The placenta, normally confined to the decidual lining of the uterine cavity, can in some circumstances invade the muscular wall of the uterus, a condition known as placenta accreta. Less common is placenta increta, in which placental cotyledons become intertwined with the muscular stroma of the uterus. Placenta percreta, in which the trophoblastic tissues penetrate the serosa of the uterus and may extend directly to adjacent structures, is even more rare and is potentially life-threatening. There have been only 10 reports of direct invasion of placenta percreta into the urinary bladder. We review these cases and report 3 recent patients, one of whom was diagnosed pre-operatively by ultrasonography.

Adult↗

PubMed1988

A role for topical 5-fluorouracil therapy in melanoma.

Topical 5-fluorouracil (Efudex) has been shown to be of great value in the treatment of skin cancers, Marjolin ulcers, and advanced squamous cell carcinoma of the mouth and esophagus. It has been advocated for use on patients with melanocytic dysplasia and lentigo maligna melanoma. This report confirms the use of topical 5-FU for lentigo maligna melanoma and melanocytic dysplasia. In melanomas with poor prognosis, preoperative treatment with topical 5-FU converts the cellular infiltrate from acute inflammatory cells to round cells which have been shown to be T-cells. We believe this preoperative stimulation of the patients' own immune reaction to the tumor may be of great significance in improving the surgical results for melanomas with a poor prognosis.

Administration, Topical↗

PubMed1987

Early management of operative injuries of the extrahepatic biliary tract.

Since 1980, the authors have managed 19 patients with operative injuries to their biliary tracts. Eleven patients (58%) incurred their injuries during cholecystectomies for acute cholecystitis (average age--56 years); seven patients (37%) received their injuries during elective cholecystectomies (average age--24 years); and in one patient (5%) the injury occurred during gastrectomy. In group I were eight patients in whom injuries were recognized and repaired intraoperatively during their initial operations. Seven of these patients (88%) had primary duct reanastomoses, and one patient had a choledochoduodenostomy. All healed without further surgery, and none later had cholangitis develop. In group II were 11 patients diagnosed and reoperated later after surgery (mean time until diagnosis, 12 days). Seven of these patients (64%) were managed with Roux-en-Y hepaticojejunostomies or choledochojejunostomies. Four patients had cholangitis develop after surgery: two had demonstrable anastomic stenosis and two had no stenosis. Three of these four patients (75%) who had cholangitis develop did not have stents used in their repairs. The overall mortality rate in this series of 19 patients was 11%. The major risk factors for biliary tract injury were the presence of acute cholecystitis and of anatomically small biliary ducts. For this latter reason, younger patients who had elective cholecystectomies were particularly at risk. In delayed repair, the use of internal stents appeared to be useful in preventing the later development of stenosis and/or cholangitis; however, recurrent cholangitis developed in two patients who did not have demonstrable anastomotic stenoses.

Bile Ducts↗

PubMed1987

Squamous cell carcinoma of the parotid gland.

Squamous cell carcinoma involving the parotid gland is an aggressive and rapidly advancing lesion which if not recognized and treated early will result in a high morbidity and mortality. We reviewed 30 patients with squamous cell carcinoma involving the parotid gland. Twenty-four patients had had previous epidermoid skin lesions in an area known to drain to the parotid gland and three resulted from direct extension into the gland from an overlying skin carcinoma, whereas only three were primary lesions of the gland. Patients who presented with involvement of the gland more than 4 months after excision of the skin lesion had a poor prognosis. Patients with epidermoid skin cancer in areas with a propensity to secondarily involve the parotid gland must be closely followed after treatment of the primary skin lesion.

Adult↗

PubMed1986

Impact of emergency angiography in massive lower gastrointestinal bleeding.

