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PubMed1987

[Blunt abdominal trauma caused by child abuse].

We report about 3 boys under 4 years of age with abdominal blunt trauma following child abuse admitted to our clinic with different diagnoses. Common were fresh or older haematomas, burn wounds, for which the parents had no plausible explanation. The children had no skeletal or intracranial lesions, but they developed abdominal pain, which became worse in the absence of the parents. X-ray and the clinical course lead us to laparatomy. In all cases we found lesions of the intestines, especially near the duodenojejunal flexure, hepatoduodenal ligament, root of the mesentery, mesocolon and retroperitoneum, in one case a pancrease rupture. All these lesions were caused by child abuse. We want to point out the problem in the diagnosis of battered child syndrome, especially of the abdominal blunt trauma.

Abdominal Injuries↗
PubMed1979

Blood coagulation abnormalities in the Schönlein-Henoch syndrome in adults.

23 adult patients with Schönlein-Henoch's syndrome were observed between 1965 and 1976. Nephropathy was noted in 18, gastrointestinal bleedings in 13, thrombosis of legs in 4, cases. Haemostasis was studied in the successive phases of the process on 185 occasions altogether. The studies included four different capillary tests, thromboelastography, the Gerendás coagulogram, determination of partial thromboplastin time and two platelet-function tests. Additional renal biopsy was performed in 10 cases, mesocolon and skin biopsy in one case each. The results of at least one of the capillary tests were found positive in each of the patients in some stage of the process. The coagulation status was marked by hyperocagulability either in itself or combined with laboratory signs of hypocoagulability. Immunohistological study of the biopsy specimens revealed glomerular fibrin deposits in 7 cases. On the evidence of the follow-up studies the laboratory tests may be used for the assessment of the activity of the process. The alternatives of local intravascular coagulation (LIC) or of compensated diffuse intravascular coagulation (DIC) are offered for the interpretation of hypercoagulability.

Adolescent↗
PubMed1985

[Ganglioneuromatosis with carcinoid foci in the large bowel].

A rare case of a 27-year-old man who suffered from ganglioneuromatosis with five carcinoid foci arising from the colon and underwent subtotal colectomy is reported. There was no malignancy. The tumors extended to the mucosa and/or submucosa, and in most parts, tumors created polypoid lesions protruding into the intestinal lumen. In the rectum the tumors showed circumscribed extension around the wall. In the sigmoid and descending colon, polypoid lesions were seen on the side opposite from the attachment line of the mesocolon. In one of five carcinoid foci, a transitional pattern between carcinoid and neuroma was investigated.

Adult↗
PubMedDate not supplied

[Postoperative pancreatic fistulas: clinical study of a series of 114 consecutive cephalic duodeno-pancreatectomies].

The present study explores the incidence, the predisposing factors and the consequences of pancreatic fistulae in a series of 114 consecutive, non selected, pancreatico-duodenal resections performed during the period January 1967-December 1982 for malignant and benign diseases of the (peri)ampullary region and the head of the pancreas. Overall hospital mortality reached 10.8% (12/114 pat.). The most common surgical complication was pancreatic fistula (17 pat.-14.9%) responsible for half of the postoperative fatal outcomes. The incidence of the pancreatic fistula is significantly influenced by a patient age of over 65 years, a preoperative serum bilirubin level exceeding 6 mg %, urgent degree of the intervention, presence of a renal insufficiency and last but not least by the poor quality of the pancreatic remnant. As surgical treatment of this complication is compromised by a high mortality (40% - 4/10 pat.), surgery should be reserved to hemorrhagic or persistent local or systemic, septic complications. Therefore more attention should be given to the prevention of this complication by a careful patient selection, based on evaluation of the different mentioned risk factors and by an adequate technique based on a separation of the different anastomoses by the greater omentum and the transverse mesocolon.

Adolescent↗
PubMed1985

Sigmoid volvulus in children.

