Catheter blockage in patients receiving long-term parenteral nutrition with fat-containing total nutrient admixture (TNA) is a relatively common complication. A study was carried out to characterize the material which is filtered out of the TNA and is a potential cause of catheter blockage. A total of 45 bags containing the same TNA solution were stored for 7 days at 4 degrees C. The stability of the solution in all the bags was then confirmed by light microscope and Coulter Counter, to determine the particle-size distribution, following which the solution was filtered through a 5-microns filter. Chemical analysis was then made to determine the amount of solid particles, fat and precipitates of Mg, Zn, Ca, Na, and K in the filter contents. Each bag was found to contain 7326 +/- 2681 solid particles as plasticizers and the main component of the filter contents was fat (99.4%) whereas electrolytes as precipitates constituted less than 0.5%. The amount of fat and electrolytes lost on the filter from the solution was negligible. Our analysis of the material trapped on the filter, which may block the catheter during long-term therapy, suggests the importance of filtration and of finding a means for dissolving the fat, the main component of the filter material.

Catheterization, Peripheral↗

PubMedDate not supplied

Lymphocyte subpopulation before and after operation in patients with benign vs malignant breast disease.

Multiple parameters of immune function were measured serially before and one and five weeks following operation in 14 patients with fibrocystic disease of the breast (Group A) and in 20 patients with stage 1-2 infiltrating duct carcinoma (Group B). These parameters included the following: WBC, total number and percentage of lymphocytes, numbers of B cells, T cells, T-active, T-helper and T-suppressor cells and the ratio between the latter as well as spontaneous suppressor or helper activity and the graft-versus-host reaction. Prior to operation no statistically significant difference was found between the two groups except for the number of T-helper cells, which was higher in Group B (p less than 0.05), and the spontaneous suppressor activity, which was higher in Group B (p less than 0.05). The finding of such a high percentage (80%) of negative graft-versus-host reactions five weeks after operation together with the high suppressor activity may indicate the presence of tumor micrometastases. The burden of surgery and general anesthesia was stronger in Group B, with a pronounced difference found between the groups (p = 0.0005), but the interaction between the influence of time (surgery and anesthesia) and the groups was not as great (p = 0.4864) and was found to be different for each group.

Breast Neoplasms↗

PubMedDate not supplied

Free perforation of small intestine in adults.

In a 14-year period 15 cases of free perforation of the small bowel in adults were treated in our department. In two patients perforation was caused by a foreign body and in six by each of the following: duplication of the small bowel, Hodgkin's lymphoma, vasculitis and steroid treatment, intussusception, adhesions, diverticulum. All patients presented with the signs of diffuse peritonitis. One patient died before surgery. Of the 14 patients operated upon, 10 underwent resection and primary anastomosis and four suturing of the perforation. In six cases the etiology remains unknown even after surgical intervention and pathological examination. The mortality rate of the 14 operated patients was 7.1%. 78.5% of the patients were operated on within 24 hours of onset of symptoms, and early surgery is considered to be the most important factor in the low mortality rate achieved in this series.

Abdomen↗

PubMedDate not supplied

Accessory adrenal: an incidental finding during orchiopexy.

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Adrenal Glands↗

PubMedDate not supplied

Upper gastrointestinal bleeding from uncommon causes in patients with concomitant peptic ulcer: a clinical, diagnostic and therapeutic pitfall.

In the majority of cases, massivm a peptic ulcer arises from the ulcer. On rare occasions, the bleeding emanates from other sites in the gastrointestinal tract. Four patients, all of whom had suffered from peptic ulceration for lengthy periods, and who were referred to hospital with severe bleeding from sources other than peptic ulcer, are presented. This group of patients poses particular diagnostic and therapeutic problems, which are discussed. The need for performing emergency gastroscopy and/or selective angiography, in an attempt to localize the source of bleeding preoperatively, is stressed. In doing so, one is taking into consideration the many difficulties sometimes encountered during operation in locating a bleeding point in a bowel filled with blood clots. In those patients in whom the source of the hemorrhage cannot be ascertained, early surgical intervention is advised, because the bleeding may possibly be coming from a tumor of the small bowel.

Adult↗

PubMedDate not supplied