Spontaneous perforation of the gallbladder during infancy diagnosed on hepatobiliary imaging

The purpose of this study was to determine the effectiveness of specialty pads as an intervention to reduce the incidence of intraoperatively acquired pressure sores. A convenience sample (N = 361) was drawn from all inpatients who underwent cardiothoracic or major vascular surgery on the standard operating room table (group 1), the air-filled pad (group 2), or the specialty foam pad (group 3). This sample was inclusive of 100% of patients during the study period who met the criteria. The incidence of pressure sore development was seven in group 1, zero in group 2, and one in group 3. There was at statistically significant difference (p = 0.0003) between group 1 and group 2. Additionally, a statistically significant difference (p = 0.0003) was found between group 1 and group 3. The foam pad and the air-filled pad were effective interventions for reducing the risk of intraoperatively acquired pressure sores.     

Sonographic diagnosis of gallbladder perforation

An outbreak of 16 cases of ciprofloxacin-resistant Acinetobacter baumannii (calcoaceticus subspecies anitratus) infections occurred during a 7-month period in a medical intensive care unit. Fifteen of the patients developed pneumonia associated with ventilator support. Possible sources considered in the outbreak investigation were sinks, ice, personnel, patients on multiple antibiotic therapy, reusable ventilator circuits, and hemodialysis. The equipment and environment associated with the outbreak were cultured. Patients on ventilators were significantly more susceptible to Acinetobacter nosocomial infection compared with the rest of the patients in the medical intensive care unit (p < 0.05). Sputum cultures were only 5% sensitive to ciprofloxacin and gentamicin, but they were 100% sensitive to imipenem (p < 0.0001). Uncloaking imipenem was a significant contributing factor in controlling this outbreak. Once outbreak control measures were instituted, Acinetobacter isolates dropped from 77 (during the outbreak year) to 9 (during the subsequent year) and no new pneumonia cases occurred.     

Preoperative diagnosis of gallbladder perforation by cholescintigraphy

Perforation of the gallbladder in patients with chronic cholecystitis is rarely diagnosed preoperatively. We describe a case in which early cholescintigraphy permitted preoperative diagnosis and, therefore, prompt laparotomy.     

Liver abscess secondary to intrahepatic perforation of the gallbladder, presenting as a liver mass

We present an unusual case of a large pyogenic liver abscess containing multiple stones caused by perforation of a necrotic gallbladder and spread of the infection into the liver. It manifested by weakness, weight loss, and a palpable liver mass, pointing toward a neoplastic process. Workup for metastatic disease was negative, and tumor markers also were negative. Ultrasound and computerized tomography were inconclusive, and the diagnosis was established by laparoscopy. Open drainage and cholecystectomy were performed, with good outcome. In the literature, there have been very few reports of intrahepatic perforation of the gallbladder resulting in formation of hepatic abscess. The presentation, diagnosis, and management of liver abscesses, as well as the complications of acute cholecystitis, are discussed.     

Aortic perforation during lumbar laminectomy

A method to determine the optimal replacement time for dye affinity adsorbents used in protein purification processes that are subjected to severe regeneration conditions has been developed. To demonstrate the utility of the method, an experimental fixed-bed decay model was employed to determine the optimum number of cycles for the adsorbent replacement. This number is a function of the column regeneration frequency and of the capital and operation costs. The implications of the results on the design and operation of dye-ligand chromatographic processes are discussed.     

Esophageal perforation. An unusual presentation with a benign clinical course

A case of esophageal perforation occurring in a 75-year-old man is presented. The clinical presentation was benign and the diagnosis of esophageal perforation was made incidental to an upper gastrointestinal barium examination. Conservative management consisting of nasogastric suctioning, antibiotics and antacids was effective in minimizing the clinical course. This represents a rare instance of a successful nonsurgical approach to esophageal perforation.     

Ocular perforation during retrobulbar and peribulbar injections

BACKGROUND AND OBJECTIVE: To determine the ocular perforations during retrobulbar and peribulbar injections. PATIENTS AND METHODS: Twenty-five ocular perforations between 1976 and 1993 occurred after 13 retrobulbar and 12 peribulbar injections. Eighteen patients (72%) were women. Eighteen eyes were myopic (72%). Risk factors included high myopia in 11 cases (44%), use of Atkinson gaze in 21 cases (84%) and a sharp injection needle. RESULTS: Deep position of the posterior pole was common. Perforation signs comprised vitreous hemorrhage in 25 eyes (100%), subretinal hemorrhage in 19 eyes (76%), retinal breaks along the inferior vascular arcade in 19 eyes (76%), and retinal detachment in 14 eyes (56%). Proliferative vitreoretinopathy developed in 11 eyes (44%). CONCLUSION: Retinal detachment strongly correlated to poor visual outcome.     

