Predominant role of bile in modulation of early postresectional enteric hyperplasia.

Pancreaticobiliary secretions modulate compensatory hyperplasia after proximal small-bowel resection. To investigate the individual contributions of bile and pancreatic juice, levels of nucleic acids in ileal mucosa of the rat were examined 48 hours after performance of jejunectomy with selective exclusion of bile or pancreatic juice. Exclusion of bile alone inhibited the postresectional increase in levels of RNA and DNA. Exclusion of pancreatic juice (but provision of bile) did not inhibit a rise in ileal RNA or DNA levels after jejunectomy. Presence of bile seems to be one of the major elements in the early stages of adaptive hyperplasia of the ileum.

Eclectic drainage of subphrenic abscesses.

In 196 cases of subphrenic abscess from 1964 through 1979, 56% were attributable to gastric, hepatic, and colonic disease or surgery. Posttraumatic abscesses in younger patients became more frequent. Synchronous suprahepatic and subhepatic abscesses or bilateral abscesses accounted for 19%. Streptococci, Escherichia coli, Klebsiella, and Bacteroides species were the most frequently isolated organisms. Although the overall mortality rate was 40%, the surgical mortality rate decreased from 33% initially to 17% recently. The mortality rate of transperitoneal drainage decreased from 41% to 16%. From 1980 through early 1983, a success rate of 84%, with no fatalities, was achieved in percutaneous radiologic drainage of 25 unilocular abscesses. At present, radiologically guided drainage should be considered for unilocular abscesses and some bilocular ones. Although extraperitoneal, extrapleural surgical drainage remains an expeditious form of treatment, it may give way to radiologic drainage. Transperitoneal drainage is preferable for multifocal abscesses and for many abscesses secondary to complications of intraabdominal surgery.

Hepatic necrosis in the pig produced by transient arterial occlusion.

The effects of transient liver ischaemia were studied in young pigs. At operation, a specially designed ligature sling was placed around the hepatic artery and brought out through the abdominal wall so that it could be later tightened. All other routes of arterial supply to the liver were divided. The arterial supply was occluded for 1, 2, 4 or 12 h on the 1st and 3rd postoperative days. Ischaemic damage was assessed histologically and by serum ASAT and acid hydrolase levels. Liver necrosis developed after 1--2 h of occlusion and increased after 4 and 12 h of occlusion. Ischaemic liver damage was reduced when the operation and occlusion were separated by 72 hr.

Transient hepatic dearterialization followed by regional intra-arterial 5-fluorouracil infusion as treatment for liver tumors.

Twenty consecutive patients with secondary liver tumors were treated with a new method of liver dearterialization, performed by transient occlusion of the hepatic artery with strangulating slings, and followed by regional intra-arterial infusion of 5-fluorouracil. Tumor regression was confirmed by angiography, laboratory tests and symptom relief in more than 50% of the patients. For patients with metastatic colorectal carcinoma the mean survival time after operation was 17 months and the median survival time was 11 months. The most common complications were abscesses and aneurysms. The treatment is judged suitable for patients with a tumor of moderate severity involving both liver lobes and without extrahepatic tumor growth.

Colostomy closure promotes cell proliferation and dimethylhydrazine-induced carcinogenesis in rat distal colon.

The influence of adaptive cell proliferation on colonic carcinogenesis was studied in male Fischer rats with a defunctioning transverse colostomy that was closed 4 wk later. Control observations were made in other rats after colonic transection, repeated at 4 wk, after laparotomy alone, or after permanent colostomy. Tumors were induced by 1,2-dimethylhydrazine (total dose, 300 mg/kg) over 11 wk, starting 2 days after the second operation. After creation of the colostomy, amounts of protein, RNA, and DNA in the distal colon halved in 4 wk (p less than 0.001), but returned to normal 7 days after restoration of colonic continuity. This reactive hyperplasia promoted the development of distal colonic carcinomas, as compared with rats having repeated transection of the bowel (incidence 32% vs. 6%; p less than 0.03). Although the amounts of protein and nucleic acid in the proximal colon were unchanged by transverse colostomy, values increased by 18%-59% 4 wk after colostomy closure (p = 0.05-0.002); nonetheless, the yield of tumors in this segment was unaltered. Suture-line cancers were commoner after repeat transection than after colostomy closure (76% vs. 39%; p less than 0.01). These data confirm the promotional effect of increased cell proliferation on intestinal carcinogenesis.