Evaluation of a method for transportation and preservation of anaerobic microorganisms.

Fecal samples from sixty patients were utilized to evaluate a method for the preservation of anaerobic organisms. Comparison was made with a method commonly employed in the collection of specimens from the operating room and bedside. Analysis of the numbers ae preservation of anaerobic fecal flora in a reliable manner during a 24 hour delay between specimen collection and plating.     

Management of breast lesions in children and adolescents.

The records of 207 patients evaluated and treated for breast abnormalities during a 10-yr period were reviewed. Patients ranged in age from 1 wk through 16 yr. Seventy-eight per cent were female. Operative procedures were performed in 134 patients (64%). Most common diagnoses were fibroadenoma, premature thelarche, and precocious puberty in the females, and pubertal gynecomastia in the males. Age and sex separate patients into natural subgroups. In females beyond the neonatal period, premature thelarche and precocious puberty are the most likely cause of breast enlargement. Breast biopsy is only rarely indicated for a distinct mass lesion in the prepubertal breast. Mass lesions in the breast of adolescent females require excisional biopsy. In the male, pubertal gynecomastia is the most common form of breast enlargement and only occasionally requires subcutaneous mastectomy for cosmetic and psychologic reasons. Careful evaluation of all children with breast enlargement is indicated to uncover underlying causes and to avoid unnecessary operative procedures.     

Appendectomy in childhood: Analysis of 105 negative explorations

Laparotomy with a preoperative diagnosis of acute appendicitis disclosed a normal appendix in 105 children (22.1 percent). In less than half of these, another condition was found or later identified, which explained the symptoms leading to operation. Ovarian lesions, acute ileocolitis, and serositis were the most frequently identified abnormalities. Twelve patients (11 percent) underwent definitive procedures in addition to appendectomy. Among patients in whom no abnormality was identified at laparotomy, peritoneal cultures yielded a broad range of organisms in 42 percent of those who had cultures. This may represent a mild form of acute primary peritonitis and may explain the symptoms which were confused with acute appendicitis.     

Changes in the incidence of necrotizing enterocolitis associated with variation of the gastrointestinal microflora in neonates.

The incidence of necrotizing enterocolitis was noted to vary in association with significant variation in the gastrointestinal microflora cultured from infants in the neonatal intensive care unit. Increased colonization with E. coli and K. pneumoniae was associated with an increased incidence of necrotizing enterocolitis, which suggests that these organisms are related to the pathogenesis of necrotizing enterocolitis.     

Mesenteric venous thrombosis in two women taking oral contraceptives

2 cases of mesenteric venous thrombosis in women taking oral contraceptives (48-year old gravida 5 taking norethindrone with mestranol for 10 years, a 33-year old gravida 2 taking Enovid and C-Quens since 1962 followed by norethindrone with mestranol 1 month prior to admission) were treated at the Jewish Hospital of St. Louis. Both patients had acute abdominal pain, vomiting, and bloody and diarrheal stools. In order to remove nonviable portions of the bowel which are viable at initail operation, 2 operations are necessary in the treatment of mesenteric venous thrombosis. Both of these patients underwent 2 operations and both had extensive segments of bowel removed. The post-operative courses of both patients were long (85 and 40 days respectively) and difficult. No predisposing or etiologic factor could be determined in either patient. A relationship of mesenteric venous thrombosis to oral contraceptives is suggested, but no definite causal relationship can be established.     

Effect of cyclosporine on carcinogenesis induced in rats by N-Methyl-N′-Nitro-N-Nitrosoguanidine

