Hæmodilution in Clinical Extracorporeal Circulation: Some Effects of Human Serum Albumin

Two groups of seven patients with uncomplicated septal defects or pulmonary valve stenosis were perfused by the use of “Travenol” bag oxygenators and a heat-exchanger for open heart surgery. A dilute perfusate was used, to which human serum albumin was added in one group for comparison with the other group. No clinical differences were found between the two groups, but hæmatocrit values suggested that the albumin prolonged the duration of hæmodilution into the postoperative period. The probable advantages of maintaining hæmodilution in this way are discussed.     

Acute Pancreatitis: A Review

A series of 68 patients with acute pancreatitis admitted to the Royal North Shore Hospital of Sydney in a three-year period is discussed. An ætiological diagnosis was made in 68% of these. There were three cases associated with a parathyroid adenoma and a 10% incidence of hæmorrhagic pancreatitis, and pseudocysts occurred in 6%. There was no mortality in the 22 patients who underwent laparotomy. The ætiological mechanisms, diagnosis and treatment of acute pancreatitis are reviewed.     

Intramural Hæmatoma of the Duodenum

The literature dealing with intramural duodenal hæmatoma is reviewed briefly. The history of an injury followed by upper abdominal pain and signs of high small bowel obstruction is highly suggestive. A lag period between injury and onset of symptoms is typical, and X-ray contrast studies are diagnostic. A personal case is described in detail.     

Small bowel obstruction due to intramural hematoma during anticoagulant therapy. With regard to two cases treated conservatively

Hemorrhage following prolonged oral anticoagulant administrations is a well recognized hazard of therapy, and hemorrhagic complications are said to occur in 10-30% of patients. Following the presentation of the cases, the authors examine the current literature concerning the problems with anticoagulants, and recommend models of diagnosis and treatment of complications by bowel obstruction. Authors report on two cases of small bowel obstruction due to intramural hematoma during anticoagulant therapy. It is extremely important to recognize this syndrome in order to avoid unnecessary operative intervention. Therefore, laparotomy is not indicated.     

The Mortality from Extradural Hæmatoma1

The mortality in a series of 155 extradural hæmatomas was 20%. The unavoidable mortality due to coexistent severe cerebral damage was only 5.1%. Delayed diagnosis, due to one of several factors, was the commonest cause of the avoidable deaths. A reliance on burr holes as a means of excluding an extradural hæmorrhage, the failure to detect the presence of coexisting space-occupying lesions, misguided lumbar punctures and postoperative complications contributed in a lesser degree to the high avoidable mortality. This analysis suggests a pattern of treatment for head injuries in general and extradural hæmatomas in particular.     

Intestinal occlusion caused by an intramural ileo-cecal-colonic hematoma during treatment with oral anticoagulants

The Authors report a case of bowel occlusion due to intramural ileocecocolic haematoma in a patient in treatment with oral anticoagulants. This case is interesting both to unusual etiology correlated to the localization and because there are many concomitant pathogenetic factors; this case was treated on urgency by bowel resection and it had a good prognosis. The Authors discuss the diagnostic and therapeutic difficulties and conclude that in patients with anticoagulant oral therapy an accurate clinical follow-up is required.     

Hæmorrhage into an Abscess Cavity: An Uncommon Complication of Pelvic Abscess

This case report illustrates the difficulty in diagnosis and management of unilateral pelvic infection in adolescent gynæcology. It also describes a rare complication of an intraabdominal abscess-delayed massive hæmorrhage into the abscess cavity.     

Spontaneous intestinal hematoma as anticoagulant treatment complication

The haemoperitoneum and bowel haematoma are complications of the oral anticoagulant treatment. The abdominal pain in patient under oral anticoagulant drugs represents a diagnostic problem; apart of the acute abdomen, we also have to consider unusual haemorrhagic lesion, rare in patients without coagulation problems. The early diagnosis of the complication in the patients permits a conservative treatment with excellent prognosis, instead of performing surgical operations in subjects with frequent comorbidities. We report a case of haemoperitoneum and intramural bowel haematoma in a patient with altered laboratory parameters and haemodynamic instability that required an urgent surgical procedure.     

