Emergency operations for nondiverticular perforation of the left colon

OBJECTIVE: Although diverticulitis is the most common cause of large bowel perforation, other disease may result in left colonic peritonitis. The aim of this study was to evaluate and compare the incidence, management, and outcome of patients with different causes of nondiverticular left colonic perforations. PATIENTS AND METHODS: From January 1992 to September 2000, 212 surgical patients underwent emergency operation for distal colonic peritonitis. Perforations were caused by diverticulitis in 133 patients (63%) and by a nondiverticular process in 79 (37%). Mortality and morbidity in patients with nondiverticular perforation of the distal large bowel its relationship with the general conditions, the grade and the cause of peritonitis were analysed. Four types of surgical procedures were used. Hartmann's procedure was performed in 40 patients (51%); intraoperative colonic lavage, resection, and primary anastomosis (ICL) in 27 patients (34%); colostomy in 7 (9%); and subtotal colectomy in 5 (6%). RESULTS: Perforated neoplasm, the most common cause of peritonitis, was observed in 30 patients, colonic ischemia in 20, iatrogenia in 13, and other causes in 16 patients. One or more complications were observed in 57 patients (72%); among causes of perforation, colonic ischemia was significantly associated with the longest hospital stay and highest mortality. Eighteen patients (23%) died. CONCLUSIONS: Left large bowel perforation by nondiverticular disease is associated with high mortality and morbidity. The prognosis of patients is determined by the development of septic shock and colonic ischemia, as underlying disease, may influence patient survival.     

Interbody Fusion in Thoracolumbar Fractures (T11–L2) Using the Percutaneous Dorsolateral Technique

Background: The authors' concept of reduction and stabilization of thoracolumbar fractures has become more sophisticated. Depending upon the fracture classification, a posterior transpedicular, an isolated anterior or a combined approach is used. Fractures with a low degree of vertebral body comminution and only one-space disk injury are reduced and stabilized by the transpedicular approach. For reliable anterior interbody fusion, the percutaneous, dorsolateral, fluoroscopically controlled application of hydroxyapatite granules has become the method of choice. To obtain better osteoconductive properties, the granules are inoculated with autologous bone marrow. A special instrument set is available for application. Patients and Methods: In a prospective clinical study, the long-term results after posterior transpedicular stabilization of thoracolumbar spine fractures (T11–L2) were followed-up. Success or failure of the method was shown by the loss of correction of the postinjury kyphosis, measured by the angle β on lateral X-rays. Results: In 66 patients, undergoing the above surgical procedure with application of synthetic hydroxyapatite granules, the loss of correction was measured 6, 12, and 24 months postoperatively. Intrinsic stable devices for transpedicular stabilization were used in all cases. After 6 months an average loss of correction of 1.54° was measured, which amounted to 3.05° after 12 months and to 4.13° after 2 years. These values proved to be better than the results of an earlier study, in which we used the same technique, but with autologous and/or allogeneic bone grafts (2.49° after 6 months, 6.30° after 12 months). The loss of correction 1 year after surgery was statistically significantly greater in the group of bone graft recipients compared to the group treated with bioceramic granules (p < 0.001, Mann-Whitney U-test). 6 months after surgery, no statistical significance was observed. Conclusions: The results imply that 1 year postoperatively, the percutaneous, dorsolateral interbody fusion technique with hydroxyapatite granules after transpedicular stabilization shows better results than a similar procedure with interbody fusion technique using bone grafts.     

Hepatitis B in the family

During a 3-year period (1992–1995), 239 index cases of hepatitis B virus (HBV) infection and 459 members of their households from the Osijek-Baranja county were examined. The aim of the study was to determine the spread of HBV infection in the families with a member verified as a virus carrier, and to identify the family members with the highest risk of infection according to kinship degrees. The retrospective and prospective methods were used in the study. The probable route of infection was assessed by the use of an epidemiologic questionnaire, and the serologic status of the study subjects concerning infection with HBV was determined by enzyme immunoassays (HBsAg, anti-HBs, anti-HBe and anti-HBc). The first member of a family identified as a virus carrier was considered an index case. HBV infection was demonstrated in 334 (47.85%) out of a total of 698 subjects. Only 21 (6.28%) of the 334 subjects with verified HBV infection developed the clinical picture of acute hepatitis B. The ratio of clinically manifest vs inapparent infection was 1:16. Serologic traces of infection were detected in 95 of the 459 family members of the index cases, yielding a mean rate of the infection among the virus carrier family members of 20.70%.     