Volvulus of the sigmoid colon is rare in children. The authors have reviewed a total of 29 cases, including five from our institution. The most common clinical picture is crampy abdominal pain and abdominal distention. In contrast to adults, in children plain abdominal films will often not yield a diagnosis. Barium enema examination can be done to locate the obstruction. Nonoperative reduction was successful in 27 per cent of all reported cases, while operative treatment was necessary in 69 per cent of pediatric patients reported. Recurrence following derotation by any means was rare. However, adequate long-time follow-up is lacking. From available data, it seems that in most cases resection is not necessary. Primary resection may be indicated for recurrence or if the bowel is compromised. Mortality was 14 per cent, occurring in poor risk patients, the very young, and patients with associated anomalies. A redundant sigmoid may undergo intermittent torsion over a period of years, making diagnosis difficult. At laparotomy, these patients have scarred striae on the sigmoid mesocolon.

Adolescent↗
PubMed1969

An attempt to experimentally produce edema disease in swine by oral administration of escherichia coli serotype O139:K82:H1.

Diarrhea, reduced appetite, and nervousness were observed following oral exposure of six pigs to freeze-thaw extract and living culture of E. coli strain 0139:K82:H1. The most significance gross change was the appearance of subserosal edema of the mesentry, especially of the mesocolon. Histological findings included perivascular edema of the brain and reticulum cells as well as lymphocytic aggregates in the renal cortex simulating early neoplasia. Edema of the submucosa of gallbladder, the duodenum, the spiral colon and the fundic stomach as well as the lymph nodes was also observed. The syndrome which was produced resembled, in many aspects, edema disease although some complicating factors were ob-

Animals↗
PubMed1977

[The functionally defective Roux Y-loop in biliodigestive anastomoses].

In comparison to common radiologic methods hepato-biliary sequential scintigraphy proves superior in the investigation of the choledocho-(hepatico-)jejunostomy Roux-en-Y. The functional behavior of the jejunal-(Roux-en-Y-) loop is demonstrated. After biliary-intestinal anastomoses, 15 healthy patients showed normal dynamic studies with unimpeded bile passage. Hypotonic loops with intrahepatic bile stasis responsible for cholangitis were seen in 2 patients. A strangulation phenomenon on the level of the mesocolon hiatus responsible for upper abdominal pain is demonstrated in one case.

Bile↗
PubMed1984

[The lung in peritonitis. Contribution of data processing to the evaluation of pulmonary risk: practical conclusions].

A retrospective study of 99 case-reports of patients with generalized peritonitis, including 38 postoperative cases involving peritoneum and lungs, was conducted with the aid of two files based on documented data containing 168 and 204 analytical criteria respectively. Data processing and statistical analysis alone were capable of establishing possible relationships between isolated or associated peritoneal factors and respiratory manifestations. Out of the vast quantity of data obtained by using this new approach, only factors significantly affecting pulmonary complications were retained: some relations could not be established because of the small number of patients studied. Respiratory complications were frequent (60%) and severe (58% mortality). They occurred in 96% of postoperative peritonitis cases, with 77% of deaths, and in 44% of primary peritonitis cases, with 36% of deaths. In contrast, when absent the mortality is reduced to 4%. Frequency distribution of clinical signs, pulmonary radiological images and the effects of gasometry are analyzed. Obstruction is a frequent and early symptom. The presence of bilateral diffuse lung shadows and their shunt effect are narrowly correlated with the presence of postoperative peritonitis. Respiratory complications were correlated with peritonitis criteria, particularly with age, the sub-mesocolon origin of the peritonitis, the rapidity of operative intervention, and surgical excision rather than shunt formation or suturing, and to the development of criteria of repeat abdominal or extra-abdominal surgery. Initial antibiotherapy and digestive suction have, on the contrary, no effect. Many other criteria were studied. A "profit" of patients liable to develop these complication is described, the mechanisms outlined, and the means of prevention and of rapid detection discussed, particularly the important role played by early gasometry.

Bacterial Infections↗
PubMed1978

[Carcinomas of the transverse colon. A series of 75 cases (author's transl)].

