[Studies of selective non-surgical therapy in perforated duodenal ulcer indicated by gastrografin test].

One hundred ml of Gastrografin was administered through the gastric tube to each of ten subjects with duodenal ulcer perforation and to each of twenty subjects which had no gastrointestinal perforation. Urine was collected from the subjects every 10 minutes up to 180 minutes following the administration of gastrogratin. The iodine level of every urine sample was assayed using inductively coupled plasma atomic emission spectrometry. The iodine level of seven subjects with open duodenal ulcer perforation was higher than the mean +2 = SD of urine from the subjects without gastrointestinal perforations. Two of the subjects had no leakage of Gastrografin demonstrated intra-abdominally during an upper gastrointestinal series. The urine iodine level of subjects with closed duodenal perforation was lower than the mean +2 X SD of urine from the subjects without gastrointestinal perforations. One of the subjects was selected non-surgical therapy, and two other subjects which underwent emergent surgery may also have been candidates for non-surgical therapy, as suggested by its indications. The above results suggest that patients with duodenal ulcer perforation but without intra-abdominal leakage of Gastrografin and urine iodine level lower than the mean +2 X SD of urine from subjects without gastrointestinal perforation following Gastrografin administration may be selectable for non-surgical therapy.

[Correlation between postoperative decrement of hematocrit and osmolarity in neurosurgical patients].

UNLABELLED: After neurosurgical treatment, surgeons sometimes observe decreased hematocrit (Ht), though fluid as well as blood transfusions were properly given during and after surgery. This study was performed to investigate the effects of osmotic change on the decrease in Ht. MATERIAL AND METHODS: Subjects were 153 patients who underwent neurosurgical treatment. Group 1: 39 patients with parasellar tumor. Group 2: 35 patients with anterior cerebral aneurysm. Group 3: other 79 patients with brain tumor or aneurysm except Group 1 and 2. As the controls, 50 patients undergoing intraabdominal operations. During the pre- and postoperative course, blood examination (Ht, RBC, blood glucose, BUN, electrolyte and blood gases), measurements of osmotic pressure (of serum, urine and cerebrospinal fluid), and checks of blood and water balance and vital signs were performed. RESULTS: As compared with the control group in which Ht decreased clearly but slightly, the neurosurgically-treated groups showed marked decreases in Ht on the 2nd to 4th day after surgery. Of them, groups 1 and 2 showed more prominent decreases. On the 1st to 4th day after surgery, serum sodium levels of groups 1, 2 and 3 increased more clearly than that of the control group. Urine volumes of groups 1 and 2 were larger during one postoperative week, and cases of diabetes insipidus were included. No significant difference was found in water balance and urinary osmotic pressure. Relationships between the serum osmotic pressure and serum sodium content, cerebrospinal fluid osmotic pressure and serum sodium content, and cerebrospinal fluid and serum osmotic pressure were seen. We lay stress on the inverse correlation between the decrease in Ht and the time-course of serum osmotic pressure.(ABSTRACT TRUNCATED AT 250 WORDS)

[Functional preservation in cancer surgery of the large intestine].

Distal Surgical margin, required in the sphincter preserving operation for rectal cancer was studied histologically on the 78 resected specimens. The extramural cancer spread, examined by clearing method, was found in 20.5%, and was more frequent and expansive compared to intramural spread of cancer. No distal spread was found in cancer limited to the rectal wall. Length of the spread by 3 cm in lower rectal cancer and 4 cm in the upper rectal cancer. Postoperative anal function showed a good or fair in patients with internal sphincteric function preserved. Postoperative dysuria and male sexual disturbance showed a close relation to the pelvic nodes dissection. Ro-dissection was followed by 20% of dysuria, while RI and R 2 46.7%, R 3 1.8%.

Postoperative evaluation of fecal continence after sphincter-preserving operations for rectal cancer.

Seventy-eight sphincter-preserving operations for rectal cancer were evaluated from the viewpoint of postoperative fecal continence. Operative procedures consisted of 39 anterior resections and 39 pull-through operations and Maunsell-Weir's operation. Postoperative fecal continence was evaluated by questionnaires and anorectal examinations including (1) the distance from the anal verge to the anastomosis, (2) the length of sensation to light touch in the anal canal, (3) electromyography of the sphincter, (4) internal sphincter reflex (5) pressure profile of the anal canal, and (6) barium enema radiography. Patients' evaluations of their continence were good when the distance of the anastomosis was over 5 cm from the anal verge, and mostly poor under 3 cm. Good or fair evaluations were obtained when the internal sphincter reflex or high pressure zone of the anal canal were preserved. Size of the reservoir was measured using a planimeter on the lateral view of the barium enema up to 6 cm from the upper margin of the anal canal. Good or fair evaluations were obtained when size was 30 cm2.