Studies on the mechanism of dog heart (Na+ + K+)-ATPase inhibition by D,L-aspartic acid and its K+ and Mg2+ salts.

d,l-aspartic acid as well as its K⁺ and Mg²⁺ salts have been found to be inhibitory to Na⁺ + K⁺)-ATPase activity of the dog heart microsomal fraction enriched with sarcolemma. According to intensity of the inhibitory effect (noncompetitive) they form the following sequel: mono-K⁺-aspartate $\text{?}\text{d,l}\text{-aspartic acid}\text{<}\text{mono-Mg}{}^{\mathrm{2+}}\text{-}\text{aspartate}\text{<}\text{mixture}$ of K⁺ and Mg²⁺-aspartate in a molar ratio of 1:1 (K⁺, Mg²⁺-ASP). The latter mixture is widely used as an agent in cardiac failure. For (Na⁺ + K⁺)-ATPase the salient effects of d,l-aspartic acid and/or its K⁺ and Mg²⁺ salts were: (i) decrease in V for ATP as substrate with unchanged K_m; (ii) for Na⁺ as an allosteric modifier of (Na⁺ + K⁺)-ATPase activity a decrease in V without any alteration in n as a measure of cooperativity between activating sites; (iii) for K⁺ a decrease in V and n as well as an increase in K_0.5. In the presence of Na⁺ and ATP the high affinity of the enzyme for K⁺ became reduced by d,l-aspartic acid, lowering at the same time the K_0.5 value.Effects like these have also been described for ouabain. The present data show that K⁺ and Mg²⁺ salts of d,l-aspartic acid act at a similar locus as does ouabain.     

Influence of human leukocyte inteferon on squamous cell carcinoma of uterine cervix: Clinical,histological, and histochemical observations

Summary Fifteen patients with invasive squamous cell carcinoma of the uterine cervix were treated with human leukocyte interferon (HLI). HLI was applied topically and i.m. to nine patients, and only topically to six. After therapy, surgical material was free from tumor cells in three patients, tumor cells were identified as invasive carcinoma in one patient and as CA in situ in two patients. Findings remained unchanged in nine patients. Tumor metastases in the lymph nodes were found in only one patient. The patients' overall response to therapy was assessed on the basis of stromal response, relation of tumor cells and macrophage activity, and the reactivity of lymph nodes.     

EEG-synchronizing effect of gamma-hydroxybutyrate and 1-hydroxy-3-amino-pyrrolidone-2 (HA-966) in relation to dopaminergic brain function.

The earlier finding that γ-hydroxybutyrate and HA-966-induced depression of the central nervous system was associated with the increase of dopamine concentration and block of its release, prompted this study of the influence which the monoaminergic system may have upon the electrocorticogram in rats.The synchronization induced by α-methyl-p-tyrosine began earlier than the decrease of the duration of arousal, indicating different sensitivities to the depressive drug action of structures responsible for synchronizing and for arousal.Five $\text{mg}\text{kg}$ HA-966 in diethyldithiocarbamate desynchronized animals increased the amplitude but the duration of arousal was unchanged. p-Chlorophenylalanine treatment of rats did not influence the synchronizing effect of HA-966 (10–20 $\text{mg}\text{kg}$) or the inhibitory effect upon the duration of arousal. Haloperidol (100 μg-4 $\text{mg}\text{kg}$) potentiated the synchronizing effect of y-hydroxybutyrate and HA-966. The number of phasic discharges in the electrocorticogram induced by treatment with anaesthetic doses of γ-hydroxybutyrate were increased by the low dose of haloperidol (100 $\text{μg}\text{kg}$), while the higher dose (4 $\text{mg}\text{kg}$) was ineffective.Animals with intact and lesioned substantia nigra compacta responded equally to the synchronizing activity of HA-966 and γ-hydroxybutyrate. Therefore, it is concluded that their effect is not due to the accumulation of dopamine in the nigrostriatal system.     

