Radioimmunodetection of tumors with monoclonal antiplacental ferritin antibody: preliminary results.

Two mouse monoclonal antiferritin antibodies were employed to detect tumors. In the first case a solitary hepatoma was defined, while in the second one, mediastinal metastases of breast cancer were detected. In both cases serum ferritin levels were raised. The availability of monoclonal antiferritin antibodies offers certain advantages over polyclonal antibodies (ease of production, purification and reproducibility). These antiferritin antibodies may be found useful in diagnosis and therapy of certain tumors.

LDA measurements and numerical prediction of pulsatile laminar flow in a plane 90-degree bifurcation.

An experimental and numerical study of pulsatile laminar flow in a plane 90-degree bifurcation is presented. Detailed LDA velocity measurements of the oscillatory flow field have been carried out. The numerical predictions, which are based on an iterative, finite-difference numerical procedure using primitive dependent variables, are in good agreement with the measurements. The results show that one separation zone is established near the bottom wall of the main duct and another near the upstream wall of the branch. The location and size of the separation zones vary within the cycle and are influenced by the Reynolds number, the flow rate ratio, and the Stokes number.

Unusual pseudoaneurysm of Dacron femoro-popliteal graft shaft. A case report.

An unusual case of pseudoaneurysm in the mid segment of a Dacron femoro-popliteal graft is reported. The radiological diagnosis was based on computed tomography which correlated well with the surgical findings. A manufacturing defect seems to be the most likely cause of this pseudoaneurysm.

Enterolithiasis.

We have seen two cases of enterolithiasis in middle-aged Bedouin women. In the first, the cause was prestenotic saccular dilatation from a postoperative stricture of the terminal ileum. In the second, stones formed in congenital diverticula in the terminal ileum and cecum. In both patients, the diagnosis was established by small-bowel enema.

Adenosquamous carcinoma of the common bile duct: a case report.

Reported here is a case of primary adenosquamous carcinoma of the common bile duct. This unusual variant of the ordinary adenocarcinoma has not, to the best of our knowledge, been previously reported as occurring in the extrahepatic bile ducts. A tumor of notorious prognostic significance, it represents an exceedingly rare and peculiar biological phenomenon of malignant metaplastic change.

Ewing's sarcoma metastatic to focal nodular hyperplasia of liver.

A case is presented of a young woman discovered at thoracotomy to have Ewing's sarcoma of the left lower ribs with soft tissue extension to the diaphragm and thoracic wall. Laparotomy at the same operation showed a nodule of focal nodular hyperplasia of the liver with a focus of metastasis from the sarcoma within the area of hyperplasia. This is the first report of metastasis of any tumor to a hepatic lesion of this sort. Possible reasons for metastasis to this type of lesion are discussed.

Diagnosis of acute cholecystitis by 99mTc-iminodiacetic acid cholescintigraphy.

99mTc-iminodiacetic acid (IDA) compounds are concentrated by hepatocytes and excreted into the biliary system. The utility of 99mTc-IDA imaging in 116 patients with suspected acute cholecystitis was studied retrospectively over a 2-year period. Visualization of the gallbladder ruled out obstructed cystic duct and acute cholecystitis with a high degree of accuracy.

Avulsion of common bile duct after blunt abdominal injury: a review of the literature.

Injury to the common bile duct following blunt injury of the abdomen has been reported in 82 previous cases in the literature that we have reviewed. An additional rare case of complete avulsion of the common bile duct at its junction with the pancreas is presented here. Diagnosis has usually been late, peritonitis has commonly been present and 33 per cent of the cases ended fatally. Although diagnosis is often late, there have been many attempts at primary repair; we describe a new technique of delayed repair, which involved intermittent closure of the common duct and was successful in increasing its diameter by the time of the second operation. The initial injury was treated by a cutaneous choledochostomy and 2 jejunostomy tubes, one for decompression and drainage and the other for feeding and replacement of bile. The final repair consisted of a choledochojejunostomy, jejunojejunostomy and T-tube drainage of the common juct. The patient is completely well after two years.

Angiographic diagnosis and treatment of hemobilia.

Hemobilia (bleeding from the biliary tract) may be secondary to trauma, inflammatory disorders, gallstones, or tumor. Although it used to be rare, it is becoming more frequent due to trauma, including iatrogenic causes. The etiology is established by selective angiography, which also facilitates embolic occlusion of the arterial branches supplying the lesion. Nonsurgical control is preferable to surgical management. Two cases are reported, emphasizing the etiologic and therapeutic aspects of interventional studies of the liver.

Cystosarcoma phyllodes.

A series of 27 cystosarcoma phyllodes diagnosed in 23 patients is presented. Treatment consisted of wide local excision with a rim of normal tissue for the histologically benign-appearing tumors, and simple mastectomy for the histologically malignant-appearing tumors. Of the three tumors with a malignant appearance, one metastasized distantly and the patient died; the other two patients were apparently cured. Of the 24 benign-appearing tumors, 3 recurred locally and were cured by reexcision. None behaved in a malignant fashion. There was one case of bilateral cystosarcoma phyllodes, and one tumor was associated with carcinoma of the breast. The local recurrence rate of 11% (3 out of 27) and mortality rate of 4% (1 out of 23) appears to justify this therapeutic approach. The precise indications for mastectomy in this disease are still unclear.

Vascular trauma: successful repair using human umbilical cord vein interposition grafts in femoral artery and vein.

A case of extensive injury to the left femoral artery and vein is presented. As circumstances did not permit the use of autogenous vein grafts, human umbilical cord vein grafts were used. Almost one year afterwards the patient is doing well and both grafts are patent.

Arterial combat injuries of the upper extremity.

The results of treatment of 101 combat injuries of the upper extremities are reported. There were 84 acute injuries and 17 late complications. There was a high incidence of associated fractures (35%) and nerve lesions (51%). Over half the injuries were repaired by saphenous vein graft replacement. There were seven early amputations related to a long delay before treatment, extensive tissue damage, and sepsis with delayed hemorrhage. There were no late amputations, but residual neurologic damage gave a less than perfect result in 32 extremities. Two injuries resulted in Volkmann's contracture. Fracture specific to the management of upper-extremity arterial injuries are outlined.

Mesenteric vein thrombosis. The importance of a second-look operation.

Mesenteric vein thrombosis is an abdominal emergency that is rarely diagnosed early. Review of the literature has shown that most cases have been treated by intestinal resection, a few by thrombectomy with or without resection. Three cases of mesenteric vein thrombosis were treated by resection, heparinization, and a second-look operation after 24 hours. When necessary, resection was carried out at the second surgical procedure followed by a third-look operation after 24 hours. After the last inspecting operation without further resection, full heparinization was continued and anticoagulation was ultimately maintained with warafin sodium (Coumadin) for at least three months. The authors believe that optimal treatment for mesenteric vein thrombosis should include anticoagulation with heparin sodium and a mandatory second-look operation.

Successful control of pheochromocytoma in pregnancy. Case report.

A patient found to have a pheochromocytoma in the 16th wk of pregnancy was successfully managed by medical treatment with phenoxybenzamine hydrochloride and propranolol. In the 38th wk of pregnancy she was electively delivered by cesarean section, and the tumor was simultaneously removed.