Fine-catheter aspiration cytology of peritoneal cavity improves decision-making about difficult cases of acute abdominal pain

Fine-catheter aspiration cytology of the peritoneal cavity was successfully undertaken in 25 of 27 hospital inpatients with acute abdominal pain because it was not clear whether they required urgent laparotomy. Cytological specimens were prepared by the cyto-sieve technique. The main test criterion was the percentage of neutrophils in the peritoneal cell sample. The decision before the test about urgent laparotomy was correct in 14 of the 27 patients, whereas the decision after the test was correct in 26 of the 27 patients (p = 0.001). 4 patients were saved unnecessary laparotomy and 8 further delay in laparotomy.

Effect of high-dose cimetidine on pulmonary extravascular water after acute smoke inhalation injury

An animal model utilizing gamma imaging was used to examine pulmonary edema of an inhalation injury model. Tests were conducted using radiolabeled tracers and a dual indicator dilution technique as well as gravimetric analysis of excised lungs to determine extravascular water formation. The effect of cimetidine (Tagamet, an H2 receptor antagonist) was investigated as a potential agent for reduction of pulmonary edema following inhalation injury. Control groups included no treatment; smoke only; fluids only; and smoke and fluids. These were compared with identical groups given the same treatments but with the addition of cimetidine (100-150 mg/kg body weight intravenously). Fluids administered were 5% body weight intravenous infusions of lactated Ringer's solution over two hours. Results show that pulmonary edema was evidenced in animals given an inhalation injury, and was markedly worsened by fluid resuscitation. Treatment with cimetidine at high doses, either before or after inhalation injury, did not protect the animals from formation of pulmonary edema.

Early detection of extravascular lung water in an inhalation injury animal model

A rabbit inhalation injury model using a dual tracer radioactive isotope technique (Rowland et al., 1986), has been utilized with small- and medium-sized molecular weight tracers. There is oedema formation at 2 h after smoke inhalation or fluid resuscitation and especially with the combination of inhalation injury and fluid resuscitation [corrected]. This oedema appears to have decreased by 24 h post-injury. There does not appear to be any difference between the small- and medium-sized tracers in the transit times of tracer in the lung vascular compartment. The increases in extravascular water volume have been confirmed by gravimetric analyses of the lungs. Thus the pulmonary oedema in the rabbit animal model is detectable within 2 h post-injury, with a return towards normal values some time within 24 h if fluid challenged for short periods. Fluid resuscitation exacerbates the amount of oedema that developed. The onset of pulmonary oedema may therefore be earlier than previously seen clinically, and fluid resuscitation modifications may be of benefit in smoke inhalation injury.

Diagnosis of the rare solid and papillary epithelial neoplasm of the pancreas by fine needle aspiration cytology. Light and electron microscopic study of a case

A case of the rare solid and cystic papillary tumor of the pancreas in a young woman is described. The diagnosis was made by fine needle aspiration cytology, with electron microscopic examination of the needle washings. The preoperative cytologic diagnosis enabled appropriate surgical treatment to be planned and carried out without undue delay. It is important to distinguish this rare tumor from other pancreatic tumors with similar cytohistologic features since, if diagnosed correctly and managed surgically, this neoplasm is associated with a good prognosis.

The presentation and management of presacral tumours

Twenty cases of presacral tumours are presented, nine males and eleven females being affected. Malignancy occurred in 50 per cent of adults and was commoner in men than in women. Diagnosis depends on a careful rectal examination. Computerized axial tomography is the single most useful investigation; however, should it not be available, plain X-rays and ultrasonography give considerable information. For lesions less than 10 cm in size a local parasacral approach is often feasible but for larger lesions an abdominal approach or combined approach should be considered.

Differential effects of intrafrontocortical microinjections of dopamine agonists and antagonists on circling behavior of rats

Asymmetric posturing and circling behavior resulting from acute unilateral manipulation of central dopamine have been used to assess this neurotransmitter's contribution to motor control. Although providing extensive evidence for the involvement of mesolimbic and nigrostriatal dopamine in motor activity, this approach has not been used to study the mesocortical system. We now report circling behaviour following acute manipulation of frontal cortical dopamine. Unilateral microinjections of the agonists, (+)-amphetamine (12 and 25 micrograms in 1.0 microliter) and LY 141865 (12 micrograms in 1.0 microliter) resulted in contraversive circling. Conversely, unilateral intrafrontocortical microinjections of the antagonist, metoclopramide (25 and 100 micrograms in 1.0 microliter) resulted in ipsiversive circling in amphetamine (1.5 mg/kg, i.p.) pretreated rats. Lower central doses of each drug and vehicle injections had no significant effect. These results provide evidence for an excitatory influence of mesocortical dopamine on motor control. This finding may implicate frontal cortical dopamine in the extrapyramidal motoric side effects of chronic neuroleptic treatment which previously have been attributed to dopamine function in subcortical areas.

Patients with acute abdominal pain: white cell and neutrophil counts as predictors of the surgical acute abdomen

Two hundred and fifty-two patients with acute abdominal pain were admitted to Wellington Hospital during three consecutive months in 1982. The prevalence of the surgical acute abdomen in these patients was 35%. There was no significant difference in performance between the peripheral blood white cell count (WCC) and neutrophil count (NC) when used as diagnostic tests of surgical acute abdomen. Neither test is sufficiently sensitive or specific to be a good predictor of surgical acute abdomen. It is recommended that the WCC be used sparingly and interpreted as a continuously distributed rather than dichotomous diagnostic test. There is no advantage in using the NC.

