Vernix caseosa peritonitis. An infrequent complication of cesarean section with distinctive histopathologic features.

The authors report two cases of vernix caseosa peritonitis, an infrequent complication of cesarean section with distinctive histopathologic findings. Both patients underwent exploratory laparotomy for unexplained abdominal pain after cesarean section. Histopathologic evaluation of surgically removed tissue revealed an organizing peritonitis, which included prominent collections of anucleate squamous cells in association with a foreign body-type granulomatous response.

Circulating prosomatostatin-derived peptides. Differential responses to food ingestion.

Prosomatostatin (pro-S) and its bioactive posttranslational products, somatostatin-14 (S-14), somatostatin-13 (S-13), and somatostatin-28 (S-28), were measured in human plasma by the use of immunoglobulins to the NH2-terminus of S-28 conjugated with agarose to separate them and, thereafter, by RIA with an antiserum recognizing the COOH-terminus of pro-S, and by specific RIA for the NH2-terminus of S-14 and pro-S. In healthy men, mean basal levels of pro-S were 4 pg equivalent S-14/ml; S-14/S-13 combined were 9 pg equivalent S-14/ml; and S-28 levels were 16 pg/ml. After a 700-kcal meal, pro-S, S-14, and S-14/S-13 did not change, whereas S-28 levels doubled by 120 min and remained elevated for 240 min.

Enteral versus parenteral nutritional support following laparotomy for trauma: a randomized prospective trial.

Although enteral nutrition is considered more 'physiologic' than parenteral nutrition, there is greater published experience with parenteral nutrition in trauma patients. To compare the efficacy of these two techniques, we prospectively randomized multiple trauma patients during their admission laparotomy to receive either central venous parenteral nutritional (TPN: n = 23) or enteral nutrition by jejunostomy (Jej: n = 23). Nutritional support began on the first postoperative day; the study period continued a maximum of 14 days.

Cimetidine clearance in the obese.

Six subjects with normal weight (mean weight = 62 kg) and six obese subjects (mean weight = 140 kg) were given a single intravenous cimetidine infusion of 600 mg over 10 to 15 minutes. Both groups of subjects had normal serum creatinine levels and were matched with respect to age, desirable body weight, height, renal function, and sex. Compared with subjects of normal weight, obese subjects had higher cimetidine systemic (1147 and 637 ml/min) and renal (808 and 318 ml/min) clearances.

Anaesthesia in the morbidly obese. A comparison of anaesthetic and analgesic regimens for upper abdominal surgery.

Seventy morbidly obese patients presented for upper abdominal surgery; 17% had pre-existing cardiovascular disease and 23% pre-existing respiratory disease. Twenty-eight patients received general anaesthesia, plus narcotic analgesia postoperatively, and 42 general anaesthesia plus thoracic epidural analgesia intra- and postoperatively. Aspects of anaesthetic management are discussed and compared with previous similar reports.

Effect of acute ethanolism on the hospital course and outcome of injured automobile drivers.

Acute ethanolism in automobile drivers is purported to be both protective and detrimental in susceptibility to injury from an accident. The potential influence of acute intoxication (serum ethanol greater than 100 mg/dl) on pattern and severity of injury, hospital course, and long-term outcome, including mortality, was examined in 182 consecutive automobile drivers requiring admission to a regional university trauma center during 1980. Significantly more drivers were intoxicated than not, 61% vs.

Influence of weight on aminoglycoside pharmacokinetics in normal weight and morbidly obese patients.

Aminoglycoside pharmacokinetics were determined in 30 normal weight patients and 30 morbidly obese patients (greater than 90% overweight). All had normal renal function and a gram-negative infection (documented by cultures, fever and elevated white blood cell counts) which was treated only with aminoglycoside antibiotics. The normal weight and morbidly obese patients were matched with respect to the following criterion: age, sex, ideal body weight (IBW), serum creatinine, site of infection, and type of aminoglycoside antibiotic (gentamicin, tobramycin, or amikacin).

Anergy in high-risk surgical patients: the role of parenteral nutrition.

The finding of delayed hypersensitivity on skin testing has been used to predict the outcome following operations, traumas or severe illnesses and has been correlated with nutritional status in some reports. To test these hypotheses, we did weekly skin tests with a battery of four antigens on 98 high-risk patients referred to the nutritional support service. Anergy persisted or developed in 72 patients, whereas 26 patients remained or became reactive.

Pancreatitis associated with primary hyperparathyroidism.

Two series of patients treated for primary hyperparathyroidism are reviewed for the incidence of associated pancreatitis. In an earlier series of 150 hyperparathyroid patients, six had documented pancreatitis as one of the primary clinical manifestations. Review of a more recent series failed to uncover a single case of pancreatitis in 26 patients with primary hyperparathyroidism.

Complications of emergency stoma formation.

