Technique to locate the end of an endotracheal tube.

The use of metallic spinal instrumentation in the low-cervical and high-thoracic spine can impede radiographic verification of the position of an endotracheal tube. The method described here may be of value in solving this problem.

Management of abdominal wall clostridial myonecrosis: the role of total gastrointestinal diversion.

We report the successful management of two patients with abdominal wall gas gangrene and emphasize the principles of proximal gastrointestinal diversion and the initial use of 100% fraction of inspired oxygen (FiO2). Each patient lacked an abdominal wall and intractable fistulas developed. Complete diversion of their gastrointestinal tracts at a proximal level facilitated closure of the fistulas and prevented possible peritoneal contamination.

Characterization of a common antigen of colorectal and mucinous ovarian tumors, COTA.

A new colon cancer antigen is reported. It is designated as COTA, Colon-Ovarian Tumor Antigen, because it is found in mucins produced by both tissues during malignancy. The new antigen was identified by making antibodies against human colon cancer tissue in goats.

Massive rectal bleeding of colonic origin: localization of the bleeding site.

Fourteen patients with massive colonic bleeding underwent preoperative evaluation including visceral angiography and/or colonoscopy. Segmental for subtotal colectomy was performed in each case. The freshly excised colonic specimen was opened and washed clean, and the mucosal surface was closely examined by manually compressing the specimen segment by segment in order to detect the minute bleeding site(s), which were then marked with a suture for histologic sectioning.

A simple method to determine the resolution of operative cholangiograms.

A cholangiographic technique which facilitates visualization of the catheter itself permits the surgeon to measure the resolution of the roentgenographic technique used. When the wall of the catheter is visible, the surgeon can be confident that the resolution of the technique is in the 0.3 mm range.

Physiopathology and management of hyperosmolar hyperglycemic nonketotic dehydration.

Results of a review of the clinical course of five patients in whom hyperosmotic hyperglycemic nonketotic dehydration developed suggests that a treatment regimen of a high dosage of insulin and free water administration may not be effective. Analysis of the physiopathology of the syndrome points to sodium and water deficits as the principal cause of symptoms. A rapid lowering of the blood glucose level may be detrimental, since this leads to an osmotic gradient between the central nervous system and the intravascular space.

Bacterial endocarditis in the critically ill surgical patient.

The association of endocarditis with persistent intraperitoneal sepsis and right-sided heat catheterization (Swan-Ganz catheter and central venous catheter) was found in four (27%) of 15 patients with endocarditis identified at the University of Kentucky Medical Center, Lexington, during a 14-year period. These four patients had (1) intra-abdominal abscesses as a persistent source of sepsis, (2) documented septicemia, (3) long-term use of right sided heart catheters, and (4) prolonged hospitalization with a fatal outcome. In each case, endocarditis with persistent septicemia was considered a major factor contributing to a fatal outcome.

Management of gastrocolic fistula.

The authors present 13 patients with gastrocolic, gastrojejunocolic, or duodenocolic fistula, the majority of which were complications of peptic ulcer disease or its treatment. In contrast to previous reports, these patients were not severely anemic, dehydrated, or malnourished at time of presentation. Pain, fecal emesis, and diarrhea were the most common presenting symptoms.

Colonic tumorigenesis in rats with 1,2-dimethylhydrazine.

Subcutaneous injections of the carcinogen dimethylhydrazine in inbred Fischer 344 male rats induced squamous-cell carcinomas in the ear canal, adenocarcinomas in the small bowel and duodenum, and adenomas and adenocarcinomas in the large bowel. The incidences of the tumors induced in the large bowel and ear canal were dose-related. As for tumors of the large bowel, the average size of adenomas was less than that of adenocarcinomas with massive infiltration beyond the muscularis mucosa.

What can experimental colorectal cancer tell us about colorectal cancer in man?

From a survey of the etiology of colorectal cancer, consideration of the basic pathologic characteristics of ulcerative colitis and familial polyposis of the colon suggests that they might be sister diseases. Similarities in the primary and secondary target organs and in fecal steroid metabolism might be more than coincidental. Thus, it would seem reasonable to pay particular attention to several groups of patients who are receiving therapy or have had operations that alter bile acid and/or cholesterol metabolism: 1) patients who have had jejunoileal bypass procedures for morbid obesity or hypercholesterolemia, 2) patients taking cholestyramine and/or other anti-hyperlipidemic agents, 3) patients receiving chenodeoxycholic therapy to dissolve gallstones, 4) patients taking the birth control pill, and 5) young patients who have had a cholecystectomy.

Technical complications of ileostomy.

A review of 45 patients with ileostomy revealed a complication rate of 24%. A higher incidence of complications was seen in those patients who were obese (80%), who had chronic ulcerative colitis (45%), or who had an emergency ileostomy because of a surgical complication (50%). Strict attention to technic should prevent the majority of these complications.

Diagnosis of acute abdominal injuries in patients with spinal shock: value of diagnostic peritoneal lavage.

Loss of sensory, motor, and reflex function during spinal shock obscures the usual signs of significant blunt abdominal trauma. In a retrospective study of ten acutely quadriplegic patients, initial physical findings, vital signs, and hematocrit determinations were not found to be helpful in detecting intra-abdominal injury. Diagnostic peritoneal lavage was an accurate indicator of the presence or absence of significant intraperitoneal hemorrhage in all ten cases in this series.

Diagnostic exploratory celiotomy: an outdated concept in blunt abdominal trauma.

Diagnostic exploratory celiotomy as the primary procedure in the trauma patient is rarely indicated since the validation of peritoneal lavage as a diagnostic technic. The accuracy of diagnostic peritoneal lavage is clearly superior to that of initial or repetitive clinical evaluation of trauma patients, and its cost is miniscule compared with unnecessary diagnostic celiotomy.

Selective management of gunshot wounds to the neck. Report of a series and review of the literature.

Thirty-two patients with gunshot wounds to the neck, 13 with multiple pellet injuries and 19 with single missile injuries, were managed selectively. Although 3 of the 32 patients died in the hospital, no death was attributable to the neck injury. This experience and a review of the literature support the concept of selective management of penetrating neck injuries with intervention based on specific indications.

Diagnostic errors with peritoneal lavage in patients with pelvic fractures.

Diagnostic peritoneal lavage, considered to be a highly accurate, technique for detecting intraperitoneal blood in the trauma patient, may be less reliable in the presence of a pelvic fracture. In a retrospective review of 222 patients with pelvic fractures, 61 patients were found who had had a diagnostic peritoneal lavage performed as part of the initial evaluation of their condition. Twenty-six of these patients had had a negative lavage result negative lavage result.

Improved treatment of popliteal arterial injuries using anticoagulation and extra-anatomic reconstruction.

Management of popliteal arterial injuries remains a challenging problem. Early recognition and treatment, arteriography, fasciotomy, and repair of concomitant popliteal venous injuries are modalities that have contributed to improved results. Systemic heparin sodium anticoagulation and selected extra-anatomic vein graft bypass of the popliteal area are two additional measures that have contributed to a 91% success rate in treatment of popliteal arterial injuries and five of six blunt injuries were treated successfully in this time period.