Biomedical subjects
Publications and source records attributed to H A Aletras.
The case of a 57-year-old man who had previously undergone left lobectomy for echinococcal disease of the lung is described. Sixteen years later he presented with empyema and bronchopleural fistula, which were treated using a pedicled intercostal muscle bundle, an omental pedicle and partial thoracoplasty. The patient recovered and is well 6 years later.
OBJECTIVE: To find out if pedicle grafts of peritoneum and transversalis muscle could be used to repair large defects in the wall of the duodenum. DESIGN: Experimental study. MATERIAL: 18 healthy mongrel dogs. INTERVENTIONS: Defects were created in the second part of duodenum and repaired with pedicle grafts of peritoneum and transversalis muscle from the anterior wall of the right side of the abdomen. MAIN OUTCOME MEASURES: Postoperative complications, appearances on upper gastrointestinal radiography two and four months after operation, and histological examination of necropsy specimens. RESULTS: There were no postoperative deaths or complications. Radiographs of the duodenum showed no abnormalities and in particular no signs of obstruction. Animals were killed at intervals from one week to eight months after operation, and the only abnormality was 20-30% stenosis found in five dogs killed within two months of operation, which did not affect gastric emptying. Histological examination showed that by four months after operation the patch was completely covered by neomucosa that was similar to normal duodenal mucosa. By six months the site of the defect was well healed and the histological appearance was the same as at four months. CONCLUSION: Pedicle grafts of peritoneum and transversalis muscle may be useful in the treatment of patients with large defects in the wall of the duodenum.
Without surgical treatment, pancreatic abscess remains a highly lethal complication of acute pancreatitis. Many surgical series have reported mortality rates of 32 to 65 per cent in treated cases. Although pancreatic abscess is a rare condition, it is more common in patients with severe pancreatitis. A retrospective study of 130 patients admitted to our unit with severe acute pancreatitis during the period from 1965 to 1987 revealed 18 cases of pancreatic abscess. All pancreatic abscesses were primary in nature, and no infected pseudocysts were included in the series. Clinical surveillance, repeated laboratory tests, conventional radiology, and especially ultrasonography and CT scan all contributed to the preoperative diagnosis. The applied treatment was surgical debridement of all necrotic tissue and either local or extensive external drainage. In 12 cases this procedure was combined with other surgical interventions. The recorded mortality rate was 16.66 per cent. Factors adversely affecting survival include: 1) severity of precipitating pancreatitis; 2) difficulty in making early and accurate diagnosis of the pancreatic abscess; 3) marked tendency for recurrence of sepsis; and 4) life-threatening associated complications and/or diseases.
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Cystosarcoma phyllodes is a rare breast lesion representing between 0.5 and 2.5 percent of all breast tumors. Its microscopic and clinical features are impressive. When first described by J. Mueller in 1838, the lesion was thought to be a benign neoplasm without metastatic potential. Nevertheless, more recent reports have shown either recurrent or metastatic cystosarcoma phyllodes. Some Authors have attempted to predict biologic behavior from histological appearance so that the extent of surgical management could be determined. However, only a small percentage of histologically malignant tumors have recurred or metastasized. The above observations stimulated the present analysis of the histology, clinical behavior, appropriate therapy and prognosis in ten patients with cystosarcoma phyllodes seen at our unit, from 1965 to 1979.
Retroperitoneal cysts are most commonly found in relation to the small bowel but may be found in the mesentery of the colon or in the omentum. Only a few hundred cases have been reported. In the present analysis four more cases are reported and the pertinent literature is reviewed. The diagnosis is made by clinical suspicion, barium meal and/or enema, sonography and axial computerized tomography. Treatment of choice is by enucleation of the cyst, if possible. Morbidity and mortality should be very low, because of recent advances in surgery and intensive care of the patient.