ABSTRACT
Described is the case of a patient who developed symptoms compatible with small bowel obstruction approximately 16 hours after a difficult self-performed left inguinal hernia reduction. Exploratory laparotomy was performed, and release of an incarcerated loop of ileum was performed. A large inguinal hernia defect also was found, and this was repaired with a Cooper's ligament repair. The patient recovered uneventfully.
Subject(s)
Hernia, Inguinal/physiopathology , Diagnosis, Differential , Hernia, Inguinal/diagnostic imaging , Hernia, Inguinal/therapy , Humans , Ileum , Intestinal Obstruction/diagnosis , Male , Middle Aged , RadiographyABSTRACT
Malnutrition, unfortunately, is not uncommon and malnourished patients suffer increased morbidity and mortality from surgery. Identification of protein-calorie deficient patients can be performed rapidly and inexpensively through standard techniques of nutritional assessment. If the gastrointestinal tract is available, safe and economic nutritional support may be provided by mouth or by tube feeding. If the gastrointestinal tract cannot be utilized, total parenteral nutrition (TPN) may be instituted via a central vein, or in selected instances peripheral amino acids, fat emulsions, or both may suffice. When failure of various organs (heart, kidneys, liver) complicates malnutrition and the underlying surgical condition, adequate nutritional support can and should be provided by adjustment of the amount and content of commercially available nutritional formulations. Optimal surgical care demands the identification and appropriate nutritional support of malnourished patients.
Subject(s)
Nutrition Disorders/diet therapy , Surgical Procedures, Operative , Amino Acids/administration & dosage , Enteral Nutrition , Fat Emulsions, Intravenous , Heart Failure/complications , Hospitalization , Humans , Kidney Failure, Chronic/complications , Liver Diseases/complications , Nutrition Disorders/complications , Nutrition Disorders/diagnosis , Parenteral Nutrition, Total , Surgical Procedures, Operative/mortalityABSTRACT
Gallstone ileus, although uncommon, requires urgent and appropriate surgical therapy if unacceptable morbidity and mortality are to be avoided. Enterolithotomy alone remains the mainstay of operative treatment for gallstone ileus, but the additional performance of a one-stage cholecystectomy and repair of fistula if desirable if the condition of the patient will allow it. One must use good judgment in selecting a surgical procedure. It is imperative to recall that the primary goal in the surgical treatment of gallstone ileus is to save a life. Future complications of the diseased gallbladder and the cholecystoenteric fistula may be treated electively under more ideal circumstances when and if they occur. Gallstone ileus, like other complications of cholelithiasis, remains a strong argument for early cholecystectomy in patients with gallstones.
Subject(s)
Cholelithiasis/complications , Intestinal Obstruction/etiology , Aged , Biliary Fistula/complications , Biliary Fistula/surgery , Cardiovascular Diseases/complications , Cholecystectomy , Cholelithiasis/surgery , Diabetes Complications , Duodenal Diseases/complications , Duodenal Diseases/surgery , Female , Gallbladder Diseases/complications , Gallbladder Diseases/surgery , Humans , Intestinal Obstruction/diagnostic imaging , Intestinal Obstruction/surgery , Middle Aged , Obesity/complications , Radiography , Time FactorsABSTRACT
One hundred patients supported with enteral tube feeding were evaluated for biochemical abnormalities. The following metabolic complications were observed: hyperglycemia (29%), hypoglycermia (2%) hypernatremia (10%), hyponatremia (31%), hyperkalemia (40%) hypokalemia (8%), hyperphosphatemia (14%) hypophosphatemia (30%) hypomagnesemia (3%), hypozincemia (11%), and hypocupremia (3%). Because of the extensive range of biochemical problems, it is recommended that subjects on tube feeding be evaluated periodically for metabolic abnormalities.
Subject(s)
Enteral Nutrition/adverse effects , Metabolic Diseases/etiology , Copper/blood , Humans , Hyperglycemia/etiology , Hyperkalemia/etiology , Hypernatremia/etiology , Hypoglycemia/etiology , Hypokalemia/etiology , Magnesium/blood , Nervous System Diseases/therapy , Phosphates/blood , Zinc/bloodABSTRACT
A diatom population consisting of 31 taxonomic entries was found in tailings from an abandoned mine near Ichthyosaur Paleontologic State Monument, Nye County, Nevada, U.S.A. The diatom population of the mine tailings resembled those found in dry lakes of the vicinity which are similar to some soil diatom populations. The mine tailings population was very similar to some Quaternary diatom assemblages in the vicinity and in other parts of the conterminous United States. The diatom population indicated that alkaline and oligohalobous conditions were prevalent with associated "indifference" with respect to the current spectrum.
