Heterotopic bone formation in abdominal operation scars

Heterotopic ossification in abdominal wounds is a rare post-operative occurrence. Two cases are presented and possible causative factors are discussed.     

Aneurysm of the sinus of Valsalva with coexistent coronary atherosclerosis

Unruptured aneurysm of the sinus of Valsalva coexistent with extensive coronary atherosclerosis was noted in a 65-year-old man. He underwent transaortic patch repair of the aneurysm and quadruple aortocoronary bypass. The essential features of adequate management of this association are discussed.     

A simple method for closure of patient ductus arteriosus in elderly patients.

A relatively simple and safe method for closure of the patient ductus arteriosus in the elderly patient is described. It has been done successfully in 4 patients.     

Tear of the anterior cruciate ligament as a late complication of meniscectomy

During the years 1973-5 we performed 190 meniscectomies. We report 4 cases of tears of the anterior cruciate ligament after meniscectomy. Although this complication is mentioned in the literature, very few orthopaedic surgeons are familiar with it.     

Primary neoplasms of the small bowel

The treatment of thirty-one malignant and eleven benign neoplasms of the small intestine is reported. The most common symptom was abdominal pain followed by vomiting, diarrhea, weight loss, constipation, and gastrointestinal bleeding. In four cases small bowel perforated. Intestinal obstruction occurred in 31 per cent of patients. Preoperative diagnosis was made in 19 per cent of patients. All eleven patients with benign neoplasms were curatively treated by resection and primary anastomosis. Eighteen of the thirty-one patients with malignant tumors had curative resection, five had palliative resection, and eight had laparotomy and biopsy only. The most common benign tumor was leiomyoma. The most common malignant tumor was lymphoma (67 per cent) followed by adenocarcinoma (16 per cent), carcinoid (10 per cent), and leiomyosarcoma (3 per cent). Twenty-four patients were available for follow up; thirteen remain alive and eleven died, seven within one year and four within two years.     

Effect of topical prednisolone and acetic acid on the antral phase of gastric secretion

After preliminary exposure of vagally denervated canine fundic pouches to prednisolone, the outputs of H⁺ secreted in response to a meat meal were increased, whereas the outputs of Na⁺ were unchanged. Conversely, after exposure of the pouch to acetic acid, the outputs of H⁺ were lower than control values, but the outputs of Na⁺ were increased; mucosal hemorrhage did not occur. When the pouches were exposed simultaneously or sequentially to prednisolone and acetic acid, and then stimulated by feeding the animals, exsorption of Na⁺ was greater than it was after exposure to acetic acid alone, and mucosal hemorrhage was observed consistently. Nevertheless, after exposure of the pouches to prednisolone and acetic acid, the peak outputs of H⁺ were more increased than they were after exposure of the pouches to prednisolone alone. The results indicated that the degree of mucosal damage caused by exposure to acetic acid was increased by giving prednisolone. The stimulatory effect of the steroid appeared to be enhanced when it was applied to the damaged, abnormally permeable mucosa.     

Patterns of mechanical obstruction of the small bowel in Nigeria

One hundred sixty-one patients with mechanical small bowel obstruction were treated within 2 years at the University of Nigeria Teaching Hospital, Enugu, Nigeria. The various causes of obstruction fairly typify the patterns of mechanical small bowel obstruction in Nigeria, except for slight differences in some parts of the country. The fairly high mortality rate reflects the difficulties encountered in management of the patients. Measures to reduce mortality are suggested.     

The use of stroma-free hemoglobin solution for partial exchange transfusion in aortic resection in dogs

Vascular surgery involves multiple transfusions with their concomitant hazards. At the start of each vascular procedure, 20 per cent of each patient's blood (approximately 1,000 of 5,600 ml) is removed and replaced with colloid and crystalloid and the withdrawn blood returned at the end of surgery. Theoretically, if 40 per cent of the blood volume (2,000+ ml) could be withdrawn, essentially no banked blood would be required for a major vascular procedure. Therefore, 40 per cent (900+ ml) of the blood volume of twenty greyhounds was withdrawn under anesthesia and replaced with stroma-free hemoglobin solution (SFHS). Abdominal aortic resection and graft replacement was performed, and any blood lost during the procedure was replaced with SFHS. After surgery the withdrawn blood was returned to the dog and excess volume removed with postoperative hemodilution diuresis. The study included a battery of twenty tests for monitoring during the procedure and at intervals from this project that in greyhounds 40 per cent or more of the blood volume may be removed and replaced with SFHS and major vascular surgery done without undue risk and with unaltered kidney function.     

