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A sodium pertechnetate Tc 99m scan of the abdomen gave positive results in a 5-year-old girl with recurrent abdominal pain and lower gastrointestinal bleeding. An ileal duplication cyst lined by gastric mucosa was found at operation. Abnormal localization of sodium pertechnetate Tc 99m can be observed in any condition with ectopic gastric mucosa.
Until the turn of the 20th century, penetrating wounds of the abdomen in war were treated conservatively, with a very high death rate. Survivors were those who recovered from or escaped hemorrhage and shock, were fortunate enough to avoid vital organ injury and lived in spite of wounds of the viscera complicated by a high incidence of sepsis. Laparotomy could not be justified as the treatment of choice until World War I when anesthesia, intravenous administration of fluids, blood for transfusion and antisepsis were available. Even so, death rates at the close of that war were 60%. It has become increasingly apparent with each successive war that the progressive reduction in morbidity and mortality in penetrating abdominal wounds depends not only on the quality of the surgery but also on advanced life support on the battlefield and early, direct evacuation to field hospitals where intensive resuscitation, skilled anesthesia and comprehensive postoperative care are available.
Abdominal computed tomographic scans were performed in 25 consecutive patients with bacterial endocarditis. Six patients had splenic infarcts, only two of whom had symptoms. Three of the six patients had no evidence of emboli to other organs. In patients with endocarditis who have had clinically apparent emboli or who are, for other reasons, being considered for valvular surgery, a computed tomographic scan of the abdomen may help in decision making.
A 72-year-old female was admitted because of a palpable hard tumor, 15 X 7 cm in size, in the left lower quadrant of the abdomen. According to a diagnosis of retroperitoneal tumor, laparotomy was performed, revealing a large tumor extending between the descending colon and the pelvic cavity, which could not be separated from the retroperitoneum, uterus, left ovary, urinary bladder or rectum. A number of metastatic nodules were disseminated to the peritoneum and mesenterium. The pathological diagnosis of the nodules was poorly differentiated carcinoma of transitional cell type, origin unknown. After discharge, oral administration of bestrabucil (100-200 mg/day), the benzoate of an estradiol-chlorambucil conjugate, was given to the patient at an outpatient clinic. The tumor ceased to be palpable when the total amount administered reached at 14 g. Ultrasonography and computed tomography demonstrated significant reduction in tumor size. A decrease in the peripheral leukocyte count was observed after every consecutive administration and it took about 2 months to recover to the normal level. No other side effects were observed in this case. Although administration was stopped at a total amount of 16.1 g, reenlargement of the tumor has not been observed for 9 months.
The work is based on an analysis of data obtained in angiographic examinations of 80 patients with blunt traumas of the abdomen.
As a complementary and individualised method CT of the pediatric chest and abdomen facilitates or permits correct diagnosis. Evaluation of neoplasms is the most frequent indication and includes precise definition of the site of origin, the extent of disease and of possible metastases. Moreover, monitoring of the treatment and follow-up studies are made much easier. Traumatic lesions of parenchymal organs are easily estimated with high accuracy. However, the relevant contribution provided by the computer-tomographic cross-sectional display has to be carefully weighed against the effort required for and possible adverse reactions induced by the examination, which altogether may be considered as slightly rather than non-invasive, including the genetic risk of radiation.
Surgically correctible causes of respiratory distress are seen infrequently, but the pediatrician and surgeon should know when surgical intervention is mandated. Surgically correctible conditions arising in the mediastinum, thorax, and abdomen are reviewed.
