Colloid versus crystalloid resuscitation in experimental bowel obstruction

The physiologic effects of fluid resuscitation were studied in 20 piglets with advanced small bowel obstruction. Two solutions were compared: 5% albumin in normal saline and normal saline. Animals resuscitated with albumin-containing solution showed higher serum colloid oncotic pressure, greater loss of peritoneal fluid, lower urine output, and progression of muscular dehydration, when compared to animals resuscitated with similar volumes of normal saline solution.     

Renal cell carcinoma in children: a report of four cases and a review of the literature

Tumors of the kidney account for approximately 25% of all (solid) neoplasms in infants and children.¹ Renal cell carcinoma had been considered so rare that Gross, in 1953, noted that there had not been a case at Children's Hospital in Boston in 30 yr.² In the last few years, however, renal cell carcinoma in children has been reported with increasing frequency. A recent case of renal cell carcinoma in a 9-yr-old girl prompted us to review our own past experience with this tumor in children. Three additional cases of hypernephroma were discovered in a review of the records of the past 11 yr. They were previously alluded to by Poole and Viamonte, in their excellent article “Unusual Renal Masses in the Pediatric Age Group.”³     

An experimental study of the vibrator in postoperative tracheobronchial clearance

Thirty-eight piglets underwent thoracotomy and endobronchial installation of thick tenacious material. External vibrations enhanced tracheal bronchial clearance significantly. The study suggests that vibrating the chest in postoperative subjects with an inexpensive commercially available vibrator may be an important aid in the prevention and treatment of postoperative respiratory complications.     

Hypercalcemia in epidermoid carcinoma of the head and neck.

Hypercalcemia occurs rarely at the time of diagnosis in patients found to have epidermoid carcinoma of the head and neck. It is particularly unlike in those patients who present with potentially curable lesions. Only 2 of our 307 patients who presented with potentially curable lesions were hypercalcemic at the time of diagnosis. Two hundred thirty-eight of these patients were followed up for two years or until death. Of the 139 who did not remain free of disease, hypercalcemia of clinical significance developed in ten (7.2 per cent). Pseudohyperparathyroidism was the suspected cause in seven of twelve patients. Debilitating symptoms were present in all patients with serum calcium levels greater thn 12.0 mg/100 ml. Treatment, when given, was effective in alleviating gastrointestinal and central nervous system problems. Although usually temporary, symptomatic improvement was appreciated by most patients and family members.     

Communication between the pulmonary and systemic circulations.

Communications between the pulmonary and systemic circulation occur normally and also in association with a number of pathological entities. On the basis of recent experience I believe that this phenomenon occurs more frequently than has previously been appreciated and may assume significant clinical importance in many cases. This report reviews the spectrum of the phenomenon of systemic-pulmonary vascular connection, particularly with regard to its occurrence and recognition in the adult age group. A number of illustrative cases are reported and the pertinent literature is reviewed.     

Gastrografin-induced hypertonicity. The pathogenesis of a neonatal hazard

Operative mortality in meconium ileus approaches 50 per cent. Recently, operation has been obviated by the administration of high Gastrografin enemas. However, the nonoperative therapy causes hypertonicity, manifested by rising hematocrit and serum osmolality and a decreased cardiac output and pulse rate. The suggested mechanism for hypertonicity is the attraction of plasma water into the gut by the concentrated “nonabsorbable” material. An alternate explanation involves absorption into the vascular system of osmolar active substances from Gastrografin. The purpose of this study is to clarify the pathogenesis of acute hyperosmolality.High Gastrografin enemas were administered to twenty-one neonatal puppies and serial blood studies were performed. A disproportionate rise in measured osmolality as compared to the calculated osmolality suggested significant absorption of the contrast material or its components through the puppy's intact gut wall. The results indicate that the hyperosmolar state is due to a combination of agent absorption and plasma water decrease.     

Editorial comments on Brock's paper

We present a study of the white blood cell count at time of admission in patients with spontaneous subarachnoid hemorrhage. A nearly normal white blood cell count has little correlation with either the clinical grade at time of admission, or with the patient's ultimate outcome. A white blood cell count exceeding 20,000, however, is associated with poor clinical grade on admission and with a 50% mortality.     

