Nonocclusive intestinal ischemia and necrosis after correction of interatrial communication with cardiopulmonary bypass. A rare and catastrophic complication.

The authors present a case of massive, nonocclusive intestinal ischemia and necrosis after surgery for correction of interatrial communication with cardiopulmonary bypass in a 22-year-old woman. This is an extremely serious complication that generally occurs in older patients. The literature mentions its occurrence in patients subjected to aortic valve replacement who have low cardiac output and in patients undergoing myocardial revascularization. Its occurrence in a young person with simple congenital cardiopathy is rare.

Helicobacter pylori after surgery for duodenal ulcer.

BACKGROUND/AIMS: The role of Helicobacter pylori as a cause of peptic ulcer is still subject to controversy. The Kock's postulates have not been yet fulfilled; the bacteria can be found in normal persons, and it persists in the stomach after the ulcer is healed. MATERIAL AND METHODS: The authors analyzed 41 persons formerly submitted to surgery (after 8 years and 4 months, as a mean), 31 to highly selective vagotomy, and 10 to truncal or selective vagotomy plus gastroduodenal drainage. All of them were asymptomatic, or had symptoms not related to ulcer relapse. RESULTS: At endoscopy the ulcers were healed in all 41 individuals, and there was evidence of gastritis in three. The histopathological exam showed gastritis in all biopsy specimens. The search of H. pylori by urease method and by Giemsa staining was positive in 40. CONCLUSION: It was concluded that the gastric acid secretion reduced by vagotomy was the main factor to healing the ulcer, not subordinated to H. pylori.

[Barrett esophagus following peptic and alkaline esophagitis]. / Esôfago de Barrett pós-esofagite péptica e alcalina.

Eight cases of Barrett's esophagus are presented, six as a result of long-term reflux esophagitis, three of them with ulcer in gastric-like mucosa, two with stenosis. The Congo-Red test in three patients showed non-secretory pattern. They could twice confirm the epithelial change in previous normal esophageal mucosa, once after alkaline reflux esophagitis in a patient with total gastrectomy and esophagus-jejunostomy. Both surgical and medical treatment of reflux could afford relief of the symptoms but they produce no change in the ectopic mucosa.

Evolutive and prognostic aspects in gastric cancer. Analysis of 189 cases.

The cases of 189 patients treated at the Surgery Service for gastric carcinoma from January 1960 to December 1978 and followed until April 1984 were reviewed in terms of evolutive behavior. Correlations between sex, age, duration of symptoms, site of tumors, lymph node metastases, stage of tumors, operability, resectability, treatment and survival were attempted. With respect to age, of the patients not operated on, survival was longer for more advanced age; the opposite occurred for the group of patients who were operated on. The impairment of lymph nodes was decisive in shortening survival; men were affected more than women and had a worse prognosis. When the tumors were located in the proximal third of the stomach, the survival rate was longer than when they were located in the distal portion and middle third of the stomach. Patients who had experienced digestive symptoms for a long time survived longer than those with a short history. It was concluded that the main prognostic factor was resectability and, regardless of any other variables, only patients from the group submitted to gastric resection survived more than 5 years.

[Hospital infection at a private hospital in Ribeirão Preto, São Paulo, Brazil]. / Infecção hospitalar em hospital privado de Ribeirão Preto, São Paulo.

The aim of this work is to prospectively evaluate the incidence of infection, from June 1986 to June 1987, in 640 patients submitted to surgical treatment at the São Francisco Hospital, in Ribeirão Preto, São Paulo, Brazil. The overall incidence of infection was 10.31%. The incidence of wound abscess was 6.25%, and urinary infection 5.75%. In the surgical procedures considered as clean, the infection rate was 8.62%, in the clean-contaminated 14.81%, in the contaminated 8.33%, and in the dirty 16.94%. The antimicrobian drugs contributed to increase the infection rate. The hospital infection rate for the patients at infirmaries was 10.88%, and for the patients at private rooms 4.92%. The mortality rate due to hospital infection was 12.12%. The authors stress that a constant attention with the hospital infection is needed to verify the infection rate to be able to make a control program of the asepsis, antisepsis and sterilization methods, as well as to improve the operative techniques and the patient's management during the pre, per and postoperative period.

