Biomedical subjects
Publications and source records attributed to S Svane.
Two cases have been reported of patients with an atherosclerotic saccular aneurysm of the descending aorta which simulated a left-sided lung neoplasm. Despite advanced diagnostic procedures, the diagnosis was not made before thoracotomy. The authors discuss some of the diagnostic problems related to thoracic saccular aneurysms.
Two women, aged 91 and 46 years respectively, developed acute pancreatitis following treatment with sulindac (Clinoril) for five weeks in the one case and four and a half years in the other. The oldest patient became acutely ill. An emergency laparotomy was performed which showed considerable pancreatic edema and typical fat necroses. The other case presented a more protracted course and was not operated. Restitution was remarkably quick in both patients after cessation of the sulindac treatment.
Emergency laparotomy was performed in a 61-year-old man because of melena. The reason for the bleeding was intestinal hemangiomatosis with multiple, small, dark tumours in two segments of the small intestine. The patient restituted completely after resection of the two affected intestinal segments. Microscopy showed submucosal cavernous hemangiomas. A review of the literature revealed that this condition is rare. Five previous Norwegian reports (1917-1964) are summarized in order to illustrate the substantial variations with regard to location, clinical course and pathological anatomical changes.
A 60-year-old female car driver wearing a combined three-point lap-shoulder seat belt was involved in a head-on-collision. The entire right breast was separated from the chest wall, whereas the overlying skin remained intact. The injury resulted in a rapid development of a monstrous haematoma in the retromammary space, and required emergency mastectomy. Seat belt lesions of the female breast are seldom referred in the literature.
Since 1923, eight cases of cryptococcosis have been described in Norway, all with meningeal affection. A distinct, solitary infiltration in the upper lobe of the right lung was discovered in a 68 year-old woman. The lobe was extirpated. Microbiological and histological investigations showed infection with Cryptococcus neoformans. No antimycotic treatment was given. Four months later the patient developed osteomyelitis of the skull due to cryptococcosis, and was treated successfully with amphotericin B and flucytosin. Further investigation of the patient revealed a defect in the T-lymphocyte immune system, but it is uncertain whether this was of any significance for the development of the cryptococcus infection.
A 62-year-old woman developed minor symptoms of subacute respiratory infection simulating bronchitis. Six weeks later, X-ray of the chest revealed a solitary round infiltration ("coin lesion") in the basal part of the left lung. No diagnosis could be made preoperatively. Thoracotomy demonstrated a plasma cell granuloma. The affected pulmonary segment of the basal part of the upper lobe was resected. There were no clinical nor radiological signs of recurrence five years after the operation.
A small ectopic liver on serosa of the gallbladder was demonstrated peroperatively in two patients with extrahepatic cholestasis and considerable distention of the biliary system. The histological architecture of the small liver was similar to that of a normal liver, with a minute bile duct communicating with the lumen of the gallbladder. This explains why the cholestasis provoked identical pathological changes in both liver and the ectopic liver tissue.
Two patients developed superior vena cava syndrome following total parenteral nutrition through a central venous catheter. Infection may have contributed to the development of the superior vena cava thromboses. In one patient a "sleeve thrombus" probably caused multiple pulmonary embolisms after the catheter was withdrawn. The other patient had a mural thrombosis with complete occlusion of the superior vena cava. The author emphasizes the importance of early diagnosis and correct treatment in order to reduce the high mortality rate due to this serious complication to central venous catheters.
A randomised multicentre clinical trial was undertaken to compare the effect on pain of indomethacin administered either intravenously or rectally to 116 patients with ureteric colic. Adverse reactions were also assessed. Of the patients receiving the intravenous injection, 48/53 (91%) achieved good pain relief (i.e. no supplementary analgesia was required) 30 min after administration, compared with 46/63 (73%) receiving the enema. Significantly more side effects occurred in the group treated intravenously. It was concluded that indomethacin administered as an enema was less effective than the intravenous form, but it should be regarded as a good alternative in the treatment of ureteric colic.
In a multicenter study the prophylactic efficacy of two antibiotic regimens was tested against postoperative septic complications following elective colorectal surgery. The study was conducted in a prospective block-randomized design. Patients were preoperatively allocated to either ampicillin, 1 gm, four times daily, and metronidazole, 0.5 gm, three times daily, for 72 hours, or to cefoxitin, 2 gm, given three times in a period of 10 hours. Both regimens were initiated immediately before surgery. Forty-five patients were withdrawn from the study after randomization. Three hundred fifty two patients (175 receiving ampicillin and metronidazole and 177 receiving cefoxitin) completed the study and were followed for one month postoperatively. The frequency of septic and nonseptic complications was not statistically significant different between the two regimens. About one third of all septic complications appeared more than two weeks after surgery. It is concluded that short-term treatment with cefoxitin is at least as efficient as a three-day treatment with ampicillin and metronidazole.
A 26-year-old woman with Turner's syndrome (45,X/46,X,i(Xq] and Crohn's disease is reported. The inflammatory bowel disease was aggressive with development of intestinal fistulas. Total proctocolectomy was performed, and the patient recovered remarkably well post-operatively. The association of Turner's syndrome and inflammatory bowel disease is reviewed, with special reference to karyotype, severity, mortality and treatment.
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Mesenterium ileocolicum commune with normal rotation of the midgut is described in an 11-year-old girl and a 12-year-old boy. Both had had recurrent abdominal pain for several years before the diagnosis was made. Barium enema showed the entire colon to be located in the middle and left part of the abdomen. Operation showed displacement of the right colon due to the mesenterium ileocolicum commune. The boy also had congenital bands across the duodenum, which could explain previous episodes of vomiting and delayed emptying of the stomach after a barium meal. The girl had only rudimentary transduodenal bands. Fixation of the right colon, lysis of duodenal bands and appendectomy were performed in both cases. Postoperatively both children have been asymptomatic. These two cases, with a common ileocolic mesentery and normal midgut rotation, demonstrate a rare abnormality of intestinal fixation during the third embryonic stage of development. Diagnosis of the cause underlying the chronic recurrent abdominal pain was delayed, but the patients were eventually cured by operation.
The case of a 28-year-old male with a neglected and protracted spontaneous pneumothorax is reported. The condition was diagnosed 45 days after the onset of symptoms. The affected lung had completely collapsed and was unexpandable. Subsequent thoracotomy revealed a firm membrane covering the visceral pleura as the sole explanation of the persistent pulmonary collapse. This variety of chronic pneumothorax seems to be rare. The lung expanded completely after decortication.
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The case of a 59-year-old, jaundiced male is reported. Autopsy revealed an obstructing blood thrombus in the common bile duct. The thrombus was firmly attached to the duct wall. Microscopic remnants of thread material were found in the centre of the thrombus, but not elsewhere. Approximately 10 months prior to death an elective and uncomplicated cholecystectomy was performed, and the cystic duct was ligated with silk. The unabsorbable thread material is supposed to have migrated through the duct wall, resulting in secondary inflammatory reaction, bleeding and finally the formation of an intra-luminal thrombus. The clinical manifestations were largely in agreement with the patho-anatomical findings.