Congenital and acquired internal hernias: unusual causes of small bowel obstruction.

Fourteen cases of small bowel obstruction caused by congenital or postoperative internal herniation of bowel and treated at the University and Veterans Administration Medical Centers, Jackson, Mississippi between 1970 and 1983 were reviewed retrospectively. Of the total, eight were congenital (three transomental, two paraduodenal, one foramen of Winslow, one ileocecal transmesenteric, and one paracecal) and six acquired (three transmesenteric, one behind a Roux-Y esophagojejunostomy, one behind a Roux-Y pancreaticojejunostomy, and one between limbs of an end colostomy mucous fistula). Gangrenous bowel was present at exploration in nine cases (64 percent, five congenital and four acquired). In no case was a correct preoperative diagnosis of incarcerated or strangulated internal hernia made. In each patient, except for one who died before celiotomy could be performed, reduction of the hernia contents, resection of necrotic bowel, primary anastomosis or, on occasion, enterostomy, and correction of the anatomic defect leading to the herniation were performed. Postoperative mortality was 31 percent (four patients). Each of the four patients had presented initially with gangrenous bowel. The clinical features and management of congenital and acquired internal hernias have been reviewed and correlated with therapeutic outcome. In addition, the difficulties in diagnosis and the features of various types of these hernias have been discussed with comments made regarding prevention of the acquired forms of these rare hernias, along with the embryologic background and methods of management of the various congenital defects.

Functional and histologic changes in vein grafts exposed to crystalloid potassium cardioplegic solution.

A canine external jugular vein to iliac artery interposition model was devised to evaluate the potential deleterious effects of cold potassium cardioplegic solution exposure to saphenous vein grafts during aortocoronary bypass procedures. The right jugular vein was harvested from 11 animals and halved, one segment being perfused with 1 liter of normal saline solution (NS) at 4 degrees C over a period of 31.7 +/- 2.5 min at a perfusion pressure of 50.5 +/- 2.6 mm Hg, and the other segment perfused with 1 liter of crystalloid potassium cardioplegic solution (CP) at 4 degrees C over a period of 24.8 +/- 3.2 min at a perfusion pressure of 53.0 +/- 1.5 mm Hg. The measured differences in the perfusion times and pressures were not significant at P less than 0.05. The grafts were then interposed into the iliac artery systems of their respective animals, and transgraft pressure gradients were measured by direct needle puncture technique and found to be 12.6 +/- 5.9 mm Hg for the CP-treated grafts and 19.9 +/- 9.6 mm Hg for the NS-treated grafts. At the time of graft harvest 7.4 +/- 0.23 months later transgraft pressure gradients were again measured and found to be 2.5 +/- 1.8 mm Hg for the CP-treated and 2.9 +/- 1.7 mm Hg for the NS-treated grafts.(ABSTRACT TRUNCATED AT 250 WORDS)

Pulmonary fungal infection. Survey of 159 cases with surgical implications.

A survey of 159 cases of pulmonary fungal disease treated at the Hospital of the University of Mississippi is presented. The fungal diseases encountered were blastomycosis, 75 cases (47%); histoplasmosis, 38 cases (24%); aspergillosis, 17 cases (11%); cryptococcosis, 13 cases (8%); nocardiosis, nine cases (6%); and actinomycosis, seven cases (4%). Coccidioidomycosis is not endemic to Mississippi. Histoplasmosis was probably more common than diagnosed, but clear cytologic evidence or detection of the organisms was the rigid criterion required for diagnosis. Immunosuppressed patients appeared to be especially susceptible to infection by certain of the fungi. Fungal diseases were found to mimic numerous other pulmonary lesions, and specific diagnosis was often long delayed. Seventy-one operations were required for diagnosis or therapy or both, with two deaths. The major pulmonary complications of the several fungal diseases have been reviewed. Pulmonary hemorrhage constituted the major emergency. Amphotericin B was the mainstay of drug therapy, but upon occasion stilbamidine, penicillin, sulfonamides, and other agents were useful in specific circumstances. Accurate diagnosis, appropriate drug therapy, and judicious operative intervention when required will achieve gratifying clinical results in the vast majority of pulmonary fungal diseases.

Tolerance of females to +GZ centrifugation before and after bedrest.

Because women may be included as passengers in the proposed Space Shuttle System, this study was designed to investigate the +GZ tolerance of women and the possible degradation of this tolerance after a period of weightlessness as simulated by bedrest. Twelve healthy Air Force Flight Nurses served as test subjects. Over a 1-week period, each subject was exposed to +GZ levels starting at +2 GZ and increasing by 0.5 GZ increments to a gray-out point. This point was determined by peripheral vision loss with a standard lightbar and by reverse blood flow in the temporal artery. Ultimately, each woman was subjected to three runs at the +3 GZ level; each run was approximately 55 min long, separated by 5-min rest periods. Eight subjects with the best tolerance times were selected for 14 d of bedrest in a horizontal position; the other four were ambulatory controls. Tests before bedrest, immediately following, and 5 d later showed that average +GZ tolerance decreased by 67% after bedrest.

Body composition changes in men and women after 2-3 weeks of bed rest.

Several parameters of body composition were measured in eight men before and after 14 days of continuous recumbency, and in eight women before and after 17 days of recumbency. The parameters measured included body weight, body water, body potassium, plasma volume, and plasma protein concentrations. From these, values were derived for body fat content, lean body mass, body cell mass, and circulating plasma proteins. In general, the men and women responded similarly to continuous recumbency. Characteristically, there was significant reduction of plasma volume and body potassium in both groups. The women showed a significant reduction in circulating plasma protein, entirely in the albumin fraction; a similar change was observed in the men. The women, but not the men, showed a significant increase in circulating fibrinogen. Both men and women lost body cell mass, while body fat content remained the same or tended to increase slightly. It is expected that similar changes would occur in weightlessness. It is further concluded that women should tolerate the weightlessness of space flight physiologically as well as men.

Effect of 14 days of bed rest on urine metabolite excretion and plasma enzyme levels.

After one week of ambulatory baseline measurement, a group of eight men 19-26 years of age remained continuously recumbent for 14 days. Studies were continued for one week following the prolonged recumbency. Urine excretion rates for a number of constituents were determined 2 days before bed rest, on day 14 of bed rest, and day 6 after bed rest. Blood plasma samples were also obtained at these times, and analyzed for several enzymes. On day 14 of bed rest significant increases were observed in urine excretion of total osmotically active substances, magnesium, calcium, phosphate, creatinine, hydroxyproline, and 17-OH corticosteroids. A decrease occurred in urinary glucose excretion. Plasma levels of alkaline phosphatase and LDH-3 were depressed, while plasma GPT was elevated. Many of these changes persisted on day 6 after bed rest, and are interpreted as concomitants of the disuse atrophy of the musculoskeletal system that characterizes prolonged bed rest and weightlessness.