Giant horseshoe intra-abdominal abscess. (57/2175)

A study of 12 patients with giant horseshoe abscess of the abdominal and pelvic cavities seen at the Surgical Services of the University of Cincinnati Medical Center has emphasized the complexity and bizarre nature of these lesions. These infections represented a huge abscess or series of communicating abscesses extending from one subphrenic space along the corresponding paracolic gutter into the pelvis, up and along the opposite paracolic space, and into the other subphrenic space. Since these lesions occurred infrequently, they were often not recognized until they had become far advanced and had produced profound effects on the patients. The diagnosis was difficult and obscured by various factors including the postoperative state after laparotomy for complex diseases or serious injuries of the biliary tract, the genitourinary tract, or the alimentary tract. An important etiologic component of the formation of these giant abscesses was the continuing escape and collection of large volumes of fluid resulting from lesions of the biliary tract, postoperative hemorrhage, or an unrecognized large perforated peptic ulcer. Nine patients were treated successfully and 3 died. The many diagnostic and therapeutic problems presented by the patients with this interesting and complex lesion have emphasized the importance of earlier and more accurate diagnosis, early and adequate surgical drainage, intelligently applied antibiotic therapy and appropriate supportive treatment. Failure to recognize and drain effectively each of the component sections of this lesion led to continuing sepsis with prolonged morbidity, progressive debility, and death.  (+info)

Do eicosanoids cause colonic dysfunction in experimental E coli O157:H7 (EHEC) infection? (58/2175)

BACKGROUND: The pathophysiology of enterohaemorrhagic Escherichia coli (EHEC) infection remains unclear. Eicosanoids have been implicated as pathophysiological mediators in other colitides. AIMS: To determine if prostaglandin E(2) (PGE(2)) and leukotriene B(4) (LTB(4)) contribute to mucosal inflammation and dysfunction in EHEC colitis. METHODS: Ten day old rabbits were infected with EHEC. For five days after infection, mucosal synthesis of PGE(2) and LTB(4) was measured in distal colonic tissue from control and infected animals and (51)Cr-EDTA permeability was assessed in vivo. Myeloperoxidase activity was measured and histological inflammation and damage were assessed at five days in control and infected animals and after treatment of infected animals with the LTB(4) synthesis inhibitor MK-886. In separate experiments, ion transport was measured in Ussing chambers, before and after in vitro addition of the cyclooxygenase inhibitor indomethacin. RESULTS: LTB(4) synthesis was increased from day 2 after infection onwards and PGE(2) synthesis was increased on day 3. Mucosal permeability did not increase until day 5 after infection. MK-886 inhibited colonic LTB(4) production but did not reduce diarrhoea, inflammation, or mucosal damage. Electrolyte transport was not significantly altered on day 3 after infection. However, both Cl secretion and reduced Na absorption found on day 5 were partially reversed by indomethacin. CONCLUSIONS: Tissue synthesis of PGE(2) and LTB(4) did not correlate temporally with EHEC induced inflammation or changes in mucosal permeability and ion transport. Cyclooxygenase inhibition partially reversed ion transport abnormalities but lipoxygenase inhibition did not affect mucosal inflammation or histological damage. We conclude that the contribution of eicosanoids to mucosal injury and dysfunction is more complex than previously suggested.  (+info)

Emergency and elective surgical treatment of portal hypertension. A review of 23 years' experience. (59/2175)

A retrospective review of surgical treatment for portal hypertension during a 23-year period in a regional unit is reported and the immediate and subsequent management of patients with bleeding oesophageal varices is discussed. Fifty-four patients with recurrent varix haemorrhage uncontrolled by conservative methods have been treated by oesophageal transection with a mortality of 22.2% (26.6% for cirrhotic patients). Thirty-two per cent of the cirrhotics were alive after 2 years. Only a minority (12%) of the survivors were considered suitable for a subsequent shunt procedure. Therapeutic portacaval anastomosis has been performed on 65 patients with a 51.2% 5-year survival (43-5% for cirrhotic patients). Further haemorrhage due to shunt thrombosis occurred in 5-3% of cases. The frequent occurrence of portal-systemic encephalopathy, increasing with duration of time following a shunt, is emphasized. The high morbidity and mortality in the poor-risk cirrhotic indicated that this type of patient is unsuitable for a portal-systemic shunt and is better treated by medical means.  (+info)