The authors report a series of 75 cases of carcinoma of the transverse colon, involving equally the right and left halves. They rarely arose from the middle segment (10% of the series). Usually the tumour was very large affecting the serous layer with lymph node invasion. Liver metastases were frequent. 50% of patients were aged over 70 years. Theoretically, wide removal attempting to cure the disease means removing both colonic angles and the areas supplied by both the superior and inferior mesenteric arteries. But fairly often the existence of vascular variations in the transverse mesocolon permits one to restrict the extent of the resection whilst saving the basic principles of radical removal. Furthermore, in 20% the treatment was purely palliative. The operative mortality was high (25%). The five year survival, in the whole series was about 50%.

Aged↗
PubMed1983

[Extracolonic-infiltrative process of the sigmoid colon and the rectosigmoid junction].

The problems of extracolic-infiltrative lesions of the sigmoid colon and recto-sigmoid junction are discussed, based on representative case studies. Because of the localisation of these bowel segments in the lower peritoneal cavity, they can be reached by direct infiltration of contiguous tumors--especially carcinoma of the ovary--or by seeding into the pouch of Douglas and the sigmoid mesocolon. In many cases characteristic roentgen-morphologic features indicate a secondary infiltration, but inflammatory and malignant lesions have to be differentiated. The differential-diagnosis must consider also diverticulitis, endometriosis and extracolic growth of colonic carcinoma. Additional ultrasonography and computed tomography may help to clear topographical relations and to detect direct and indirect signs of peritoneal carcinomatosis and abscess.

Adenocarcinoma↗
PubMed1978

[Revascularisation of the arteries of the digestive tract by retrosternal bypass from the left subclavian artery (author's transl)].

This technique of revascularisation of the digestive arteries is suggested when the infrarenal aorta cannot be used. The hepatic artery is reimplanted in the coeliac region. The vein graft is passed in the root of the transverse mesocolon and anastomosed with the superior mesenteric artery. The subclavian artery, frequently used in the revascularisation of the neck vessels, was felt to be preferable to the axillary artery. Passage of the graft retrosternally avoids any kinking or compression in the abdominal wall. The patient's own saphenous vein is the most suitable material. If this is not possible, a varicosity preserved by cold was felt to be preferable to a dacron tube.

Aged↗
PubMed1978

[Anatomical basis of abdominal cavity radiology (author's transl)].

The interpretation of the blank abdominal roentgenogram is made easier by the knowledge of radiological aspects of limits between peritoneal and retroperitoneal compartments. This knowledge rests on the images, often faintly contrasted, provided by ligaments, mesotheria, fascias and boundary muscles defined by opposition to the fatty layers that frequently stress their contours. In this work, we have defined the inferior (pelvis) and lateral (paracolic sinuses) contours of the abdominal cavity, some singularities of the compartments above and below the mesocolon and also mesenteric connexions. The importance of these structures for differential diagnosis of fluid or gas collections and abscesses (origin, location, propagation) is illustrated. The normal and pathological radiological aspects of the three retroperitoneal compartments (perirenal, pararenal anterior and posterior) and their projection area on the film were demonstrated. As the radiological demonstration of all these structures depends on the conditions of the investigation, we have tried with a material comprising 300 cases, to define the technical conditions and plan of observation that appear most favorable.

Abdomen, Acute↗
PubMed1983

Intra-abdominal lymphangiectatic cysts: an uncommon abdominal lesion in children and young adults.

Three patients with intra-abdominal lymphangiectatic cysts, with details of their clinical radiologic, and pathologic findings, provide examples of the diverse and confusing clinical manifestations of this uncommon lesion. Their diversity is largely the result of their variable size and location within the mesentery, omentum, or mesocolon. Radiologic examination provides the greatest aid in preoperative diagnosis, and is useful in differentiation from ascites and other abdominal lesions. The characteristic histologic appearance of lymphangiectatic cysts provides their ultimate classification.

Adolescent↗
PubMed1981

Gastric adenocarcinoma: a comparison of the accuracy and economics of staging by computed tomography and surgery.

