Idiopathic segmental infarction of the greater omentum successfully treated by laparoscopy: report of case.

Idiopathic or spontaneous segmental infarction of the greater omentum (ISIGO) is a rare cause of acute right-sided abdominal pain. The symptoms simulate acute appendicitis in 66% of cases and cholecystitis in 22%. Progressive peritonitis usually dictates laparotomy, and an accurate diagnosis is rarely made before surgery. The etiology of the hemorrhagic necrosis is unknown, but predisposing factors such as anatomic variations in the blood supply to the right free omental end, obesity, trauma, overeating, coughing, and a sudden change in position may play a role in the pathogenesis. We present herein the case of a 37-year-old man in whom ISIGO, precipitated by obesity and overeating, was successfully diagnosed and treated by laparoscopy. Resection of the necrotic part of the greater omentum is the therapy of choice, and ensures fast recovery and pain control. Serohemorrhagic ascites is a common finding in ISIGO, and careful exploration of the whole abdominal cavity should be performed. The laparoscopic approach allows both exploration and surgical intervention.

Inability of intact cells of Treponema denticola to degrade human serum proteins IgA, IgG and albumin.

Treponema denticola has been shown to be associated with periodontitis in man and animals. The organism ferments amino acids and thrives on the proteins in the periodontal pocket. Accordingly, T. denticola possesses various proteolytic enzymes, including a chymotrypsin-like protease, capable of hydrolyzing a whole range of proteins, including immunoglobulins. Yet, it is not clear whether the intact cells of T. denticola can degrade immunoglobulins and albumin. The purpose of this study was to clarify this point. Three strains of T. denticola were cultured in liquid medium, and cells were harvested by centrifugation. Protein degradation in cell suspensions was assayed by capillary electrophoresis and immunonephelometry. None of the T. denticola strains appeared to be able to degrade IgA, IgG, or albumin, while a strain of P. gingivalis completely hydrolyzed these proteins. The findings suggest that, in the periodontal pocket, T. denticola depends on proteinases from other bacteria for utilization of the available serum proteins. This is in accordance with clinical data showing a close relationship between T. denticola and strongly proteolytic bacteria, such as Porphyromonas gingivalis and Bacteroides forsythus.

[Integration, organization and results of ambulatory surgery in a central hospital]. / Integration, Organisation und Resultate der Tageschirurgie an einem Zentrumsspital.

Principally driven by economic necessity, i.e. reduction of health care personnel and beds, a significant increase in number of major operations for in-patients and a general attempt to reduce costs, a day-surgery unit was established for the Surgical Department at the Kantonsspital St. Gallen. Several requirements have to be met: Standardized techniques have to be applied by experienced surgeons and strict selection criteria for patients as well as intensive preoperative patient information and consenting have to be observed. During a two year period (September 1992 to August 1994) 389 patients were evaluated for ambulatory surgery. 106 patients (27.2%) had to be rejected for social, medical and financial reasons. Eventually operations were carried out on 283 patients. The majority of procedures performed were for herniae (37.8%) followed by varicose vein-surgery (22.6%). Only 8 patients had to be admitted for observation as in-patients, this was mainly due to difficulties in postoperative mobilisation and micturition problems. To monitor our quality of care, questionnaires were sent to patients and general practitioners (GP's). 98% of patients were satisfied with the preoperative information standards. Difficulties in adapting to a postoperative daily routine was stated by 13% of patients. 80% of patients would again opt for surgery on a day-care basis in future. 81% of GP's reported a positive benefit for their patients from ambulatory surgery. All GP's were prepared to undertake preoperative patient evaluation according to standardized selection criteria. A significant reduction in costs can be expected. With the current health-insurance system this is unfortunately achieved with an increased financial burdening for the patient.

[Ambulatory surgery--a sensible future perspective]. / Tageschirurgie--eine sinnvolle Zukunftsperspektive.

Increasing costs in health system, reduction of bed capacities and lack of nurses force to search for solution. To prove that day surgery may be a kind of solution, a pilot project was analysed during 8 months. This project was fully integrated in normal clinical management. Operated patients (n = 100; hernias, varicosis, proctological and other indications), preoperatively selected by specific criterias, and the family doctors were questioned retrospectively of their experiences. The results were very encouraging. Moreover we stated that day surgery is cost-covering. So day surgery is to consider as an important factor to cost-reduction.

Dysregulation of atrial natriuretic factor in hypertension-prone man.

To evaluate the hypothesis of an atrial natriuretic factor (ANF) deficiency in hypertension-prone humans, we investigated plasma ANF and other variables in 116 white offspring of normotensive parents (ONorm) or essential hypertensive parents (OHyp). Ten ONorm and 10 OHyp, all men matched for age and body habitus, were studied after 4 days of low (70 mmol/day) and high (350 mmol/day) dietary sodium intake. After mild sodium restriction, plasma ANF did not differ between ONorm and OHyp (9.7 +/- 0.7 vs. 9.0 +/- 1.3 fmol/L). On high sodium intake, plasma ANF increased in ONorm, but not in OHyp (to 18.3 +/- 1.7 vs. 11.7 +/- 1.7 fmol/L; P less than 0.001). On the other hand, acute responses of plasma immunoreactive ANF (irANF) to saline loading or a norepinephrine-induced rise in blood pressure did not differ significantly between 8 ONorm and 8 OHyp. Fifty-one additional ONorm and 45 OHyp were evaluated during liberal sodium intake. Groups were further subdivided according to whether 24-h urinary sodium excretion was 91 mmol/m2 or less (modest salt intake) or more than 91 mmol/m2 (high salt intake). Twenty-four-hour urinary sodium was similar in the 26 ONorm and 21 OHyp on a modest salt intake (121 +/- 6 vs. 116 +/- 9 mmol) and in the 25 ONorm and the 24 OHyp on a high salt intake (226 +/- 10 vs. 221 +/- 9 mmol). However, compared with ONorm, plasma irANF in OHyp was slightly lower on modest sodium intake (7.7 +/- 0.7 vs. 5.3 +/- 0.7 fmol/L; P less than 0.05) and markedly reduced on high sodium intake (15.0 +/- 1.3 vs. 8.0 +/- 1.3 fmol/L; P less than 0.001). Moreover, the slope of the relationship between plasma irANF and 24-h urinary sodium was flatter in OHyp than in ONorm (z test = 2.4). We postulate a new endocrine syndrome characterized by a relative plasma ANF deficiency during high sodium intake in some hypertension-prone humans. This functional defect becomes apparent during chronic, rather than acute, stimulation of ANF release. It occurs as a familial disturbance and may potentially predispose to the development of hypertension.