Mesocolic hernia: an unusual internal hernia.

Internal hernia may be either congenital or acquired. Its incidence has been reported to be 1-2%. Herniation may be persistent or intermittent. Internal hernia is a rare cause of small bowel obstruction with a reported incidence of 0.2-0.9%. The most common type is paraduodenal. Less common types include mesocolic hernia, which occurs following abdominal surgery. We report mesocolic hernias in two young patients, which presented as small bowel obstruction without any prior abdominal surgery.

Pulmonary complications of feeding tubes: a new technique of insertion and monitoring malposition.

OBJECTIVE: To confirm the value of a new technique that will ensure safe introduction of feeding tubes. DESIGN: Two case reports; an anatomical and physiologic description of deglutition; and a case study. SETTING: A level 2 regional referral centre. PATIENTS: Thirteen anesthetized adult patients and 7 awake subjects, comprising patients scheduled to undergo elective surgery, medical staff and health care volunteers. INTERVENTIONS: Airway sampling for carbon dioxide with capnography in 13 anesthetized adults with the tip of the feeding tube in the pharynx, in the esophagus and in the trachea, and airway sampling for carbon dioxide from the pharynx and esophagus in 7 awake subjects during introduction of the feeding tube. Fluoroscopic monitoring of the position of the tip of the feeding tube during introduction in two patients and two volunteers. MAIN OUTCOME MEASURES: Carbon dioxide levels at the tip of the feeding tube during introduction. RESULTS: In all patients, with the tube either in the trachea or pharynx, a normal capnogram was displayed. When the tube was introduced into the esophagus no capnogram curve was seen, indicating the absence of carbon dioxide. With the subject lying down during introduction, the weighted tube followed the posterior pharyngeal wall to the upper esophageal sphincter. CONCLUSION: Positioning of the patient lying down with the head flexed and capnographic measurement of carbon dioxide levels from the tip of the feeding tube during insertion is a safe, accurate and cost-effective method for the introduction of feeding tubes.

Axial volvulus of the small bowel caused by Meckel's diverticulum.

BACKGROUND: A mechanism where the presence of a Meckel's diverticulum might cause bowel obstruction by twisting the small bowel along its long axis has been described. The developmental anatomy of the Meckel's diverticulum and its blood supply has been traced. Various other ways a Meckel's diverticulum can cause an obstruction have been enumerated. METHODS: We have reported two cases where the presence of a Meckel's diverticulum was the cause of bowel obstruction in a fashion hitherto not described. One patient had intermittent bouts of obstruction; the second patient had an acute obstruction. RESULTS: Preoperative investigations for a Meckel's diverticulum are not always fruitful, and most of the time the diagnosis is made at operation. When a Meckel's diverticulum is encountered at operation, division of its mesentery, the mesodiverticular band, rather than diverticulectomy, to relieve the volvulus described might devitalize the Meckel's diverticulum and should be avoided. CONCLUSIONS: A new mechanism by which the presence of a Meckel's diverticulum can cause an obstruction has been described. A short mesodiverticular band causes the bowel to twist along its long axis, precipitating the obstruction. This condition should be kept in mind in patients with a bowel obstruction who have not undergone any previous abdominal operation.

Osteomyelitis of the spine due to Salmonella: case report, review of clinical aspects, pathogenesis and treatment.

Osteomyelitis of the spine caused by Salmonella is rare. The authors describe a case in which the patient had fusion of the L1 and L2 vertebrae, which were affected by osteomyelitis. The infecting organism was Salmonella typhimurium. The authors describe the relationship of the vascular anatomy to the development of osteomyelitis of the spine. They discuss the clinical features, diagnosis, pathogenesis and treatment of the disease. Although the association of osteomyelitis due to Salmonella and sickle cell disease has long been known, this patient did not have sickle cell disease or any other condition that would compromise the immune system.

A new technique for resection of liver tumours.

We have described a simple technique that reduces bleeding and operative time in liver resections. The technique is useful in peripheral lesions, particularly in segmentectomies and nonanatomical resections of the liver. This technique is not advocated for extended right hepatectomies and left hepatectomies because of possible injury to the hilar vessels, which would compromise the blood supply to the remaining lobe. However, preoperative mapping of the hepatic vasculature by computed tomographic portography can help avoid injury to these vessels and may make some lobectomies amenable to this technique.

Correction of the published sequence for the human proteolipid protein gene.

In the human proteolipid protein gene, the base sequence of the intronic region 5' to exon 6 was found to be 5'-ctctttcattttcctgcag-3' and not 5'-ctctttt-cattttcctgcag-3' as previously reported.

A simplified procedure for cDNA and genomic library construction using nonpalindromic oligonucleotide adaptors.

The properties and characteristics of oligonucleotide adaptors for use in a simplified procedure for the construction of cDNA and genomic DNA libraries are described. The adaptors are suitable for joining to blunt ended cDNA or sheared genomic DNA, and then to the cohesive ends of restriction sites in vectors. Each adaptor consists of two oligonucleotides with complementary but nonpalindromic sequences that include an internal restriction site, a 5' phosphorylated blunt end, and an overlapping or staggered 5' hydroxylated end corresponding to a restriction endonuclease site in a vector of choice. Ligation of the blunt end to high molecular weight target DNA proceeds efficiently and there is no tandem concatenation of the adaptor. Insertion into the appropriate vector only requires ligation of the cohesive ends. There is no requirement for methylation, restriction enzyme cleavage, G-C tailing, or denaturation after ligation of the adaptor to the target DNA, all characteristics of other procedures.

Organization of repetitive DNAs in the guinea pig genome.

Investigation of restriction enzyme families observed in Bam HI and Eco RI digest of guinea pig DNA has led to the demonstration of a 4.0 kb cryptic satellite called MRICp which has 6300 copies and comprises 1% of the total genome. MRICp has been shown to encompass the Eco RI 4.0 kb family, the Bam HI 3.4 kb family and the Bam HI 3.7 kb family. The 1.5 kb Eco RI family is part of an L1 LINE that is present in the guinea pig and in other rodentia. It is part of a larger LINE, probably 6.5 to 7 kb in size, and some copies are embedded in satellite I DNA sequences.

Aortoenteric fistula: case review and a new surgical technique.

The authors describe a new surgical technique for the management of aortoenteric fistula and report on the diagnosis and management of five such cases. The new technique consists of stapling the afferent and efferent loops of bowel as close to the fistula as possible. In a bleeding patient this effectively stops the blood loss into the bowel; when a patient is not actively bleeding, it helps in the retraction of the bowel away from the operative site. The authors propose that this technique be used by a surgeon with limited vascular experience to temporize the blood loss and transport the patient to a vascular unit. The recommended procedure is total excision of the graft with an axillobifemoral bypass. Acute awareness of the condition and prompt early operation in a patient who has undergone aortic surgery will result in lower death rates.

Cutaneous gangrene: a rare complication of coumarin therapy.

Sodium warfarin was administered to a 59-year-old woman with congestive cardiac failure and deep vein thrombosis. After 3 days of therapy the nipple and areola of the left breast became inflamed; the entire breast then became necrotic. Gangrene spread and a simple mastectomy was performed. The patient died from pulmonary embolism 1 day after operation. Histologic examination of the breast revealed thrombi in some of the arteries and veins. The etiology of this condition is obscure, and there is no known way of preventing or effectively treating the condition. Simple mastectomy or more conservative local excision recommended.