Colonic perforation by ventriculoperitoneal shunts

Two cases of colonic perforation by a ventriculoperitoneal shunt are presented. One was diagnosed by routine abdominal roentgenograms, the other by instilling metrizamide into the distal shunt tubing. A review of the 32 previously reported cases revealed a mortality of 15%. Bowel perforation from a ventriculoperitoneal shunt should be managed with intravenous antibiotics as well as removal of the shunt. If the patient has a benign abdominal examination and no prior history of abdominal complications from a ventriculoperitoneal shunt then the abdominal catheter can be removed percutaneously. However, in the presence of severe peritonitis, or a previous history of serious abdominal problems from the shunt catheter, such as an infected pseudocyst or other intraabdominal pathology, such as active regional enteritis or an abscess, we recommend laparotomy for removing the catheter with primary closure of the bowel perforation.     

Colonic epithelial atrophy induced by a fibre-free diet in rats is reversed by minimal amounts of luminal butyrate,but only in the short term

Background: Luminal butyrate may be trophic to the colonic epithelium, but this effect is poorly characterized. The aim of the present study was to define the dose?response, time‐course, site‐specificity and the dependence on background diet of the effects of butyrate on epithelial proliferation in normal distal colon, using an in vivo rat model of colonic substrate delivery. Methods: Male Sprague‐Dawley rats, maintained on a fibre‐free diet, had butyrate infused twice daily into the colonic lumen via polyethylene tubes placed at laparotomy. Varying dose levels (0?80 µmol/d; 4 d), site (caecal vs distal colonic), duration of infusions (1?5 weeks; 80 µmol/d), or dietary fibre intake were investigated. Epithelial proliferative indices were assessed stathmokinetically. Results: Four‐day infusions of butyrate led to a progressive trophic effect (cells/crypt column increased from 37.9 ± 1.6 at 0 µmol/d to 44.7 ± 1.2 at 80 µmol/d) on fibre‐deprived colonic mucosa, related linearly to the daily butyrate dose (P < 0.001, linear regression). This effect was mediated by increases in the number and proportion of mitoses, related to the square of the butyrate dose (P < 0.001 in each case, polynomial regression). Butyrate (80 µmol/d) was associated with significantly higher cellularity (59.9 ± 1.4) and mitotic activity (4.9 ± 0.6) per crypt column compared to vehicle controls (50.3 ± 1.6 and 0.9 ± 0.2, respectively; P < 0.05, t‐tests), at 1 and 3 weeks, but not at 5 weeks. Butyrate had similar effects on distal colonic crypt cellularity (62.0 ± 1.5) when delivered caecally, but in rats fed a fibre‐containing diet, colonic crypt cellularity (55.3 ± 3.2) was similar to baseline (59.6 ± 1.9). Conclusions: Trophic effects of butyrate are concentration‐dependent and occur at low doses in the short term, but are not sustained over longer periods. They are seen only in a fibre‐deprived state and appear to be independent of the site of administration.     

Colonic perforation by a large gallstone: A rare case report

INTRODUCTION

Herein we present the case of an 86-year-old woman with gallstone perforation of the sigmoid colon.

PRESENTATION OF CASE

An 86-year-old woman with known cholelithiasis presented to our office with one week of abdominal pain and nausea. X-rays taken at presentation demonstrated pneumobilia, and CT scan showed a 3.5 cm gallstone in the sigmoid colon. Medical management was unsuccessful in passing the stone, and a colonoscopy on day 4 was unsuccessful in incorporating the stone. Subsequent clinical deterioration prompted a laparotomy, where a perforation was discovered. A Hartmann''s procedure was performed and the patient recovered after a complicated post-operative course.

DISCUSSION

Gallstone ileus is an uncommon, but medically important, cause of bowel obstruction. This presentation is considered a surgical emergency and thus prompt identification and removal is essential. Obstructions tend to occur in either the stomach or along the various segments of the small intestine but have been reported in the colon as well.

CONCLUSION

In cases of gallstones that manage to pass into the large intestine, it is prudent to attempt conservative measures for passage. Failure to do so should raise suspicion of a possible stricture, either benign or malignant, preventing its evacuation. Earlier surgical intervention should be considered in these cases.     