We studied a series of 22 patient with proven gastric adenocarcinoma who underwent upper gastrointestinal radiography, computed tomography, upper gastrointestinal endoscopy, and/or surgical exploration and resection. Based on the computed tomographic findings, gastric carcinoma was classified into one of four stages: stage 1, intraluminal masses without gastric wall thickening; stage 2, gastric wall thickening (> 1 cm) and exophytic masses; stage 3, gastric wall thickening and contiguous spread of tumor into adjacent organs such as the pancreas, spleen, liver, transverse mesocolon, or esophagus; and stage 4, gastric wall thickening with distant metastatic disease. The stage of gastric malignancy as determined by computed tomography was correlated with presenting symptoms, location of tumor, upper GI findings, endoscopy, and findings of surgical exploration. The cost and estimated initial saving realized by performing routine preoperative gastric computed tomographic examinations were analyzed. Our results indicated that computed tomographic staging of gastrointestinal malignancy correlated closely with surgical findings and compared with other modalities, local extension, regional adenopathy, and the size of the tumor mass were better evaluated by computed tomography. Computed tomographic staging of gastric tumors cost $7150 and resulted in an estimated initial savings of $35,000-$56,000. The results of this study indicated that computed tomography is an accurate, cost effective method of preoperatively staging gastric carcinoma, capable of providing staging information heretofore only available by surgical exploration.

Adenocarcinoma↗
PubMed1978

[Long-term transplantation of mature sensory neurons].

The spinal ganglia were transplanted into the mesocolon of adult cats for periods of from 1 day to 9 months. About 30% of differentiated sensory neurons survived during the longterm transplantation. The intensive regeneration of the sensory neurons processes was characteristic of the transplanted neurons. Total myelinization of the regenerating nerves occurred during the 3rd--5th month. Potential regeneration capacity of the differentiated neurons and possibly of their prolonged transplantation were revealed.

Animals↗
PubMed1982

[Tubular rectum and colon resection. A new operative method for the removal of large adenomas and low-risk carcinomas].

A new operative method for the removal of large sessile tubular or villous adenomas and small early carcinomas of the low risk type by a "tubular" colonic or rectal resection is described. The term "tubular" applies to a short segmental resection of the colon or rectum with complete preservation of the mesocolon or mesorectum and the marginal or superior hemorrhoidal artery. This tubular resection has been used by us since 1981 in 11 patients (7 adenomas, 3 adenocarcinomas and one carcinoid). There was no suture line leakage. No lethality and so far no recurrence. The advantages of this new operative technique over conventional methods are discussed in detail.

Adenocarcinoma↗
PubMed1981

[Histological studies of multiple subperitoneal nodules produced by prolonged administration of estrogen (author's transl)].

It has been reported that multiple peritoneal fibroids were produced in guinea pigs treated with large doses of estrogens, and the nodules regressed when the steroid stimulant was discontinued. Recently, these experimental nodules were considered to be simulating the disseminated pattern of Leiomyomatosis Peritonealis Disseminata (LPD). Although these experimental nodules were considered to be composed of fibroblasts by light-microscopic studies, LPD was verified to be composed of smooth muscle by electronmicroscopic studies. Therefore, it is indispensable to study these experimental nodules by electronmicroscopy, when we discuss about the similarities between experimental nodules and LPD. Guinea pigs were treated with various doses of estradiol benzoate (E) [40, 80, 100, 200 microgram/day, thrice a week, intramuscular injection]. After treatment for three months, every dose of E produced the lesions simulating the disseminated pattern of LPD: multiple nodules in various sizes, scattered on the surface of the uterine horn, peritoneum, spleen and pancreas, and in the omentum and mesocolon. Ultrastructurally, the nodules were composed of the cells resembling fibroblast. We conjectured that estrogen differentiates and proliferates the cells of the features of fibroblast-like cells from subcoelomic mesenchyme, resulting in the production of multiple superitoneal nodules simulating the disseminated pattern of LPD.

Animals↗