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At least 577 records · Page 32Linked to original sources
PubMed1980

Are nitrite and N-nitroso compounds in gastric juice risk factors for carcinoma in the operated stomach?

The concentration of nitrite and N-nitroso compounds was examined in the fasting gastric juice of 44 patients operated on for ulcer disease an average of 2.5 years previously and in 26 age-matched patients with healthy stomachs (controls). The concentration of nitrite and N-nitroso compounds in the gastric juice of the vagotomised patients did not differ from that of the controls. On the other hand, significant increases in nitrite concentrations were found in the gastric juice of patients managed by Billroth I or II procedures. The fraction of N-nitroso compounds was significantly increased only in the Billroth II resected stomach. These findings are relevant to the known cancer risk inherent in the gastric stump.

Bacteria↗
PubMed1984

Dissolution of biliary duct stones without papillotomy in a patient with Billroth II resection and Crohn's disease.

A patient with a Billroth II resection and Crohn's disease subsequently developed obstructive jaundice and biliary sepsis. Three hepatic duct stones were demonstrated by ERC. After overcoming the obstruction by means of temporary retrograde internal drainage, perfusion of glyceryl-1-monooctanoate-carnosine and bile-acid-EDTA solution (2) was combined with sucralfate instillation into the blind loop via a duodenal tube. During successful treatment of the cholangiolithiasis, no deterioration of Crohn's disease was seen. Secondary effects such as abdominal pain or diarrhoea, were treated symptomatically.

Aged↗
PubMed1980

Peritoneal lavage in penetrating thoracic trauma.

Fifty-one patients with penetrating wounds of the thorax at or below the 4th intercostal space were evaluated with peritoneal aspiration and lavage. Nineteen gunshot wound and 32 stab wounds were studied and there was a 22% incidence of diaphragmatic penetration and/or intra-abdominal injury. There were ten true positive and one false positive study. There were 39 true negative and one false negative lavage. Peritoneal aspiration and lavage is a test of high sensitivity (91%) and specificity (98%). It has proven to be a useful screening technique in patients with penetrating wounds of the thorax. Peritoneal aspiration and lavage identify the patients with diaphragmatic penetration and intra-abdominal injury and minimize negative exploration.

Abdominal Injuries↗
PubMed1985

Impalement injuries.

Impalement injuries are unusual, complex surgical problems. We present a case of impalement through the spine and abdomen, describe a two-team approach to operative extraction utilizing simultaneous laminectomy and laparotomy incisions, and outline the management of an infectious complication caused by unusual bacterial and fungal pathogens. General principles of management include: the impaling object must be stabilized and manipulation avoided during extrication and transport. Operative removal requires careful preplanning, and should be tailored to the specific presenting injuries, with early multispecialty involvement as necessary. Extensive exposure is mandatory and may be achieved through a variety of standard or unconventional incisions so as to permit extraction of the impaled object under direct vision. Meticulous care of the traumatic wound is necessary, and careful followup is required for recognition and early management of infectious complications.

Abdominal Injuries↗
PubMed2004

Local recurrence following surgical treatment for carcinoma of the lower rectum.

BACKGROUND: The present paper examines the local recurrence rate following surgical treatment for carcinoma of the lower rectum with principally blunt dissection directed at tumour-specific mesorectal excision (including total mesorectal excision when appropriate). METHODS: During the period April 1987-December 1999, 123 consecutive resections for carcinoma of the middle and distal thirds of the rectum were performed. The patients had low anterior resection, ultra low anterior resection or abdomino-perineal resection. Ninety-six eligible patients underwent curative resection. The mean follow-up period was 66.8 months +/-44.3 (range 3-176 months). Data were available on all patients having been prospectively registered and retrospectively collated and computer coded. RESULTS: The overall rate of local recurrence was 5.2% (four recurrences following ultra low anterior resection and one following abdomino-perineal resection. No local recurrence occurred after low anterior resections.). Local recurrences occurred between 16 and 52 months from the time of resection, and the cumulative risk of developing local recurrence at 5 years for all patients was 7.6%. The overall 5-year cancer specific survival of the 96 patients was 80.8%, and the overall probability of being disease free at 5 years, including both local and distal recurrence, was 71.8%. CONCLUSION: The results of the present series confirm the safety of careful blunt techniques combined with sharp dissection for rectal mobilization along fascial planes resulting in extraction of an oncologic package with tumour-specific mesorectal excision (or total mesorectal excision when appropriate).

