Lymphocyte subpopulation before and after operation in patients with benign vs malignant breast disease.

Multiple parameters of immune function were measured serially before and one and five weeks following operation in 14 patients with fibrocystic disease of the breast (Group A) and in 20 patients with stage 1-2 infiltrating duct carcinoma (Group B). These parameters included the following: WBC, total number and percentage of lymphocytes, numbers of B cells, T cells, T-active, T-helper and T-suppressor cells and the ratio between the latter as well as spontaneous suppressor or helper activity and the graft-versus-host reaction. Prior to operation no statistically significant difference was found between the two groups except for the number of T-helper cells, which was higher in Group B (p less than 0.05), and the spontaneous suppressor activity, which was higher in Group B (p less than 0.05). The finding of such a high percentage (80%) of negative graft-versus-host reactions five weeks after operation together with the high suppressor activity may indicate the presence of tumor micrometastases. The burden of surgery and general anesthesia was stronger in Group B, with a pronounced difference found between the groups (p = 0.0005), but the interaction between the influence of time (surgery and anesthesia) and the groups was not as great (p = 0.4864) and was found to be different for each group.

Free perforation of small intestine in adults.

In a 14-year period 15 cases of free perforation of the small bowel in adults were treated in our department. In two patients perforation was caused by a foreign body and in six by each of the following: duplication of the small bowel, Hodgkin's lymphoma, vasculitis and steroid treatment, intussusception, adhesions, diverticulum. All patients presented with the signs of diffuse peritonitis. One patient died before surgery. Of the 14 patients operated upon, 10 underwent resection and primary anastomosis and four suturing of the perforation. In six cases the etiology remains unknown even after surgical intervention and pathological examination. The mortality rate of the 14 operated patients was 7.1%. 78.5% of the patients were operated on within 24 hours of onset of symptoms, and early surgery is considered to be the most important factor in the low mortality rate achieved in this series.

Catheter obstruction: analysis of filter content of total nutrient admixture.

Catheter blockage in patients receiving long-term parenteral nutrition with fat-containing total nutrient admixture (TNA) is a relatively common complication. A study was carried out to characterize the material which is filtered out of the TNA and is a potential cause of catheter blockage. A total of 45 bags containing the same TNA solution were stored for 7 days at 4 degrees C. The stability of the solution in all the bags was then confirmed by light microscope and Coulter Counter, to determine the particle-size distribution, following which the solution was filtered through a 5-microns filter. Chemical analysis was then made to determine the amount of solid particles, fat and precipitates of Mg, Zn, Ca, Na, and K in the filter contents. Each bag was found to contain 7326 +/- 2681 solid particles as plasticizers and the main component of the filter contents was fat (99.4%) whereas electrolytes as precipitates constituted less than 0.5%. The amount of fat and electrolytes lost on the filter from the solution was negligible. Our analysis of the material trapped on the filter, which may block the catheter during long-term therapy, suggests the importance of filtration and of finding a means for dissolving the fat, the main component of the filter material.

Clinical implications of anatomic variations of the splenic artery.

An aberrant course of the proximal splenic artery was observed in nine of 26 adult cadavers dissected for mapping of the lesser omentum. Such an aberrant course makes the artery vulnerable to iatrogenic injury. In view of this relatively high prevalence of splenic artery aberration, it is suggested that surgeons operating in the area of the lesser omentum should keep in mind the possibility of its occurrence and the dangers that it may present.

Comparative study for preoperative staging of rectal cancer.

A comparative study of preoperative evaluation of rectal cancer is presented. Sixty-eight patients with rectal cancer were examined digitally and by computerized tomography and transrectal ultrasound. Preoperative staging was compared with pathologic findings at surgery. Digital examination and transrectal ultrasound were accurate in 82.8 and 76.2 percent, respectively and were superior to CT, which was accurate in 65.5 percent of cases for assessment of rectal wall invasion. All three modes play a role in preoperative assessment, but digital examination and rectal ultrasound appear to be more effective.

The immunologic profile of anesthetists.

