Hepatic-portal venous gas in acute colonic diverticulitis

The diagnosis and assessment of severity of acute colonic diverticulitis may be difficult. A case is presented, in which the delayed diagnosis of diverticulitis resulted in the development of a diverticular mesocolic abscess complicated by hepatic-portal venous gas (HPVG). The utility of ultrasound as a rapid, noninvasive tool to diagnose this distinctly rare condition is outlined. The literature on HPVG associated with acute colonic diverticulitis is reviewed, and the therapeutic options are discussed. Received: 16 August 1996/Accepted: 19 February 1997     

Improvement of blood viscosity after infusion of low-molecular hydroxyethyl starch (Expafusin) in healthy subjects]

In healthy volunteers, 500 ml of a 6% low molecular weight hydroxyethyl starch solution (Expafusin) was infused intravenously within 30 minutes. Blood samples for the measurement of rheological parameters were obtained before and after the infusion. Blood and plasma viscosity were significantly decreased after the infusion of HES. Red cell deformability as measured by a filtration technique was slightly improved. Red cell aggregation as measured by a light transmission method was markedly reduced. Repeated infusion of 500 ml Expafusin indicates that the improvement of the flow properties of blood can be maintained for more than 3 hours.     

Comparisons of tactile thresholds between implant-supported fixed partial dentures and removable partial dentures.

This study compared the tactile sensitivity of splinted abutment and denture teeth of 16 fixed partial dentures (FPD) supported by blade implants and 16 removable partial dentures (RPD) in patients with Kennedy Class I and Class II edentulous conditions. No significant differences were noted between the tactile thresholds of the natural abutment teeth and artificial teeth in the FPD and RPD groups. The splinted abutment teeth required 45.4 g, or 5.4 to 5.8 times higher occlusal loads than did those needed for the comparable nonsplinted teeth, to detect the stimulus. A further increase of 54% in thresholds with the FPD and over 100% with the placement of the RPD indicated the superiority of the RPD in terms of load distribution as a result of the cross-arch splinting and mucosal support. Moderate positive correlations (r = 0.37 to 0.46; P < .05) between tactile thresholds and masticatory performance were found, signifying that reduced tactile perception was not responsible for the incomplete restoration of the masticatory function with RPDs or FPDs but might be contributing to increased masticatory performance within both treatment groups.     

Tracheotomy — A satisfactory method in the treatment of acute epiglottitis. A clinical and functional follow-up study

A follow-up study, including clinical examination, X-ray and function tests, of 27 children with acute epiglottitis treated with tracheotomy at the ENT-Department, Mölndal Hospital during 1971–1975 has been performed. The function tests were an important part of the investigation and included measurement with the He-dilution technique, flow—volume curves and the forced oscillation technique. No child had any detectable tracheal stenosis or any other serious per- or postoperative complication. The only complication at all was one ugly scar on the neck. The tracheotomized patient needs very little sedation and the time spent at the intensive care unit can be shorter than for those patients treated with nasotracheal intubation.     

Breaking strength of small intestinal anastomoses

The breaking strength of standardized small bowel anastomoses at different times after surgery was studied in the rat. The anastomotic strength with sutures in place successively decreased during the first 3 postoperative days to approximately 15 percent of the immediate postoperative value. This indicates a rapid decrease in the suture holding capacity of the gut wall in the early postoperative course. From the fourth day onward a rapid increase in strength was recorded. This could be due not only to deposition of collagen in the tissue bridging the anastomosis but also to the regained capacity of the gut wall to withstand tearing forces. After 14 days the strength of the anastomosis was due mainly to healing, and the relative contribution from the sutures was negligible. It may be that tearing of sutures through the tissue is more important than defective healing for anastomotic complications.     

Myocardial transmural pressure in ventilated patients

The validity of oesophageal pressure measurement as an indicator of intrathoracic pressure changes during IPPV and CPPV was evaluated in 14 patients after open heart surgery. Simultaneously recorded pressures from the airway, pericardium, oesophagus and left atrium all demonstrated an increase following IPPV and CPPV directly proportional to the increasing PEEP level. A significant positive correlation was found between the pressure increase in the pericardium and oesophagus. Therefore the measurement of oesophageal pressure closely reflected the changes in intrathoracic pressure, in recumbent, ventilated patients and enables the cardiac transmural pressure to be calculated. However, during CPPV the increase in oesophageal pressure did not fully reach the corresponding pressure changes in the pericardium and resulted in an over-estimation of the cardiac transmural pressures. Transmural left atrial pressure appeared to decrease as the lung was inflated during mechanical ventilation with increasing PEEP. This decrease is probably due to the direct effect of regional lung pressure on the pericardium and heart, an effect that cannot be recognized by measurement of oesophageal pressure. Such constraints limit the evaluation of myocardial performance according to the Starling relationship during mechanical ventilation with high airway pressures.With the support of the Swiss National Fund for the advancement of Scientific Research, Berne. Application no. 3.831-0.79