Subject(s)
Hydrocortisone/therapeutic use , Methylprednisolone/therapeutic use , Snake Bites/drug therapy , Animals , Antivenins/therapeutic use , Crotalid Venoms/administration & dosage , Crotalid Venoms/antagonists & inhibitors , Dogs , Humans , Hydrocortisone/pharmacology , Kidney Glomerulus/pathology , Male , Methylprednisolone/pharmacology , Rats , Snake Bites/mortality , Snake Bites/pathologyABSTRACT
The behavior and treatment of gastrointestinal carcinoid tumors have been the subject of much discussion. Size, location, and histologic invasiveness have been shown to correlate with regional and remote metastasis in previous series. We reviewed 81 patients with gastrointestinal carcinoids seen at the Medical University of South Carolina Teaching Hospitals since 1950. An unusual case of a 0.5 cm primary ileal carcinoid with widespread intra-abdominal and hepatic metastases is documented. In this series carcinoids were found (in order of decreasing frequency) in the ileum, appendix, rectum, right colon, duodenum, jejunum, stomach, ampulla of Vater, sigmoid colon, and pancreas. Metastases were found in 17% of the overall group. Two carcinoids presented with intussusception, while one was found within a Meckel's diverticulum. In addition to the small metastatic ileal carcinoid, one patient with a rectal carcinoid measuring 0.4 cm was found to have metastases after low anterior resection. Because all extra-appendiceal gastrointestinal carcinoids are potentially metastatic, it is stressed that regional lymphadenectomy en bloc with primary excision is the treatment of choice wherever feasible. If the lesion is small or has not invaded deeply, local excision with close follow-up may be an acceptable alternative.
Subject(s)
Carcinoid Tumor/pathology , Intestinal Neoplasms/pathology , Adolescent , Adult , Aged , Carcinoid Tumor/mortality , Carcinoid Tumor/surgery , Female , Humans , Intestinal Neoplasms/mortality , Intestinal Neoplasms/surgery , Middle Aged , Neoplasm MetastasisABSTRACT
Forty-five patients with snake bite were studied: 33 were classified nontoxic and 12 toxic. There were no deaths and four complications in the nontoxic group; two deaths and three complications in the toxic group. The data suggest that rapid recovery is generally to be expected in nontoxic patients regardless of the form of local therapy. The risk of antivenin complications outweighs the minimal therapeutic benefits when administered to most nontoxic patients. If nausea and vomiting are the only manifestations of systemic toxicity antivenin may not be necessary for rapid and complete recovery. The combination of hypotension and bleeding diathesis represents a particularly severe form of toxicity that may result in death if adequate systemic and supportive therapy is not rapidly instituted.