Reports in the literature have suggested possible impairment of immunocompetence in operating theater personnel. In a group of 18 physician anesthesiologists the following were determined: hemoglobin concentration; white blood cell count; numbers of T, B, and natural killer (NK) lymphocytes; number of T-active cells; and numbers of T-helper/inducer (Th) and T-suppressor/cytotoxic (Ts) cells; and the Th/Ts ratio. Function of T lymphocytes was evaluated using the local xenogeneic graft-versus-host reaction and spontaneous suppressor or helper activity of T cells. The same parameters were determined in a group of 18 age- and sex-matched healthy controls. It was found that no matter what their age or how long they have been engaged in anesthetic practice, anesthetists show no immunosuppression as evidenced by these parameters.

Intramural hematoma of duodenum following endoscopic intestinal biopsy.

We present the fourth case to be reported in the literature of intramural hematoma of the duodenum following endoscopic small bowel biopsy. It is the first reported to have been diagnosed by ultrasonography and confirmed by contrast roentgenograms. Conservative treatment was effective in achieving satisfactory resolution of the obstruction within seven days, as evidenced by barium meal examination. The mechanism of trauma, in light of the other cases reported in the literature, is discussed.

Acute cholecystitis complicating unrelated disease: etiological considerations.

The phenomenon of acute cholecystitis complicating an unrelated operation has been reported with increasing frequency, and may be preceded by a variety of operative procedures and a lack of previous biliary tract symptoms. Among eight such patients treated by us, seven developed acute cholecystitis postoperatively, and in one it was discovered during operation for bleeding duodenal ulcer. Two patients had undergone wide excision of the breast; two, highly selective vagotomy; one, nephrolithotomy; one, truncal vagotomy and gastroenterostomy; and one, left hemicolectomy and colostomy. In three patients, urgent cholecystectomy was performed, and four were treated conservatively with subsequent elective cholecystectomy. Histopathological studies revealed acute and chronic cholecystitis in all eight patients and cholelithiasis in four. One patient died in septic shock. Numerous contributing factors have been suggested, including hypovolemia and biliary stasis, as well as the presence of stones. It would appear that chronic cholecystitis or other biliary pathology, as found in our eight patients, is a major factor in the development of this manifestation.

Congenital segmental dilatation of small intestine with oesophageal atresia and duodenal atresia in a premature infant.

In a premature infant documented to have oesophageal atresia laparotomy revealed the additional findings of segmental dilatation of the small intestine as well as duodenal atresia, the coincidental occurrence of which is extremely rare. Resection of the dilated segment was performed with end-to-end one-layer anastomosis and side-to-side duodeno-duodenostomy and a feeding gastrostomy was created. Three months later end-to-end oesophago-oesophagostomy was successfully performed via a right thoracotomy. During the 8 years since then the child's growth and development have been normal.

Acute inflammation and distension of the gall bladder in infancy.

Acute cholecystitis in children is a rare disease which has been associated with haemolytic anaemias, intercurrent illness and congenital anomalies. Acute inflammation and distension of the gall bladder in infancy is very rare and the underlying cause is usually not identified. This study describes two infants presenting with acute acalculous cholecystitis with marked distension of the gall bladder. It is stressed that this entity must be taken into account in the differential diagnosis when there is a palpable mass and/or tenderness in the right abdomen, particularly in the presence of intercurrent illness. Early operation is recommended and cholecystectomy is the preferred procedure.

Primary hyperparathyroidism in children.

We present here a series of seven children with primary hyperparathyroidism caused by parathyroid adenoma. Chief cells were the primary element in six patients and water-clear cells in one patient. A brief review of the literature on primary hyperparathyroidism in children is included. Emphasis is placed on the clinical characteristics of this rare disease in children.

Histopathologic high risk factors influencing the prognosis of patients with early breast cancer (T1N0M0).

A retrospective study of 78 women with early breast cancer was undertaken with the aim of detecting histopathologic risk factors that would influence the prognosis of these patients. Histologic tumor type, nuclear grade of tumor, tumor margin, and lymphoid infiltration near the tumor as well as blood vessel invasion and lymphatic tumor emboli were evaluated. The overall 10 year survival rate was 79.2 percent. In correlating the aforementioned criteria against survival rate, it was found that the patients without any of the histopathologic risk factors had a 100 percent rate, whereas those with one risk factor had a 79 percent rate and those with two or more risk factors a 66 percent rate. Nuclear grade and lymphoid infiltration were found to have the highest significance in regard to recurrence and the mortality rate. The findings of this study suggest that in patients classified as having T1N0M0 disease without any of the histopathologic risk factors, operation is the only treatment indicated. Patients with one or more positive risk factors should receive adequate adjuvant therapy in order to increase their survival rate.