Rectal lumen obliteration from stapled hemorrhoidopexy: can it be prevented?

Stapled hemorrhoidopexy is an operation that is widely used and accepted as a standard procedure by many surgery clinics as the postoperative pain is minimal, period needed for return to work and social life is short and recurrence rate is acceptable. However, stapled hemorrhoidopexy may also result in some major complications. An important proportion of these complications (such as anastomosis dehiscence, rectovaginal fistula, anorectal stricture and rectal obstruction) occur due to the errors of purse string suture technique. In this report, we present a case of rectal obstruction following stapled hemorrhoidopexy in a 27-year-old female patient with fourth grade hemorrhoidal disease and want to draw the attention to the probable ways by which rectal obstruction can occur due to this surgical method. The complication that occurred was related to a purse string suture that also crossed an internal rectal prolapse. Paying attention to the technique of purse string placement during the procedure, placing purse string sutures 3-4 cm proximal to the dentate line with intervals of 1-1.5 cm, verifying the existence of a lumen before introducing the stapler and just including the rectal mucosa will minimize the risk of complications.

Heterotopic gastric mucosa in gallbladder associated with kidney agenesis and congenital hip dysplasia.

Heterotopic gastric tissue in the gallbladder is an extremely rare condition. There is not any specific clinical or laboratory finding and correct diagnosis is not possible before histopathological examination. Preoperative diagnosis usually resembles a polypoid Lesion or a fixed gallstone. We reported a 34-year-old female patient with heterotopic gastric mucosa in the gallbladder associated with congenital hip dysplasia and kidney agenesis. Laparoscopic cholecystectomy was performed and histopathology of the resected specimen showed that the "polyp" consisted of heterotopic gastric mucosa with glands of body and fundic type. Some cases of heterotopia in the gallbladder come from metaplasia, and may be one of the causes of gall bladder cancer. We discussed the clinical and histologic features of heterotopic gastric tissues and reviewed reported cases in the literature.

The assessment of urinary function following extended lymph node dissection for colorectal cancer.

AIMS: The aim of the current study is to demonstrate whether the effects of extended systematic lymph-node dissection (ESLND) on urinary dysfunctions differ from those of curative radical surgery (CRS) only for rectal cancer. METHODS: We present data about our patients who underwent rectal resection for rectal cancer over 5 years. One hundred and seventy patients with rectal cancer were reviewed with respect to surgical procedures and post-operative urinary problems. RESULTS: We performed CRS on 146 patients and CRS+ESLND on 24 patients, and analysed the incidence of post-operative urinary dysfunction in both groups. Urinary incontinence rates were 39 and 58%, urinary retention rates were 4 and 16%, for the patients from CRS group and CRS+ESLND group, respectively. CONCLUSIONS: We conclude that the addition of ESLND to CRS does not increase the frequency of post-operative urinary dysfunction, apart from an increased risk of urinary retention.

Family study of the aggregation of eating disorders and mood disorders.

BACKGROUND: Family studies have suggested that eating disorders and mood disorders may coaggregate in families. To study further this question, data from a family interview study of probands with and without major depressive disorder was examined. METHOD: A bivariate proband predictive logistic regression model was applied to data from a family interview study, conducted in Innsbruck, Austria, of probands with (N = 64) and without (N = 58) major depressive disorder, together with 330 of their first-degree relatives. RESULTS: The estimated odds ratio (OR) for the familial aggregation of eating disorders (anorexia nervosa, bulimia nervosa and binge-eating disorder) was 7.0 (95 % CI 1.4, 28; P = 0.006); the OR for the familial aggregation of mood disorders (major depression and bipolar disorder) was 2.2 (0.92, 5.4; P = 0.076); and for the familial coaggregation of eating disorders with mood disorders the OR was 2.2 (1.1, 4.6; P = 0.035). CONCLUSIONS: The familial coaggregation of eating disorders with mood disorders was significant and of the same magnitude as the aggregation of mood disorders alone--suggesting that eating disorders and mood disorders have common familial causal factors.

Unusual localizations of hydatid disease.

