[Perforation of the small intestine]. / Le perforazioni dell'intestino tenue.

BACKGROUND: Small bowel perforation is a major problem in abdominal typhi disease, but is seldom observed in Italy, as Salmonella typhi infections are rare in this Nation. The cause of perforation varies greatly. The reported mortality is high and varies from 23 up to 42%. A retrospective study has been performed in order to find how to improve the outcome. METHODS: A series spanning 10 years is reviewed, from January 1, 1987 to December 31, 1997, comprising 60 patients with small bowel perforation, operated in a urgency setting in the Operating Room of the Emergency Department of the Molinette Hospital in Torino. Resection and primary anastomosis were utilized in 33 patients, 27 underwent oversewing. In 3 patients a colostomy was felt necessary because of a concomitant damage of the colon. RESULTS: No leakages occurred. Hospital stay varies from 1 day to 76 days (24 days mean). Mortality is consistent with literature: 20 patients (33%) but the cause is related to the primary diseases of the patients. Delay in diagnosis did not affect the patient's outcome. CONCLUSIONS: In conclusion, it is confirmed the one-time surgery as the choice treatment in small bowel perforations from causes other then S. typhi infection. Mortality is not directly related to the consequences of surgical repair.

[Hemolysis and multiple trauma. A clinical case report]. / Emolisi e politrauma. Descrizione di un caso clinico.

A patient is described who presented hemolysis after a chest and head trauma. We checked out every possible cause of anemia and our conclusion is that trauma itself was the cause of hemolysis. As an explanation, we suggest that red blood cells were broken in lung capillaries because of endothelial damage due to pulmonary injury.

Effect of macrophage stimulation on collagen biosynthesis in the healing wound.

Immunomodulators that enhance macrophage function have been shown to be beneficial in a number of wound-healing models in humans and in experimental animals. The exact mechanism of this improved healing is unclear. To assess the role of collagen biosynthesis, the immunomodulator glucan phosphate was utilized in two murine models of wound healing, i.e., colon anastomosis and full-thickness skin incision. Tensile strength was evaluated using computer-assisted constant velocity tensiometry. Collagen biosynthesis was determined by assaying hydroxyproline content of wound hydrolysates by N-(9-fluorenyl)methoxycarbonyl/o-phthalaldehyde high-performance liquid chromatography. Experimental animals were treated with (1-3)-beta-D-glucan phosphate (250 mg/kg) intravenously 24 hours prior to colon anastomosis or skin incision. A second dose of glucan phosphate was given immediately postoperatively. Control animals received dextrose and water (5% w/v) intravenously. Tensile strength and hydroxyproline content were measured on postoperative Day 3. In the skin wound model, glucan phosphate treatment increased (P < 0.05) tensile strength by 42 per cent (342.5 +/- 12.2 vs 241.8 +/- 4.8 g), and hydroxyproline content was increased by 23.5 per cent (242.0 +/- 14.4 vs 196.8 +/- 10.5 pmol/microg; P < 0.05). In the glucan phosphate group, colon tensile strength was significantly (P < 0.05) increased by 34 per cent (34.2 +/- 2.3 g vs 45.8 +/- 2.1 g), and hydroxyproline content was increased by 7 per cent (47.45 +/- 3.31 vs 44.34 +/- 3.74 pmol/microg). These data indicate that macrophage modulation with glucan phosphate will increase tensile strength in experimental colon and skin wounds. In addition, we observed a positive correlation between glucan phosphate treatment, wound tensile strength, and collagen biosynthesis.

Rupture of thoracic aorta resulting from blunt trauma.

BACKGROUND: Traumatic rupture of thoracic aorta caused by blunt trauma has been observed more frequently in recent years. The aim of this study was to evaluate the state of the art of diagnostic methods used to identify this injury and the surgical techniques used to repair it. METHODS: The study was performed in 29 patients undergoing surgery for traumatic rupture of thoracic aorta from November 1979 to July 1995. RESULTS: All patients presented multiple blunt traumatic injuries. The suspicion of traumatic aortic rupture always arose when evidence of an enlarged mediastinal shadow was found on the chest X-ray, subsequently confirmed in 27 cases using aortography. During the period 1993-1995 11 patients underwent CT scan before aortography, which resulted false negative in 3 cases (27.2%). The decision to perform surgery was based on well defined priorities: abdominal injuries took priority over the aortic injury, and in stable patients with intracerebral injuries, head CT scan and neurosurgery were performed first. Eight patients died (overall mortality was 27.5%). CONCLUSIONS: CT scan should not be used for the diagnosis of aortic traumatic rupture because it is a waste of time (all patients have to undergo aortography before surgery) and the false negative rate is too high.