Biomedical subjects
Publications and source records attributed to C Hatzitheofilou.
We report a patient who developed tension pneumopericardium following penetrating trauma to the chest. Lung adhering to the pleura due to previous infection prevented the lung from collapsing and resulted in diversion of the air leak into the anterior mediastinum and from there through a breach into the pericardium.
Ischaemic necrosis of the lesser curve of the stomach is thought to be a specific but rare complication of highly selective vagotomy. While it commonly presents as a free perforation, it may also present as sloughing of the mucosa only, a gastric fistula or a sealed perforation of the lesser curve mimicking a chronic gastric ulcer. We describe a case in which ischaemic necrosis of the lesser curve presented as a chronic gastric ulcer from a sealed perforation.
Twenty patients with penetrating injuries of the vertebral artery who were treated as emergencies were subjected to the following operative approaches: five cases, Henry's approach (posterior) and modified Henry's approach (anterior); five cases, limited exposure and application of metal clips; four cases, plugging of the arterial defect with Oxycell or crushed muscle; three cases, control with ligatures and non-conventional exposure of the artery; one case, inflation of a balloon catheter within the vertebral canal; one case, repair of the lacerated first extraosseous part of the vertebral artery. One patient died from exsanguination on the operating table, before any repair was possible. The overall mortality was 20 per cent and the mean hospital stay 6.1 days. Thirty-five per cent of the patients presented with neurological complications, and 55 per cent left the hospital well. No advantage of Henry's classical approach over limited exposure and control with metal clips was shown, when mortality, hospital stay and long-term problems were compared. Because of its relative simplicity we suggest that the metal clipping of the vertebral artery, above and below the site of injury, is an effective technique that can be used to stop the bleeding. One case presented as a false aneurysm of the vertebral artery, following a stab wound. This was successfully treated with excision of the aneurysm and vertebrovertebral artery bypass, using a saphenous vein graft.
This study involved 163 patients with penetrating injuries of the diaphragm (knife, 139; bullet, 24). Intra-abdominal injuries were present in 122 patients (75 per cent) and this resulted in early diagnosis and treatment of the associated diaphragmatic injury (mortality 3.2 per cent). In the remaining 41 patients (25 per cent) the injury was confined to the diaphragm, and the diagnosis was missed during the initial admission in 10 patients who returned at a later stage with diaphragmatic hernia. A diaphragmatic hernia was found in 24 cases (14.7 per cent). Fourteen of these were diagnosed during the initial admission (mortality 7.1 per cent) and the remaining ten were diagnosed during a subsequent admission (mortality 30 per cent). The initial chest radiograph was diagnostic of diaphragmatic injury in 13 per cent, abnormal but not diagnostic in 76 per cent, and completely normal in 11 per cent. The importance of early diagnosis in reducing mortality, morbidity and hospital stay is emphasized. A high index of suspicion, careful clinical examination, and serial chest radiographs remain the best way of making the diagnosis.
This is a prospective study of 230 patients with penetrating injuries of the back. The decision to operate or observe was taken exclusively on the abdominal physical findings. One hundred ninety-five patients (85%) did not require operation, 30 (13%) underwent a therapeutic laparotomy, four (1.7%) an unnecessary operation, and one patient (0.4%) had a completely negative laparotomy. The diagnosis and management was delayed in five (2.2%) patients with no serious consequences. Mortality rates were not recorded in this series. The initial physical examination was accurate in 95.2% of the patients. We suggest that penetrating injuries of the back should be assessed in the same way as anterior abdominal injuries. Physical abdominal examination is reliable in detecting significant intra-abdominal injuries.