Hydatid disease is endemic in several Mediterranean countries, posing an important health problem for these countries. The hydatid cyst is characterized by cystic lesions with clear boundaries, which can be observed in all parts of the body. Approximately 70 % of hydatid cysts are situated in the liver, followed by the lung (25 %). The kidneys, spleen, bile ducts, mesentery, soft tissue and brain are less frequent sites. We investigated patients who were treated for hydatid disease in our departments in the last 5 years with respect to localization of the disease, symptoms, surgical intervention, length of hospitalization, diameters of the cyst, and classification by Gharbi. In this retrospective and descriptive study, 176 patients are evaluated who were treated for hydatid disease between 1995 and 1999 in our departments. Of these patients, 14 were included with localization other than in the liver and lungs. Fourteen of the patients diagnosed with unusually located hydatid disease were men, six were women. Their mean age was 41.6 +/- 20.8 years; the length of hospital stay was 7.07 +/- 0.4 days. Overall, 28.6 % of patients with unusually located hydatid cyst had recurrent disease. The time period since last cyst operation was 5.25 +/- 3.5 years. The mean cyst diameter was 96.5 +/- 54.5 mm. According to Gharbi's classification, three cases (21.4 %) of the unusually located hydatid cysts were type I, two (14.3 %) type II, and eight (57.1 %) type III. There was only one case of type IV and no cases of type V. Spleen and kidneys are the organs where hydatid disease is most frequently observed after the liver and lung. It can be observed in all parts of the body including the brain, peritoneum, mesenterium, choledochus, pancreas, bone and muscles. The type of treatment is determined by the localization and type of hydatid disease. Surgical treatment for splenic hydatid cysts is splenectomy. The functional kidney should be saved in non-communicable hydatid disease. Total excision is almost never possible; endocystectomy and drainage procedure should be preferred for hydatid disease of the brain, pancreas and choledochus. Chemotherapy is usually given because of the risk of recurrence; this medical treatment consists in albendazole and mebendazole administration for 3-6 months in the postoperative period.

Immature teratoma in both mediastinum and liver of a 21-Year-old female patient.

We present a case of an immature teratoma of the liver and the mediastinum. A 21-year-old female patient presented with dyspnea, abdominal pain, and abdominal mass. Abdominal ultrasonography showed a liver tumor which is located in the right lobe and composed of cystic and solid elements. Computed tomography (CT) also showed a big mass which contained multiple high density, nodular, semi-solid, heterogenic structures in the liver and another mass which contained multiple low density cystic lesions in the anterior mediastinum. Right thoraco-abdominal approach was performed on the patient and a complete macroscopic resection of tumors was achieved without complications. Both tumours were evaluated as having an intact capsule. The mediastinal tumour extended to the diaphragm on the right side, and is dissected from the 'surrounding lung, pericardium' and excised from diaphragm. Right hepatic lobectomy was performed for liver tumour. Intraoperative frozen sections of the liver tumor revealed teratoma. But the final pathological diagnosis was immature teratoma. Chemotherapy was given after surgery. The patient tolerated the procedure well and her postoperative course was unremarkable. At the first follow up 4 months after surgery she was alive and well and there was no evidence of recurrence, but the patient died within seven months with hepatic recurrence and spreading metastasis.

Slowing of human arm movements during weightlessness: the role of vision.

The human motor system responds to weightlessness by the slowing of movement. It has been suggested that deficits in visuo-motor co-ordination cause this effect. We studied the mechanisms of the slowing of movement in three long-term missions to the Russian space station Mir. In particular, the role of vision in the control of movement in microgravity has been studied in these experiments on seven cosmonauts, pre-, in-, and post-flight. The cosmonauts made arm movements to visual targets under the following conditions of visual control: no visual control, interrupted visual control, and undisturbed visual control. The results showed that the slowing of movement during weightlessness was manifested by decreases of peak velocity and peak acceleration, was not associated with a prolongation of the movement phase of deceleration, and was not affected by manipulation of the conditions of visual control. The slowing of movement tended to subside after the months of the flight and completely disappeared within days after the landing. Accuracy of the movements strictly depended on the constraints imposed on the vision and remained unaffected in-flight. The data presented demonstrate that the slowing of movement in microgravity is not directly related to deficits in sensori-motor co-ordination and is not associated with a reduction of the accuracy of movement. The strategy for motor control in microgravity seems to be directed towards the generation of smooth movements and the maintenance of their accuracy.

Are preoperative serum gastrin levels related to resectability and survival in gastric cancer?

The aim of this study was to determine the correlation between serum gastrin and resectability in patients with gastric cancer, and to see whether any difference could be demonstrated according to the histologic type and survival. Between 1994 and 1996 records of 34 consecutive patients with gastric carcinoma serum gastrin levels were measured and correlated with age, gender, lymph node positiveness, metastasis, Lauren's classification and survival. The mean serum gastrin level of patients was 98.38 pg/ml (normal range: 25-125 pg/ml). Twenty-six of 34 patients (76.5%) had normal gastrin levels and eight patients (23.5%) had high gastrin levels. Sixty-five per cent of patients with normogastrinaemia underwent resection with extended lymphadenectomy, while 38% patients with hypergastrinaemia underwent extended resection. All the hypergastrinaemic patients died within the first year, but in the normogastrinaemic group one, two and five-year survival rates were 39%, 23% and 4%, respectively. Even though these results are not statistically significantly different in regard to preoperative serum gastrin levels, we conclude that preoperative hypergastrinaemia is associated with unresectability and poor survival in patients with gastric cancer.

