Primary human tumor cells and continuous cell lines differ in clonal growth in soft agar.

This study is a sequel in our continuing efforts to improve the colony forming efficiency of the Human Tumor Colony Assay. We have previously reported that the use of culture media supplemented with rat red blood cells and a low oxygen environment resulted in notable improvements in the clonal growth of three different tumor cell lines (colon, breast and melanoma). We now report, however, that the application of these methods to cells from 18 different samples of primary human tumors resulted in no improvements in growth. Our results suggest that caution must be exercised in extrapolating results obtained from the use of homogeneous cell lines to that of cells from human solid tumors.

Crohn's disease in the elderly.

Surgical procedures for Crohn's disease of the small intestine, colon, or rectum were performed in 25 patients who were 65 years of age or older. In elderly patients with primarily small-bowel disease, good results were obtained uniformly by ileal resection and primary intestinal anastomosis. In 15 patients, Crohn's disease involved primarily the large intestine. Subtotal abdominal colectomy with end ileostomy restored health and permitted weight gain in six patients, although three required subsequent proctosigmoidectomy for recurrent rectal symptoms (average interval--18 months). Four patients underwent one-stage proctocolectomy, with one postoperative death and delayed healing of the perineal wound in the three survivors. Major complications frequently followed surgical procedures for suspected sigmoid diverticulitis in elderly patients with unrecognized Crohn's disease of the colon.

Cholelithiasis and cholecystitis in children after repair of congenital duodenal anomalies.

Duodenal surgery, particularly the correction of duodenal anomalies, may be associated with an increased incidence of subsequent cholelithiasis and cholecystitis in children. We review the case histories of two children. Each child experienced acute cholecystitis with gallstones nine years after the correction of duodenal anomalies (annular pancreas, duodenal stenosis) in the neonatal period. At reoperation, intense fibrosis was noted in the hepatoduodenal area, while cholangiography demonstrated abnormalities of the common hepatic and common bile ducts. These cases suggest that the correction of duodenal anomalies may favor the subsequent development of gallstones in children. Fibrosis may have compressed the common bile duct, with stasis permitting gallstone formation. Intrinsic bile duct abnormalities, which may accompany duodenal anomalies, could also play a role. Thus, a history of previous duodenal surgery in a child with abdominal pain may strengthen a tentative diagnosis of cholecystitis. Also, at the time of exploration, the surgeon should be alert to the possibility of biliary tract abnormalities.

Bacterial peritonitis in patients with ventriculoperitoneal shunt.

Bacterial peritonitis is an unusual complication of ventriculoperitoneal (VP) shunt for hydrocephalus. This complication, usually associated with peritoneal cysts of perforated viscus, may occur as the first manifestation of shunt infection. Early recognition of this form of bacterial peritonitis and appropriate antibiotic therapy may avert major abdominal surgery in selected cases.

Leg ischemia following surgery for abdominal aortic aneurysm.

Resection of an abdominal aortic aneurysm was associated with intraoperative or postoperative leg ischemia in seven of 100 consecutive survivors of this procedure. Distal embolization of thrombus and debris is the apparent cause in the majority of cases (six). One case of stenosis at a graft-to-vessel anastomosis was identified. Early (intraoperative) thromboembolectomy averted tissue loss in four cases. The role of concurrent lumbar sympathectomy in ameliorating ischemic tissue loss is evaluated. Postaneurysmectomy leg ischemia may accompany other serious complications, particularly hypotension and renal failure.

Injury to the portal vein: a hazard during common bile duct exploration.

Portal vein injury is an unusual but dramatic complication of biliary surgery. Unlike major arterial injury, this complication may, in carefully selected cases, be managed successfully without primary repair.