Biomedical subjects
Publications and source records attributed to S Brynitz.
Intestinal obstruction in a 14-year-old boy was caused by herniation of small intestine through a defect in the lesser omentum. The aetiology and management of this rare condition are discussed.
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With a view of elucidating factors influencing mortality in patients with thoracic empyema, which varies widely (10-50%) in reported case series, a retrospective analysis was made. The series comprised 259 patients treated for thoracic empyema at Bispebjerg Hospital in the period 1965-1980. The mortality was 33% in the total case series, 61% when the underlying pathology was malignant and 25% when it was benign. As malignancy was apparently cured in only 17% of the cases, the investigation was focused on the 200 patients with benign conditions underlying the empyema. The mortality then ranged from nil in spontaneous pneumothorax and thoracic trauma to 50% in lung abscess. Most of the patients with empyema were elderly, but there was no clear difference in mortality between younger and older groups. Concomitant, other disease was present in 80% of the patients who died, but in only 40% of the survivors. Mortality showed no significant difference in relation to primary treatment. Staphylococcus aureus was statistically predominant among the fatal cases. It is concluded that empyema occurring, as in the present study, mainly in elderly and enfeebled patients, is a serious complication with high mortality.
A series of 39 patients treated for perforation of the esophagus in a department of thoracic surgery is presented and discussed. All but three of the lesions arose from instrumentation within the esophagus. The treatment was mainly operative. There were no deaths among the nine patients with perforation of the cervical esophagus, but the mortality was 63% in the patients with thoracic lesions, partly as a result of frequent presence of serious disease in other organs. The authors stress the importance of more rigorous attention during intra-esophageal instrumentation to early detection and treatment of perforation.
Three patients with chronic Staphylococcus aureus empyema following pneumonectomy were treated with continuous chlorhexidine (0.02%) irrigation of the cavity. The empyema became sterile, but after a few days symptoms of cerebral intoxication appeared in all three patients. The symptoms resolved when the treatment was discontinued. Use of continuous chlorhexidine irrigation treatment of large wounds and cavities is therefore to be discouraged.
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In a prospective study of 230 patients followed up for 5 years after hospital admission for acute non-specific abdominal pain, 21 patients (9 patients) could not be traced, and 11 (5 percent) had died. Only one death was related to symptoms from the first admission. Of the remaining 198 patients, 77 percent were healthy and free of any symptoms during the observation period. Fourteen patients (7 percent) had been hospitalized once more due to acute abdominal pain; 5 had acute appendicitis. The others had diagnosed recurrences of nonspecific abdominal pain. Sixteen percent complained of continuing of intermittent abdominal symptoms, mainly of benign colonic or gynecologic origin, while malignant disease developed in 1 percent (or 4 percent of patients over 50 years of age). It is concluded that control of these patients is generally unnecessary, but when symptoms recur further examinations, especially for colonic or gynecologic disease, should be carried out. In patients over 50 years old, the possibility of malignant disease should be kept in mind.
In a prospective trial comprising 202 patients operated on because of suspicion of acute appendicitis, the diagnostic accuracy was 70 percent based on histologic examination of all removed appendices. The diagnostic accuracy was lowest in women less than 50 years old and in young patients (aged 20 years or less), being about 60 percent in both of these groups. The reasons were gynecologic disorders and uncharacteristic abdominal pains, respectively. Twenty-three of the 142 patients with acute appendicitis had perforation (16 percent). The frequency of perforation was significantly higher in patients more than 50 years old. Postoperative complications were seen in 11 percent of the patients. There was no significant difference in the frequency of complications in patients with a normal appendix and no other surgical abdominal disorder and patients with nonperforated appendicitis. However, there was a statistically significant difference between these two groups and the group with perforated appendicitis. In the latter group, postoperative complications occurred in 39 percent of the patients as opposed to 4 percent and 8 percent, respectively, in the former groups.
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Autoperfusion of canine kidneys was investigated as an alternative method to determinate the ischmic organ damage following various preservation procedures. As a compromise between implantation of the donor kidney and normotherimic isolated perfusion, autoperfusion is shown to offer some advantages in the study of the pathophysiology of the ischemic damaged kidney. Within 3 hours of autoperfusion, we obtained detailed information about the immediate regenerative ability of the glomerular, tubular, and vascular functions following various sorts of ischemic trauma.
Histologic examination of two perforated Meckel's diverticula revealed carcinoid tumours. One of the diverticula also contained a foreign body. All resected diverticula should be histologically examined, as ileal carcinoids often are multiple, and even small tumours have metastasization potentiality.