The weeping behavior in anorexic and bulimic females.

BACKGROUND: The aim of the study was to examine the proneness, the functions and triggering situations of weeping in anorexic and bulimic women. METHODS: Participants were 36 anorexic and 31 bulimic female patients and 56 age-matched female controls. All women completed the Questionnaire on Adult Crying. We limited our study to results on 'crying proneness', 'functions of crying' and 'determining factors of crying'. RESULTS: Bulimic patients reported to have cried significantly more often in the last 4 weeks, to be more likely to cry in situations of distress and to have used weeping significantly more often as a manipulative behavior than control women. Anorexic patients rated their tendency to cry significantly lower and experienced weeping as significantly more negative than controls. CONCLUSIONS: Compared to control women, anorexic patients associated weeping with negative feelings as opposed to bulimic patients who appeared to use weeping on an intentional basis. These deviations from control women seem to mirror the introvert character of anorexic patients and the extrovert impulsive personality of patients with bulimia nervosa, respectively.

Obstructive jaundice promotes bacterial translocation in humans.

BACKGROUND/AIMS: Significant bacterial translocation was demonstrated following experimental biliary obstruction, however very little is known about the importance and the prevalence of gut-origin sepsis in obstructive jaundice patients. Therefore, the aim of this study was to investigate the concept of gut-origin sepsis in obstructive jaundiced patients and its clinical importance. METHODOLOGY: Twenty-one patients requiring laparotomy for obstructive jaundice (group I) and thirty patients operated on electively mainly for chronic cholecystitis (group II) were studied. Peritoneal swab, mesenteric lymph node, portal venous blood, liver wedge biopsy and bile were sampled for culture immediately after opening the peritoneum. Additionally, peripheral blood samples were taken pre- and post-operatively from all patients. Post-operatively, patients were monitored for infectious complications. RESULTS: The mean serum bilirubin concentration, gamma glutamyl transferase and alkaline phosphatase levels in jaundiced patients before therapeutic intervention were significantly higher than in control patients. Five patients demonstrated bacterial translocation in group I (24%), whereas only one did so in group II (3.5%, p < 0.05). Septic complications were detected in three patients, but only in two with bacterial translocation in group I. There was one patient with bacterial translocation who had septic complication in group II. CONCLUSIONS: The present study demonstrated that obstructive jaundice significantly promotes bacterial translocation in humans, however, its clinical importance has yet to be defined.

Effect of CO(2) insufflation on bacteremia and bacterial translocation in an animal model of peritonitis.

BACKGROUND: The widespread adoption of the laparoscopic approach has created some concern over the potential for increased risk of bacteremia and sepsis due to increased intraabdominal pressure in patients with intraabdominal infection and peritonitis. This study examines the effect of the CO(2) pneumoperitoneum on bacteremia and bacterial translocation. METHODS: New Zealand white rabbits were assigned into three groups of 10 animals. In group 1, 100 ml of sterile saline was infused into the peritoneal cavity under 10 mmHg CO(2) insufflation for 1 h. Group 2 received 100 ml of saline containing 10(9) CFU/ml (colony-forming units) E. coli strain 0163 and 10 mmHg CO(2) insufflation for 1 h. Group 3 received an identical bacterial inoculum, followed by a 10-cm midline laparotomy. Blood samples were taken for culture by cardiac puncture at various intervals during the experiment. At 6 h after being subjected to the experimental procedures, the rabbits were killed and their organs were cultured quantitatively for translocating bacteria. RESULTS: In group 1, neither blood nor organ cultures were positive, whereas in group 2 all blood cultures became positive in 1 h, and intraperitoneally infused bacteria translocated to the lung and kidney in all rabbits. In group 3, blood cultures became positive in 1 h, all but two of the rabbits had translocated bacteria in their lungs, and kidney samples from two of the rabbits were culture-positive. CONCLUSIONS: Our results indicate that both CO(2) pneumoperitoneum and laparotomy increase the incidence of bacterial translocation from the peritoneal cavity into the bloodstream. Thus, the risk of translocation to extraperitoneal organs such as lung and kidney is increased significantly by laparoscopy. Therefore, laparoscopic surgery should be avoided or used cautiously in the setting of acute peritonitis.

