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Three patients with appendicitis were seen with bladder tumor, hematuria, and pelvic mass with ureteral obstruction, respectively. These cases represent a spectrum of difficult diagnostic problems and illustrate that appendiceal abscess involving the urinary tract may present as urologic disease. Thus, it is important to consider appendicitis in the differential diagnosis.
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OBJECTIVE: To determine the pathological classification and the clinical characteristics of intestinal duplication. METHODS: Eighty-four pediatric patients with intestinal duplication were proved on operation in the last 20 years in the Second Hospital of Harbin Medical University and Harbin Children's Hospital. The pathological classifications were as follows: enteral septum type (2), parietal cyst type (9), parenteral canal type (31), parenteral cyst type (35), and solitary type (1). The clinical presentations and complications included: abdominal mass (24), illius (41), hemorrhage of digestive tract (15) and intestinal perforation with peritonitis (3). Two asymptomatic cases were discovered incidentally. RESULTS: Among the 84 patients, 82 healed, 1 newborn complicated by intestinal fistula died of septicemia, and the other one died of toxic shock. CONCLUSIONS: Recognizing the pathological types, common presentations and complications, and applying the corresponding examination methods timely, doctors may improve the diagnostic accuracy.
The clinical and radiological features of seven patients presenting with cholecystocolic fistulae are reviewed. The majority of the patients were elderly (age range 43-85 years, mean 70.7 years) and there was a female preponderance (6:1). The condition usually has a benign clinical course. Diarrhoea was the most common presenting symptom and the typical clinical features of gallbladder disease were absent. Cholangitis occurred in only one patient. The time between onset of symptoms and diagnosis varied from 1 week to 2 years (mean 22 weeks). In only one patient was the diagnosis of biliary-intestinal fistula suspected on the basis of the plain abdominal radiograph (Case 5). A diagnosis of cholecystocolic fistula was established by barium enema (5 cases), endoscopic retrograde cholangiopancreatography (ERCP) (1 case) and diagnostic laparotomy (1 case). The only cause identified in this series was acute or chronic cholecystitis.
BACKGROUND: Early enteral feeding (EF) may result in fever, elevated white blood cell count, increased serum levels of liver enzymes, and diarrhea. We name the complications "enteral refeeding syndrome", as a subtype of refeeding syndrome, because they are likely to result from long-term lack of lumen nutrition. The aim of this study was to investigate the characteristics of enteral refeeding syndrome after long-term total parenteral nutrition (TPN), and the solution for the disease. METHODS: We collected the clinical data of 100 patients with gastrointestinal fistula, who were cured from Apirl 2001 to July 2002. Their fasting time, daily stool frequency, body temperature, heart rate, respiratory rate, levels of transaminases, alkaline phosphatase (AKP), and gamma-glutamylcyclotransferase (gamma-GT), white blood cell count, and systemic inflammatory reaction syndrome (SIRS) score were recorded before and 1, 3, 5, 10, and 15 days after EF. Student's t test and analysis of variance were used to analyze the data. RESULTS: Of the 100 patients, 56 were cured after selective resection of intestinal fistula, 15 were cured by emergency operation, and 29 recovered spontaneously. The levels of AKP and gamma-GT increased significantly on the 3rd day after EF [On the 3rd day after EF, (243.0 +/- 121.6) U/L and (177.2 +/- 109.9) U/L vs. before EF (181.5 +/- 127.5) U/L and (118.4 +/- 94.2) U/L, P < 0.05], and decreased gradually afterwards. The SIRS scores on the 1st day (1.05 +/- 1.08) and 3rd day (0.96 +/- 1.11) after EF were significantly higher than that before EF (0.72 +/- 0.84), then decreased to 0.83 +/- 0.91, 0.49 +/- 0.73 and 0.32 +/- 0.60 on the 5th, 10th and 15th days after EF. The number of patients with diarrhea at 1, 3, 5, 10 and 15 days post-EF were 31, 26, 12, 13, and 7, respectively. CONCLUSIONS: The longer the TPN lasts, the more severe the enteral refeeding syndrome becomes. Continuous EF is effective for the syndrome. Early enteral nutrition is useful in preventing it.
