Exogenous peritonitis

A syndrome of abdominal pain, intestinal obstruction, weight loss, and fever can be caused by adhesions from granulomatous peritonitis. Contamination of the abdominal cavity at operation by cotton lint from disposable surgical drapes and laparotomy pads appears to be the etiological factor. Exogenous granulomatous peritonitis has been virtually ignored as a cause of postoperative intestinal obstruction, but we recognized three cases in the same community hospital during a 6-month period. Special stains and characteristic morphology identified the offending agent. Some patients may require corticosteroids or nonsteroidal anti-inflammatory drugs, such as indomethacin, to prevent recurrence of the syndrome.     

Parathyroid transplantation

This is a review of our current experience with the technique of parathyroid transplantation in man. We have performed 68 autografts and 2 allografts. The indications for parathyroid autotransplantation include primary and secondary parathyroid hyperplasia, repeat neck exploration for persistent or recurrent hyperparathyroidism, and total thyroidectomy for carcinoma. Indications for allotransplantation include the unsuccessful medical management of hypoparathyroidism and complete DiGeorge's syndrome. Graft function was successful in a high percentage of cases as documented by a normal serum calcium concentration with the grafted parathyroid tissue as the only source of parathyroid hormone, by detecting high concentrations of PTH in the antecubital vein draining the grafted arm and, histologically, by light and electron microscopy of the grafts.

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Résumé Revue de notre expérience de transplantation des parathyroïdes chez l'homme: 68 autogreffes et 2 allogreffes. Les indications de l' autotransplantation sont l'hyperplasie primitive ou secondaire des parathyroïdes, les réinterventions pour hyperparathyroïdie persistante ou récidivante et la thyroïdectomie totale pour cancer. Les indications de l'allotransplantation sont les échecs du traitement médical de l'hypoparathyroïdie et le syndrome de DiGeorge complet. Dans un pourcentage élevé de cas, ces transplants sont fonctionnels, comme le prouve la calcémie normale, le tissu greffé étant la seule source d'hormone parathyroïdienne, les doses élevées de PTH dans les veines drainant le bras où la greffe a été faite et l'étude en microscopie optique et électronique du tissu transplanté.

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Supported by Grant RR30 from the General Clinical Resources Center Program of the Division of Research Resources, National Institutes of Health and by a grant from the John A. Hartford Foundation.     

Multimodality imaging of osteomyelitis

Early diagnosis of osteomyelitis continues to be a clinical problem. Multiple imaging modalities are being used for the diagnosis of osteomyelitis, but none of them is ideal for all cases. The choice of modality depends on several factors based on an understanding of the pathophysiologic aspects of different forms of osteomyelitis. After a brief introduction outlining some basic principles regarding the diagnosis of osteomyelitis, pathophysiologic aspects are reviewed. Advantages and disadvantages of each imaging modality and their applications in different forms of osteomyelitis are discussed. The use of different imaging modalities in the diagnosis of special forms of osteomyelitis, including chronic, diabetic foot, and vertebral osteomyelitis, and osteomyelitis associated with orthopedic appliances and sickle cell disease is reviewed. Taking into account the site of suspected osteomyelitis and the presence or absence of underlying pathologic changes and their nature, an algorithm summarizing the use of various imaging modalities in the diagnosis of osteomyelitis is presented.     

Warm Heart Surgery: A Prospective Comparison Between Normothermic and Tepid Tempurature

Due to concerns about complications from normothermic core temperature during cardiopulmonary bypass, we initiated a prospective randomized study of 200 consecutive patients. In one group (group A), both the heart and the body temperature were kept at 37°C. In the second group (group B), both the body and myocardial temperature were allowed to drift down to 34°C. There were no differences between these two groups in age, sex, preoperative numbers of elective, urgent, emergent, redo patients, or coronary artery bypass (CAB), valve, CAB/valve procedures. Their preoperative neurological, pulmonary, renal, and vascular disease status were similar. Preoperative EF was 53% in group A (100 patients) and 52.5% in group B (100 patients). Group A required more volume (p = 0.001) and had less urine output (p = 0.03) during and post bypass. Group A required more phenylephrine hydrochloride (p = 0.05) and had more difficulty managing blood pressure. Strokes and renal failure necessitating dialysis occurred more often in group A but without statistical significance. More difficulties occurred in the normothermic (37°C) group and cardioprotective effects of warm heart surgery may remain intact at 34°C. Mild “drifted/tepid” hypothermic heart surgery could be a better and safer procedure.     

Evaluation of a Family Care Program for Released Mental Patients

The objectives and operation of a large family care program are described briefly. Following a review of prior research, an axiomatic theory is formulated to account for the effects of program components on the outcome of placement in family care boarding homes. It is pointed out that confirmation of one hypothesis of such a theory may confirm all the postulates and hypotheses constituting the theory. Therefore considerable research effort can be conserved by testing only that hypothesis. Multivariate analysis of attribute data confirms the hypothesis that the less extensive the planning for patients' release and the higher the level of social performance demanded of the patients, the more likely will be their return to the hospital. Comparative and other data are presented to demonstrate the relative effectiveness of the program. Some problems and compensating advantages of continuous program evaluation are discussed.     

Descending and segmental inhibition of transmission through the spinocervical tract

1. Micro-electrode recordings were made from axons of the spinocervical tract in unanaesthetized decerebrate-spinal cats.2. The effects of stimulation of (1) descending systems at the level of the upper cervical spinal cord and (2) hind limb cutaneous nerves, on discharges of spinocervical tract neurones were examined.3. Effects were obtained from bilateral spinal cord regions in the dorsolateral funiculi and the most medial and ventral parts of the ventral funiculi and also from the dorsal columns in the upper cervical region even though the columns had been transected at low thoracic and upper lumbar levels.4. Stimulation of either descending or segmental systems inhibited spontaneous and evoked responses. Facilitation was not seen. The inhibition had a time course of up to 250 msec, with maximal action at 20-40 msec and was greatest for polysynaptic responses or those evoked from the smaller myelinated cutaneous axons.5. It is suggested that the descending and segmental systems converge on to common inhibitory interneurones.