Arsenic-related Bowen's disease, palmar keratosis, and skin cancer.

Chronic arsenical intoxication can still be found in environmental and industrial settings. Symptoms of chronic arsenic intoxication include general pigmentation or focal "raindrop" pigmentation of the skin and the appearance of hyperkeratosis of the palms of the hands and soles of the feet. In addition to arsenic-related skin diseases including keratosis, Bowen's disease, basal-cell-carcinoma, and squamous-cell carcinoma, there is also an increased risk of some internal malignancies. Arsenic-related diseases are common in areas of the world where the drinking water has a high arsenic content. In this paper, we describe a 35-year-old male patient who had arsenic-related keratosis, squamous-cell carcinoma in the palmar area of his left hand, and Bowen's disease on his left thigh. The patient worked in a borax mine for 15 years, so he was exposed to arsenic in drinking water, airborne arsenic in his workplace, and had direct contact. The patient was treated for 11 months for arsenic-related keratosis until an axillary lymph node metastasis occurred; the lesion was excised and diagnosed to be malignant. Bowen's disease was detected when the patient was being treated for cancer. No other malignancy was found. The patient is still receiving regular follow-up care.

Knowledge of calories and its effect on eating behavior in overweight, normal weight, and underweight individuals.

BACKGROUND: To assess changes in the eating behavior of overweight, normal weight, and underweight individuals in response to knowledge about the caloric content of their food. METHODS: Anonymous self-report questionnaires were completed by 1041 staff members attending the Innsbruck University Hospital cafeteria shortly after it started to display the caloric content of all meals. The questions covered the subjects' weight history, body image, eating behavior, and response to knowledge of caloric content. RESULTS: Among the respondents, 141 were classified as overweight, 728 as normal weight, and 118 as underweight. Overweight individuals reported a significantly more frequent change in eating behavior in response to the information, and were also significantly more distressed about weight and eating and dissatisfied with their bodies and their weight than normal and underweight individuals. CONCLUSIONS: Overweight individuals were more likely to report that they had modified their eating in response to information about calories. Whether this reflects an actual change in eating behavior, or merely a wish to give socially desirable responses, remains uncertain.

The effect of short-term octreotide administration on the histologic structure of stomach, duodenum, jejunum, colon, liver and gallbladder in an experimental pancreatitis model.

It is known that long-term administration of octreotide leads to changes in the histology of intraabdominal organs and plasma biochemical values. The purpose of the present study was to evaluate the histological effect of short-term octreotide administration on digestive organs in the experimentally induced pancreatitis by ligating pancreatic duct. The sham operation was performed on 20 rabbits in Groups 1 and 2. Acute pancreatitis was induced by pancreatic duct ligation in 20 rabbits in Groups 3 and 4. Octreotide was administered subcutaneously to the rabbits in Groups 2 and 4 at a dosage of 10 microg/kg/day for 7 days. The animals were sacrificed at the end of day 7, blood and tissue samples were collected. There was no histological changes in the stomach, duodenum, gallbladder, or small and large intestines of those group which received octreotide, while hepatic bile duct proliferation, bile duct epithelium proliferation, periportal inflammation and venous stasis were observed in liver histology. In conclusion, one-week octreotide administration in this experimental acute pancreatitis model was not associated with pathologic changes in digestive organs except liver.

Can postoperative abdominal wound dehiscence be predicted?

The purpose of this study was to identify risk factors in wound dehiscence and to determine which factors might be predictable. Forty patients with abdominal wound dehiscence were compared with 40 control patients standardized by sex and age. Hypoproteinemia, nausea/vomiting, fever, wound infection, abdominal distension, type of suture material, 2 or more abdominal drains, and the surgeon's experience were factors significantly associated with wound dehiscence. Emergency surgery, jaundice, ostomy, total parenteral nutrition, ascites, pulmonary morbidity, co-existence of disease, anemia, leucocytosis, and type of incision were nonsignificant variables. The number of patients with wound dehiscence increased with an increase in the number of risk factors, reaching 100% for patients with 8 risk factors. The risk factors of wound dehiscence can be predicted early and their number can be decreased before and after surgery by an experienced surgeon, leading to a lowered incidence of wound failure.

Prevalence of activated protein C resistance and analysis of clinical profile in thromboembolic patients. A Belgian prospective study.

