A report of three cases with an oesophageal perforation treated with a coated self-expanding stent.

A perforation of distal oesophagus in benign cases occurs usually as a complication of endoscopic procedures or due to perforating external trauma. Perforations caused by blunt trauma are rare and usually involve high-energy accidents. The time of diagnosis, severity of the perforation, degree of mediastinal and pleural contamination and treatment are the most important factors predicting the outcome. Treatment may be conservative, comprise primary suturation or include oesophageal resection. We present three cases with a benign oesophageal perforation, which we have treated with a coated stent. One of the cases suffered from a thoracic oesophageal perforation due to a lesser trauma, while the other two cases are perforations caused by complications of endoscopy.

Simple ligation vs stump inversion in appendicectomy.

Although modern gastrointestinal surgery has abandoned the invagination of stapler closures, the traditional technique for appendicectomy with appendix stump invagination is still in common use. In a prospective study altogether 200 patients operated on for acute appendicitis were treated either by simple ligation or ligation and inversion of the appendix stump. The complication rates between the two groups were equal. Thus, we recommend the simple ligation technique for conventional as well as for laparoscopic appendicectomy because it is simpler and faster, and it preserves the intact anatomy of the caecal wall.

Operative treatment of severe pancreatitis in the Päijät-Häme Central Hospital during 1986-1990. A retrospective analysis of 35 patients.

Thirty-five of 556 (6.3%) patients with acute pancreatitis were treated with standard operative technique in our hospital between 1986 and 1990. All of the operated patients had necrotizing course of the disease. The aetiology was alcohol in 80.0%, biliary disease in 11.4%, postendoscopic retrograde cholangiopancreatography (ERCP) in 5.7% and postoperative in 2.8% of the patients. The median delay from admission to hospital to operation was only one (mean 1.9; range 0-10) day. The operative technique consisted of careful debridement of necrotic tissue and continuous high volume lesser sac lavage. The overall mortality was 8.6% (3/35) and morbidity 68.6% (24/35). The low overall mortality rate in necrotizing pancreatitis in this retrospective study supports our concept that our operative technique is effective and early operative intervention is justified in the treatment of necrotizing pancreatitis even if there may have been some unnecessary laparotomies.

99m-technetium-HmPAO-labelled leucocytes in the diagnosis of acute colonic diverticulitis.

Eighteen patients with abdominal symptoms clinically resembling acute colonic diverticulitis were studied with 99mTc-labelled leucocytes on average 5 days after the onset of symptoms. The diagnosis of diverticular disease was confirmed in all cases by means of barium enema or sigmoidoscopy. The leucocyte scan was positive in 13 patients, nonspecific in four and unclear in one patient. The diagnostic possibilities in acute colonic diverticulitis are discussed.

The effect of gabexate mesilate on the outcome of acute hemorrhagic pancreatitis in pigs.

The effects of gabexate mesilate (GM) on hemodynamics and phospholipase A2 activities (PLA2) during acute hemorrhagic pancreatitis (AHP) were studied in 17 piglets which were randomly divided into three groups: The control group (CG) received only the fluid replacement, whereas the pretreatment group (PG) was given an infusion of GM (20 mg/kg/5h), which was started 30 min before and in the treatment group (TG) 30 min after the induction of AHP. AHP was induced by infusing a mixture of trypsin and sodiumtaurocholate (1 ml/kg) into the pancreatic duct, and the animals were followed up for 5h. Two animals of the CG died, but no mortality was observed in the other groups. Histologically, acute hemorrhagic pancreatitis was detected in all animals, but no significant differences were observed between the groups. PLA2 activity in the serum increased rapidly after the induction of AHP in the CG, and it was significantly (P less than 0.05) higher 5h after the induction in the CG than in TG or PG. No significant differences developed between the groups in cardiac indices or hemodynamic pressure parameters during the 5h of surveillance, but the volume of secreted exudate into the peritoneal cavity was significantly (P less than 0.05) smaller in the PG than in the CG. In conclusion, GM treatment and pretreatment reduced mortality and the amount of the secreted ascitic fluid during AHP. Moreover, the activity of circulating PLA2 was inhibited in the groups receiving GM.

Early assessment of amputation level in frostbite by 99mTc-pertechnetate scan. Case report.

The assessment of amputation level in frostbite is a clinical problem. A simple 99mTc-pertechnetate scan offers useful possibilities for this purpose. Experience of the method is presented.

The use of resorbable polyglycolic acid mesh in the treatment of splenic injuries--a report of two cases.

The use of resorbable polyglycolic acid mesh in the treatment of splenic injuries offers an alternative in conservative splenic surgery. We report on two patients who were successfully treated with polyglycolic acid mesh for Grade III splenic injuries and discuss the difficulties in surgical techniques when trying to avoid splenectomy in splenic injuries.