Biomedical subjects
Publications and source records attributed to C H Dejong.
A case of bilateral simultaneous rupture of the patellar tendon due to apicitis patellae is presented. Clinical picture, diagnosis, pathogenesis and treatment are discussed. In addition, the literature on the subject is reviewed.
Two cases of intra-uterine testicular torsion of the intravaginal type are presented. Orchiectomy of the affected testicle and contralateral orchidopexy were performed in both cases, followed by an uneventful postoperative course. Classification, clinical presentation, pathogenesis and treatment are discussed.
Glutamine serves as a shuttle of useful nontoxic nitrogen, supplying nitrogen from glutamine-producing (eg, muscle) to glutamine-consuming tissues. True production rates of glutamine are difficult to measure, but probably are less than 60 to 100 g/d for a 70-kg man. During catabolic stress increased amounts of glutamine are released from muscle, consisting of protein derived glutamine, newly synthesized glutamine, and glutamine losses from the intramuscular free pool. The large and rapid losses of free muscle glutamine are difficult to restore, presumably as a result of disturbances in the Na+ electrochemical gradient across the cell membrane. Whereas increased amounts of glutamine are released from muscle, glutamine consumption by the immune system (liver, spleen) also is enhanced. Thus, during catabolic stress changes occur in the flow of glutamine between organs. These changes are not necessarily reflected by alterations in the whole-body appearance rate of glutamine. In contrast with the gut, where glutamine is taken up in a concentration dependent manner, the immune system actively takes up glutamine despite decreased plasma concentrations. Supplementation with glutamine influences uptake by both the gut and the immune system, as evidenced by increased mucosal glutamine concentrations and gut glutathione production. There is evidence suggesting that this improves gut barrier function. Although the benefit of glutamine supplementation is most evident from experimental studies, clinical studies on the effect of glutamine do exist and suggest that glutamine supplementation has beneficial effects with regard to patient outcome.
Two cases of primary adenocarcinoma of the appendix are reported. Both patients presented with a clinical picture resembling acute appendicitis. One case was complicated by a pseudomyxoma peritonei. The other patient additionally had several colonic adenomatous polyps and a malignant neoplasm of the ascending colon. Primary adenocarcinoma of the appendix is rare and only some 250 cases have been reported. It usually presents as acute appendicitis in the 6th or the 7th decade. Prognosis and histology closely resemble that of colonic adenocarcinoma. Resection of the ileocecal segment is the first choice treatment in all stages except Dukes A. In Dukes A appendectomy alone is sufficient treatment. After ileocecal resection the 5 year survival is better than after appendectomy alone for Dukes' stages B and C. Clinical presentation and treatment of the adenocarcinoma and a remarkable complication, the pseudomyxoma peritonei, will be discussed.
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