Technique and survival after laparoscopically assisted right hemicolectomy

Background The role of laparoscopic colon resection in the management of colon cancer is still controversial. In this article, the surgical strategy and techniques are described, with further consideration of the oncologically relevant aspects.Methods Between March 1993 and July 2003, we performed laparoscopic right hemicolectomy in 56 patients with right colon carcinoma. Average age was 74.5 years (range, 17–92). We performed a standardized surgical procedure that included mobilization from the vascularized mesenteric bridges with a window technique, transection of the ileocolic lymphovascular pedicle, and lateral and proximal mobilization of the ileocecum, ascending colon, right flexure, and proximale transversum. After enlargement of one of the trocar incisions the exteriorized colon was resected and an extracorporeal anastomosis was performed in the standard manner.Results There were no conversions to open. The mean operating time was 119 ± 38 min, the mean length of resected colon was 27.8 ± 4.48 cm, and the average width of the clear margins was 6.8 ± 5.3 cm. One patient died. Lymph nodes were positive in 21 patients. The 5-year survival rate in the 48 patients who were operated on with curative intent was 75%. We have had two local recurrences. The overall 5-year mortality-free fraction was 63%. Cox multivariate analysis showed that the mortality-prognostic factors were tumor stage and length of resected colon, whereas Kaplan-Meier analysis showed that the mortality-prognostic factors were positive lymph nodes and tumor stage.Conclusions Our results show that laparoscopic right hemicolectomy for colon cancer can be performed safely. Complications and recurrence rates are comparable to those for left-sided laparoscopic and open procedures. Therefore, we recommend this procedure as the method of choice. Laparoscopically treated patients with stage II and stage III disease have almost the same cumulative rate of survival.     

Evidence of central cholinergic mechanisms in the appearance of affective aggressive behaviour: Dissociation of aggression from autonomic and motor phenomena

Carbachol, muscarine, eserine and neostigmine injected into the cerebral ventricles of conscious cats evoked emotional behaviour with aggression, autonomic and motor phenomena as well as clonic-tonic convulsions. The main and the most impressive feature of the gross behavioural effects of intraventricular carbachol, muscarine, eserine and neostigmine in conscious cats was the affective type of aggression. However, neostigmine produced aggressive behaviour only in about one-quarter of the experiments. After intraventricular hemicholinium-3 and triethylcholine carbachol, muscarine, eserine and neostigmine elicited autonomic and motor phenomena. In these cats cholinomimetics and anticholinesterases evoked only slight hissing and snarling. Choline administered into the cerebral ventricles of hemicholinium-3- and triethylcholine-treated cats restored the emotional behaviour with aggression, autonomic and motor phenomena as well as clonic-tonic convulsions to intraventricular carbachol, muscarine, eserine and neostigmine. The restored gross behavioural changes to eserine were almost of the same intensity, while those to carbachol and muscarine were of lesser intensity than in control cats. From these experiments it is concluded that cholinergic neurones are involved in the appearance of the affective type of aggression resulting from intraventricular carbachol, muscarine, eserine and neostigmine.     

The effect of antiaggregating drugs on the patency of grafts in the arterial system

In experiments in dogs we studied the effect of anti-aggregating agents on the patency of prosthetic vascular grafts (4 mm in diameter) and vein grafts, both placed in areas with a rate of flow ranging between 50–60 ml/min. All 6 prosthetic grafts became occluded in the nonmedicated controls, 1 of 5 prosthetic grafts remained patent for a prolonged period of time in dogs receiving 250 mg acetylsalicylic acid 3 times a day, while 5 of 6 prosthetic grafts remained patent in animals receiving an antiaggregating mixture. Follow-up studies showed that antiaggregating medication had no effect on the patency of vein grafts, but it prevented the formation of mural thrombi and subendothelial proliferation.

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Résumé Nous avons étudié chez le chien l'effet d'agents anti-aggrégants sur la perméabilité de greffes vasculaires prothétiques (4 mm de diamètre) et veineuses ayant des débits de 50–60 ml/min. Les greffes prothétiques se sont toutes obstruées chez les 6 témoins non traités; chez 5 animaux recevant 250 m g d'acide acétylsalicylique 3 fois par jour, 1 greffe est restée perméable à long terme; sur les 6 animaux recevant l'agent anti-aggrégant, 5 greffes sont restées perméables. Pour les greffes veineuses, la médication anti-aggrégante n'a aucun effet sur la perméabilité; mais elle prévient la formation de thrombi muraux et la prolifération sous-endothéliale.

     

Scintigraphic methods in the diagnosis of M. Hodgkin

The authors examined 40 patients with Hodgkin's lymphoma suspected from the localization of the process in mediastinum. They used X-ray investigation, radioisotope lung perfusion, radiogold-colloid lymphography and ⁶⁷Ga-citrate scintigraphy.They found that, when the disease was diagnosed, X-ray examinations including tomography and lung perfusion gave reliable information in only half the cases whereas the other two nuclear medical methods showed positive results in 88% and 82%, respectively. In the diagnosis of relapse, the yield of these former methods was substantially higher, between 82–90%.