Use of parenteral nutrition in treatment of advanced regional enteritis

Eight patients with advanced regional enteritis characterized by multiple areas of involvement, previous surgery (5 of 8), and failure on medical therapy (6 of 8) were placed on total parenteral nutrition for a period of 30 days. In eight of nine courses administered, definite improvement marked by weight gain, diminished pain, decreased diarrhea, and increased serum albumin was found. However, clinical remission was transient in seven of eight successful courses, indicating that parenteral nutrition is not a definitive form of therapy. However, the results suggest that parenteral nutrition may be useful in patients with regional enteritis to a) restore nutrition, b) induce remission, and c) prepare a debilitated patient for surgery. Additional experience is required to determine the efficacy of parenteral nutrition for therapy of fistulae caused by regional enteritis.     

The colitis of Behcet's disease: A separate entity?

Summary An additional case of Behcet's disease with colonic involvement has been presented. This association is rare, as only 13 prior cases with adequate data were available for comparison. Controversy exists as to whether these cases represented true involvement of the colon by Behcet's disease, coincidental inflammatory bowel disease and Behcet's disease, or merely autoimmune phenomena associated with inflammatory bowel disease. Unusual colonoscopic lesions noted in our patient and other features enumerated in the text suggested to us that at least some of these cases represented primary Behcet's disease involving the colon.     

Gastric blood flow

Summary In summary, the vascular bed of the stomach is an area of great potential importance to both gastric and vascular physiologists. There are available many technics for its investigation. Simultaneous study of both hemodynamic and secretory phenomena can be conducted on the stomach. In the next few years information concerning the circulation of the stomach may help elucidate problems in the physiology and pathology of gastric secretion. Hightower observed recently: The topic of visceral circulation, particularly as it pertains to the digestive tract, has not been commented upon in recent...Reviews of Physiology. This subject has become increasingly important in the past few years and is an area with which physiologists interested in the digestive system will become more and more concerned.³³     

Exchange transfusion in the treatment of patients with acute hepatitis in coma

Summary Acute hepatic necrosis with profound coma carries an ominous prognosis. Conventional therapy has had little influence on recovery. Various new therapeutic modalities are currently being tried. Survival figures derived by compiling reports on exchange transfusion are somewhat encouraging when the data are compared to the salvage rate in patients with fulminant hepatitis treated conventionally, even after the addition of steroids. Current knowledge is lacking as to the specific lethal factor (s) and/or mechanism (s) that are operating in these patients. Pathogenetic ignorance notwithstanding, the remarkable regenerative power of the liver dictates that all efforts be made to sustain life, as the therapist hopefully awaits recovery. If facilities and personnel are available, we feel exchange transfusion should be considered when 24 hr of intensive conventional therapy, including high doses of steroids, fails to bring about significant improvement. Any decision on duration of therapy in the absence of neurologic improvement remains arbitrary. Histologic evidence of liver cell regeneration, if it can be obtained, may justify continued therapeutic efforts. Exchange transfusion must be evaluated by a cooperative controlled study before its therapeutic value can be established.     

Isolated polyarteritis nodosa affecting the cecum

Summary We report the case of a 52-year-old white male who developed low back pain and 35-pound weight loss and whose barium enema revealed a constricting lesion of the cecum. After resection, polyarteritis was found to be the cause of the lesion. There was no other histological evidence for arteritis in this patient.The opinions expressed herein are those of the authors and not necessarily those of the Department of Defense, U.S. Air Force, or the Uniformed Services University of the Health Sciences.Figures are published with permission from the Armed Forces Institute of Pathology.     

Nonoperative management of delayed splenic rupture in an adult

Due to the evidence that a splenectomized patient is at increased risk for serious infection, nonoperative management of splenic injury, as well as operations designed to preserve functioning splenic tissue, have been recently reported. Most experience in nonoperative management has been in the pediatric and young-adult age groups. We report a case of delayed rupture of the spleen in a middle-aged patient who was successfully managed nonoperatively and was followed with ultrasonography to resolution.Supported in part by the Bureau of Medicine and Surgery Clinical Investigation Program.