Osteomyelitis following translumbar aortography

Osteomyelitis of the lumbar spine occurred in a patient following translumbar aortography. Treatment included surgical drainage and systemic antibiotic therapy. Fever and progresive neurological dysfunction were relieved. There is controversy about the safety and efficacy of translumbar versus percutaneous transfemoral aortography. The translumbar route, is not the primary approach, is a reasonable alternative; bleeding complications are infrequent and infection is rare.

Successful rehabilitation following amputation of dominant versus nondominant extremities

In a study of 154 lower extremity amputees who received prostheses, those patients who lost a left lower extremity tended to make better progress in rehabilitation than those who required a prosthesis for the right leg. Eighty-three percent of the amputations were performed for vascular disease with no right-left difference. Heart disease played a greater role as a factor in limiting rehabilitation in those with left limb loss. Goals set and attained for loss of the left leg were higher than those for loss of the right leg. Left leg amputees can navigate more frequently without aids than can the right leg amputees. The use of a cane made both groups equal in rehabilitation time. Patients with a loss of the left leg attained maximum benefits of rehabilitation sooner than their colleagues with a loss of the right leg. Differences were nearly 2.3 weeks when the median was 22 weeks.

Microvascular procedures in the management of lymphedema

The burgeoning field of lymphatic research, and the applications of surgical and microsurgical techniques to the problem of lymphedema have been briefly reviewed. The chronicity of this symptom complex and the relative sparsity of cases in developed countries make controlled clinical trials of treatment unfeasable and comparisons of present regimens difficult. However, continued investigation will undoubtedly be fruitful.

Histologic and ultrastructural studies of canine pancreas fed an elemental diet

A clinically available elemental diet (Vivonex-100) has been fed to healthy mongrel dogs. Compared to a regular chow diet and regulated so as to maintain a stable weight, no changes were noted on light or electron microscopy and six months' maintenance. Extrapolating, the pancreas shows no evidence of a "resting state" according to this data.

Eosinophilic cholecystitis

A somewhat obese, 40-year old female presented with a classic history of gallbladder disease and a peripheral eosinophilia of 14% without an allergic history. A nonvisualizing oral cholecystogram was followed by an uneventful cholecystectomy. Pathological examination revealed a calculus in the cystic duct and a pure transmural eosinophilic infiltrate of the gallbladder wall. Postoperatively the peripheral eosinophilia returned to normal. Biopsies of the small bowel one year later showed focal mucosal eosinophilia when the patient had recurrent abdominal pain, diarrhea and peripheral eosinophilia. Eosinophilic cholecystitis may represent a descrete entity in search of an etiology or involvement of the biliary tract by eosinophilic gastroenteritis.

Elemental diet and bile induced pancreatitis

The effectiveness of an elemental diet was investigated as both a prophylactic and therapeutic agent in experimental canine pancreatitis. Pancreatitis was induced by operative injection of a bile -saline solution mixture under pressure retrograde into the main pancreatic duct. In addition to a preinjection control sample, serial biopsies were obtained at 30 minute intervals for 90 minutes after injection and fixed for light and electron microscopic examinations. In addition, preoperative and postoperative blood samples were drawn and analyzed for amylase. After operation, half of the dogs from each original group were fed Vivonex-100, the other half from each group, regular laboratory chow, yielding four ultimate groups based on preoperative and postoperative diets. Successful induction of pancreatitis was evaluated by the difference between preoperative and postoperative amylase values, all of which were significant by group at the p less than 0.01 level. No ultrastructural evidence was found for the modification of zymogen granules with the pretreatment elemental diet nor were differences evident, histologically or ultrastructurally, in the severity of pancreatitis between the pretreated and nonpretreated groups. Finally, gross mortality figures demonstrated no efficacy of elemental diet for pretreatment prophylaxis of acute pancreatitis.

5-Hydroxytryptamine extraction by the lung

Both 5-hydroxytryptamine and norepinephrine are removed from blood during a single passage through the pulmonary vasculature of the dog; 5-hydroxytryptamine is removed to a greater degree than is norepinephrine. The magnitude of extraction of both 5-hydroxytryptamine and norepinephrine is similar to that previously determined in man. In the intact dog, imipramine inhibits the uptake of 5-hydroxytryptamine by the lung in a dose-dependent manner.

Intestinal calcium absorption: differences in transport between duodenum and ileum

The interaction of calcium with sugar, sodium, and water absorption was studied in rats fed laboratory chow and in vitamin D-deficient and -repleted rats with the use of intestinal loops in vivo. Calcium absorption in the duodenum was enhanced by D-glucose only in the vitamin D-deficient state. In both vitamin D-deficient and -repleted ileum, calcium absorption decreased when NaCl was replaced by mannitol; however, it remained unchanged when NaCl was replaced by choline chloride or urea. Calcium absorption was enhanced by actively transported sugars and by increasing net water flow generated by differences in osmotic pressure and urea. Under all experimental conditions there was a strong association between net water and calcium absorption in the ileum. These findings suggest that calcium absorption is enhanced by solvent drag, although the role of sodium cannot be excluded entirely.

