Mesenteric vein thrombosis after injection sclerotherapy for oesophageal varices. Case report.
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Biomedical subjects
Publications and source records attributed to H B Abramowitz.
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A 6-kg explosive charge detonated under a seat in the center of a crowded city bus in Jerusalem, killing three passengers immediately. Of the 55 survivors, all of whom were transferred to two major medical centers, 29 were hospitalized. Among those admitted, a high rate of primary blast injuries was found, including perforated ear drums (76%), blast lung (38%), and abdominal blast injuries (14%). Two of the latter patients suffered bowel perforations, which were diagnosed with considerable delay. Eight patients (31%) had sustained life-threatening trauma, consisting of a combination of primary, secondary, and tertiary blast injuries. The overall mortality rate was 10.3%. The large number of primary blast injuries, including the unexpected finding of bowel perforations, is explained by the high amplitude of the air pressure wave (3.8-5.2 atm) and its relatively long duration (2-3 msec) resulting from the detonation of the high-energy explosive charge in the small, enclosed space of the bus. Besides the usual wounds sustained by victims of an explosion that occurs in a confined space, the possibility of primary blast injury to the abdomen and to the lungs should be taken into account by the treating surgeon.
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The accurate diagnosis of acute lower abdominal pain continues to be a problem. In Israel, a diagnostic sign often sought as indicating pelvic peritonitis is a rectal temperature of greater than 1.0 C higher than the simultaneous oral temperature. We established that in each of the 20 emergency rooms surveyed both oral and rectal temperatures are measured as part of the admission procedure for patients with acute lower abdominal pain. The charts of three groups of 100 patients with acute lower abdominal pain were studied retrospectively. A rectal temperature of greater than 1.0 C higher than the oral was found in about 10% of each group. Both oral and rectal temperatures were raised in 56, 69 and 37% of each group, respectively. The rectal temperature alone was elevated in 8.5% of patients with appendicitis or pelvic inflammatory disease (PID), as well as in 6% of patients with undiagnosed abdominal pain. Oral temperatures alone were elevated in 4.5% of patients with acute appendicitis or PID and also in 13% of patients with undiagnosed abdominal pain. These differences were not significant. We conclude that the common Israeli practice of measuring both rectal and oral temperatures in patients with acute lower abdominal pain gives no more information than the measurement of either one.
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In an attempt to develop a noninvasive test to assess objectively the magnitude of venous valvular dysfunction in pathologic states, photoplethysmography (PPG) was compared to venous pressure in the saphenous vein at the ankle. Simultaneous venous pressure and PPG recordings were taken before, during, and after exercise with subjects in the sitting position. In a total of 338 paired measurements in 24 normal, 25 postphlebitic, and 14 varicose limbs, PPG and venous pressure tracings appeared to be identical; data points had a correlation coefficient of great significance (r = 0.898). Postexercise recovery times clearly separated the normal from the postphlebitic limbs. Varicose limbs were assessed accurately regarding results of proposed surgery using an above-knee tourniquet. It appears that the PPG evaluation provides information comparable to venous pressure studies and does so more quickly and noninvasively. The test holds promise in measuring results of direct venous reconstructive surgery as well as in venectomy procedures.
Perforation of the hypopharynx due to traumatic attempted endotracheal intubation usually occurs during resuscitation efforts under poor conditions, but may occur even under optimal conditions due to improper technique. The implication of the appearance of subcutaneous emphysema in the neck, cyanosis, or pneumothorax during or following attempts at endotracheal intubation should be known. Direct laryngoscopy may be helpful in establishing the injury but early radiological examination is necessary for diagnosis of the site and extent of the perforation. The radiological contribution appears to be decisive in the choice of treatment. The radiological findings and the considerable morbidity observed in 6 cases of hypopharyngeal injury are described.
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Spontaneous rupture of the stomach may occur in cases of abnormal distension and reduced emptying capacity, either by normal peristalsis or by vomiting, of the stomach. We present a case of spontaneous rupture of the stomach in which the dilatation was due to apple fermentation and gas formation in the stomach. Peristalsis was inadequate for stomach emptying due to impaction of apple skins in the duodenum. The inability to vomit was due to a Nissen fundoplication performed 18 months earlier.
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