Value of cultures of tissue samples taken at operation for lower intestinal perforation.

Tissue cultures from perforations of the lower intestinal tract commonly yield both aerobes (coliform organisms) and anaerobes (Bacteroides sp. and Clostridium sp.). To determine the consistency of this pattern and the value of intraoperative cultures, the authors reviewed the hospital records of 115 patients with perforation of the appendix (100 patients) or colon (15 patients), treated between 1987 and 1990, in whom organisms were cultured from tissue samples taken intraoperatively. Attention was paid to the organisms cultured, their distribution and antibiotic sensitivity in initial samples and in subsequent samples obtained when there were septic complications. On average, 4.7 bacterial isolates per patient were obtained. The common organisms were as expected: Bacteroides fragilis, Escherichia coli and Clostridium sp. Although the culture results did not affect the management of these patients, the sensitivity of Bacteroides fragilis to cefoxitin was found to be lower than expected, indicating a shift in sensitivity.

Jejunum is preferable for construction of a Bianchi bowel-lengthening procedure in swine short bowel.

This study compared the efficacy of a Bianchi bowel-lengthening procedure performed in residual ileum and jejunum of a 75% short bowel model. Eighteen female piglets underwent a 75% mid small bowel resection. After a 6-week period, animal weights were similar and pigs were randomly assigned to one of three treatment groups: (1) a control group receiving no further therapy; (2) a group receiving a Bianchi procedure in the residual jejunal segment; and (3) a group receiving a Bianchi procedure in the residual ileal segment. All were followed for a further 12 weeks. Jejunal Bianchi-treated short bowel animals demonstrated a greater final weight gain (78.8 +/- 4.9 kg) compared with nontreated short bowel (63.0 +/- 6.6 kg) and ileal Bianchi-treated short bowel groups (69.3 +/- 6.9 kg) in addition to a larger jejunal diameter. The increased weight gain in the jejunal Bianchi-treated group was not a consequence of initial bowel length, food intake, changes in bowel length, digestibility of nitrogen or fat, or nutritional status. Furthermore, kinetic constants for D-glucose absorption following 18 weeks of short-bowel syndrome demonstrated a lowered glucose maximal transport rate (Vmax) in animals with nontreated short bowel compared with sham-operated controls. Additionally, jejunal and ileal glucose Vmax was further lowered in the presence of a Bianchi procedure. We conclude that: (1) during short-bowel syndrome, body weight gain was significantly higher in animals when the Bianchi procedure was performed in jejunum; (2) the short-bowel syndrome decreased intestinal glucose absorption; and (3) the Bianchi procedure itself further impaired glucose transport.

Carotid body tumours: the University of Alberta Hospital experience.

At the University of Alberta Hospital between 1950 and 1988, 17 patients who had a diagnosis of carotid body tumour were seen; 15 of them were followed up for an average of 8 years (range from 1 to 38 years). In 14 patients the tumour was removed surgically. There were no operative deaths and no strokes occurred. The most frequent complication was cranial nerve deficit. Of the 15 patients followed up, 10 (67%) manifested a deficit of the facial, vagus or hypoglossal nerve. The primary tumour was diagnosed histologically as a benign neoplasm in all 14 patients operated on, but in 3 distant metastases developed or there was invasive local recurrence. Patients with malignant tumour were significantly (p less than or equal to 0.01) younger than those with a benign tumour. Carotid body tumours can be managed safely with respect to stroke complications, but cranial nerve injuries continue to be a problem. Malignant tumours are difficult to distinguish from benign tumours except that they tend to occur in younger patients. Prompt surgery and close follow-up is particularly important in patients with carotid body tumour.

Perforated benign gastric ulcer: the case for simple closure.

During the 12 years from 1975 to 1986 at University of Alberta Hospital, Edmonton, 36 patients were found to have a perforated gastric ulcer. A review of their operative treatment revealed that only one patient had a definitive gastric resection despite reports in the literature recommending the procedure. This study was undertaken to determine if simple closure was appropriate treatment for the majority of these patients. Even the enthusiasts of gastric resection would agree that advanced patient age, serious underlying disease and delay in treatment are contraindications to the procedure for perforated gastric ulcer. We found that 28 (78%) of the 36 patients had one or more of these contraindications. Thus, the high-risk nature of the patients presenting to our institution with perforated gastric ulcer explains the frequent use of simple closure in these cases. The data from this study indicate that the profile of patients presenting with perforated benign gastric ulcer needs to be defined before generalizations regarding surgical treatment are made.

