Steroid-dependent anti-Hu negative paraneoplastic encephalomyelitis and small cell lung carcinoma.
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Biomedical subjects
Publications and source records attributed to C Escamilla.
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The effects of peripheral sympathetic denervation induced by guanethidine administration to newborn and 10-day-old female guinea pigs on puberty, ovulation and the follicular population were analysed. Peripheral sympathetic denervation beginning at birth resulted in the loss of ovarian norepinephrine content (0.95. +/- 0.1 ng/mg wet tissue in untreated control animals vs non detectable in treated animals). Guanethidine administration to newborn or 10-day-old guinea pigs advanced puberty (age of vaginal opening: 27 +/- 1.2 days (newborn), 26 +/- 1.7 (10-day-old) vs 37 +/- 0.7 (control), P < 0.001) and ovulation. The number of corpora lutea in control and denervated animals was similar (3.5 +/- 0.2 vs 3.3 +/- 0.3). The relative weight (mg/100 g body weight) of the ovaries and adrenals in the denervated animals autopsied during the late follicular phase (24-48 h after vaginal opening) increased (ovaries: 27.8 +/- 1.3, 28.9 +/- 3.0 vs 20.9 +/- 0.8, P < 0.05; adrenals 36.4 +/- 1.4, 37.0 +/- 0.8 vs 31.6 +/- 1.5, P < 0.05), while the uterine weight diminished (179 +/- 13, 149 +/- 28 vs 292 +/- 20). When the animals were killed during the late luteal phase (9-11 days after vaginal closure), the relative weight of the ovaries of newborn guanethidine-treated animals was higher than that of the control animals (21.4 +/- 1.7 vs 16.8 +/- 1.4, P < 0.05). The mean number of follicles counted in the ovaries of denervated animals was significantly higher than in control animals (1736 +/- 230 vs 969 +/- 147, P < 0.05). The mean diameter of the follicles in the untouched control ovary in animals killed in the late follicular phase was significantly larger than from animals killed in the late luteal phase (263 +/- 3.9 microns vs 248 +/- 3.0 microns, P < 0.01). The mean diameter of the follicles measured in the ovaries of denervated animals was significantly higher than in controls (animals treated from birth 274 +/- 2.0 microns vs 255 +/- 2.4, P < 0.05; animals treated from day 10, 286 +/- 2.3 microns vs 257 +/- 2.3, P < 0.05). When the mean diameter of the follicles in the left and right ovary of the untouched control was analysed, the follicular diameter in the left ovary was significantly larger than in the right ovary (309 +/- 6.0 microns vs 214 +/- 3.9, P < 0.01); the response of the left and right ovaries to sympathetic denervation was the opposite. The results obtained in the present study suggest that ovarian innervation plays a role in the regulation of follicular growth, maturation and atresia which is not related to changes in steroid secretion by the ovary, but to other regulatory mechanisms.
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INTRODUCTION: The phenomenon of subclavian steal is a frequent haemodynamic phenomenon which rarely causes symptoms in the vertebrobasilar territory. When this does occur, it is known as the subclavian steal syndrome. CLINICAL CASES: We describe two patients with the syndrome of left subclavian steal diagnosed by doppler. In one of them, symptoms appeared after exercise of the left arm. Various aspects of the syndrome are discussed in relation to diagnosis and indications for treatment. CONCLUSIONS: The subclavian steal syndrome is a condition which can be reliably diagnosed using doppler and the treatment of which should be decided individually in each case.
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Of 99 patients with 117 gastrointestinal bezoars, 69 had undergone previous surgery, the most common operation being bilateral truncal vagotomy with pyloroplasty (55 patients). An excessive intake of vegetable fibre was found in 38 patients and poor mastication in 27. Thirty bezoars presented with gastric symptoms and patients had endoscopy as the diagnostic technique; 87 caused symptoms of intestinal obstruction with the diagnosis made by plain abdominal radiography. Medical treatment by enzymic or endoscopic fragmentation was used for 17 of 30 gastric bezoars; surgery was required in the remainder. Intestinal bezoars causing obstruction can be fragmented and 'milked' to the caecum. The stomach should be explored for associated gastric bezoars.
BACKGROUND: Bezoars are large conglomerates of vegetable fibers, hairs, or concretions of various substances located in the stomach or small intestine of humans and certain animals, mainly ruminants. Gastrointestinal bezoars have constituted a relatively common clinical reality ever since the introduction of truncal vagotomy associated with drainage or gastric resection in the treatment of gastroduodenal peptic ulcer. STUDY DESIGN: This study presents a series of 87 cases of intestinal bezoar treated in our department of general surgery. Analysis was made of data obtained retrospectively from clinical histories, together with a clinical and endoscopic review of the patients. RESULTS: Most of the patients had had previous operative treatment (76.3 percent), the most commonly used technique being bilateral truncal vagotomy plus pyloroplasty (75.8 percent). An excessive intake of vegetable fiber was revealed in 39.5 percent of the cases, and alterations in dentition and mastication in 24 percent. Operative treatment was used in all patients. We attempted to fragment the bezoar and milk it to the cecum. Enterotomy and bezoar extraction were reserved for cases where fragmentation was impossible, as enterotomy was associated with more complications (p < 0.05). CONCLUSIONS: Bilateral truncal vagotomy plus pyloroplasty and a excessive ingestion of vegetable fiber are the main factors predisposing to bezoar formation. Clinically, intestinal bezoars manifest themselves in most cases as complete intestinal obstruction. Simple roentgenography of the abdomen is the fundamental technique for diagnosing the occlusive syndrome. Treatment must be operative, during which the bezoar is fragmented and milked to the cecum. The stomach must be explored for associated bezoars.
We present a series of 56 patients with gastrointestinal bezoar following previous gastric surgery for gastroduodenal peptic ulcer. The following parameters were studied: factors predisposing to bezoar formation (type of previous surgery, alimentation, and mastication), form of clinical presentation, diagnostic tests, and treatment. A bilateral truncal vagotomy plus pyloroplasty had been performed previously on 84% of patients, 44% revealed excessive intake of vegetable fiber, and 30% presented with bad dentition. The most frequent clinical presentation was intestinal obstruction (80%). This was diagnosed mainly by clinical data and simple abdominal radiology. The main exploratory technique for diagnosing cases of gastric bezoar was endoscopy. Surgery is necessary for treating the intestinal forms, and one should always attempt to fragment the bezoar and milk it to the cecum, reserving enterotomy and extraction for cases where this is not possible. The small intestine and stomach should always be explored for retained bezoars. Gastric bezoars should always receive conservative treatment, endoscopic extraction, and/or enzymatic dissolution; gastrotomy and extraction should be performed when this fails.
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