Adenocarcinoma↗
PubMed2005

Duodenal perforation: an interesting case report.

We describe a young child presenting with vomiting and altered neurological status. An incidental finding of pneumoperitoneum on abdominal X-ray led to laparotomy and the discovery of a duodenal perforation. We describe the difficulties in making the diagnosis of duodenal perforation in children and some of the factors that led to the delay in diagnosis in this case.

Diagnosis, Differential↗
PubMed2002

Conclusions from a study of venous invasion in stage IV colorectal adenocarcinoma.

AIMS: Venous invasion is an established predictor of prognosis in colorectal cancer (CRC). The reported incidence of venous invasion in CRC specimens varies between 10% and 89.5%, mainly as a result of interobserver variability and differences in specimen processing (for example, staining with haematoxylin and eosin (H+E) alone versus the addition of an elastic fibre stain). This study was performed with three purposes in mind, namely: (1) To assess and compare the incidence of venous invasion diagnosed on H+E stained tissue versus tissue stained with both H+E and an elastic fibre stain. (2) To estimate the inherent false negative rate associated with the diagnosis of venous invasion by histopathological evaluation of resected CRC specimens. (3) To compare the resulting data regarding incidence, quantity, site, and type of venous invasion to the pertinent literature. METHODS: Venous invasion was assessed on sections from 81 CRCs resected from patients with synchronous distant metastases (hepatic and non-hepatic). Only stage IV tumours were studied for the following reasons: (1) it can be assumed that in all patients with distant haematogenous metastases venous invasion had occurred, thus enabling the false negative rate to be calculated; (2) there can be no dispute about the clinical relevance of the various characteristics of venous invasion identified in the tumours of patients with synchronous distant haematogenous metastases; and (3) to eliminate the effect of variance in tumour stage on the incidence of venous invasion. Initially, H+E stained sections were studied for venous invasion. Sections that were negative or questionable with regard to venous invasion were then stained with an elastic fibre stain, and a second search for venous invasion was carried out. Venous invasion was characterised by incidence, quantity, type, and site. The chi(2) test for independence was used to compare the incidence of venous invasion in colonic versus rectal and rectosigmoid primary tumours, and in patients with hepatic versus non-hepatic metastases. RESULTS: Venous invasion was identified in 42 (51.9%) (of the 81 specimens on H+E stained sections. The addition of the elastic fibre stain enabled the diagnosis of venous invasion in 15 (38.5%) of the remaining 39 specimens, increasing the overall incidence to 57 of 81 cases (70.4%). Of the 57 positive specimens, venous invasion was minimal in 27 (47.4%), intermediate in five, (8.8%) and massive in 25 (43.9%). Only intramural veins were involved in 18 (31.6%), only extramural veins in 26 (45.6%), and both intramural and extramural veins in 13 (22.8%) of the 57 positive specimens. The filling type of venous invasion was found in 41 (71.9%), the floating type in 28 (49.1%), and the infiltrating type in six (10.5%) of the 57 positive specimens. There was no significant difference between the incidence of venous invasion in the colon (42 of 60; 70%) versus rectal and rectosigmoid tumours (15 of 21; 71.4%; p = 0.8539), nor in the incidence of venous invasion in patients with hepatic (49 of 70; 70%) versus non-hepatic (eight of 11; 72.7%) metastases (p = 0.9018). CONCLUSIONS: The addition of an elastic fibre stain enables the identification of venous invasion in a considerable proportion of sections from CRC tumours that are falsely negative for venous invasion on H+E stain alone. The inherent chance of missing venous invasion on histopathological evaluation of CRC tumours stained with H+E and elastic fibre stains is at least 10.5%, and may be as high as 29.6%. In a large proportion of stage IV CRCs, despite the presence of synchronous distant metastases, only a minimal extent of venous invasion (that is, one to two involved veins) is demonstrable in the primary tumour. This suggests that only minimal venous invasion is required for the seeding of clinically relevant haematogenous metastases, and emphasises the careful, dedicated search for venous invasion that is required from the pathologist. Although extramural venous invasion was predominant in stage IV CRCs, in a considerable proportion of tumours (about a third) only intramural venous invasion was found. This suggests that intramural venous invasion may also seed clinically relevant haematogenous metastases, and should therefore also be considered as an indicator of poor prognosis.

Adenocarcinoma↗