Emergency stoma formation in the high-risk patient is a morbid procedure. In a series of 51 stomas in 49 nonelective operative procedures, a morbidity of more than 50% was retrospectively identified. Nine (18%) of 49 patients died, and four (8%) of these patients died of complications directly related to stomal failure or formation.

Use of op site as an occlusive dressing for total parenteral nutrition catheters.

A retrospective study of standard hyperalimentation catheter dressing compared to the use of Op Site has demonstrated that Op Site is cost and time effective and is efficacious for attaining a low catheter sepsis rate. It is easy for nursing personnel to apply and comfortable for the patients to wear. Op Site may be contraindicated in diaphoretic patients.

Gastroplasty in patients with symptoms of reflux esophagitis.

Forty-one patients underwent gastroplasty by the technique of Gomez and has at least one year of follow-up study. Fifteen patients had symptoms of reflux esophagitis preoperatively. At present, only two have symptoms of reflux esophagitis and both were free of symptoms until reversal of the gastroplasty.

Natural history of incidental appendectomy in patients with Crohn's disease who required subsequent bowel resection.

The records of 20 patients with Crohn's disease who underwent incidental appendectomy and later required bowel resection were reviewed and the following conclusions ascertained. If the patient had had abdominal pain for less than 1 week, appendectomy is followed by minimal problems. If the patient has had abdominal pain for longer than 1 week, incidental appendectomy is followed by an 83 percent incidence of fistula or sinus tract, arising not from the appendiceal stump but from the terminal ileum.

Boerhaave syndrome. Successful conservative management in three patients with late presentation.

Three patients with Boerhaave syndrome were successfully managed with nonoperative treatment. The diagnosis was delayed 5 days in one patient and 10 days in the other two. None of the patients appeared septic.

Gastric pH monitoring as a prognostic indicator for the prophylaxis of stress ulceration in the critically III.

Previous studies have documented the efficacy of prophylaxis in the prevention of stress ulceration and bleeding in critically ill patients. In an effort to determine whether all critically ill patients require prophylaxis, 144 patients admitted to an intensive care unit were monitored by continuous indwelling nasogastric or gastrostomy tubes. Any patient with a measured gastric pH of less than 4 was treated with prophylactic cimetidine or antacids to maintain a pH of 4 or greater.

Trauma to major visceral veins: an underemphasized cause of accident mortality.

In the period 1970-1978, a mortality rate of 44% resulted in 45 patients who suffered major intra-abdominal venous injuries. An especially grave prognosis accompanied wounds to the inferior vena cava and the hepatic and portal venous systems. Management of damage to major veins presents several difficulties.

Randomized prospective evaluation of cimetidine and antacid control of gastric pH in the critically ill.

One hundred forty-four critically ill patients admitted to an intensive care setting were randomly assigned to cimetidine or antacid treatament groups. Gastric pH was monitored hourly. One hundred twenty-three (85%) patients demonstrated a fall in pH to less than 4 and were considered to require prophylaxis.

Preoperative CEA level: a prognostic test in patients with colorectal carcinoma.

Preoperative and postoperative carcinoembryonic antigen (CEA) levels were evaluated in 42 patients with colorectal carcinoma. Preoperative CEA values correlated inversely with survival at a statistically significant level and provided prognostic information not available by pathologic staging. Postoperative plasma CEA can accurately predict recurrent disease and may, when serial values are elevated, serve as an indication for a second-look procedure.

Crohn's disease in the older patient.

The progress of 141 consecutive patients with Crohn's disease, operated upon by the same surgeons, was examined. Patients were compared by age of onset of the disease. Few patients with Crohn's disease were older than 50 years of age and even less had a diagnosis after this age.

The operative management of Crohn Disease.

The natural history of Crohn disease* is varied and unpredictable, and its cause is not known. No modality of treatment has definitely been shown to alter its course. Surgical treatment was carried out in a consistent fashion in 141 consecutive patients with Crohn disease.

Inflammatory tissue reaction in rabbit bowel injected with Crohn's homogenates.

Homogenates from the terminal ileum of a patient with Crohn's disease with granulomas were prepared as snap-frozen or fresh and were injected into the ascending colonic walls of New Zealand white rabbits. Control animals were injected with 1 per cent bovine serum albumin alone. The rabbit bowel was examined after 1 year, and lesions were noted in each of the rabbits injected with Crohn's disease homogenate, irrespective of the type of tissue preparation.

Failure of cimetidine prophylaxis in the critically ill.

Stress ulcers with subsequent hemorrhage are a well-recognized cause of morbidity and mortality in patients hospitalized for other serious illnesses. In 39 critically ill patients, cimetidine was used as a prophylaxis against stress ulcers with the intent to keep the gastric pH level above 4. In 11 of the 39 patients, cimetidine alone did not effect consistent elevation of the gastric pH level above 4.