Fifty patients with massive lower gastrointestinal bleeding were initially managed with emergency angiography. The average age was 67.2; mean hematocrit, 23.7; and average transfusion, 7.6 units. Thirty-six patients (72%) had bleeding site located; bleeding sites were distributed throughout the colon. Etiologies of bleeding included diverticular disease (19 patients) and arteriovenous malformations (15 patients). Twenty of 22 (91%) patients receiving selective intra-arterial vasopressin stopped bleeding; however, 50% rebled on cessation of vasopressin. Thirty-five of 50 (70%) patients underwent surgery, with 57% operated on electively after vasopressin therapy. Seventeen patients had segmental colectomy, with no rebleeding. Nine of the 17 patients had diverticular disease in the remaining colon. Operative morbidity in these 35 patients was significantly improved when compared to previously reported patients undergoing emergency subtotal colectomy without angiography (8.6% vs. 37%) (p less than 0.02). Emergency angiography successfully locates the bleeding site, allowing for segmental colectomy. Vasopressin infusion transiently halts bleeding, permitting elective surgery in many instances.

Adult↗

PubMed1986

Use of absorbable collagen for hemostasis in general surgical patients.

Absorbable collagen sheet hemostat was used to obtain hemostasis in 62 general surgical patients. It was unusually effective in controlling profuse capillary, venular, and arteriolar bleeding in 61 of the 62 patients, with a mean time to hemostasis of 2.2 minutes. Collagen hemostat was particularly effective in the gallbladder bed after cholecystectomy, at liver and pancreatic biopsy sites, and on the cut surface of the thyroid gland. Collagen hemostat was also effective in inducing hemostasis in three patients with altered coagulation parameters associated with liver disease and in another patient with von Willebrand's disease. The material was easy to handle when wet with blood and did not stick to gloves, surgical instruments, or sponges. The collagen sheet hemostat also conformed well to tissues. None of our 62 patients experienced foreign body reaction, infection, or allergic manifestations.

Adolescent↗

PubMed1985

False-positive hematuria.

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False Positive Reactions↗

PubMed1985

Physicians' group seeks nuclear arms ban.

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Humans↗

PubMed1985

Pancreas divisum may be only coincidental.

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Cholangiopancreatography, Endoscopic Retrograde↗

PubMed1984

Postoperative adhesions causing colon obstruction.

Intermittent abdominal distention and chronic abdominal pain with constipation are common complaints among middle-aged women who have previously undergone pelvic surgery. These patients are frequently diagnosed as having problems that are psychosomatic in origin. This article reports four female patients seen between 1979 and 1980 who had undergone previous pelvic surgery and had such complaints. All were diagnosed preoperatively by colonoscopic examination as having partial left colon obstruction caused by postoperative adhesions, a previously unreported disease. Successful treatment consisted of lysis of adhesions, reperitonealization of the pelvis, and restoration of the colon to its normal anatomic position.

Adult↗

PubMed1983

Diagnosis and treatment of echinococcal cy of the liver.

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Adult↗

PubMed1983

Intracranial placement of nasogastric tube: an unusual complication.

We have described a case of intracranial placement of a nasogastric tube in a patient with severe head trauma. This complication occurs as a result of either passage through a traumatic defect in the cribriform plate associated with a severe head injury or direct penetration through an intact cribriform plate by an improperly passed rigid nasogastric tube. In combative semicomatose or comatose patients, oral placement may be preferable to nasogastric placement of a gastric tube.

Accidents, Traffic↗

PubMed1981

A new concept in the management of Marjolin's ulcers.

Marjolin's ulcers have a grave prognosis, especially when regional nodes are involved. Recent studies suggest such cancers are in an immunologically privileges sites due to the dense scar tissue. The prognosis has been shown to be much worse for tumors not having a round cell infiltrate prior to surgery, as in Marjolin's ulcers. The use of topical 5-fluorouracil (5-FU) induces a round cell infiltrate. Three case reports of large Marjolin's ulcers are presented which were first treated with topical 5-FU. Radical ablative surgery was avoided in these patients with a successful outcome.

Administration, Topical↗