Comparison of capillary and venous blood lactate and glucose values during cycle ergometry.

Introduction: The present study compared blood lactate and glucose values obtained from capillary and venous samples, and examined the utility of a modified capillary tube (55 mm in length) for a YSI 2300 Stat analyzer.

Methods: Sixteen subjects (17-26 yrs) completed a graded exercise test using a cycle ergometer. Blood samples were collected during the last minute of each three minute stage from an indwelling venous catheter and via finger puncture.

Anterior sacral meningocele and the scimitar sign. Report of a case.

Anterior sacral meningocele is an unusual lesion that usually presents as a presacral mass. This is a case presentation of a young woman who presented with amenorrhea. On physical examination, a large presacral mass was found.

Ogilvie's syndrome developing after ethanol ablation of renal cell carcinoma.

Urological procedures frequently are implicated as a cause of Ogilvie's syndrome. We report the first case of Ogilvie's syndrome following ethanol ablation of a renal cell carcinoma. The urologist must be alert to the development of this complication.

Anal lesions. When to suspect carcinoma.

Anal carcinoma appears in a variety of forms and may be easily confused with a benign disorder. Diagnosis must be confirmed by biopsy. All anal lesions require careful evaluation and follow-up to ensure resolution of benign disease or proper treatment of malignancy.

Urgent cholecystectomy.

A retrospective review of cholecystectomy at the Naval Regional Medical Center, Portsmouth, Virginia revealed 92 patients (22%) who had urgent or early operation for acute cholecystitis. There were no infections or deaths in this group and the complication rate was similar to that of patients who had elective cholecystectomy. We advocate liberal use of intraoperative cholangiography in these patients.

Obstructing left-sided colon carcinoma. Appraisal of surgical options.

This study is a retrospective analysis over a 10-year period of 37 patients who presented with a large bowel obstruction secondary to a left-sided colon cancer. Our patients were confined to those with clinical evidence of acute obstruction with lesions located from the mid-transverse colon to the rectum. Thirty-eight per cent of these lesions occurred at the sigmoid level.

Cholecystectomy concomitant with other intra-abdominal operations. Assessment of risk.

In a retrospective study, 1,416 cholecystectomies performed during a three-year period were reviewed to define the risk of cholecystectomy when combined with another intra-abdominal procedure. Group 1, cholecystectomy alone (1,148 patients), with subsets of cholangiography and/or common bile duct exploration, had a complication rate of 14.29% and a mortality of 0.

Necrotizing perineal infections.

Necrotizing perineal infections ("Fournier's gangrene") are polymicrobial, gas producing, and rapidly progressive. Rapid resuscitation and adequate debridement are essential in the early treatment of these infections. Repeat debridements under anesthesia, attention to nutrition and finally reconstructive surgery are important in the subsequent treatment.

Traumatic perineal laceration.

Four cases of pelvic trauma associated with a deep perineal tear are reported. The mechanism of injury, preoperative and operative care of this type of injury are discussed. The theory that the tear is similar to an explosion is presented.

Fistula in ano.

An eight year retrospective review of 133 patients with fistula in ano found the majority to be of cryptoglandular causation. Many patients had symptoms for longer than one year. Operation was performed safely under spinal anesthesia, locating the internal opening in 117 patients, performing a fistulectomy in 80 patients and a fistulotomy in the remainder.

Mucinous adenocarcinoma developing in chronic anal fistula: report of two cases and review of the literature.

Mucinous adenocarcinoma developing in a chronic anal fistula is a rare tumor of the anus of which there are less than 150 reported cases. There has been some debate as to whether the fistula is the source of the tumor, or whether the fistula is the presenting feature of a slow-growing, indolent carcinoma. Two recent cases seen at our hospital are presented, along with a review of the literature and what we feel to be strong evidence that the fistula and associated anal glands are indeed the source of this unusual tumor.

Appendicitis with a palpable mass.

Forty-two patients with abdominal masses caused by appendicitis underwent immediate surgery. A clear separation between a phlegmon and abscess could not be made before operation. In most patients, it was possible to perform an appendectomy and, thus, obviate the need for appendectomy at a subsequent admission.

Cecal diverticulitis.

Cecal diverticula may be solitary or an extension of leftsided diverticulosis. They may be true or false. Diverticulitis in the cecal area is usually found at the time of surgery for presumed appendicitis.

Ovarian metastases from colon carcinoma.

A case report describes a postmenopausal woman who presented with vaginal bleeding and a pelvic mass. She was found to have a colon cancer with a large metastasis in the right ovary. A review of the literature suggests that ovarian metastasis from a primary colon carcinoma is not rare.

The diagnosis of appendicitis.

Presented is a retrospective study of 359 patients admitted through the emergency room with nontraumatic abdominal pain who were evaluated for appendicitis. A review of presenting signs and symptoms and initial laboratory data is discussed and diagnostic criteria are established.

Measles and appendicitis.

Two patients who were admitted in the prodromal stage of measles with right lower quadrant pain are described. One patient underwent appendectomy. Histologic examination of the appendix showed the characteristic Warthin-Finkeldey giant cells in the subepithelial layer and allowed the pathologist to predict a measles rash before it appeared.

Localized giant pseudopolyposis of the colon in ulcerative colitis.

Recently a patient with ulcerative colitis developed abdominal pain and a left upper quadrant mass. A 67Ga-citrate scintiscan showed increased activity over the mass. A barium enema demonstrated retrograde obstruction at the splenic flexure and intraluminal multilobulated tissue masses.

Incidental appendectomy at the time of surgery for ectopic pregnancy.

Incidental appendectomy at the time of surgery for ectopic pregnancy can be performed safely in the appropriately selected patient. The added procedure does not place the patient at increased operative risk and spares her from the possible subsequent development of acute appendicitis.

Tuberculous anal ulcer.

Two patients with anorectal tuberculosis, without prior or concurrent knowledge of active pulmonary infection with mycobacteria, are described. Anal fissure in an unusual location which is slow to heal should have a biopsy performed, with appropriate stains and cultures carried out, to rule out tuberculous disease. Chemotherapy is then highly effective for ulcerative perianal tuberculosis.

Anorectal abscess.

A five year retrospective review of anorectal abscesses included 181 admissions in which all but five were explained by the anal glandular hypothesis of causation. Delays in treatment occurred because of misdiagnosis, attempts at nonoperative management and inhospital procrastination. These abscesses are notorious for the recurrence rate after treatment.

Crohn's disease with spontaneous ileoumbilical and ileovesical fistulae.

A 17-year-old male with Crohn's disease involving the terminal ileum and cecum developed an umbilical fistula in the absence of previous surgery. While on intravenous hyperalimentation he developed an enterovesical fistula and was successfully treated by surgical resection. This combination of an enterovesical and umbilical fistula has not been previously reported.

Diverticular disease of the colon: surgical management at a military hospital.

A recent review of the surgical management of diverticular disease of the colon included 73 patients. One-stage resections were accomplished in 67%, primarily in patients operated on electively for recurrent diverticulitis or fistula, and in the group of patients with cecal diverticulitis operated on for presumed appendicitis. Single-stage resection with ileorectal anastomosis is also preferred in patients with massive diverticular bleeding.

High intramuscular anorectal abscess.

Six percent of the anorectal abscesses drained last year at the Naval Regional Medical Center, Portsmouth, Va, were of the high intramuscular variety. High intramuscular perianal abscesses may be difficult to diagnose because of the lack of external signs. It is important that a patient with unexplained anal pain be examined, under anesthesia if necessary.