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.     

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.     

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     

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.     

Von Frey's method of measuring pressure sensibility in the hand: an engineering analysis of the Weinstein-Semmes pressure aesthesiometer

The development of microsurgical techniques has generated a resurgence of interest in estimating local pressure sensibility as a measure of sensory improvement. Because our experience with Weinstein's modification of Von Frey's probes yielded variable and poorly understood results, we measured two sets of probes and examined them in the light of the engineering principles on which their behavior is based. The mechanical behavior of the nylon monofilaments can be described as buckling with one end built in and the other end pinned. The probes are relatively uniform and consistent. However, no loss in sensitivity would accompany division of the set into two or three equivalent sets. Variations in the buckling stress as high as a factor of eight are difficult to avoid. Gross errors arise from careless application, variations in the elastic modulus due to changes in temperature and humidity, and variations in the attachment of fibers to handles and differences in the ends of the filaments. Interpreting results for this instrument requires an understanding of the factors which can influence those results. The rpobes are simple to use but easy to misinterpret.     

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.     

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.     

Osteoid osteoma of the hand

A review of all cases of osteoid osteoma of the hand seen by four hand surgeons over the last 10 years was performed. Seven cases were documented. Average follow-up was 28.3 months. Average age of the patients was 21.1 years. Five men and two women participated. Six lesions were in the right and one in the left upper extremity. Delay from presenting symptoms to definitive treatment averaged 13.5 months with a range of 7 to 30 months. Surgical excision was curative in all cases. We concluded that although a very unusual occurrence, osteoid osteoma of the hand should be considered in the differential diagnosis of pain in the hand.     

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.     

High-pressure water jet injury of the hand

A rare case of high-pressure injection injury to the thumb with water is reported. The problem was managed without surgical exploration despite subsequent involvement of the small finger.