The results of radiological examination of the thorax and abdomen were studied in premature babies with Rhesus incompatibility. In the 53 cases where Rhesus incompatibility was the only abnormal finding, various measurements were made on the radiological images: cardiothoracic index, liver and spleen, distances between the digestive tract loops and the thoracic wall. The same measurements were made in two groups of premature babies, born at the same period of gestation, who acted as controls. The most frequently observed thoracic abnormality was interstitial edema with hypervascularization (50% of the moderate forms) which was present in 14 of the 18 severe cases. Total opacity of both lung fields was noted with the same frequency in the severe forms with anasarca as in the moderate forms without clinical edema. The cardiothoracic index was increased in 40% of the moderate cases and in all severe cases (normal values for premature babies of 30 to 36 weeks: 0.48 +/- 0.04). Pleural effusions were present in 20% of the moderate, and 6 out of 18 severe cases. Abdominal organ measurements in the two control groups were as follows: --premature babies (34 to 36 weeks): --liver: 47 mm +/- 5.3, --spleen: 11.5 mm +/- 2.1, --distance between loops and wall: 7.1 mm +/- 1.4. --premature babies (30 to 33 weeks): --liver: 41 mm +/- 4.7, --spleen: 10.4 mm +/- 3.4, --distance between loops and wall: 6.4 mm +/- 1.2. The babies with Rhesus incompatibility had hepatosplenomegaly which was constant in all severe cases but present in only 70% of moderate cases, an increased distance between the digestive loops and the thoracic wall in all severe forms, and in 15% of moderate forms without clinical ascites. Normal radiological images developed after about 5 days for thoracic signs, and between 7 and 10 days for abdominal signs. Complete recovery occurred in all cases, even severe, except one case, where Rhesus incompatibility was the only abnormality. In 22 cases, Rhesus incompatibility was associated with another disorder: in 12 cases a hyaline membrane was present which radically changed the prognosis (8 deaths secondary to this infection out of a total of 12 deaths). Apart from the study of the Rhesus abnormality, a systematic examination of the size of the liver and the spleen, and measurements of the distances between digestive tract loops and thoracic wall in the first thoraco-abdominal radiological image in a premature baby, can be of diagnostic value for intraperitoneal infections and eflusions of the new-born.
A recent increase in the frequency of abdomen perforating wounds has been observed in Ivory Coast, related wih social condition changes. The authors study 61 cases, recorded in 10 years. Most of the cases (62,3 p. 100) are caused by side-arms and 14,8 p. 100 by fire-arms. If 59 p. 100 of the cases resort to criminal assault, 5 p. 100 were caused by suicide attempt; the other cases were consequence of various accidents. The surgical procedures are described. Death rate, with 4 cases, was only of 6,5 p. 100.
Diagnostic imaging is a useful adjunct in evaluating the stable patient with blunt trauma to the abdomen who is not in need of emergent celiotomy. Plain and contrast roentgenography, sonography, scintigraphy, CT and angiography have unique applications in identifying injuries caused by blunt forces. Roentgenograms of the cervical spine, upright chest and pelvis with intravenous pyelography are indicated early to identify injuries that may jeopardize the patient's outcome. Upper gastrointestinal series, with water-soluble contrast medium, are useful in confirming suspected diaphragmatic and duodenal abnormalities. Urethral, bladder and ureteric injuries are readily diagnosed with the results of retrograde urethrography, cystography and pyelography, respectively. Ultrasound is particularly useful in diagnosing and following post-traumatic complications by identifying and localizing hematomas and other fluid collections. Radionuclide scintigraphy is a reliable screening method for injuries to the spleen, liver and kidneys but most importantly, scans are useful in observing patients treated without an operation. Because of the unsurpassed sensitivity and specificity of the recently introduced CT scanners, CT is the roentgenologic screening method of choice in the stable multi-trauma patient with blunt abdominal injury. However, angiography is still the most informative method of assessing vascular injury and, at times, may be both diagnostic and therapeutic. Although, it should be reserved for selected instances when noninvasive studies are inconclusive or performed incidental to necessary pelvic or thoracic aortography. The type and extent of suspected injury usually dictates the nature of the roentgenologic evaluation. Studies that duplicate previous findings or interfere with the ability to pursue needed additional investigative studies should be avoided. Finally, it is crucial that celiotomy should not be delayed by time-consuming studies in the unstable patient.
Enhancement of brain lesions occurs as a result of disruption of the blood-brain barrier. The contrast medium will therefore accumulate in the pathologic lesion and a prolonged contact between the potentially toxic contrast medium and the nervous tissue occurs. In the parenchymatous organs of the abdomen the contrast media diffuse freely into the extravascular space and are rapidly washed out again. As a consequence the adverse effects of the contrast media must be more seriously considered in brain than in body CT. Therefore, non-ionic contrast media, which are less toxic than the ionic ones, are recommended in brain CT. A review is given of four randomized, double blind, parallel studies of iohexol at CT. In three of these investigations iohexol was compared with metrizoate and ioglicate at cerebral CT and in a fourth with metrizoate at abdominal CT. All investigations showed a better tolerability of iohexol than of the ionic compounds. No difference in the enhancement properties was found.
