Non-Meckel's ileal diverticulitis with perforation: a rare cause of acute right lower quadrant pain.

A man, aged 74, presented with a rare clinical entity of an acute surgical abdomen similar to acute appendicitis. This case showed a non-Meckel's ileal diverticulitis that was complicated with a diverticular perforation and associated peritonitis. This is a very rare but potential life-threatening surgical emergency, mimicking the clinical presentation of acute appendicitis. The subject of small bowel non-Meckel's diverticulitis is reviewed because of the rarity of this condition and the diagnostic challenges it poses.

Hand-assisted laparoscopic splenectomy for a splenic hamartoma: two case reports.

We present two patients, each with a hamartoma of the spleen. These cases were thought to be well indicated for a hand-assisted laparoscopic approach and subsequent treatment was successful. Focal lesions of the spleen should be removed intact to allow a complete histological examination and to avoid peritoneal dissemination in case of malignancy. In these patients, the hand-assisted laparoscopic approach makes it possible to remove an unmorcellated organ and has the advantages of the laparoscopic technique. It can be considered as one of the suitable methods of surgical treatment.

"Twist & slide" bowel obstruction: two different rare causes of adult bowel obstruction in the same patient.

A man, age 68, presented with two rare clinical entities of adult bowel obstruction. This case showed a caecocolic intussusception (due to a caecal malignant lesion) with a small bowel volvulus secondarily. These are rare but potential life-threatening surgical emergencies.

Fissure-in-ano, to divide or not to divide?

Anal fissure is one of the most common and painful proctological pathologies affecting mainly young individuals. The physiopathology in the development of a chronic anal fissure seems to be a combination of internal anal sphincter hypertonia and poor vascularization at the posterior midline. Treatment of acute fissures is conservative with supportive therapy, leading to healing in the majority of the patients. Open or closed lateral internal sphincterotomy is the treatment of choice for chronic anal fissures. In low pressure chronic fissures, sphincterotomy should be avoided and a V-Y island advancement flap may be an alternative procedure. Sphincterotomy can induce anal incontinence, a feared complication of this technique. Recent interest has developed in chemical sphincterotomy with local botulin toxin injections or glyceryl trinitrate application. Long-term follow-up is needed to evaluate these new therapeutic options.

Comparison of lung volume measurements by single breath helium and multiple breath nitrogen equilibration methods in normal subjects and COPD patients.

The validity of the single breath helium dilution method for accurate measurement of the total lung capacity (TLC) was investigated. Comparison was made with the multiple breath nitrogen equilibration technique in 22 normal subjects and 37 patients with chronic obstructive pulmonary disease (COPD). The single breath method underestimated the TLC in all the normal individuals and 33 of 37 patients with COPD. Possible explanations for the falsely low lung volumes include uneven distribution of inspired air due to closing volumes and induced bronchoconstriction.

Airway constrictor effects of leukotriene D4 in dogs with hyperreactive airways.

Leukotriene D4 (5 micrograms/ml) aerosol constricts airways of dogs with nonspecific airway hyperreactivity but not of mongrel dogs which lack nonspecific airway hyperreactivity. RL increased 200 +/- 25% and Cdyn decreased to 77 +/- 5% of the prechallenge value. LTD4 (10 micrograms/ml) produced no further increase. Atropine (0.2 mg/kg) prevented the increase in RL and decrease in Cdyn, suggesting that part of the effect of LTD4 on airways is neurally mediated.

Nifedipine aerosol attenuates airway constriction in dogs with hyperreactive airways.

We investigated the ability of a calcium channel blocker nifedipine, given as an aerosol, to attenuate bronchoconstriction induced by citric acid, Ascaris antigen, and methacholine in Basenji-Greyhound dogs. citric acid 10% increased pulmonary resistance (RL) 4.2-fold +/- 1.0 (mean +/- SEM) and 1.7-fold +/- 0.7 in untreated and nifedipine-pretreated dogs (P less than 0.05). Dynamic compliance (Cdyn) fell to 0.58 +/- 0.07 and 0.66 +/- 0.07 of control values in untreated and nifedipine-treated dogs, respectively (p greater than 0.05). Ascaris antigen increased RL 5.1-fold +/- 0.83 and 3-fold +/- 0.48 in untreated and nifedipine-treated dogs, respectively (p less than 0.05); Cdyn decreased to 0.33 +/- 0.04 and 0.48 +/- 0.03 in untreated and nifedipine-treated dogs, respectively (p less than 0.05). In 5 dogs challenged with 0.3 mg/ml methacholine, RL increased 6.1-fold +/- 0.7 and 4.4-fold +/- 1.0 in untreated and nifedipine-treated dogs, respectively (p less than 0.05); Cdyn fell to 0.41 +/- 0.-3 and 0.46 +/- 0.07 of control values in untreated and nifedipine-treated dogs (P greater than 0.05). Neither 40% ethanol nor nifedipine-ethanol altered resting RL and Cdyn. We conclude that nifedipine effectively attenuates bronchoconstriction induced by citric acid, Ascaris antigen, and methacholine in dogs with hyperreactive airways.

Effects of zinc ion on the conformation of antigenic determinants on insulin.

Comparison of c.d. spectra of Zn-insulin with Zn2+-free insulin demonstrated significant differences. It has been proposed that these differences are due to either changes in the structure of insulin monomers within aggregated insulins or the results of insulin aggregation. The effect of Zn2+ on the immunological activity of insulin indicated that the antigenic determinants of insulin were also altered. The apparent loss of immunological activity of monoiodotyrosylinsulin was demonstrated to be due to the loss of Zn2+ rather than the substitution of iodine. The immunological activity of Zn-insulin and Zn2+-free insulin was compared in both the radioimmune and immune haemolysis-inhibition assays by using an identical population of antibodies and concentrations of inhibitor. Relative to Zn-insulin, Zn2+-free insulin had a markedly attenuated immunological activity in the immune haemolysis-inhibition assay, whereas in the radioimmune assay slightly greater immunological activity was observed with the Zn2+-free insulin. These observations are submitted as evidence that the removal of Zn2+ perturbs the conformation of determinants that react with antibodies operative in the immune haemolysis-inhibition assay (immune haemolysis determinants) and has a minimal effect on the conformation of determinants that react with antibodies operative in the radioimmune assay (radioimmune determinants).

Structural studies of insulin and insulin derivatives using various immunologic indicators and antibody populations.

These studies suggest that the immunologic indicator in the radioimmune assay, 125I-iodoinsulin, selects antibody populations from within the antiserum that interact with determinants distant from the solvent surface on the insulin molecule to which iodine is substituted. Evidence is presented that the connecting peptide of proinsulin is in close proximity to regions on the solvent surface of the A-chain of insulin that include the tyrosyl residues at A-14 and A-19. A marked immunologic cross-reaction between derivatives of insulin with perturbations in the regions of tyrosyl A-14 and A-19 was noted in the radioimmune assay employing desalanine-(B-30)-desasparagine-(A-21)-insulin antiserum. This observation is consistent with the presence of a restricted population of antibodies in such antisera that is directed toward immunologic determinants in or near the insulin dimer site. The apparent immunologic activity of insulin derivatives depends on which antibody populations from the antiserum pool can react with the immunologic indicatory employed on the one hand and on the composition of antibodies in that antiserum on the other. These studies indicate that the specificity of antibody populations in a given antiserum can be identified and their levels quantitated with several assay systems, each employing one of a variety of indicators.