Primary malignant tumors of the small bowel

Primary malignant tumors of the small bowel are uncommon and are often diagnosed at an advanced stage. A 10 year survey (1967 to 1977) of the clinical records at one hospital revealed 39 cases of primary malignant tumors of the small bowel. The most common symptoms were abdominal pain (89.7 percent) and weight loss (77 percent). Six patients presented with complications of enterovesical fistula, bleeding and perforation. Preoperative diagnosis was suspected in 27 cases (69.2 percent). Adenocarcinoma was the most common tumor, followed by carcinoid tumor, lymphoma, leiomyosarcoma and melanoma. The treatment of choice was surgical resection whenever possible. Curative resection was attempted in 25 cases. Adjuvant radiotherapy and chemotherapy was used in four patients with lymphoma. Twenty-seven patients (69.2 percent) are alive from 1 to 6 years after diagnosis and treatment. The 5 year survival rate is 35 percent. Earlier diagnosis is essential if the prognosis for patients with small bowel malignancy is to be improved.     

Failure to achieve success with remedial gastric surgery

Twenty-five patients underwent a variety of gastrointestinal operations in an attempt to gain relief from symptoms of recurrent ulcer and/or postgastrectomy syndromes excluding dumping. Only eleven obtained a satisfactory result. Conversion to a gastroduodenostomy provided the best relief for bilious vomiting.     

Chondrosarcoma of the hand

Chondrosarcoma is a rare tumor that involves the fingers. The treatment of choice is early diagnosis and amputation of the involved finger.     

Detection and treatment of recurrent cancer of the colon and rectum

A series of 177 patients with recurrent colorectal cancer treated at the Massachusetts General Hospital is examined retrospectively. Two thirds of recurrences were observed by the second postoperative year, and 15% of patients were asymptomatic. Pelvic recurrences were usually attributable to rectal or sigmoid tumors, whereas right-sided carcinomas frequently spread to the liver. The commonest methods of clinical discovery of recurrence included findings of abdominal and pelvic masses, hepatomegaly, and positive chest films. The average survival after discovery of recurrence was only eleven months, but 23 patients having reresections for cure lived an average of thirty-three months. Seven patients (30%) undergoing reresection for cure represented probable cures. Chemotherapy with intravenous 5-FU provided poor palliation, but radiotherapy gave satisfactory relief of symptoms in approximately 50% of patients, particularly those with rectal or low colon lesions. A program of follow-up is offered since there is evidence that even the symptomatic patient may be well palliated or even cured by surgical resection of the recurrence or palliative therapy.     

Management of small bowel fistulas

Fifty-two patients with fistulas that arose from the small intestine were encountered in the 6 year span between 1975 and 1981. The mortality rate in this group was 38 percent, the average hospital stay was 95 days, and 47 patients were receiving total parenteral nutrition for an average of 56 days. Intraabdominal sepsis and peritonitis forced early reoperation in eight patients in whom exteriorization of the fistula as an ileostomy and mucous fistula and reconstruction after a long interval, was a more successful means of management than were attempts at immediate resection and anastomosis. Nineteen of 44 patients (43 percent) had spontaneous closure while receiving parenteral nutrition without oral feeding. The average time span to spontaneous closure of the fistula was 25 days. Delayed reoperation was carried out after a long interval in patients without spontaneous closure. There was a high rate of success with resection of the fistula and primary anastomosis.     

Technic of tracheostomy in the adult

The use of two Senn retractors gives excellent exposure to the trachea, minimizes dissection, and increases the accuracy and safety of the procedure.