Anastomotic insufficiency in small bowel surgery —incidence and treatment

Summary In the period 1977–1981 234 small bowel anastomoses were constructed in 143 patients. Eight anastomoses showed leakage (3.4%) and from nine anastomoses a fistula developed (3.8%): a total rate of disturbed healing of small bowel anastomoses (7.3%). In the presence of intra-abdominal infection this rate was 14.8%, in the absence of infection 0.8%. The results of treatment with oversewing and with resection and immediate anastomosis were disappointing. Better results were obtained by dismantling of the anastomosis, establishment of a split-enterostomy and reestablishment of continuity in a second stage. Mortality was 3/17 (18%). The literature is reviewed.

---

Insuffizienz von Dünndarmanastomosen — Ineidenz und Therapie

Zusammenfassung In dem Zeitraum 1977–1981 wurden bei 143 Patienten 234 Dünndarmanastomosen angelegt. Acht Anastomosen zeigten eine Nahtleckage (3,4%), bei neun entwickelte sich eine Fistel (3,8%): die Gesamthäufigkeit von Wundheilungsstörungen bei Dünndarmanastomosen war 7,3%. Bei gleichzeitigem Vorliegen intraabdominaler Infektionen betrug die Häufigkeit 14,8%, ohne diese 0,8%. Die Resultate einer Therapie durch Übernähung oder Resektion mit sofort anschließender Reanastomosierung waren enttäuschend. Befriedigendere Ergebnisse wurden durch Aufheben der Anastomosen, Anlage einer split enterostomy unter Wiederherstellung der Kontinuität in einer zweiten Sitzung erzielt. Die Mortalität betrug 3/17 (18%). Ein Literaturüberblick wird gegeben.

     

Prediction of individual patient prognosis: value of computer-aided systems

Physicians take both diagnosis and prognosis into account when allocating treatment. However, by "prognosis" physicians usually imply a somewhat vague impression concerning large groups of patients. One possible task for decision support studies is to design and construct systems that accurately predict individual patient prognoses. The authors constructed and tested such systems in three areas of medicine (inflammatory bowel disease, upper gastrointestinal tract hemorrhage, and acute chest pain). In each area, the individual patient's symptoms were compared with a computer-held database of information via a Bayesian analysis, prior and conditional probabilities being derived from large-scale real-life surveys. Prospective trials designed to test these predictive systems by reference to test series comprising over 4,000 patients indicate that a firm prognostic prediction can generally be made; where made, the accuracy of prediction is over 90%. Ways in which this type of prediction may be of clinical value are discussed.     

Amyotrophic cerebellar hypoplasia

Summary Lower motor neuron degeneration, cerebellar hypoplasia, atrophy of pons, olives, and cerebellum, sclerosis of thalamus and pallidum, and deficient myelination were found in a 2-months-old baby with laryngeal paralysis, mental retardation, progressive amyotrophy, and slow nerve conduction velocity. Such changes seem characteristic of an unusual syndrome previously referred to as cerebellar hypoplasia in Werdnig-Hoffmann disease, or anterior horn cell disease with pontocerebellar hypoplasia. Although the pathologic changes in lower motor neurons are indistinguishable from those in other cases of infantile spinal muscular atrophy, the consistent reproducibility of a complex pathologic pattern suggests that this is probably a manifestation of a separate disease process. The term amyotrophic cerebellar hypoplasia (ACH) is a convenient designation for the syndrome.Supported in part by National Institutes of Health grant no. RR75     

