Biomedical subjects
Publications and source records attributed to M Nobel.
Laparoscopy using carbon dioxide has been a standard gynecological procedure for many years. During the past 3 years, it has become commonly used in general surgery as well. Laparoscopic cholecystectomy is rapidly spreading world-wide. Although minor and major complications have been attributed to this procedure, their frequency is low. We report a case of subcutaneous emphysema following laparoscopic cholecystectomy.
Auditory brainstem evoked response-(ABR) may be affected by changes in cerebral blood flow. Apart from its primary indications for prevention of stroke and transient ischemic attacks-(TIA's), internal carotid endarterectomy-(ICE) has been shown to improve cognitive function and cause diminution of tinnitus and vertigo. A one-week postoperative ABR previous study of patients undergoing ICE demonstrated no change in ABR recordings. In order to evaluate possible late changes, we have conducted a prospective study of the delayed effects of ICE on ABR in 13 patients. No initial pathology was noted and no significant change found in any of the absolute and interpeak latencies of ABR waves.
Epidermoid carcinoma of the skin of the head and neck may uncommonly involve the parotid gland by either direct extension or metastases to the parotid lymph nodes. The parotid gland contains a rich network of superficial and deep nodes, draining a large area of the facial region, with the preauricular, cheek, ear, and eyelid dominating. Few patients with direct parenchymal invasion of the parotid gland by a simultaneously existing squamous or basal cell carcinoma were reported. We could find no report discussing direct tumoral invasion into the submandibular salivary gland. Three patients with squamous cell carcinomas and 2 with basal cell carcinomas of the skin directly involving the underlying salivary glands are presented. The few authors discussing this subject concur that treatment should include resection of the primary tumor along with parotidectomy. Elective neck dissection and irradiation are proposed. The course of disease, treatment, and survival of our patients are discussed.
The syndrome of inappropriate secretion of arginine vasopressin (AVP) known as the syndrome of inappropriate antidiuretic hormone secretion (SIADH) is characterized by hyponatremia that results from water retention attributable to persistent AVP release. It may occur in a variety of malignant and nonmalignant lesions, with small cell or oat cell carcinoma of the lung by far responsible for the largest number of these cases. Cancer of the head and neck may be a rare cause of SIADH, and only a few such cases have been reported. We describe four patients with advanced cancer of the head and neck region with coexisting SIADH. Diagnosis and treatment are reported and the literature is reviewed. The possible occurrence of SIADH in the head and neck surgical practice should be kept in mind. Since SIADH is usually transient, water restriction and parenteral sodium chloride may be sufficient in overcoming the acute phase.
The standard treatment for cholelithiasis is cholecystectomy at open operation, which requires relatively long hospitalization and long absence from work. These socio-economic factors and a desire to avoid operative trauma and its complications led to the development of noninvasive therapy. The methods used so far, stone dissolution and extracorporeal shock wave lithotripsy, have proven unsatisfactory. The first takes a long time and has a high recurrence rate, the second has relatively frequent complications. Furthermore, both methods leave the diseased gallbladder in place. During the past year laparoscopic cholecystectomy has been developed in various centers and has been adopted in our department. We describe our initial experience with the technique in 70 cases aged 18-79 years.
Duodenal duplication cysts are rare and are usually found in neonates or young children who present with obstructive symptoms. It accounts for 4-12% of all duplications in the gastrointestinal tract. The rate of other developmental abnormalities has been reported as high as 38%. In few instances have duodenal duplication cysts been described in adults. A case of duodenal duplication cyst in a 46-year-old woman is presented. The diagnosis was established preoperatively by computerized tomography and ultrasound examination.
False aneurysm of the carotid artery is a rare complication of carotid endarterectomy. We present a 65-year-old woman and a 68-year-old man with this condition. In 1 the artery had been closed with a Dacron patch graft, and in the other by direct suture. In the first case the aneurysm was successfully repaired with an expanded GoreTex (PTFE) patch graft sutured with monofilament nylon. In neither case was an organism grown from cultures taken at operation. The incidence of false carotid aneurysm as a complication of endarterectomy is only 0.3%. Usually infection is the main cause. It is therefore surprising that closure with a synthetic patch-graft is not a predisposing factor in the development of false carotid aneurysms, neither according to the literature nor in our own very limited experience with this complication.
Spontaneous biliary cutaneous fistula is a rare complication of inflammatory perforation of the gallbladder. We describe a 70-year-old woman who developed a fistula between the gallbladder and the skin following drainage of an abdominal wall abscess. In such cases primary drainage of the abscess alone is advisable. Only after the active infection has subsided should definitive cholecystectomy and excision of the fistulous tract be carried out.
A duodenal duplication cyst containing enteroliths in an adult patient is presented. The preoperative diagnosis was established by computed tomographic (CT) and ultrasound (US) examinations. To the best of our knowledge this is the first description of enteroliths in a duodenal duplication cyst.
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A case of small intestinal obstruction in an 82-yr-old woman caused by an ileoileal intussusception is reported. At the leading point of the intussusceptum an adenomyomatous hamartoma was found. In a review of the literature we were unable to find a similar case.
This paper is based on two presentations under the auspices of thf Edinburgh Medical Group in 1976. Dr Noble and Professor Mason, explore the incidence of incest and society's attitudes to it from legal, anthropological, medical and social viewpoints. They place this in a world context by looking at the universal prohibition of incest and the theories related to that taboo. In conclusion, they suggest that there seem to be sufficient sensible grounds on which to base a reappraisal of attitudes to incest. Their conclusions are in turn appraised by brief commentaries from a moral philospher and a psychiatrist.
Over the last decades much attention has been directed to establishing the cause of altered fetal growth and habitual abortion. Great emphasis has been placed on placental blood flow, but relatively few studies have been published on the effect of impaired uterine blood supply. This study examined the effect of impaired uterine blood flow using the white rat, with its bilateral uterine horns. Three groups of rats with bilateral, left unilateral, or right unilateral artery ligation were compared with a control group for number and weight of fetuses at term. The results showed that the impaired rats produced significantly fewer fetuses than controls (means: 8.59 vs. 11.21, respectively; P less than .001) and those fetuses had lower mean birth weights than controls (5.295 g vs. 5.800 g, respectively; P less than .05). While conception was possible even in rats with impaired uterine blood flow, the differences at term suggest that impairment of the maternal blood flow may contribute toward intrauterine growth retardation and habitual abortion. The clinical significance of these findings and suggestions for future research are discussed.