Effect of total parenteral nutrition on biliary lipids in neonates.

To study the effect of total parenteral nutrition (TPN) on biliary lipids in critically ill neonates, biliary lipid concentrations were determined in 13 neonates before starting TPN, in 8 receiving TPN for up to 2 weeks and in 9 receiving TPN for up to 8 weeks. Bile was very dilute in the 13 neonates not receiving TPN owing to a low concentration of bile acids. In many the bile-acid concentration was below the critical micellar concentration, thus cholesterol in bile was not dissolved. The neonates receiving TPN for up to 2 weeks showed a marked increase in bile-acid content and had levels above the critical micellar concentration. This apparently beneficial effect of TPN disappeared after 2 weeks and neonates who received TPN for 3 to 8 weeks again had bile-acid levels below the critical micellar concentration. Three conclusions may be drawn from this study: (a) in the fasting state before TPN is begun, the cholesterol content of bile relative to phospholipid and bile acids increased in linear fashion during the fasting period; (b) short-term TPN of up to 2 weeks' duration was associated with an increased bile-acid content to levels at which cholesterol could be dissolved; (c) neonates on long-term TPN and no oral intake secrete extremely dilute bile with an insufficient concentration of bile-acid molecules to form micelles to dissolve cholesterol. This finding may explain some of the adverse hepatobiliary changes associated with long-term administration of TPN.

Effect of wheat bran on serum lipoproteins and biliary lipids.

In this study nine patients with gallstones and nine healthy volunteers were given a high bran diet for 4 weeks. At the outset and at 4 weeks bile specimens were obtained for determination of biliary lipid values, size of the bile-acid pool and bile-acid ratios, and blood specimens were drawn to determine the serum concentration of triglycerides and of lipoprotein-bound cholesterol. Three patients with gallstones remained on the high bran diet for 6 months or more and samples were analysed again. The high bran diet produced a substantial decrease in biliary cholesterol values in patients with gallstones after 4 weeks, and a significant increase in the concentration of high density lipoprotein-cholesterol in the serum of patients who course was followed for 6 months or longer.

The effect of prosthetic gallstones on total bile acid pool size in dogs.

A reduction in total bile acid pool size was noted in nine of ten dogs after the implantation of inert prosthetic gallstones. Sham cholecystotomy without implantation of a prosthesis also produced a small decrease in bile acid pool size but was significantly less than the decrease noted with prosthetic stones. Bile acid ratios--cholic acid, chenodeoxycholic acid and deoxycholic acid--did not change after implantation of prosthetic stones. These findings raise the possibility that the small total bile acid pool size noted in patients with cholesterol gallstones is a phenomenon secondary to the pathologic state of the gallbladder.

The effect of hepatic bile on retained common duct stones.

Study of the time interval since cholecystectomy in 91 patients with symptomatic choledocholithiasis who presented after cholecystectomy led to the conclusion that retained common duct stones increase in size with the passage of time. The inference is that, in these patients bile remains supersaturated with cholesterol after cholecystectomy.

Prolonged secretion of lithogenic bile after cholecystectomy.

Hepatic bile samples were obtained from 8 subjects 1 1/2 to 23 years after cholecystectomy for presumed cholesterol gallstones. The content of cholesterol, bile acids and lecithin was determined for each bile sample and compared to the values found in gallbladder bile in 15 control subjects undergoing cholecystectomy for pure and mixed cholesterol stones. Plot of the data on triangular coordinates and subsequent determination of lithogenic index showed that bile was supersaturated with cholesterol in both groups of patients. The cholesterol content of bile remained at supersaturated levels following cholecystectomy and showed no tendency to return toward normal levels with the passage of time.

A human/mouse hybrid model for the study of human genetic factors influencing tumor cell growth.

Somatic cell hybridization (fusion) was carried out between cells of the murine lymphoma L-5178Y(r) and peripheral human lymphocytes. The L-5178Y(r) line is deficient in hypoxanthine-guanine phosphorybosyl transferase (HGPRT). Using a selective medium system, it was possible to isolate hybrid cell clones having the complete complement of murine chromosomes as well as the human X chromosome on which the gene for HGPRT is located. This model system may be used to study the effect of the human X chromosome on the phenotype of the murine lymphoma.