Atypical congenital atresia of the esophagus. Treatment of this anomaly by means of retrosternal colon transplant.
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Biomedical subjects
Publications and source records attributed to F A ROGERS.
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Elevated serum amylase is a frequent concomitant of perforated gastroduodenal ulcer. To determine if there might be significant correlation between an increase in amylase and some of the other factors associated with ulcer perforation, a study was made of the clinical records of 1,000 patients with perforation of gastroduodenal ulcers. Sixteen per cent of the patients had amylase levels of 200 Somogyi units or more. This rise in serum amylase comes about in cases of perforated peptic ulcer as a result of peritoneal lymphatic absorption of fluid containing pancreatic enzyme which is spilled through the perforation. Among patients with perforated ulcers and elevated serum amylase levels, the higher the amylase level, the higher the mortality rate. The factors of amount of abdominal fluid spill, the duration of the perforation before surgical closure, the size of the perforation, shock and recent ingestion of food were also studied for possible relationship with elevated serum amylase. All appeared to be statistical if not etiological associates of abnormal serum amylase levels. Because high amylase values so often occur in perforated ulcer, there is no amylase level that can be considered diagnostic of acute pancreatitis.
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The literature on the subject and the records of 40 cases of proven gallstone obstruction in the small intestine observed at the Los Angeles County General Hospital over a 27-year period were reviewed. The incidence of this type of obstruction is about 1.5 per cent of all cases of mechanical intestinal obstruction; and it occurs more often in women than in men-the ratio was 3.7 to 1 in the Los Angeles County General Hospital series. In general, the majority of patients are in the seventh decade of life, although in the present series the age average was well over 70 years. Gallstones large enough to cause intestinal obstruction almost invariably reach the intestinal tract through a fistula between the gallbladder and the duodenum. The symptoms of gallstone obstruction are principally those of mechanical obstruction of the small bowel. The usual site of obstruction is the distal ileum. When gallstones are the cause of obstruction, the symptoms may be intermittent. Surgical operation is the treatment of choice. Exploration should include a complete examination of the intestinal tract to make certain multiple stones are not overlooked, and the right upper quadrant should be palpated for the presence of an acutely inflamed gallbladder or more calculi.
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