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A radioimmunometric assay was developed from P3 lung carcinoma target cells to detect anti-lung cancer antibodies. Of 100 sera from lung cancer patients tested, 80 (80%) were positive. However, only 6/30 (20%) sera from cancer patients with other cancers, 1/25 (4%) of sera from patients with nonmalignant lung disease, and 0/20 sera from healthy donors were positive. Quantitative absorptions showed that sera from lung cancer patients cross-reacted with other lung cancers, gastrointestinal cancers, and/or fetal lung tissues, but not with breast carcinomas, melanomas, sarcomas, fetal skin, or normal lung tissues. Two lung cancer antigens were defined: LCA-1, which shared antigenic determinants with GI tumors and fetal lung tissues, and LCA-2, which showed cross-reactivity only with GI tumors.
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A case of agenesis of the right hemidiaphragm in a 6-year-old child is reported. The rarity, aetiological differences in comparison with other diaphragmatic hernias, and other embryological aspects of this anomaly are discussed. The diagnostic and therapeutic approach to this entity is also presented.
Autopsy slides from 22 melanoma patients who received bacille Calmette-Guérin BCG immunotherapy and who had a postmortem examination at the UCLA Center for the Health Sciences were examined for the presence of granulomas. Granulomas were found in six patients (29%) who received BCG but not in a group of 25 melanoma patients who did not have BCG immunotherapy. A number of factors were tested for correlation with the presence of granulomas in the autopsy material. Fifty-five percent of the patients who received BCG by both intralesional and time technique developed granulomas. No patients given BCG by the tine technique alone developed granulomas. No correlation was found between granulomas and the presence of symptoms after the administration of BCG, the duration of BCG immunotherapy, the patient's age, the number of BCG administrations, treatment with immunosuppressive agents, the length of survival after the last BCG administration, the presence of a positive PPD reaction, a positive history for granuloma-forming diseases and tests for immunocompetence. However, these results provide evidence that the route of BCG administration strongly influences the frequency of granulomas in melanoma patients who received BCG immunotherapy.
There is mounting evidence that hyperthermia of 42 degrees C or greater is tumoricidal to cell cultures and to animal and human tumors. However, temperatures of 45 degrees C or greater may have greater potential therapeutic benefit. The ability to selectively achieve such highintratratumor temperatures without injury to normal tissue may be due to the relatively poor blood flow in tumors compared with that in normal tissues. While vascularity and blood flow are known to vary significantly among tumors, we found that of 52 tumors evaluated, temperatures of 42 degrees C or greater in 42 tumors (81 per cent) and of 45 degrees C or greater in 23 tumors (44 per cent) appeared to be independent of the histologic type of tumor. Therefore, therapeutic hyperthermia may be possible for most varieties of human solid cancer.
Two hundred patients suffering from peptic ulcer have been examined for urinary stones. Two hundred healthy controls have been similary studied. In 14 patients from the first group (7%) urinary calculi were found, whereas the percentage in the second group was only 1%. This difference is statistically significant (P less than 0.01) (x2 distribution test). The increased incidence of peptic ulcer was attributed to the consumption of calcium in combination with easily absorbable alkalis (sodium bicarbonate). These findings must be considered in therapy for peptic ulcer diathesis.
A new technic for restoration of gastrointestinal continuity following pancreatoduodenectomy for cinoma of the head of the pancreas is described and the advantages discussed. We believe this method prevents any leakage of the anastomosis and reduces mortality and morbidity because of better drainage. Also, by avoiding stasis, infection, which is a common complication in this kind of surgery, is prevented.
A case of liver actinomycosis successfully treated with high doses of penicillin for a long period after surgery is reported. The unusual location of the disease and early detection difficulties delayed the diagnosis and establishment of proper treatment, causing additional liver damage. Serum globulin levels, alkaline phosphatase and turbidity tests were of diagnostic significance. Adequate drainage of the lesion and long-term antibiotic treatment with penicillin proved therapeutically satisfactory.
Fifty-five patients underwent thorough laboratory and clinical investigations for pancreatic cancer. The disease was diagnosed in 32 patients. Thirty of these plus three others who did not undergo the sequence of tests underwent exploratory surgery. Pancreatic cancer was found in all. The high diagnostic accuracy was mainly due to the secretin test. We used Dreiling's technic for this test, which we think is the most popular and accurate technic.