Dislodged Nephrostomy Catheter: An Unusual Case of Idiopathic Transposition of Nephrostomy Catheter From Transplanted Kidney to Adjacent Small Bowel Loop: A Case Report

A 72-year-old man with a past medical history notable for deceased renal transplant presented to the interventional radiology department for routine right lower quadrant renal transplant nephroureteral catheter exchange. The nephroureteral catheter was placed in 2016 because of the presence of a hematoma causing partial page kidney and hydronephrosis.An antegrade nephrostogram was notable for opacification of the small bowel instead of the renal collecting system. The patient then subsequently developed urinary retention and intractable abdominal pain. Because of the combination of events, it was deemed necessary for laparotomy and surgical repair of the small bowel. Intraoperative findings were notable for small bowel adhesion to the abdominal wall but otherwise no evidence of acute inflammatory changes. In this case report, we describe the first case of an idiopathically dislodged nephrostomy catheter to the small bowel from a transplanted kidney and its successful management.     

Gastrinoma associated with common bile duct obstruction and the ectopic production of ACTH.

A case of adrenocortical hyperfunction due to ectopic production of ACTH by a gastrin-producing tumor of the pancreas is described. Cushing's syndrome preceded the appearance of the overt Zollinger-Ellison syndrome by 2 years and was treated by bilateral adrenalectomy. The Zollinger-Ellison syndrome was initially treated with cimetidine, which successfully reduced the secretion of gastric acid. Because the pancreatic gastrinoma continued to grow, causing obstruction of the common bile duct, biliary diversion and total gastrectomy were performed. There is evidence that the pancreatic gastrinoma was the source of the ectopic production of ACTH and possibly secretion. The role of Histamine-2 blocking agents as therapy in the Zollinger-Ellison syndrome is discussed.     

Metabolic evidence that regional hypothermia induced by cold saline protects the heart during ischemic arrest

The rationale for cold saline induced hypothermic myocardial protection during ischemic cardioplegia has been limited for the most part to empiric and contractility observations. The aim of this study was to evaluate the degree of metabolic protection afforded by this procedure. In 21 dogs (C) placed on total cardiopulmonary bypass, normothermic ischemic arrest was induced for 60 min followed by 30 min of reperfusion. In 8 other dogs (CS), similarly treated, the heart was continuously cooled with saline at 5°C before and during the ischemia. Myocardial biopsies analyzed for ATP, ADP, creatine phosphate (CP), lactate and glycogen (Gly), were obtained before cross clamping at 15, 30, 45 and 60 min of ischemia and after 30 min of reperfusion.Significantly higher levels of ATP, CP and Gly were found in the CS hearts during and following the cross clamp period. These data indicate that local hypothermia slows the breakdown of high energy phosphate moieties during ischemic arrest. However, despite the protection afforded, ATP remains significantly depressed following reperfusion.     

The Penrose drain: a safe, atraumatic colostomy bridge

Because of the problems associated with the large, bulky bridges presently used for construction of loop ostomies, particularly complications of leaks and skin excoriation, we have studied the use of the Penrose drain as an alternative. This method has been time-tested on 45 patients and has been found to be safe, reliable, and inexpensive and has gained popularity among patients and ostomy nurses. The bulky colostomy bridge should no longer be accepted as a standard of care.     

A functional treatment method for interphalangeal pyogenic arthritis

A treatment plan for pyogenic arthritis has been devised in which the accessory collateral ligaments are resected through radial and ulnar midaxial incisions. The surgical wound is debrided and copiously irrigated with an antibiotic solution, and intravenous antibiotics are instituted before operation and continued after operation. Physical therapy is begun within 24 hours of surgery and includes active range of motion (ROM) of all joints, dynamic splinting, and hand therapy to ensure both full flexion and extension. Forty patients were treated with this method within a 6-year period. Of five interphalangeal (IP) joints of the thumb, four regained 0 degree to 60 degrees full ROM and one gained 15 degrees to 65 degrees limited ROM. Of the two distal IP joints, one regained full ROM and the other became fused. Among the 33 proximal IP joints, 13 regained full ROM of 110 degrees and 13 regained limited ROM. Good functional results were obtained with this treatment plan in lieu of amputation, which previously was the most likely treatment.