OBJECTIVES: To assess the prevalence of activated protein C resistance (APC-R) among healthy subjects and thromboembolic patients and to determine the clinical characteristics associated with APC-R. DESIGN: A prospective study. SETTING: One academic medical centre. SUBJECTS: 91 health controls and 126 thromboembolic patients. MEASUREMENTS: Patients and control were genotyped for the factor V Leiden (VaQ506) mutation. The anticoagulant response of the patient's plasma to activated protein C was also determined. RESULTS: The frequency of APC-R was 3.3% among healthy control subjects and 22% among thrombotic patients of whom 18% were heterozygous and 4% were homozygous. The mean age at the first thrombotic event and the severity of thrombotic disease including the proportion of proximal deep vein thrombosis and the frequency of lung embolism were identical among APC-R positive and negative patients. A family history of thromboembolic disease was elicited more frequently in APC-R positive than in APC-R negative patients (57% vs. 22%, P < 0.001). The recurrence rate was higher for APCR-R positive patients (57% vs. 34%, P < 0.05). The percentage of cases with a factor predisposing to thrombosis was very similar in APC-R positive (57%) and negative (68%) patients. CONCLUSIONS: A familial history of thromboembolic disease and recurrences are significantly more frequent among APC-R positive than APC-R negative patients.

A case of pure renal hydatid cyst without multiple organ involvement.

Hydatid disease of the urinary tract is very rare. We report a case of pure renal hydatid cyst, with its clinical presentation and management.

[Railroad suicides and attempted suicides in Austria 1990-1994. Extending the hypothesis mass media transmission of suicidal behavior]. / Eisenbahnsuizide und-suizidversuche in Osterreich von 1990-1994. Erweiterung der Hypothese medialer Vermittlung suizidalen Verhaltens.

Suicide on railways (either by being run over by or jumping in front of a train) is one of the "hardest' suicide methods. In Austria, 617 suicides or attempted suicides on railways were registered between 1990 and 1994. This amounts to 5.73% of all suicides committed in this period with women showing a higher percentage than men. In both men and women there was a predominance of younger age groups; the mean age was higher in women than in men (48.0 vs 40.4 years). There was a significant increase in suicides or attempted suicides on railways after a television report on the stress suffered by train drivers concerning possible suicides. Persuading the mass media to treat the subject of "suicide' with reserve and with greater caution, even when not presenting a distinct suicide model, may be of importance in general suicide prevention.

[Movement disorders in weightlessness]. / Bewegungsstörungen in der Schwerelosigkeit.

The system MONIMIR has been developed to study the coordination of eye, head and arm movements as well as spinal reflexes in microgravity and was used during three spaceflights on board of the station MIR. The following investigations in the course of the experiment MONIMIR were performed: (1) slow head movements in three planes, (2.3) fast pointing movements of eyes, head and arm to acoustic and visual targets, (4) tracking movements of eyes, head and arm to visual targets, (5) head and arm movements based on short term memory and (6) patellar-tendon-reflex. In microgravity different functions and effectors showed different nature and degree of disturbance and different courses in adaptation; in most of the tests exactness and velocity of head and arm movement was decreased; head movements were more disturbed than arm movements; fast pointing movements were more severely affected than slow tracking movements which partly improved; visual controlled movements showed better adaptation as only proprioceptive controlled movements; the patellar-tendon-reflex was highly increased. Disturbances were most pronounced in the early stage of the spaceflights; at later stages most of the performances improved. Methods and results can be used not only for improvement of election and health control of cosmonauts/astronauts for future longterm space missions but also for diagnostics and research of adaptational processes in course of diseases or extreme conditions on earth.

Single-photon emission computed tomography studies with 99mTc-hexamethylpropyleneamine oxime in dementia: effects of acute administration of L-acetylcarnitine.

The acute effects of intravenously administered L-acetylcarnitine (LAC) were evaluated with single-photon emission computed tomography (SPECT) and 99mTc-hexamethylpropyleneamine oxime in 30 demented patients (21 with a clinical diagnosis of Alzheimer's dementia and 9 with mixed-type dementia). Two SPECT scans were performed: in basal conditions, and 30 min after the administration of 500, 1,000, 1,500, or 2,000 mg LAC intravenously. Tracer activity ratios were determined in 10 pairs of cerebellar, cortical and subcortical regions. After administration of the lowest dose of LAC, no changes from the basal values were observed in any of the regions examined. The higher doses of the drug significantly elevated the tracer activity in cortical regions, particularly in the parietal lobe, which showed an impaired regional cerebral blood flow in the basal study. These effects of LAC and their relation with the cholinomimetic properties of the drug are discussed.