated a cystic mass of the lower pole of the spleen. Splenectomy was carried out. Histologic examination showed a pseudocyst of the spleen with a fibrous capsule without an epithelial lining. The treatment and pathogenesis of pseudocysts of the spleen secondary to infectious mononucleosis are discussed.

Acute necrosis of the intestinal mucosa with high serum levels of diamine oxidase.

A patient with acute necrosis of the intestinal mucosa and high serum diamine oxidase activity is described. The 71-year-old woman, with a history of hypertension and cardiovascular and peripheral arteriosclerotic disease, presented with acute epigastric pain, vomiting, and a deteriorating hemodynamic condition. Serum level of the intestinal enzyme diamine oxidase (DAO) obtained on admission, approximately 24 hr after the onset of symptoms, was 7.4 times above the normal value. An exploratory laparotomy performed 6 hr later revealed cyanosis and areas of transmural necrosis involving the entire small bowel. The bowel was not resected because of the extent of lesion. Thirty hours after the first sample was taken and 2 hr before death, the serum DAO level was only slightly above normal. It is suggested that this biochemical marker could provide a valuable tool for the early diagnosis of intestinal ischemia.

Hemangiopericytoma: case reports.

The authors' experience with two recent cases and their review of the literature suggest that the behaviour of hemangiopericytoma is unpredictable and that wide surgical excision is the treatment of choice because of the potential for malignant change.

[Surgical treatment of sternal tumors]. / Tratamiento quirúrgico de los tumores de esternón.

Sternal tumors are rare. The surgical indication in case of metastasis is only justified if the primitive tumor is considered cure and with solitary metastasis. The en-block surgical resection must be based on pre-operative exploration in which a thoracic CAT SCAN has a very important role to determine the extent of the tumor and the anatomico-pathological control of the margin of resection during surgery. The reconstruction using methyl-methacrylate plate is interesting because of its rigid mounting by a moldable substance during surgery, being radiotransparent, inert and well-tolerated by the organism. On high sternal position it contributes to stabilize the scapular belt and assures mediastinal protection. The authors present a case of a partial sternectomy due to metastatic thyroid carcinoma with en-block resection and reconstruction by a methyl-methacrylate moulded plate.

[Partial sternectomy for metastatic tumor with reconstruction using a methylmethacrylate plate]. / Sternectomie partielle pour tumeur métastatique avec reconstruction par plaque de méthylméthacrylate.

A case of partial sternectomy for metastatic thyroid carcinoma is reported. En bloc excision was followed by reconstruction using a molded plate of methylmethacrylate. Sternal tumours are rare and operations for cure of metastases are justified only if the general condition of the patient permits and in the patient with a single metastasis whose primary cancer operation was a radical one. Extensive en bloc excision is based on preoperative investigation in which computerized axial tomography has an important place in delineating the extent of the tumour and providing accurate knowledge of the margins of the section. Reconstruction with methyl-methacrylate allows a rigid setting with a material that can be molded, is radiolucent, inert and well tolerated. In the upper sternum it contributes to the stability of the shoulder girdle and protects the underlying mediastinal structures in a cosmetically acceptable way.

[False aneurysms of the subclavian artery]. / Les fauc anévrysmes de la sous-clavière.

The authors describe two cases of false aneurysm of the right subclavian artery. One was due to a penetrating cervical injury and the other to blunt thoracic trauma. Both patients were treated surgically. Early diagnosis by aortography and surgical treatment are important. The operation is difficult because of the cervicothoracic course of the subclavian artery. Because of this a wide approach should be made and reconstruction is mandatory.

Ultrasonography in the diagnosis of rectus abdominis hematoma.

Because bleeding into the rectus sheath may give a clinical picture simulating an acute abdomen, it is essential that an accurate diagnosis be made so that an unnecessary laparotomy is not performed. Plain films do not give adequate information and computerized axial tomography is not always available, but ultrasonography, which is noninvasive and is readily available, provides an accurate diagnosis as in the case reported in this paper. A 57-year-old woman had bilateral hematomas of the rectus sheath that did not occur simultaneously. She had a chronic debilitating disease as do the majority of such patients. Long-term cortisone therapy with secondary breakdown of connective tissue was probably the predisposing factor. During a blood transfusion that was needed following operation for osteomyelitis the patient had a severe reaction accompanied by sudden onset of severe abdominal pain on the left side. Ultrasonography confirmed the tentative diagnosis of rectus sheath hematoma. The patient was treated conservatively. The pain subsided within a few days leaving an ecchymosis. Two weeks later she experienced a similar pain on the right side which was also diagnosed by ultrasonography as a rectus sheath hematoma. Again, with conservative treatment the pain subsided leaving discolouration of the skin. The authors stress the value of ultrasonography in diagnosing rectus sheath hematoma and the importance of conservative management.