Infarction of the olivary area of the medulla oblongata

The two first cases of an infarct involving the arterial olivary territory of the medulla oblongata are reported. In the first one, an old infarct of the medial territory and a recent infarct involving the whole inferior olivary nucleus at its middle third level were associated. Rostrally this infarct was reduced to the medial reticular formation and internal half of the olive. Caudally it was reduced to its external half. In the second case the infarct involved only the external half of the right olive, but involved also the external half of the left olive with the lateral territory. From these two cases and from the anatomic, pathologic and clinical data reviewed in the literature, the authors propose as "total" olivary territory a triangular area including all the inferior olivary nucleus, the dorsal accessory olivary nucleus and partly the medial reticular formation, and as "minimum" olivary territory the external half of the olive. The many important medial, lateral and cranio-caudal arteries which supply the olivary territory account for these "total" and "minimum" territories, as well as for some cases in the literature. They account also for the pyramid-like cranio-caudal extension of the olivary territory infarction. The olivary territory is likely to be supplied by two short circumferential arterial groups, i.e. inferior bulbar and superior medullo-pontine. Nevertheless, the cause of the olivary territory infarction is an occlusion of the vertebral artery.     

Penetrating ocular injuries in young patients. Initial injuries and visual results

Penetrating injuries are a leading cause of unilateral visual loss in young patients. We reviewed the records of 197 patients aged 18 years or younger who underwent primary repair of a penetrating ocular injury at the Wilmer Ophthalmological Institute from January 1970 through December 1981. The injury was caused by sharp objects in 49% of cases, missiles in 35%, and blunt trauma in 14%. Of 159 patients with at least 6 months follow-up, 110 (69%) achieved final vision of 5/200 or better, and 77 patients (48%) achieved final visual acuity of 20/50 or better. The prognosis after a penetrating injury is strongly influenced by the nature of the injury and the extent of initial damage. Several factors were found to correlate with an unfavorable visual outcome, including: initial preoperative visual acuity of worse than 5/200, injuries due to blunt trauma, wounds involving the sclera, double penetrating injuries, dense vitreous hemorrhage, and wounds associated with an intraocular "BB" pellet.     

Plants that poison in Uruguay

Poisoning by plants has different traits in each country, according to geographical, botanical and also socio-cultural characteristics. The incidence of "plant calls" to the Poison Control Center in Uruguay is not very high, but it is due usually to symptomatic cases affecting children. Plant poisoning in adults is less frequent, being due to home-made medicine, and, in women, to the popular belief in the abortive quality of some plants. Suicide attempts are rare. The different species that cause consultations, and the clinical characteristics are briefly analyzed, as well as the problems that a Poison Control Center usually has to face in poisoning by plants.     

Care delivery among refugees and internally displaced persons affected by complex emergencies: a systematic review of the literature

Journal of Public Health - This study reviews the empirical evidence on care delivery in complex emergencies (CEs) to better understand ways of improving care delivery and mitigating inequity in...     

Is reflection like soap? a critical narrative umbrella review of approaches to reflection in medical education research

Advances in Health Sciences Education - Reflection is a complex concept in medical education research. No consensus exists on what reflection exactly entails; thus far, cross-comparing empirical...     

Preoperative management of obese patients undergoing bariatric surgery: Role of endoscopy and Helicobacter eradication

BackgroundObesity is a pandemic disease associated to severe health problems. Management is usually multimodal, but many patients eventually need surgery to reduce weight. Many guidelines recommend endoscopy prior to surgery. This study reviews a series of patients undergoing sleeve gastrectomy to see whether endoscopy performance and histopathological findings influence surgery outcome.Material and methodsRetrospective series of patients undergoing sleeve gastrectomy as bariatric procedure at a single institution. We have reviewed the demographic data, the associated pathologies, endoscopic findings prior to surgery, histopathological findings in the surgical resection specimen and postoperative complication rate.Results259 patients fulfilled criteria for the study. Over 70% were women and the mean age was 46.9 (SD 9.8). Preoperative endoscopy was performed in 28.9% of the patients and biopsy only in 19.3%. Helicobacter pylori was detected in 28% of the patients undergoing endoscopy (either in the biopsy or the urease test) and eradicated before surgery in all the patients. Helicobacter pylori was present in 9.7% of the surgical resection specimens and its presence was significantly associated with the development of postoperative complications, mostly staple line leaks (p = 0.01).ConclusionOur study confirms that Helicobacter infection is significantly associated with postoperative complications after sleeve gastrectomy. It is therefore important to detect its presence and eradicate it before surgery.