[Cancer of the breast in young women].
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Biomedical subjects
Publications and source records attributed to M Dintsman.
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Ileus caused by impaction of hardened residual barium stagnated in the colon-a rare complication of barium-meal examination-constitutes a particularly serious problem when it occurs following abdominal operations, leading to postoperative ileus. The administration of Gastrografin in such cases has proven efficacy in the dissolution of inspissated barium, refractory to routine means of evacuation. Four case reports provide an illustration of this problem. The satisfactory results obtained, and the hitherto reported lack of side effects of this compound, justify recommendation of Gastrografin as a safe, simple method for use in the management of these cases.
Wandering spleen with torsion of the splenic pedicle is a rare condition with vague clinical manifestations. If this diagnosis is under condiseration, it can be established by angiography or by splenic scan.
Cryoglobulinemia with peripheral cryoglobulinemic neuropathy is reported in a patient with Gaucher's disease. To the best of our knowledge, a similar relationship has not been previously described. The question whether the cryoglobulinemic neuropathy in this patient is related to Gaucher's disease, or is a mere coincidence, is discussed.
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Two cases in which serious intra-abdominal complications were masked by results of the contrast examination using Gastrografin were encountered. This caused the authors to review critically the use of Gastrografin in the differential diagnosis of paralytic ileus versus mechanical intestinal obstruction. In a series of 41 cases in which the diagnostic problem was not solved initially by means of physical examination and plain abdominal roentgenograms, the Gastrografin examination proved reliable in 28 (68 per cent). The reliability of the examination was defined as the relative number of cases in which a correct decision could be made for or against surgical operation. It is concluded that Gastrografin is a valuable diagnostic aid in controversial cases of ileus. A "negative" result of the examination, however, would never be allowed to damp the surgeon's awareness of possible serious intra-abdominal conditions, which the contrast examination has failed to disclose and which require immediate surgical intervention.
Twenty-seven patients treated for pancreatic and/or biliary-cutaneous fistulas have been reviewed. Four patients died mainly because of cardiopulmonary and septic complications. Spontaneous sealing of the fistula occurred in 81% of the conservatively treated cases (48% of all cases). All the LO fistulas but only 68% of the HO fistulas treated conservatively sealed spontaneously. Eleven patients were treated surgically. There were three deaths and three failures (reappearance of fistula). All the patients who died had been operated on within three months after the appearance of HO fistulas. There was no mortality among the patients with LO fistulas or among patients operated on at a later stage. We have reached the following conclusions: 1. There is a significant difference in prognosis between low output and high output fistulas. 2. In LO fistulas, there is no need for a surgical intervention aimed to close the fistula unless it persists for at least one year. 3. In HO fistulas, if a corrective operation is necessary, it should be withheld for at least three months whenever possible. 4. Roux-en-Y fistulojejunostomy is considered to be the procedure of choice. 5. Infection and premature colsure of the external part of the fistulous tract should be avoided by insertion of drains and repeated surgical drainage, where necessary. 6. High caloric feeding, elemental diet and intravenous hyperalimentation are very important factors that enhance recovery in the surgically and conservatively treated patients.
We describe a patient in whom retroperitoneal dissection of an infected pseudocyst of the pancreas into the left inguinal region imitated an incarcerated hernia. The high level of diastase (32,000 units/ml) in the fluid from the inguinal region and the roentgenologically demonstrated communication between the pancreas and the left inguinal region proved that the source of the fluid was the pancreas. The appearance of a mass in the inguinal region in an alcoholic patient who has recently had pancreatitis should arouse suspicion of an origin in a dissecting pseudocyst of the pancreas.