ABSTRACT
Fifty patients were studied prospectively to determine the value of diagnostic peritoneal lavage in the evaluation of acute peritonitis. Forty-five patients had a clinical diagnosis of acute peritonitis based on physical findings, and 5 patients were normal control subjects. All lavages were performed with an open technique in the operating room prior to laparotomy. Lavage fluid was analyzed for white and red blood cell counts, the differential, amylase, protein, bilirubin, and pH. Results were analyzed by multiple logistic regression. Thirty-two of the 45 patients with clinical peritonitis had the diagnosis confirmed at laparotomy. A white blood cell count in the lavage fluid greater than or equal to 200 cells/mm3 was associated with a 99% probability of peritonitis.
Subject(s)
Peritoneal Lavage , Peritonitis/pathology , Acute Disease , Adolescent , Adult , Aged , Aged, 80 and over , Amylases/analysis , Ascitic Fluid/chemistry , Ascitic Fluid/enzymology , Ascitic Fluid/pathology , Bilirubin/analysis , Child , Colonic Diseases/diagnosis , Colonic Diseases/pathology , Erythrocytes/pathology , Female , Humans , Leukocytes/pathology , Male , Middle Aged , Neutrophils/pathology , Peritonitis/diagnosis , Prospective Studies , Proteins/analysisABSTRACT
The purpose of this study was to determine the significance of collateral supply from the hypogastric arteries (HGAs) to the inferior mesenteric arterial (IMA) bed. Peak systolic "stump" IMA and radial arterial pressures were obtained before and after clamping the right HGA, the left HGA, both HGAs, the middle colic artery (MCA) only, or the MCA plus right HGA, MCA plus left HGA, and MCA plus both HGAs in patients with aortoiliac aneurysm or occlusive disease. Six patients (four with aneurysms and two with occlusive disease) had patent IMAs. Five patients (four with aneurysms and one with occlusive disease) had chronically occluded IMAs. In the six patients with patent IMAs, clamping of the HGAs decreased the IMA-stump pressure index (IMA-SPI) from 0.61 +/- 0.20 to 0.56 +/- 0.17, 0.54 +/- 0.17, and 0.54 +/- 0.19, respectively (p greater than 0.05) whereas clamping only the MCA decreased the IMA-SPI from 0.61 +/- 0.20 to 0.32 +/- 0.15 (p less than 0.01). In the five patients with chronically occluded IMAs, clamping of the HGAs decreased the IMA-SPI from 0.60 +/- 0.11 to 0.59 +/- 0.12, 0.58 +/- 0.12, and 0.57 +/- 0.11, respectively (p greater than 0.05), whereas clamping the MCA decreased the IMA-SPI from 0.60 +/- 0.11 to 0.34 +/- 0.04 (p less than 0.01). These data suggest that branches of the superior mesenteric artery provide the major collateral pathway to the IMA bed and that the contribution through branches of the HGAs is insignificant in the acute setting.
Subject(s)
Hemodynamics , Mesenteric Arteries/physiopathology , Splanchnic Circulation , Aorta, Abdominal/physiopathology , Aorta, Abdominal/surgery , Aortic Aneurysm/physiopathology , Arterial Occlusive Diseases/physiopathology , Arterial Occlusive Diseases/surgery , Arteries/physiopathology , Blood Pressure , Colon/blood supply , Constriction , HumansABSTRACT
This is a retrospective review of twenty-two patients surgically treated for leiomyosarcoma. All but two patients had an advanced tumor of at least 8 cm size or involving contiguous structures. The most commonly performed operation was subtotal gastrectomy. The gastric resection required en bloc resection of contiguous structures in 10 patients. Fifteen patients with curative resection had a three year survival of 58 per cent. The overall group had a three year survival of 35 per cent. Advanced gastric leiomyosarcomas present a surgical challenge to complete resection, but when the procedure is accomplished the patient has a reasonable curative potential.
Subject(s)
Leiomyosarcoma/surgery , Stomach Neoplasms/surgery , Adult , Aged , Female , Humans , Male , Middle AgedABSTRACT
The trochanteric bursa is anatomically quite susceptible to traumatic injury. However, specific reports of traumatic trochanteric bursitis in the literature are lacking. This may be due to failure to recognize this condition and to differentiate it from other pain syndromes involving the hip. This case report demonstrates the clinical presentation and management of traumatic trochanteric bursitis.