Nineteen patients (11 women and eight men) aged 20-68 received long-term parenteral nutrition, mostly at home, for six to 63 months (mean 19 months). Indications for LTPN were extensive, active Crohn's disease in three patients, intestinocutaneous fistulas in three, and short-bowel syndrome in the remaining 13 patients. Subclavian or intra-atrial (Broviac) catheters were most commonly used, for which the average life was four and seven months respectively. Complications of long-term parenteral nutrition included pneumothorax in four out of 48 subclavian vein punctures. Catheter-induced thrombosis of central veins was shown by phlebography 17 times in nine patients, and eight episodes of total occlusion occurred. Two of these patients had pulmonary infarction. Nineteen episodes of catheter sepsis occurred in 11 patients, but only one was fatal. Complications related to intestinal disease included intra-abdominal abscesses and intestinal fistulas, and disturbances of liver function. Five patients died, though in only two was death related to long-term parenteral nutrition. One of these patients died from catheter sepsis, the other had subdural haematoma possibly caused by anticoagulant treatment. Eight of the 14 surviving patients still needed parenteral nutrition. All received a disability pension, but six had an acceptable quality of life with almost normal social activities.Despite problems such as difficulties in maintaining standardised infusion programmes, it was concluded that long-term parenteral nutrition at home is practicable and consistent with an acceptable quality of life.
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The absorption of emulsion of soybean oil, soybean oil and molted butter was compared with that of the Intralipid preparation manufactured by Vitrum. The experiments were carried out on a dog and rats using the method of isolated intestinal fistulae. It was found that the emulsion of soybean oil prepared by the authors was absorbed in a degree similar to that of Intralipid fat emulsion and that it could be used as a component of a preparation intended for balanced non-residual intraintestinal nutrition.
Previously, we demonstrated that the hydrophobic surfactant Pluronic L-81 (L-81) inhibits the intestinal formation and transport of chylomicrons (CM) but not of very low-density lipoprotein-sized (VLDL) particles. The present study was undertaken to determine whether infusion of egg lecithin results mainly in secretion of VLDL by the small intestine and whether L-81 has any effect on their formation and secretion. Intestinal fistula rats were infused intraduodenally at a rate of 3 ml/h with a lipid emulsion containing 20 mM egg lecithin and 19 mM sodium taurocholate for 8 h. This was then followed by another 8 h of infusion of a similar lipid emulsion but with 0.5 mg/h of L-81 added. Lymphatic lipid output was measured, and lymph lipoproteins were sized by use of electron microscopy. Whether L-81 was present or not, no significant difference was detected in the lymphatic triglyceride, phospholipid, or cholesterol outputs. Based on agarose gel electrophoresis, sizing of intestinal lymph lipoproteins, and also the determination of lipid in the intestinal lymph CM and VLDL as separated by ultracentrifugation, VLDL were the major lipoproteins present in lymph during the infusion of egg lecithin. Thus, intraduodenal infusion of egg lecithin in the rat results mainly in the transport of VLDL and is not affected by the administration of L-81. The results suggest that CM and VLDL are assembled separately by the enterocytes and indicate the usefulness of L-81 in further investigating the pathways and regulation of intestinal lipoprotein synthesis, assembly, and secretion.
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Two hundred and thirteen ileal pouch-anal anastomoses were performed in Switzerland from August 1980 to December 1991, 174 (82%) of them in 7 centres. One hundred and sixty four patients (77%) were operated for ulcerative colitis, 47 (22%) for familial polyposis and 2 others (1%) for another reason. A J pouch was created in 176 cases (83%), an S pouch in 35 cases (16%) and a W pouch in 2 cases (1%). Detailed results were available for 157 (74%) of the 213 operated patients: 81 females (52%) and 76 males (48%) with a mean age of 33.5 years (10-65). One hundred and twenty seven patients (81%) were operated for ulcerative colitis, including 42 as an emergency, and 30 (19%) for familial polyposis. One hundred patients (64%) developed complications which required one or several reoperations (laparotomy and/or perineal operation) in 64 cases (41%). Pouchitis was the most frequent complication (19%). Small bowel obstruction and pelvic abscess secondary to an anastomotic leak were the complications most frequently requiring second laparotomy with an incidence of 13% and 11%, respectively. The mean number of stools per 24 hours was 5.5 (2 to 14). 27% of patients passed one or several nocturnal stools every night, 27% occasionally, and 46% never. Occasional faecal incontinence was reported by 8 patients (6%) and 4 patients (3%) reported uncontrollable urgency. Nine patients retained a permanent ileostomy (failure rate: 6%).