Erosive hemorrhagic gastroduodenitis with fibrinolysis and low factor XIII. (60/2175)

Four patients with erosive hemorrhagic gastroduodenitis were found to have high fibrinolytic activity of the gastric juice. No increase in the fibrinolytic activity could be demonstrated in the circulating blood, but the values found for fibrinogen, plasminogen and alpha2-macroglobulin were low. A high content of FDP was found in the serum. All patients had a markedly decreased content of factor XIII. Platelet count and other coagulation components were normal. These findings were interpreted as signs of local fibrinolysis in the diseased parts of the gastrointestinal canal. The bleeding stopped after oral and intravenous administration of a fibrinolytic inhibitor (AMCA Cyclokapron) and of factor XIII-containing concentrate. In bleeding from gastroduodenal ulcer and esophageal varices, no increase in gastric fibrinolytic activity was found. It is suggested that the high local fibrinolytic activity in the stomach in erosive gastritis together with the low content of factor XIII contributes substantially to the hemorrhage in this condition. These observations may lead to a revision of the treatment of such cases.  (+info)

Comparison of fibreoptic endoscopy in acute upper gastrointestinal haemorrhage in Africans and Europeans. (61/2175)

The results of endoscopy in acute upper gastrointestinal haemorrhage were compared in a group of 138 Africans and one of 84 Europeans. Contrary to widely held clinical opinion, the incidence of gastric and duodenal ulceration was similar in the two races. Peptic ulcers were the main source of bleeding in both groups and were surprisingly more common than varices in the Africans. Bleeding from varices, however, was far more common in the Africans than in the Europeans. Stomal ulcers were confined to Europeans. Gastric erosions, often attributed to herbal medicines, were more common in the Africans but the difference was not significant. The study was not designed to determine reduced mortality since the introduction of endoscopy, but management, especially in the Africans, was aided by early recognition of haemorrhage from oesophageal varices and acute gastric erosions.  (+info)

A prospective comparative trial between early endoscopy and radiology in acute upper gastrointestinal haemorrhage. (62/2175)

A prospective comparative trial is reported between the results of early endoscopy and barium meal examinations in 150 patients admitted with acute upper gastrointestinal haemorrhage. One hundred and thirty-eight patients underwent both investigations within 24 hours of admission. Emergency endoscopy accurately identified the source of haemorrhage in 86% of patients and emergency radiology identified the source in 51%. Misleading positive reports were given endoscopically in 3% and by barium meal in 8%. The identification of the source of haemorrhage was possible in 126 patients (91%) by the use of both methods. Emergency endoscopy is shown to be superior to emergency barium meal examination, but the examinations are complementary and both should be used for these patients.  (+info)

Analysis of 140 consecutive autopsy cases of cerebrovascular strokes in northern Japan. (63/2175)

On the autopsy findings of the 140 consecutive stroke cases, some characteristics of cerebrovascular diseases in this district were discussed. Predominance of intracranial hemorrhage (cerebral hemorrhage and subarachnoid hemorrhage) over cerebral infarction was still evident. Ruptured intracranial aneurysms were demonstrated in 98% of fatal subarachnoid hemorrhage. Compared with the autopsy data of other institutions, the age of death was generally low, the median age for cerebral hemorrhage, subarachnoid hemorrhage and cerebral infarction falling in the fourth, fifth, and sixth decade, respectively. Cerebellar hemorrhage was relatively frequent, while blood dyscrasias and other symptomatic hemorrhage constituted only a small part in contrast with the report of American authors. A dominant role of hypertension in causing strokes was concluded from both the heart weight and the clinical records.  (+info)

Gastrointestinal hemorrhage from adhesion-related mesenteric varices. (64/2175)

As a result of this retrospective analysis of hemorrhage from a porta-systemic venous shunt occurring within the small intestine, we believe that the early diagnosis of the syndrome is strongly suggested by the presence of varices in unusual locations demonstrated by the venous phase of mesenteric arteriography. In all patients portal hypertension was present, and in all the affected bowel was adherent to postoperative adhesions on old suture lines. The syndrome was treated variously with lysis of adhesions, bowel resection, or portal-systemic shunt. Those patients with excellent hepatic reserve survived and had no further gastrointestinal bleeding.  (+info)