The Snug Seton: short and medium term results of slow fistulotomy for idiopathic anal fistulae

OBJECTIVE: To assess the short and intermediate outcomes of a modification of the traditional cutting seton technique, using a 'snug' silastic seton, to treat idiopathic anal fistulae. PATIENTS AND METHODS: Between August 1997 and December 2002, 35 patients with idiopathic fistulae (4 female; age 26-76 years) underwent insertion of a 'snugly' tied 1 mm silastic seton (silicone nerve vessel retractor, Medasil), as definitive treatment. Short-term assessment was performed by case note review. Patients were subsequently invited to participate in a medium-term review. RESULTS: Twenty-nine patients' notes (3 female) were available for short-term analysis. Fistulae were classified as intersphincteric (9) and transsphincteric (20). The seton spontaneously cut out in 15/29 (52%) after a median of 24 weeks. In 14 patients the seton enclosed residual tissue (< 5 mm) required division as a day case procedure, at a median of 35 weeks. All fistulae healed but 10/29 (34%) patients (1 female; 8 transsphincteric) experienced minor incontinence. Sixteen patients participated in a medium-term review at a median of 42 months; 7 had experienced early continence disturbance. No patient suffered recurrence, but minor incontinence persisted in 4/16 (25%) patients (0 females; 3 transsphincteric). All patients were at least 'satisfied' with the outcome. CONCLUSION: In the short and medium term, the 'snug' seton is a safe and effective addition to the fistula surgeon's armamentarium.     

低剂量丝裂霉素短时加药诱导膀胱癌细胞凋亡的研究

目的探讨低剂量丝裂霉素（MMC）短时处理,诱导膀胱癌细胞凋亡的可能性。方法应用细胞和分子生物学技术检测各MMC处理条件对靶细胞生长和凋亡的影响。结果低剂量MMC处理EJ细胞1小时或2小时,均出现典型凋亡特征．其中,100mg／L,和20mg／L,MMC对凋亡的诱导作用最佳且处理时间的长短,对抑癌结果无明显影响。结论以一半的临床MMC用药剂量和时间即可有效诱导膀胱癌EJ细胞凋亡,为拟定更合理的膀胱癌腔内化疗方案提供可靠的实验佐证。     

Effect of short term use of oral contraceptives on fibrinolytic activity of the blood

2 oral contraceptives (Primovular 21 and Deoleuton 21) caused a statistically significant lowering of the blood fibrinolytic activity in 14 of 20 women after only 1 month of treatment. It is suggested that this finding may prove of considerable importance for early detection of cases which may be prone to thrombotic episodes.     

长短方案降调节的比较

自从1978年第一例试管婴儿在英国诞生以来,辅助生育技术(ART)发展迅速:从常规体外受精一胚胎移植(IVF-ET)到卵胞浆内单精子显微注射(ICSI),再到胚胎种植前遗传学诊断(PGD),未成熟卵母细胞体外成熟培养(IVM)等等,只经历了短短几十年的时间,其变化日新月异,为不孕不育患者带来了福音.     

Ponseti method in the treatment of post-operative relapsed idiopathic clubfoot after posteromedial release. A short term functional study

BackgroundRelapsed clubfeet deformity after surgical treatment by posteromedial release are frequently encountered in pediatric orthopedic practice and further revision surgery may be needed. As surgery adds more fibrosis and scaring, complication may be devastating and treatment is challenging. Ponseti method, the gold standard technique for treatment of clubfoot may be of a value in the management of postoperative relapses.Aim of the studyDetermine the effectiveness of Ponseti casting Method in treatment of relapsed idiopathic clubfoot in children after being treated with surgical posteromedial release.Materials and methodsProspective interventional study of 17 patients (25 feet) presented with a relapsed idiopathic clubfoot deformity after previous surgical posteromedial release. The patients were reviewed using Pirani and Dimeglio score. Ponseti method was done to obtain supple, flexible foot rather than a fully corrected foot, the residual deformity were treated by, heel cord lengthening or tenotomy, tibialis anterior transfer, follow up was for a minimum of 12 months.Result17 Patients (25 feet) their age ranging from 1 to 10 years were evaluated and treated. Casts were applied until the only deformities remaining were either hindfoot equinus and/or dynamic supination.22 feet required a heel cord procedure for equinus and 13 required tibialis anterior transfer for dynamic supination. The follow up (average 56.1 months) was for a minimum of one year. 4 feet had persistent heel varus deformity which required Calcaneal osteotomy later. Three feet didn’t need more casting and 2 feet were resistant cases that required further Ilizarov procedure, 4 needed lateral arch shortening and other 4 needed posterior capsulotomy. Improvement in the Pirani and Dimeglio scores was highly statistically significant.ConclusionPonseti method for treatment of relapsed clubfeet after a previous posteromedial soft tissue surgical release is an effective, non invasive, with excellent results.     