Cyclosporine administration has been associated with the development of lymphomas in human transplant patients as well as animals. Its effect on the genesis of common epithelial carcinomas is unknown. To investigate this N-methyl-N′-nitro-N-nitrosoguanidine (MNNG) was administered in drinking water to Wistar rats. Seventy-five young healthy male animals were divided into six groups and received cyclosporine alone, cyclosporine followed by MNNG, MNNG alone, cyclosporine during MNNG administration, MNNG followed by cyclosporine, and no treatment. Cyclosporine seemed to have minimal overall health effects and no cancers were encountered in the group receiving this agent alone. Animals in all carcinogen-treated groups developed gastric and upper intestinal carcinomas by Week 39. No statistically significant differences among carcinogen-treated groups were evident with respect to tumor incidence, histology, or distribution. There appeared to be trends (not statistically significant) toward a greater incidence of small bowel carcinomas in animals receiving cyclosporine plus MNNG as compared to those receiving MNNG alone; greater multiplicity of small intestinal carcinomas in animals receiving cyclosporine after MNNG as compared to all other groups; and greater incidence of small bowel tumors > 1 cm³ in animals receiving cyclosporine after MNNG as compared to all other groups. The median total tumor volume in the animals receiving cyclosporine following carcinogen was significantly greater than in any other group. This study does not support a policy of aggressive surveillance for gastrointestinal carcinoma in the human population receiving cyclosporine.     

Ruptured abdominal aortic aneurysm. Treatment and review of eighty-seven patients

Between 1954 and 1973 at the Texas Heart Institute, eighty-seven patients underwent operation for resection of ruptured abdominal aortic aneurysms. Included in this series were eighty-one men and six women who ranged in age from forty-four to eighty-four years. Hospital mortality, including intra- and postoperative mortality (within thirty days of operation), was 21 per cent. Mortality for men was 19.8 per cent and for women, 33.3 per cent.The lower mortality indicates that abdominal aortic aneurysms should be excised electively. When rupture does occur, aggressive surgical treatment can produce gratifying results.     

Evaluation of choledochoduodenostomy in the treatment of malignant obstruction of the biliary tree.

The results of direct decompression of the common duct for malignant obstruction of the distal biliary tree by side-to-side choledochoduodenostomy are presented. Thirty-three patients were treated with twenty-four (73 per cent) having carcinoma of the pancreas. Seventy-two per cent of the patients had had previous cholecystectomy or cholelithiasis whereas the common duct was utilized in preference to cholecystojejunostomy in six patients. The operative mortality was 12 per cent and six patients had complications. No deaths could be attributed to the choledochoduodenostomy, and complications did not significantly affect palliation. Mean postoperative survival was 10 +/- 0.9 months. Two patients had obstruction of the anastomosis as a terminal event. This study suggests that appropriately applied choledochoduodenostomy is a simple, effective means to decompress the common duct obstructed by tumor.     

Capsular and vascular invasion: important prognostic factors in Wilms' tumor.

The influence of capsular and vascular invasion on prognosis was determined retrospectively in 52 children with Wilms' tumor. Local recurrence was more prevalent (0.26) in patients with rupture or capsular invasion than in any other group. Inadequate postnephrectomy irradiation or infiltration of the liver by nephroblastoma cells appeared to be predisposing factors in the development of these reccurrences. Of the 26 patients with gross or microscopic vascular invasion, 13 developed metastasis. This proportion was significantly higher than in patients without vascular involvement (p less than 0.05). These observations emphasize the importance of microscopic detection of capsular and vascular invasion in staging of Wilm's tumor.     

Prophylactic intraperitoneal povidone-iodine in alimentary tract surgery

In controlled experiments intraperitoneal povidone-iodine significantly reduced the mortality of mice (p < 0.01) and rats (p < 0.01) with induced peritonitis. Povidone-iodine irrigation of the rat colon before and after anastomosis did not interfere with healing or inhibit peritoneal adhesion formation. However, a newly formulated povidone-iodine solution containing increased PVP significantly reduced adhesion formation in a controlled study in rats.     

Practical considerations in fabric vascular grafts. Introduction of a new bifurcated graft

A new bifurcation graft is introduced which conforms to the anatomic requirements of the aortoiliac segment. The graft material is made of 70 denier Dacron fiber manufactured in a warp-knit to prevent excessive fraying and to decrease porosity. Porosity studies indicate that the new material is approximately half as porous as other available Dacron graft materials. The new graft sizes of 12 by 7 and 14 by 8 mm more closely approximate the human aorta and common iliac arteries than do other available standard bifurcation grafts.The new bifurcation prosthesis has been used as an arterial bypass graft in 135 patients requiring surgery for aortoiliac occlusive disease. Of these patients, 64 per cent did not require blood replacement during surgery. The early operative results are comparable with those of other reported series.