The subparietal cleavable spaces in the abdomen were studied with the view to their practical application in general surgical practice. These studies formed part of an applid anatomy research project on the repair of anterolateral gaps in the abdominal wall, using large prostheses, inserted without direct fixation, as a means of reinforcement of the visceral sac. The spaces were meeasured at different levels in 20 adult cadavers, and the values obtained were used to prepare representations on a plane surface. These morphological and metric data should enable the surgeon to make his incisions more easily, and to obtain a more effective insertion and use of prostheses for reinforcement of the peritoneal sac, thus avoiding the waste of time and material, and the various difficulties usually encountered.
The morphologic aspect of abdominal tuberculosis are evaluated by C.T. The necrotising tuberculosis of the genitourinary tract presents course cystic lesions of fluid density. Similar morphologic criteria are seen in ileocecal tuberculosis. The peritoneal tuberculosis is characterized by large soft tissue masses of a high density which can be found in nearly all areas of the abdomen. The increased morbidity of tuberculosis in people from foreign countries living in the Federal Republic of Germany is pointed out.
35 out of 57 patients with gastric carcinoma presented with a so called "target" pattern. In cases with distal cancer the more advanced cases with endoscopic types Borrmann III/IV showed this sign more frequently than less advanced forms, i.e. suspected early cancer, Borrmann I or Borrmann II. On the other hand in endoscopically advanced cancers Borrmann III/IV a thickening of the gastric wall was more frequent in distal than in proximal localization of carcinoma. The presence of target sign in abdominal ultrasound did, statistically, not influence gastric resection. Other findings, which were observed exclusively in gastric cancer type Borrmann III/IV, like infiltration to the surrounding (pancreas, liver), liver metastasis, and/or ascites, were decisive. Additional sonography of the abdomen is, therefore, a valuable preoperative diagnostic procedure in gastric cancer beside upper GI endoscopy and biopsy.
Authors present a case of cystic lymphangioma of the abdomen in an adult patient. Pre-operative investigations are based on ultrasound and computed tomography since plain films, excretory urograms and barium enema are less helpful. Opportunity of such a diagnosis in adult is not frequent.
The article is devoted to the assessment of efficiency of reinfusion of blood in patients with injured internal organs of the chest and abdomen and its influence upon the hemostasis system. The cavitary blood due to possessing a number of specific qualities has been shown to be a valuable transfusion medium. Its reinfusion does not aggravate abnormalities of the hemostasis system resulting from massive blood loss due to chest and abdominal traumas.
One hundred patients undergoing operation for penetrating and potentially contaminated wounds of the abdomen were given cefamandole or a combination of cephalothin-tobramycin by a random, single blind method as preventive therapy. Results were evaluable for 49 patients receiving cefamandole for a success rate of 93.9 per cent. The 45 evaluable results in the second group had a success rate of 88.9 per cent. Those in the single therapy group also required fewer days of treatment and of hospital confinement, resulting in lower per patient cost. Results of this study show cefamandole to be an efficacious alternative for surgeons seeking a single agent therapy.
Today CT of the pediatric chest and abdomen is an accepted and established diagnostic modality. Detection of pulmonary metastases and the staging of malignant lymphoma of the mediastinum are main indications for thoracic CT, whereas in other neoplastic mediastinal or thoracic wall lesions, which are much rarer, CT is complementary to very valuable conventional examinations. However the cross-sectional display free of superposition and the possibility of density-measurement are outstanding advantages for both thoracic and abdominal CT. Abdominal extension of malignant lymphoma is accurately determined; pretherapeutic staging and followup evaluation of primary retroperitoneal, hepatic and pelvic neoplasms are further indications in selected patients. After blunt abdominal trauma CT does not only demonstrate the extent of parenchymatous laceration, but also provides exact assessment of perfusion and/or function of an organ.