The Desmoid Tumour,A Diagnostic Problem in the Gynæcological Patient: A Report of Four Patients

The case reports of four patients who presented to the gyn?cological ward with desmoid tumours are described. Two patients had an abdominal wall tumour, which in one was mistaken for an ovarian mass and in the other for an incisional hernia; the other two patients presented during pregnancy with a pelvic mass, and an initial diagnosis of pelvic hæmatoma was made in both. Because of its rarity, there is frequently a lack of diagnostic awareness of this tumour, particularly in the gyn?cological patient. Opinion is divided on the malignant nature of the tumour; the current view is that it is a locally invasive neoplasm which does not metastasize. Management by radical excision without the sacrifice of major nerves or vessels has been recommended.     

Anæmia and Surgery: A Retrospective Clinical Study

A study has been made comparing the surgical performances of 145 anæmic patients who had hæmoglobin levels below 10 gm/100 ml of blood with the surgical performances of 412 routine surgical cases. While there appeared to be an apparent increase in cardiac arrests or deaths during surgery or in the early postoperative period in the anæmic cases, it is doubtful whether this is significant. Other surgical or postoperative complications did not appear to occur more frequently in the anæmic cases than in the controls, nor did the complications in the anæmic patients require treatment not given to patients in the control series.     

THE COMBINED APPROACH TO CANCER THERAPY IN CANCER CENTRES

In the complex field of cancer therapy the cancer centre approach may be seen more clearly by division of its structure into vertical and horizontal components. Vertically, there are numerous special consultative clinics in types of cancer usually associated with a body region (lung, breast, melanoma, etc.). Horizontally, there are teams of specialists (surgeons, radiotherapists, solid tumour chemotherapists), in some clinics supplemented by hæmatologists, immunologists, and endocrinologists, providing a wide therapeutic spectrum. Working together in a particular consultative team, the specialists are clinical oncologists, but without the summed wisdom and expertise of the group, the members are more accurately designated individually as specialists in the field from which they spring, for example, thoracic surgeon, hæmatologist, radiotherapist, and so on. The team approach lends itself to full exploitation of all the centralized sophisticated cancer machinery, be it in the form of equipment like celltrifuges and linear accelerators, a range and depth of cancer monitoring aids, or a medical record system aligned to a computer, with consequent immediate and long-term therapeutic gain to patients. For the State there is greater efficiency and hence economy. In teaching, the aggregation of all matters relating to cancer therapy presents enhanced opportunities for training of technicians and scientists and nurses as well as doctors, for postgraduate instruction, and for continuing education. For progress in understanding cancer, it is clear that clinical research in conjunction with the combined approach in cancer centres can be conducted with sufficient numbers of patients to give statistical credence to clinical trials.     

RENAL ANGIOGRAPHY AND THE MANAGEMENT OF SEVERE CLOSED RENAL TRAUMA1

The purpose of this study was to determine the place of selective renal angiography in the assessment of major renal trauma. Thirty-one cases of renal injury assessed by urography and angiography were reviewed, and the radiological features correlated with the subsequent clinical course. Based on the angiographic findings, a classification of these more severe injuries is proposed, and the prognostic significance of renal ischæmia demonstrated. Because conservative treatment in those cases with significant ischæmia is likely to fail, early elective surgery is recommended. In this selected group, viable renal tissue can be preserved, and the necessity for subsequent nephrectomy due to secondary hæmorrhage, or continuing urine leakage, is avoided.     

