Eleven patients with hydatid disease of the liver with intrathoracic involvement have been treated at this hospital, and another patient was treated previously elsewhere. The clinical and roentgenologic symptoms depend greatly upon the evolutionary stage of the disease. General conditions are seriously affected in instances of ruptured and infected cysts. When the cysts open into the tracheobronchial tree as a result of coughing up pus in profuse quantities, the general condition may improve to a certain degree, but bronchopulmonary symptoms increase at that moment. An important spitting of bile must alert us to the existence of biliary hypertension. This condition must be treated first to avoid recurrence of the process. According to our experience, surgical treatment is based upon correct drainage of the cystic intrahepatic cavity under the diaphragm, separating the pleural cavity completely from the intrahepatic; excision of the transdiaphragmatic fistulous tract; conservative indications for pulmonary resection, and possible existence of biliary hypertension before and after operation.

Adult↗

PubMedDate not supplied

Perineal necrotizing infection.

Perineal necrotizing infection is a severe disease that ever since its first description by Fournier in 1883 has been referred to by many names prompted by its protean nature in terms of location and suspected etiology. We treated nine patients with PNI. The infection began as a perineal abscess of long evolution (7 days +/- 2 SD) in eight patients. The ninth patient had had an inguinal herniorrhaphy 3 days before. The cultures of the exudates and tissues always yielded aerobic and anaerobic mixed flora of colorectal origin, except in one instance, in which S. aureus and hemolytic streptococcus A were identified. The treatment was medical support and wide surgical debridement of the infected tissues. In six patients a left transverse colostomy was performed. Only one patient died, of septic shock. On the basis of the results in our series and on a review of the literature, it is our opinion that PNI is a mixed bacterial infection that despite its origin, clinical appearance and microbiologic findings, is highly uniform in terms of clinical course and treatment. Therapy is based on radical surgical debridement with excision of all necrotic tissue. The current plethora of terms seems impractical and confusing. We propose a rather comprehensive term perineal necrotizing infection for the sake of clarity.

Adult↗

PubMedDate not supplied

Hepatic trauma.

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Adolescent↗

PubMedDate not supplied

[Variations in post-small bowel resection gastric acid hypersecretion and hyper-gastrinemia after vagotomy and antrectomy. Experimental study in rat (author's transl)].

Resection of the small bowel provokes gastric acid hypersecretion and hyper-gastrinemia. Various studies have been conducted to assess the effects of vagotomy and antrectomy on post-resection gastric hyperacidity, both on basal levels and those after stimulation with histamine and pentagastrin. Similar studies involved hypergastrinemia levels. A total of 100 Sprague-Dawley rats were divided into 6 groups : controls (C). massive small bowel resection (R), vagotomy plus pyloroplasty (VP). antrectomy (A), vagotomy plus pyloroplasty and bowel resection (VPR), and antrectomy plus bowel resection (AR). - It was demonstrated that vagotomy is the most effective method for reducing gastric acid hypersecretion after small bowel resection. Antrectomy provokes diminution of gastric acid secretion in animals without bowel resections, but neither this nor gastrinemia levels are significantly altered in operated animals. Synergistic action of the mechanisms provoking post-resection and post-vagotomy hyper-gastrinemia is observed when they occur in the same group of animals, the incidence being higher than that observed after vagotomy or resection alone. Gastrinemia levels increased after VPR or reduced after AR cannot be differentially transposed to gastric secretion in these two groups of animals, demonstrating that, under these conditions, blood gastrin levels are not the principal factor involved in gastric secretion control.

Animals↗