Lipomatosis of the ileocecal valve leading to episodes of partial small bowel obstruction.

The cases of two female patients with lipomatosis of the ileocecal valve inducing episodes of intestinal obstruction are presented. A barium enema with air contrast was performed in patient 1; patient 2 was operated on to treat ileus. Resection of the fatty tissue from the ileocecal valve was performed at operation, after histologic diagnosis on frozen section. These cases suggest that limited resection removing fatty tissue is effective and preferable to more radical resection.

Combination of serum carcino-embryonic antigen and C-reactive protein--a useful test in preoperative staging of colorectal cancer.

The value of the simultaneous estimation of serum carcino-embryonic antigen (CEA) and C-reactive protein (CRP) concentrations in staging patients with colorectal neoplasias was evaluated. The study included 95 patients with benign or malignant epithelial tumors of colon and rectum. The simultaneous negative values of CEA and CRP were able to exclude stage D tumors with a specificity of 92.6% (P less than 0.001). Simultaneously positive values of CEA and CRP were able to diagnose stage C or D tumors with a specificity of 92.1% (P less than 0.001). It is concluded that the combination of CEA and CRP tests can substantially contribute to the preoperative staging and assessment of the extent of colorectal cancer.

Endoscopic transpapillary catheterization of the gallbladder followed by external shock wave lithotripsy and solvent infusion for the treatment of gallstone disease.

Herein we describe the techniques and early results of attempted endoscopic transpapillary catheterization of the gallbladder (ETCG) in combination with external shock wave lithotripsy (ESWL) and solvent infusion in the treatment of 23 consecutive, symptomatic patients with gallstones. Despite anticipated difficulty in advancing wires and catheters through the cystic duct, impeded by tortuosity of its lumen, ETCG was successfully accomplished in 20 of the 23 patients (86.9%). Through an indwelling catheter, obstructed gallbladders were drained in 4 patients and combined treatment with ESWL and infused solvents was carried out in 18 patients. Combined treatment resulted in elimination of gallstones from the gallbladders of 14 of 18 patients (77.7%). Treatment was complicated by mild pancreatitis in only 1 of 20 successfully catheterized patients; there was no mortality.

Value of serum acute-phase reactant proteins and carcinoembryonic antigen in the preoperative staging of colorectal cancer. A multivariate analysis.

In 55 patients with benign or malignant neoplasias of the large bowel, serum carcinoembryonic antigen (CEA), C-reactive protein (CRP), alpha 1-antitrypsin (AAT), alpha 1-acid glycoprotein (AAG) levels, and the percentage of serum protein electrophoretic components were measured. Statistical analysis showed significant correlations between serum CEA, CRP, AAG, and AAT levels and the percentage of serum beta-globulins with the stage of the disease. Multivariate discriminant analysis gave a final prognostic model that included serum CEA, CRP, and AAT levels and the percentage of the serum beta-globulins with a significance of P less than 0.000001. The authors conclude that the serum acute-phase protein levels, in combination with serum CEA concentrations, have a definite role in the preoperative staging of large bowel cancer.

Adenomyoma of the common bile duct.

Adenomyomas are rare pseudotumors of the extrahepatic biliary tract. Their microscopic appearance does not differ significantly from similar malformations of the peritoneal cavity. We describe a patient who presented with obstructive jaundice and who was treated successfully with a surgical resection and a hepaticojejunal anastomosis.

Unusual primary locations of hydatid disease. Case report.

Two unusual cases of primary hydatid disease are described. In one of them a retroperitoneal cyst, presenting as a palpable abdominal mass, was strongly adherent to the inferior vena cava and dislocated the right kidney. Partial cystectomy and drainage were performed. The other cyst, of the right ischiorectal fossa, was initially misinterpreted as a perineal of sciatic hernia. It was completely removed. No other site of hydatid disease was found and the patients remain well 3 and 4 years postoperatively.

Postoperative changes in serum bromine value.

The changes in bromine levels in the blood serum of 40 patients who were operated upon are discussed herein. The results of this study demonstrate that all patients who received anesthetics rich in bromine (halothane and Fluothane) have an increase in serum bromine levels postoperatively. Eight of ten patients with high serum bromine levels postoperatively had intense symptomatologic findings which could be attributed to an instance of acute brominism.

Prophylactic cholecystectomy during splenectomy for beta thalassemia homozygous in Greece.

The impact of prophylactic cholecystectomy upon early mortality and morbidity of splenectomy for patients with beta TH H was investigated. The results of our study suggested that it is a safe procedure that is not associated with any increase in operative mortality and postoperative complications. This was true even when beta TH H was complicated by pigment cirrhosis and ascites. In view of increasing longevity of those patients with beta TH H, as well as the increased risk for gallstones even after splenectomy, we recommend the use of prophylactic cholecystectomy as a standard approach for all patients undergoing splenectomy for beta thalassemia homozygous.

The effect of preoperative treatment with cimetidine on postoperative wound sepsis.

The results of preoperative treatment of uncomplicated duodenal ulcer patients with Cimetidine are presented. Cimetidine given preoperatively increases the pH of gastric aspirates and alters the bacterial flora of the stomach at the time of operation, resulting in an increased incidence of postoperative wound sepsis. Discontinuing Cimetidine 2 days before surgery is a safe step against the risk wound sepsis.

Long term consequences of bacterial colonization of the biliary tract after choledochostomy.

We studied 48 patients--36 who underwent cholecystectomy and choledochotomy-choledochostomy for cholesterol gallstones and 12 patients as controls who underwent different types of extrabiliary operations. In our material, we observed that, in a high proportion of instances, infected bile during the early postoperative period remained contaminated for six months postoperatively--in an obviously unobstructed bile duct. In patients in whom Escherichia coli was isolated both early and late postoperatively, a statistical significancy was found. This phenomenon consists of a favorable condition for precipitation of calcium bilirubinate, triggering new pigment stone formation.

A comparative study of trace elements in normal and cancerous colorectal tissues.

Quantitative study of the Zn, Cu, K, Rb, Mn, Pb and Ni trace elements by the x-ray fluorescence method in normal and cancerous tissue samples, obtained from 18 patients suffering from cancer of the colon and rectum, shows that cancerous tissues exhibit statistically higher K, Rb, and Cu concentration than corresponding normal tissues. There are evidences that also Ni and Pb are elevated in cancerous tissues. Finally Zn and Mn do not show any appreciable difference in normal and cancerous tissues.

Aneurysm of the splenic artery.

Two cases of multiple aneurysms of the splenic artery are reported. The aneurysms themselves were asymptomatic and the patients were operated upon for other reasons. In the first case the aneurysm was of an arteriosclerotic nature and in the second it coexisted with portal hypertension. The literature on this subject is briefly reviewed.