Case report: malignant giant cell tumour of the pancreas presenting as a large pancreatic cyst.

Carcinoma of the pancreas is a common tumour. Histologically, the majority are adenocarcinomas of duct origin. Carcinomas of the pancreas containing giant cells are uncommon and those containing osteoclast-type tumour cells are very rare. We report a case of malignant giant cell tumour presenting as an extremely large, thin walled haemorrhagic cyst of the pancreas. This tumour is most unusual in that the wall is composed of multiple highly pleomorphic malignant-looking multinucleated giant cells as well as numerous osteoclast-like giant cells in a stroma of small spindle shaped mononuclear cells.

A comparison of suprapubic and transurethral drainage for postoperative urinary retention in general surgical patients.

Percutaneous suprapubic bladder drainage, using an indwelling Silastic catheter, was compared with transurethral catheterization for the management of postoperative urinary retention in general surgical patients. In a prospective controlled trail, the overall incidence of postoperative retention was 7%. The urinary infection rate was 70% with transurethral catheterization and 8% with suprapubic drainage. Patients accepted suprapubic damage much more readily than transurethral cateterization and both medical and nursing personnel found the former method easier to manage effectively. Also, the patients' ability to pass urine spontaneously could be assessed without removing the catheter. However, minor mechanical complications were more common with suprapubic drainage. The cost of the two systems is comparable. We conclude that the routine use of suprapubic catheter drainage in the management of postoperative urinary retention significantly reduces the incidence of infection and is the preferred method of treating this common complication.

Quantitative peritoneal lavage in the assessment of intraperitoneal inflammatory processes.

Quantitative peritoneal lavage in order to assess the volume of the intraperitoneal fluid was performed in 34 female patients with acute abdominal pain and signs of peritoneal irritation. The peritoneal lavage was done using the dye-dilution technique with Evans-Blue Human Serum Albumin Complex (EBA) as a marker. In 22 patients with intraperitoneal inflammatory process the mean volume of exudate in the peritoneal cavity was 585.1 ml while in patients without any intraperitoneal inflammatory process the mean volume of the intraperitoneal fluid was 128.7 ml. This difference between the volumes was statistically significant (p less than 0.05). It is felt that an intraperitoneal fluid volume of above 250 ml is a highly suggestive indicator of an intraperitoneal inflammatory process. A quantitative peritoneal lavage with EBA as a marker can therefore be used as a diagnostic tool in the evaluation of patients with acute abdominal pain.

Anesthetic drugs accelerate the progression of postoperative metastases of mouse tumors.

Experiments were made to investigate the effect of four anesthetic drugs that are commonly used in surgical practice on the postoperative growth of mouse tumors in syngeneic recipients. These experiments revealed that some of the anesthetics when applied for surgical excision of the local tumor, strongly accelerated postoperative progression of spontaneous lung metastases produced by the 3LL Lewis lung carcinoma and by the B16 melanoma. Some of the drugs caused the appearance of metastases in organs, such as the liver, in which spontaneous metastases are not usually produced by these tumors. A T10 sarcoma clone that does not produce detectable metastases in immune intact mice even following intravenous injection, did produce metastases when injected into animals treated with pentothal sodium.

Effect of magnesium sulfate on platelet deposition in rabbits following temporary arterial occlusion with surgical clips.

The effect of magnesium sulfate on thrombus formation in vivo was studied by scanning electron microscopy utilizing the model of endothelial damage by temporary arterial occlusion with a Heifetz clip. Examination of arterial segments compressed by the surgical clip for 30 minutes, followed by 2 hours of reflow, revealed marked attachment of platelets and deposition of erythrocytes, with very few leukocytes, to exposed subendothelial tissues. This thrombotic deposition protruded as much as 150 mu into the vascular lumen (15% of luminal diameter). By contrast, in animals pretreated with magnesium sulfate, this deposition was limited to isolated areas of single or very few platelets with few erythrocytes or leukocytes. The difference in overall quantity of thrombus formation between nontreated and magnesium sulfate-treated groups was much less obvious after 24 hours; however, fewer leukocytes and erythrocytes were seen to be attached to the platelet carpet in the treated group as compared with the nontreated group. The effect of magnesium sulfate on the overall quantity of thrombus formation corresponded inversely to the measured levels of serum magnesium in these groups.

Atropine suppression of basal and metoclopramide-induced human pancreatic polypeptide secretion in man.

The administration of metoclopramide (MET) increased human pancreatic polypeptide (hPP) levels in 17 of 18 male and female control subjects. In all the control subjects, the increase was from a mean (+/- SD) basal level of 96 +/- 60 pg/ml, to a peak of 221 +/- 170 pg/ml. The peak occurred at 30 min, and levels had decreased by 60 min in all subjects. Atropine pretreatment in five male control subjects significantly decreased basal hPP levels and completely abolished the response to MET. It thus likely that the hPP increase consequent to MET administration is related to the latter's cholinergic properties.

Immediate reconstruction in ablative head and neck surgery.

Effective reconstructive techniques are available for immediate, primary repair of surgical defects caused by extensive ablation for malignant conditions of the head and neck. Primary repairs rely heavily on the principle of 'axial-based' skin flaps which can be transposed into the defects without delay. Three cases are presented to illustrate the method.

Alkaline phosphatase in auxiliary liver transplantation.

Auxiliary liver allografts were inserted into baboons and allowed to undergo rejection. The incorporation of (14)C leucine into alkaline phosphatase was measured in both host and donor livers with the aid of an anti-alkaline phosphatase antibody. The results indicate that the increased serum alkaline phosphatase levels found under these circumstances are due to increased synthesis of the enzyme by both livers. Furthermore, it was shown that in the absence of biliary obstruction, this enhanced production of alkaline phosphatase is accompanied by an increase in the excretion of the enzyme into bile. It is suggested that the stimulus for the enhanced production of alkaline phosphatase is a substance which is normally produced in the liver and excreted into the bile.