Effects of unilateral microinjections of sulpiride into the medial prefrontal cortex on circling behavior of rats

Bilateral 6-OHDA lesions of rats' medial prefrontal cortex increased locomotor activity after 7-10 days suggesting that cortical DA may normally inhibit motor behaviour. However, hyperactivity may have resulted from enhanced subcortical DA function. Acute manipulation of frontal cortical DA neurotransmission in the present experiment avoided lesion-induced subcortical changes. Sulpiride (0, 6, 12, 24 micrograms in 1 microliter) was injected unilaterally into the medial prefrontal cortex of rats pretreated with (+)-amphetamine (1.5 mg/kg, i.p.). Circling behavior was scored during four 5-min intervals of a 60-min test session which began with injections and placement in a flat, circular arena. SUL resulted in ipsiversive circling whereas its vehicle did not. These results were consistent with those seen with other DA drugs and suggest an excitatory influence of frontal cortical DA on locomotor activity.

Peritoneal neutrophilia: a potential indicator of the surgical acute abdomen

The percentage of neutrophils in a peritoneal cell sample (PNP), obtained at operation, was measured in 250 patients who underwent urgent laparotomy because 'the surgical acute abdomen' (SAA) was suspected. The PNP was substantially higher in patients with confirmed SAA than in others and is potentially a very sensitive and very specific test of SAA. If the PNP was available as a diagnostic test for patients with acute abdominal pain, there might be a significant reduction in unnecessary and delayed laparotomies.

Changes in the pattern of disease managed by general surgeons in New Zealand, 1940-80

Changes in the pattern of disease managed by general surgeons in New Zealand, were assessed for the period 1940-80, using the public hospital admission and cancer incidence data of a representative selection of diseases. During the forty-year period, there was an increase in the incidence of four of the five cancers studied, and an increase in admission rate for non-specific abdominal pain, head injury (indicated by skull fracture), peripheral arterial disease (indicated by aortic aneurysm), gall-stone disease and pancreatitis, large bowel disorders and breast diseases. There was a decline in admission rate for appendicitis, stomach disorders and goitre.

Meta-iodobenzylguanidine in metastatic phaeochromocytoma

A case of metastatic phaeochromocytoma is presented. Meta-iodobenzylguanidine was used to locate the tumour but failed to show two functioning abdominal metastatic deposits. Although meta-iodobenzylguanidine appears to be highly specific for phaeochromocytoma, a negative scan does not exclude a functioning tumour with confidence.

Sex differences in subsite incidence of large-bowel cancer

A review of patients with large-bowel cancer at a major New Zealand hospital showed an excess of right-sided colonic tumors in females compared with males. These observations stimulated analysis of the National Cancer Registry registration data for large-bowel cancer for the whole of New Zealand in the years 1972 to 1975 (4678 patients). Rates for each site were calculated and age-standardized, using world population figures. The findings confirmed that females have a higher incidence of right-sided colonic cancer and males a higher incidence of rectal cancer and showed a significant trend in this direction from the ascending colon toward the rectum. The observed differences between males and females suggest differences in the etiology of the tumor and should be taken into account in assessing modalities and outcomes of treatment.

Cancer of the pancreas in New Zealand 1970-1974

There were 991 new cases of cancer of the exocrine pancreas in the New Zealand population for the five years 1970-74. The disease had a higher incidence in men than women and in Maoris compared to Europeans. There was no increase in incidence in the period 1950-52 to 1971-73. Most of the cancers occurred in the head of the pancreas and were described as adenocarcinomas. Seventy seven per cent of the patients had lymph node metastases or advanced disease at the time of diagnosis. Only 7 per cent were able to have resectional surgery and in 90% specific therapy was not given. The estimated crude three-year survival rate of all patients was four per cent and the median survival time was 1.7 months. The crude three year survival rate after resection was 9.8% and the median survival time was 5.8 months. The most important variables affecting survival were stage of disease and age of patient.

Cancer of the stomach in New Zealand: 1970-74

A total of 1,891 new cases of cancer of the stomach occurred in New Zealand (1971 population 2,862,631) in the five years 1970-74. There was a higher incidence in men than women and in Maoris compared to Europeans. The disease had declined in incidence by about 50% in 20 years. Most of the cancers occurred in the distal stomach and were described as adenocarcinomas. Seventy percent of the patients had a lymph node metastases or advanced disease at the time of diagnosis. Only 39% were able to have resectional surgery and in 57% specific therapy was not given. The estimated crude five year survival rate of all patients was 7.8% (relative rate 10.2%) and the crude five year survival rate after resectional surgery was 18.7% (relative rate 24.7%). The most important variables affecting survival were the stage of the disease and the age of the patient.

The wound fibroblast and macrophage. I: Wound cell population changes observed in tissue culture

The number and type of cells which migrated from sequential explants of wounded fascia in rats reflected the dense and changing cell populations observed in healing wounds. Macrophages appeared in large numbers from explants taken in the 5 days following injury, thereafter fibroblast-like cells predominated. The results support the hypothesis that the fibroblast-like cell of tissue culture is the same as the wound fibroblast. The technique can be used to obtain wound cells and provides a useful bridge between in vivo and in vitro means of investigating wound repair.

The wound fibroblast and macrophage. II: Their origin studied in a human after bone marrow transplantation

The origin of the wound fibroblast and macrophage was studied in a patient following bone marrow transplantation, using sex chromosome markers. Fibroblast-like cells emigrating from explants of a 5-day-old skin wound had the host karyotype, whereas macrophages had donor markers. These results suggest that the wound fibroblast in man is of local tissue origin, whereas wound macrophages are derived from haemopoietic tissue.