Bleeding schwannoma of the small intestine: a diagnostic problem. Case report.

A rare case of intermittently bleeding, solitary benign schwannoma of the small intestine is presented. The tumor was identified by abdominal selective angiography. The importance of this investigation in cases of gastrointestinal bleeding without obvious cause is stressed.

Late cosmetic results of wound closure, strips versus suture.

Following 264 non-contaminated abdominal operations, skin closure was performed after randomization to Steri-Strip tape suture or conventional continuous 3-o or 4-o Dermalon suture. The cosmetic results were evaluated six and 46 months after the operation. In the six-month review Steri-Strip tape suture showed advantages over conventional suturing. However, follow-up of 217 patients revealed no significant differences in late cosmetic results after about four years.

Small bowel fistulas treated with somatostatin: preliminary results.

Small bowel cutaneous fistula appearing after laparotomy was treated with the tetradecapeptide somatostatin in six patients to reduce the volume and enzyme content of the intestinal secretion. Continuous intravenous infusion of somatostatin diminished output from the fistula in all cases. Spontaneous fistula closure occurred after 11 to 33 days of treatment in four patients. There were no complications such as sepsis, peritonitis, or wound or skin problems from the contact with intestinal secretion. The hospital stay ranged from 19 to 50 days and bowel function was restored to normal. These preliminary results indicated that somatostatin can promote healing of small bowel fistula by inhibiting intestinal secretions.

A prospective study of antisperm antibody development in acute epididymitis.

The association between acute epididymitis and development of antisperm antibodies was investigated by the gelatin agglutination technique in prospectively collected serum samples from 27 patients. Agglutinating antisperm antibodies, mainly of the IgG class, were detected in seven men (27 per cent), a significantly increased frequency compared to prevalences previously found among blood donors and men from infertile couples. The antibodies developed de novo in four patients (15 per cent). The increased incidence of positive sera and the kinetics of the antibody responses strongly indicate a causal link between acute epididymitis and autoimmunization against spermatozoa. In the majority of the patients the antibody titers were low, being of only theoretical importance in respect to later fertility.

Thyroid function after surgical treatment of nontoxic goitre. A randomized study of postoperative thyroxine administration.

Following thyroid resection for nontoxic goitre, 29 euthyroid patients were randomly allocated to no medication or to 0.2 mg levothyroxine daily (17 and 12 patients). The two groups were comparable in age, sex, extent of surgery and thyroid pathology. The patients were free from other endocrine disorders and had no other medication. Serum TSH, T4 and T3 were measured and T3-resin test performed preoperatively and 14 days and 3, 6, 12 and 18 months postoperatively. All values were within normal range. Only at the 3-month follow-up could statistically significant intergroup differences be observed, with T4 higher in the thyroxine-treated and TSH higher in the untreated group, but the outset values were thereafter regained. The T3 values in both groups were slightly reduced immediately after the operation. There was no recurrence of goitre in the 18-month observation period, and none of the findings suggested that routine thyroxine treatment is of value after resection of nontoxic goitre "in Denmark".

Foreign body perforation of the gastrointestinal tract with formation of liver abscess.

A unique case of foreign body perforation of the stomach directly into the liver with formation of a liver abscess is presented. The literature concerning foreign body perforation of the gastrointestinal tract complicated by liver abscess is reviewed.

Conservative surgical treatment of splenic cysts.

The common treatment of splenic cysts is splenectomy, but with today's knowledge of the important position of the spleen in the infection defense, it is advisable to preserve the spleen whenever this is possible, especially in younger individuals. A large non-parasitic, benign splenic cyst is excised. Postoperative ultrasound control presents a normal appearance of the spleen.

Recurrence of nontoxic goitre with and without postoperative thyroxine medication.

The incidence of postoperative recurrence of nontoxic goitre was evaluated in 175 patients. The average observation period was 8.8 years. Levothyroxine (Eltroxin) had been taken by 104 of these patients as long-term prophylaxis against goitre recurrence. Ten (9.5%) of the 104 had recurrence. The other 71 patients received no or only brief thyroxine medication postoperatively. In this group there were eight recurrences (11.3%). The difference was not significant, nor did the two groups differ significantly in regard to sex and age distribution, pathologic anatomy and observation time. Routine long-term administration of thyroxine after thyroid resection is not justified from the results of this study.

Chlamydia trachomatis in acute epididymitis.

The etiology of acute epididymitis was studied in 52 patients. Infection with Chlamydia trachomatis was demonstrated by culture or serology in 13 patients. In men under the age of 25 C. trachomatis was associated with 7 out of 9 cases of epididymitis, in contrast to none of the 19 cases in men above 35. Culture from the urethra is probably sufficient in diagnosing infection with C. trachomatis in patients with acute epididymitis, since only one patient with a negative urethral culture had a chlamydia-positive aspirate from the epididymis. Half of the cases of epididymitis in men above the age of 35 years were associated with urinary tract infection. One patient was infected with N. gonorrhoeae and one had tuberculosis of the epididymis.

Nontoxic goitre. I. Surgical complications and longterm prognosis.

In the period 1960-1968, 182 patients underwent surgery for nontoxic goitre at Roskilde County Hospital. The total frequency of peroperative complications was 10%. After a mean interval of 16.4 years, 162 of the patients could be followed up and 86% expressed satisfaction with the result of thyroid surgery. Only two patients (1.2%) had longterm sequelae in the form of voice problems and calcium requirements. No thyroid cancer appeared in the observation period. In 19% there was recurrence of benign goitre. The interval to recurrence was 1 month to 14 years.

Nontoxic goitre. II. A study of the pituitary-thyroid axis in 14 recurrent cases.

Of 182 patients operated on for nontoxic goitre, 162 could be followed up after a mean period of 16.4 years. In 31 (19%) of the 162 patients the goitre had recurred. No patient had received regular thyroid-substitution therapy postoperatively. Of the 31 recurrences, 14 had not been treated at the time of follow-up. These 14 patients were matched with controls (without recurrence) from the original series, according to sex, age and time of operation. Thyroid-stimulating hormone (TSH), serum thyroxin (T4), triiodothyronine (T3) and thyroid antibodies were determined in both groups. There were no intergroup differences as regards TSH and T4, which were within normal range. T3 values were elevated in both groups, but were significantly higher in the patients with goitre recurrence than in their control group. Routine postoperative use of thyroid-substitution therapy is not supported by the findings in this study.