Biomedical subjects
Publications and source records attributed to M Dintsman.
Two cases are presented demonstrating that the differentiation of gastric pseudolymphoma from lymphoma often cannot be made solely on the basis of the clinical, radiological, endoscopic, or even pathological picture but may be resolved by immunohistological staining for lymphocyte markers.
Two methods for the preservation of splenic function following trauma to the spleen were studied and compared in dogs and puppies. One method was splenectomy and autotransplantation of small pieces of splenic tissue, and the other--ligation of the main branches of the splenic artery after partial splenectomy. Dogs subjected to splenectomy alone or laparotomy alone served as controls. Splenic function was assessed on the basis of resistance to sepsis by virulent pneumococci. Cultures were obtained from the blood, peritoneal fluid and intraabdominal organs 3 days after i.v. injection of the pneumococci; none of the adult dogs in any of the groups had positive cultures. Among splenectomized puppies, 55.5% had positive cultures for pneumococci, whereas those which underwent ligation of the splenic artery and partial splenectomy had negative cultures. Microscopic examination of the autotransplants revealed loss of the characteristic structure of splenic tissue, whereas in the dogs in which the splenic artery had been ligated, the spleen showed numerous islands of tissue with well-preserved follicular structure. We suggest that in children with severe splenic trauma, ligation of the splenic artery may provide a promising alternative to splenectomy.
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A patient with spontaneous rupture of the stomach, treated successfully by a proximal gastrectomy, is described. The probable cause of the rupture was the ingestion of a large meal accompanied by functional blockage of the normal gastric outlets. Only immediate surgical intervention can reduce the high mortality rate associated with this rare condition.
Two patients with tuberculous peritonitis are described to exemplify some of the diagnostic problems that may be encountered in this rare disease. Both presented with fever, abdominal pain and a deterioration in their general condition. In both cases Ziehl-Neelsen staining and animal inoculation were negative. In the first patient, who underwent repeated hospitalization and investigation, the diagnosis was established following a therapeutic trial with antituberculous drugs administered after unsuccessful treatment of a cecocutaneous fistula that developed after drainage of a periappendicular abscess and appendectomy. In the second patient, the diagnosis was confirmed at laparatomy. Since bacteriological studies often fail to render a positive diagnosis, it is suggested that the clinical picture together with a histological finding compatible with tuberculous peritonitis should be sufficient for diagnosis and the institution of treatment.
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A sixty-seven-year-old man found to have a seminoma of an undescended intra-abdominal testis is believed to be the oldest reported patient with this presentation. This case emphasizes the importance of careful palpation of the testis as part of the routine physical examination at any age. Testicular tumor or metastases should be included in the differential diagnosis of retroperitoneal mass.
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A prospective clinicobacteriological study was undertaken in 100 patients undergoing biliary surgery, to assess the influence on the postoperative course of early antibiotic treatment that was instituted in accordance with the results of intraoperative Gram's staining of gallbladder bile. The wound infection rate was found to be 9% and there wee no other septic complications. The sensitivity of Gram's staining as compared with the results of bile cultures was found to be 65.5%. This study provides additional evidence of the value of Gram's staining of bile as a means for the early discovery of pathogens and early institution of antibiotic therapy, both important factors in lowering the rate of infective postoperative complications.
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