[Infusion of ileal juice by distal stoma]. / Infusao de suco ileal por estomia distal.

The authors present a simple and practical method to avoid the ileal juice expoliation in patients with ileostomy after intestinal resection. In the cases presented, after the resection, stomies were performed of the proximal and distal portions of the intestine, in relation to the extirpated segment. The juice collected in the proximal stomy was infused in the distal stomy, simulating that way the physiologic intestinal transit.

Evaluation of vagotomy by the Hollander-Congo red test.

In the present study, the completeness of vagotomy in patients who underwent truncal and highly selective vagotomy is evaluated, comparing them with control groups of normal persons and patients with a duodenal ulcer. The evaluation was made by the Hollander test, followed by the endoscopic Congo red test, using the same hypoglycemic stimulus. Gastric acid production was higher in the patients with duodenal ulcer, followed by the normal persons. Lower acidity levels were obtained for patients with truncal vagotomy than for patients with highly selective vagotomy. During the Congo red test, we noted that the patients with truncal or highly selective vagotomy had small black spots in the gastric mucosa, except those having a recurrent ulcer, denoting incomplete vagotomy. Nevertheless, when we observed the appearance of the gastric mucosa, we noted a similar aspect for those having had a vagotomy and for normal persons. This appearance was completely different from the patients with a duodenal ulcer. We concluded that truncal vagotomy greatly reduces the level of gastric acid production, while highly selective vagotomy does so to a lesser extent. The endoscopic aspect of these patients during the Congo red test was similar to that for normal persons.

[Study of the length of a stay of partial gastroduodenectomized patients]. / Estudo da duraçao da internaçao em pacientes submetidos a gastroduodenectomia parcial.

The length of stay for 482 partial gastrectomy patients in the Servico de Cirurgia de Ribeirao Preto in the period from 1960 to 1974 is compared with that of four other neighbor hospitals for the year 1973. There was reduction in the length of stay during these years and it was more obvious when compared the other four hospitals. The authors claim that early discharge and home management should always be recommended and suggest an analysis of factors interfering with length of stay.

[Normal value of electrolytes in the gastric juice]. / Valores normais de electrolítos no suco gástrico

In the present paper, the authors present the concentrations of electrolytes (Na, K, Ca, Mg and Cl) in the gastric juice of Na and K obtained by the flame photometer and by the atomic absorption spectrophotometer and conclude that the flame photometer may give false results when used to determine the electrolytes in the gastric juice.

[Thickness of the pyloric muscle in relation to Chagas' disease]. / Espessura do musculo pilórico relaçao com doença de Chagas (relaçao com doença de Chagas

The authors analyzed the thickness of the pyloric muscle of 139 patients with peptic ulcer or gastric cancer. Subtracting the muscular thickness of pylorus measured by a ruler from the thickness estimated by the formula, P.T.=0.0415 X W+2.9, where P.T. represents the thickness of the pyloric muscle in millimeters and W represents the weight of the body in kilograms, they had the deviation from normal, in mm. The muscles with deviations greater than 3 mm were considered hypertrophics. Comparing their material with those of Horwitz et al the authors observed a difference in the group of patients with duodenal ulcer without stenosis in which they obtained 16.5% cases with muscular hypertrophy. Surprisingly, those patients showed positivity of sorologic reactions to Chagas' disease in 83.3% of the cases. These results together with the work of Kunze which demonstrated in 1973 that Chagas' disease may be one of the causative factors of the pyloric muscular hypertrophy, make the authors attribute to the neurological disturbances caused by the American Tripanosomiasis the difference observed.