ABSTRACT
Exploratory laparotomy with splenectomy was performed on 275 patients with hisologically confirmed Hodgkin's disease. In 188 patients the laparotomy was a primary one to determine more precisely the state of the disease. A secondary laparotomy was performed in 87 patients 1-12 years after diagnosis and radiotherapy. In 17.5% of patients the state had to be revised after laparotomy with splenectomy. In 38 the disease had further progressed, while in ten it had slighty regressed. In four cases clinical stage I proved to be stage III. Even prognostically more favourable forms may have progressed at first diagnosis. There was no correlation between B-symptoms and histological type, but there was between B-symptoms and spread of the disease. Calculated spleen weight provided no clue as to spleen involvement. There was no clear relationship between spleen involvement and histological subclassification. Risk-effect analysis indicate that laparotomy with splenectomy was useful because it makes optimal treatment possible.
Subject(s)
Hodgkin Disease/diagnosis , Adult , Female , Follow-Up Studies , Humans , Laparotomy/adverse effects , Laparotomy/methods , Male , Organ Size , Spleen , Splenectomy/adverse effects , Splenectomy/methods , Time FactorsABSTRACT
Intestinal infarction in the absence of organic vascular occlusion received increasing attention in recent years. The clinical picture is discussed based on results in 9 cases, an attempt to suggest a possible pathophysiological mechanism is made. Prophylactic digitalisation especially in the elderly patient in the absence of severe heart failure and in cases with already low mesenteric perfusion may lead to a further vasoconstriction and to hemorrhagic enteropathy. Therapeutic possibilities are discussed.
Subject(s)
Gastrointestinal Hemorrhage/etiology , Aged , Gastrointestinal Hemorrhage/surgery , Humans , Infarction/complications , Infarction/surgery , Intestinal Diseases/complications , Male , Mesenteric Arteries/surgeryABSTRACT
The diagnostic and therapeutic problems of duodenal rupture in blunt epigastric trauma are shown in the light of 5 observations. Patients with blunt epigastric trauma must be supervised clinically for at least 48 hours in order to recognize in good time injuries of the internal organs by the increasing symptoms of peritoneal irritation. During the operation all abdominal organs are inspected and, in the event of suspected duodenal rupture, particularly the retroperitoneal wall segments are searched since the intestine is often ruptured simultaneously at several sites. Duodenoscopy during the operation accelerates the surgical exploration and is an additional safety factor. As a rule, the duodenal rupture closes without complication within the first 24 hours after suturing, while discovered too late and treated incompletely it may lead to death under the clinical picture of retroperitoneal phlegmon with septic shock; even today the overall mortality is still about 20%.
Subject(s)
Abdominal Injuries/complications , Duodenum/injuries , Abdominal Injuries/diagnosis , Abdominal Injuries/therapy , Adolescent , Adult , Child , Child, Preschool , Duodenal Diseases/etiology , Endoscopy , Female , Humans , Male , Rupture , Wounds, NonpenetratingABSTRACT
Monocytopoiesis was analyzed in patients with severe, acute inflammations induced by surgical interventions as well as in others with mild, chronic inflammations in connection with gastric or duodenal ulcers. The state of acute inflammation was assumed to be associated with a high and steeply rising monocyte demand as opposed to the constant and relatively small monocyte recruitment in chronic inflammation. In chronic mild inflammatory reactions DNA synthesis activity of promonocytes was increased by a factor of about two; the promonocyte pool was normal. In patients who underwent surgical operations changes in the following parameters were observed during the first 15 h after start of surgery: (1) average increase in 3H-TDR labelling index by 38%; (2) average enlargement of promonocyte pool by 34%, (3) and relase of immature cells from the bone marrow into the blood. Increase in DNA synthesis activity as well as expansion of the promonocyte pool causes an enhanced monocyte production rate. The 'shift to the left' in monocyte egress is equivalent to a reduced stem-cell-to-blood transit time. These variations permit short-term adaptation of monocytopoiesis to varying demands.