人工肱骨头置换术后的近期疗效

目的评价Neer型人工肱骨头置换术的近期疗效。方法自2000年8月至2004年1月采用人工肱骨头置换术治疗21例肱骨近端严重关节内粉碎性骨折,男5例,女16例;年龄64～76岁,平均70岁。根据AOMüller分型,C13例,C28例,C310例。手术采用改良Thompson切口,假体以后倾40°位植入,肩袖予以重建。术后康复训练分为三个阶段。第一阶段为术后第1d～6周,主要进行被动练习。第二阶段为术后第7～12周,X线片示大、小结节愈合的征象后,进行肩部肌肉的等长收缩训练。第三阶段为术后第13～24周,恢复肩关节周围的肌力与活动度。采用Neer评分系统,根据患者疼痛、功能、肩关节活动范围及解剖恢复情况评价疗效。结果术后随访时间14～55个月,平均34.5个月(2.8年)。17例无肩痛,4例偶有肩痛。21例均能完成日常生活动作。肩关节活动范围平均为:前屈115°,后伸42.5°,外展85°,内收32.5°,外旋40°,内旋50°。全组无脱位及半脱位。Neer评分优8例(>90分),良9例(80～90分),可3例(70～79分),差1例(<70分),优良率为80.9%,患者主观满意率90%。结论人工肱骨头置换术治疗肱骨近端严重关节内粉碎性骨折,近期疗效满意,但应严格掌握适应证。注意微创技术、适当增大人工肱骨头后倾角度、可靠有效地重建肩袖、重视术后正规康复训练是提高疗效的关键。     

Pulmonary effects of short term selenium deficiency.

BACKGROUND: Selenium dependent glutathione peroxidase (GPx) reduces hydrogen peroxide (H2O2) and organic hydrogen peroxides in both normal and pathological states. Chronic dietary deficiency of selenium results in a gradual decrease in GPx and altered response to environmental stress. However, glutathione-S-transferase (GST) isozymes may increase and compensate for chronic GPx deficiency. The pattern of antioxidant enzyme activity and immunolocalisation of various enzymes in rat lung has not been described in short term (< 3 weeks) acute selenium deficiency. METHODS: The time course of GPx depletion from rat lung (measured every five days in subgroups of rats) during acute dietary selenium deficiency was evaluated. After 20 days of depletion, enzyme activity of lung GPx, catalase, superoxide dismutase (SOD), glutathione reductase (GR), glucose-6-phosphodiesterase (G-6-PD), and GST were determined. Immunohistochemical localisation of GPx and SOD was also performed. The response to lethal hyperoxia (> 95%) in control and selenium deficient rats was then established. RESULTS: At 20 days, lung GPx activity in the rats fed a selenium deficient diet was one third less than in control animals who received a normal diet, while changes in blood enzymes between control and deficient animals were similar. Other lung enzyme activities remained normal with the exception of cyanide inhibited SOD activity measured in selenium deficient rat lungs which declined to approximately 50% of normal. Immunohistochemical localisation of GPx showed a generalised loss of the enzyme throughout the lung parenchyma with some possible sparing of activity in epithelial cells of the bronchioles. When exposed to lethal hyperoxia, selenium deficient animals were more susceptible than control rats. CONCLUSIONS: This is the earliest time at which dietary selenium deficiency has been shown to produce moderate loss of GPx activity. This change in activity was associated with increased susceptibility to pulmonary oxidant stress. However, the role of decreased SOD activity (presumed to represent copper, zinc SOD), although unexpected, may have been a major contributor to increased damage from hyperoxia. These results emphasise the complex potential interaction of elemental deficiency with the natural antioxidant response to lethal hyperoxia.     

The short term distribution of thiopentone in the dog

Rapid sampling of arterial blood following intravenous infusion of thiopentone at various speeds has demonstrated that the peak concentrations for doses given over five seconds are at least twice those for doses given over fifteen seconds. The area under the curves and the dispersed arterial concentrations show no significant difference between infection speeds.     

Long and short term patency of radiocephalic arteriovenous fistulas

Eighty-three radiocephalic fistulas in 71 uremic patients were retrospectively investigated. The fistulas were grouped according to construction, viz. side of radial artery to side of cephalic vein and end of cephalic vein to side of radial artery. The aim was to find and evaluate factors influencing fistula patency rate, with special emphasis on type of anastomosis. The early failure rate was significantly higher in the end-to-side group. The late failure rate was not influenced by mode of fistula construction. The fistula failure rate showed no correlation to patient age. Diabetes did not influence failure rate, but significantly shortened the mean patency time.