Treatment of hypertension during the course of kidney diseases

The aim of this paper was to discuss: pathomechanism of arterial hypertension in patients with renal diseases and the choice of antihypertensive therapy and optimal target blood pressure in these patients.     

Study of the course of the incidence angle during growth

A report is given of a cure by ivermectin of a 19-year-old patient with chronic, persistent, 3-year-old intestinal strongyloidosis resistant to several dosage regimens of conventional anthelminthics, including the current drug of choice for strongyloidosis thiabendazole and its therapeutic alternative, albendazole. Ivermectin was administered, first as a single, oral dose of 200 micrograms/kg with consequent reduction in larval output, but no complete parasitological cure. A second course of ivermectin, 200 micrograms/kg administered for two consecutive days, resulted in complete parasitological cure, as evidenced by the absence of Strongyloides stercoralis larvae in stool samples examined through the kato thick smears, Baermanns concentrations as well as in the 'enterotest' performed on jejunal fluid. The patient has remained parasitologically cured, after 7-months follow-up. Ivermectin was well tolerated with mild clinical and biochemical reactions which did not last for long.     

Natural course following fractures during the growth years

Minimal deviation adenocarcinoma (MDA) of the uterine cervix is an extremely well-differentiated adenocarcinoma arising from the endocervix, with minimal morphological deviation from normal endocervical columnar epithelium. We performed DNA cytometric investigation using DNA image analysis in three cases of MDA. For the diagnosis of DNA aneuploidy, we used a combined method of single cell and stemline interpretation of DNA histograms. The most significant finding is that DNA image analysis of all three cases of MDA revealed a hypodiploid stemline DNA value in the histograms of the measured cells and consequently the diagnosis of DNA aneuploidy (DNA index: 0.63, 0.88, and 0.63, respectively). On the basis of our results, we believe that DNA image analysis is useful as a diagnostic aid in doubtful cases of MDA. We find MDA is an aneuploid tumor with a hypodiploid stem cell subpopulation.     

Hemoperitoneum caused by spontaneous rupture of a true splenic cyst

A 34 year-old man presented with hemoperitoneum from a spontaneously ruptured spleen. At laparotomy, a 5-cm diameter splenic cyst was found to be ruptured. Histological examination confirmed the diagnosis of a true splenic cyst of the mesothelial type. Spontaneous rupture with hemoperitoneum is a rare but potentially lethal complication of a true splenic cyst.     

Management of mucosal perforation during pyloromyotomy for infantile pyloric stenosis

Mucosal perforation during Fredet-Ramstedt pyloromyotomy is the cause of unnecessary morbidity and death if unrecognized. Previously, a variety of closure have been advocated. In 1,777 cases there has been 42 (2.3%) intraoperative perforations. One unrecognized perforation led to a postoperative death. Closure of a mucosal tear is accomplished safely by a simplified suture technique without prolonged convalescence or death.     

Vascular resection during surgical resection for advanced gallbladder carcinoma

We evaluated the results of vascular resection during surgical resection for advanced gallbladder carcinoma. Twelve patients underwent vascular resection (portal vein in 11, hepatic artery in 2, inferior vena cava in 2) in 58 resected patients with advanced gallbladder carcinoma (stage III and IV). The surgical rate was higher in the nonvascular resection group (61%) than in the vascular resection group (25%) (p < 0.05). Surgical morbidity and mortality rates were not significantly different between the two groups. The survival rate was remarkably higher in the curative resection group (n = 29) (55.6% at 1 year, 30.3% at 3 years, 20.8% at 5 years) than in the noncurative resection group (n = 29) (26.3% at 1 year, 0% at 2 years) (p < 0.05). Survival rates of the nonvascular resection group (n = 46) were 45.3% at 1 year, 23.4% at 3 years, and 16.1% at 5 years. However, no patient in the vascular resection group (n = 12) survived longer than 2 years. In conclusion, vascular resection during surgical resection for advanced gallbladder carcinoma does not result in a more favorable prognosis, despite similar surgical risk as in nonvascular resection procedures.     

Nuclear differentiation during the course of syncytiogenesis in mouse trophoblast

The second communication of our experiences with extracorporeal blood irradiation comprises a systematical investigation of the conditions in blood picture and, in one case, of the morphological findings within lymph node punctures, during long-term treatment of two selected patients with a rather different course of the disease. One of the cases showed a typical pattern of chronic lymphadenosis which was to be influenced fairly well; the other case revealed an aggressive tendency with only a feeble response to extracorporeal blood irradiation. By means of toluidine blue staining, until now being used for the verification of nucleoli and their different shapes only in experimentations on animals, a good correlation of the nucleole analysis in the peripheral blood picture and in the lymph node biopsies with the clinical progress of the disease has been observed. Thus, this simple cytological method combined with customary clinical examinations may serve as a criterion for the judgement on the course of the disease and on the therapeutic success.