Two cases of ruptured splenic artery aneurysms with unusual clinical presentation are reported. In one case an inflammatory abdominal process was suspected, while in the other the operation was delayed by several hours due to the unexplained coma, high blood sugar levels and lack of signs of shock until an advanced stage of the disease. As there was no active bleeding during the operation, the presence of free blood in the abdomen and clots in the omentum provided the clue for localization of the source of the bleeding.

Abdomen, Acute↗

PubMedDate not supplied

Small for gestational age infants in pregnancies following jejunoileal bypass.

Two small for gestational age (SGA) infants resulting from pregnancies following jejunoileal bypass are described. Our two cases and five similar cases reported in medical literature are reviewed. It seems that SGA is the main problem in pregnancies following jejunoileal bypass. Adequate and careful monitoring of these pregnancies is advocated.

Adult↗

PubMedDate not supplied

Indications for exploration of the bile ducts.

A series of 477 choledochotomies for suspected choledocholithiasis is presented. The indications for exploration of the common bile duct are reviewed. Absolute indications are: palpable stones in the common bile duct, stones seen on intravenous cholangiography and jaundice during the operation. When there are only relative indications, an intraoperative pre-exploratory cholangiogram should be performed so that unnecessary exploration can be avoided.

Adolescent↗

PubMedDate not supplied

Rupture of an aortic abdominal aneurysm presenting as painful obstructive jaundice.

An unusual case of a ruptured abdominal aortic aneurysm is described. The patient presented with sudden abdominal pain and obstructive jaundice and was misdiagnosed as suffering from biliary colic. Two months later there was a pulsating mass in the abdomen palpated and the patient operated on. The only pathology which could explain the jaundice was an organized retroperitoneal hematoma extending from a small sealed rupture of the aneurysm towards the head of the pancreas and duodenum.

Aged↗

PubMedDate not supplied

The decisive role of fine needle aspiration cytology in the preoperative work-up of breast cancer.

During an 18-mo period, 760 palpable mammary lesions were examined and aspirated. When indicated, mammography was performed in addition. Three separate aspirations were performed in each lesion utilizing 23 gauge (0.6 mm) needles. Biopsies were performed following aspiration in 206 lesions; and 470 of the cases in whom biopsies were not performed were followed up clinically for periods of 10 to 26 mo (mean period 15 mo). Accuracy and sensitivity of the cytological examination were found to be far higher than that of clinical evaluation or mammography. Aspiration cytology resulted in only 1.5% false negative, no false positive, and only 1.65% inconclusive reports. On the other hand, clinical evaluation and mammography yielded 35 and 29% false negative, 0.3 and 0.8% false positive, and 6.75 and 8.8% inconclusive findings, respectively. Eleven malignant cases that were considered to be benign both clinically and mammographically, were correctly diagnosed cytologically. Aspiration cytology was found to be the most accurate of the preoperative diagnostic methods.

Biopsy, Needle↗

PubMedDate not supplied

Aortocaval fistula due to rupture of abdominal aortic aneurysm.

Two patients with spontaneous aortocaval fistula due to a ruptured aortic abdominal aneurysm are described. This accident is one of the rarest complications of such an aneurysm and is a severe surgical emergency with widely varying symptoms. Although its recognition should be obvious, it poses both diagnostic and therapeutic problems. One of our patients survived following 45 days of hemodialysis treatment.

Aged↗