肠系膜静脉血栓形成七例临床分析

为探讨肠系膜静脉血栓形成的临床诊治经验，作者从病理生理、病因、致病因素、临床表现、诊断及治疗等方面对肠系膜静脉血栓形成进行了探讨。作者１９８４年至１９９６年收治了肠系膜静脉血栓形成患者７例，全部经手术治疗并经病理证实。本组７例患者经手术及抗凝治疗，其中５例治愈，２例死亡。作者认为此病大多数以急腹症就诊，术前要做出正确诊断有一定难度。对可疑病例必须进行严密观察及适时开腹探查。为降低死亡率，必须彻底切除包括外观正常但含有血栓系膜的肠袢，此外应早期、足量给予抗凝治疗。     

肠系膜静脉血栓形成13例临床分析

目的探讨肠系膜上静脉血栓形成(MesentericVenousThrombosis,MVT)的早期诊断及治疗,以减少并发症发生。方法对13例MVT病人的临床特点、诊断及治疗方法进行分析。结果全部手术治疗,术后均病理确诊为MVT。术前4例CT检查明确诊断,9例误诊。11例治愈,2例死亡。结论该病早期症状和体征无特异性,不易确诊,CT分辩率高,有早期诊断价值。一旦确诊,主张早期手术治疗,切除坏死肠段及栓塞肠系膜,术后抗凝治疗是降低病死率及预防复发的重要手段。     

Hæmangioblastomas of the Hindbrain: A Report of 18 Cases

Eighteen cases of hæmangioblastoma of the hindbrain are reported, with reference to age and sex incidence, association with von Hippel's angiomatosis retina and Lindau's syndrome, distribution of lesions and clinical presentation. The outcome of surgical intervention is discussed, and a case of recurrent and multiple tumours is presented.     

Extended venous ischemia of the small intestine caused by portal thrombosis. Value of diagnostic celioscopy and intestinal bi-exclusion (Thiry-Vella technique)

Mesenteric venous thrombosis is a rare disease with no specific signs. It's major risk is intestinal ischaemia and necrosis. We report the case of a young women who presented with unexplained abdominal pain and subnormal abdominal ultrasound. The diagnosis was made on laparoscopic exploration which allowed anticoagulant therapy followed by proximal and distal divertingostomies of the ischemic bowel. Small bowel continuity was re-established after 3 month of total parenteral nutrition. The patients is doing well 1 year after surgery. She is still under anticoagulant therapy. The etiology found was a hypermegacaryocytosis as seen in myeloproliferative disease.     

ACUTE PANCREATITIS: THE QUEENSLAND SCENE

One hundred patients suffering from acute pancreatitis and studied in two large teaching hospitals in Brisbane between 1959 and 1973 were reviewed. Gallstones were present in 43 patients (of whom 31 were female), and a history of alcoholic excess was elicited in 23. Sixty-three patients were aged over 50 years. Characteristic clinical features included spreading epigastric pain with radiation to either of the upper quadrants of the abdomen. Left-sided upper abdominal peritonitis associated with severe repetitive vomiting was suggestive of the diagnosis. The serum amylase level in most cases fell below the arbitrary diagnostic level of 500 Somogyi units/100 ml within 72 hours of the onset of the pain. Acute hæmorrhagic necrosis of the pancreas was positively diagnosed in 15 patients, six of whom died. The overall mortality rate in the series was 9%.     

Traumatic Hæmobilia

A series of laboratory experiments is described, in the course of which central liver injuries were produced by the use of a sharp instrument introduced through a laparotomy incision. After this, appropriate blood chemistry investigations were carried out, and the fæces were examined for occult blood. The significance and implications of the findings of hæmobilia in the human subject are discussed.     

Spontaneous Intramural Hæmatoma in the Sigmoid Colon of a Hæmophiliac

This paper describes a case of intramural hamatoma of the colon occurring spontancously in a patient with hæmophilia so mild that the diagnosis was unsuspected before operation. Successful resection was achieved with a minimun of blood loss. During subsequent surgery, it was necessary to control bleeding with repeated infusions of cryoprecipitate.