Acute and chronic venous insufficiency in the finger

Venous hypertension with subsequent chronic venous insufficiency and its sequelae in the hand is reported as an uncommon complication of arteriovenous fistulae for hemodialysis.

Pancreatic enzyme response with an elemental diet

Elemental diets can maintain or slightly improve the nutritional status without a major stimulatory effect on the pancreas. Six dogs were maintained with a regular chow diet, switched to an elemental diet and, subsequently, returned to a chow diet. Cannulation of the pancreatic duct through a duodenal cutaneous fistula revealed the enzyme response to be decreased in a dog maintained with an elemental diet, with no or only a slight weight gain. Return to a regular diet resulted in a return of pancreatic enzyme response.

Serosal tears following colonoscopy

After colonoscopic perforation, laparotomy was performed in a 28-year-old woman. Seromuscular tears and lacerations were found in an adjacent loop of sigmoid colon that appeared normal through the colonoscope. At laparotomy, the mucosa of that loop was entirely intact. Six weeks later, a laparotomy was again performed, revealing well-healed lacerations with extensive adhesion formation. The incidence of this complication in patients undergoing colonoscopy is unknown.

What influence does age have on rehabilitation of amputees?

A study of 194 male lower extremity amputees, with an average age of 56.8 years, showed that vascular disease is the most common cause of limb loss at all ages. Increasing age was correlated with an increasing incidence of bilateral amputation and arteriosclerotic and pulmonary problems, lower goals and levels of achievement, increased mortality during therapy, fewer amputees who were able to return home, an increased number of aids (cane, crutches, wheelchair), and a longer rehabilitation period. Many patients over age 65 required nearly a year of rehabilitation to achieve maximum benefit.

The role of the nurse epidemiologist in infection control and continuing education

A university affiliated Veterans Administration Hospital had an increase in the number of serratia isolates. An epidemiologic investigation, including personnel and environmental prevalence study, helped correct errors in technique, management and judgment. A nurse epidemiologist prevented a cluster of infections from becoming an epidemic.

Management of amputation-stump breakdown

Seven cases of above-knee amputation stump breakdown following surgery for arteriosclerosis obliterans were successfully treated with Travase ointment. (Bacillus subtilis proteinase). Rehabilitation was facilitated because secondary closure of the previously infected necrotic wounds could be more rapidly undertaken.

Rehabilitation after bilateral lower extremity amputation

Fourty-four men (average age, 61.5 years) who had undergone amputation of both lower extremities were studied at a Veterans Administration hospital. Vascular insufficiency was the most frequent reason for amputation. In 26 of the patients bilateral below-knee amputations had been performed. Although diabetes mellitus was present in 26 of the patients, it severely hampered rehabilitation in only four. Twenty-nine (nearly 65%) of the 44 patients became totally independent in daily functions. However, the average time required for maximum rehabilitation was almost 30 weeks.

The hepatorenal syndrome: recovery after portacaval shunt

Reversal of the morbid hepato-renal syndrome has been achieved in a cirrhotic patient with ascites following successful side-to-side portacaval shunt. The hepatorenal syndrome is defined as progressive unresponsive renal failure with previously normal kidneys in the presence of impaired hepatic function. Although the etiologic mechanism has not been defined, it is suggested the relationship of increased intrahepatic sinusoidal pressure on the thoracic duct and subsequent decreased lymph flow are interrelated to increased levels of aldosterone and manifested by (chylous) ascites. Laboratory and clinical evidence suggest that cirrhotics with ascites have remarkably high levels of aldosterone secretion via the rennin-angiotensin-adrenal cortex mechanism. This is the group that develops hepatorenal syndrome. Reduction of the intrahepatic pressure and decompression of the portal hypertension can be successfully achieved with a side-to-side shunt which should return the aldosterone-rennin-angiotensin axis to normal and subsequently reverse the hepatorenal syndrome.

Associated diagnoses which complicate rehabilitation of the patient with bilateral lower extremity amputations

Cardiopulmonary problems were the most common limiting factor in the rehabilitation of 42 bilateral lower limb amputees. Diabetes mellitus and local stump problems, most common in below knee amputees, delayed rehabilitation but, subsequently, obtained the highest goals. Thirty of the 42 amputees finally were self sufficient; the average time required was 30 weeks to maximum benefit.

Barium granuloma of the rectum: an uncommon complication of barium enema

Barium sulfate granuloma of the rectum may develop when this contrast material is forced through a discontinuity in the rectal mucosa. The ensuing mass may be confused with carcinoma. Preoperative biopsy and attention to plain films will prevent unnecessary inappropriate surgery.

A review of echinococcal disease

Echinococcal infestation, although still a rare occurrence in most of the United States, is being seen with increasing frequency. Three cases of hepatic echinococcosis are described. A review of the salient features of the disease is presented along with various aspects of diagnosis and therapy.

Succinic dehydrogenase as a measure of tissue viability in the cadaver kidney. Influence of perfusing solutions

Succinic dehydrogenase (SDHG) has been studied in the rabbit cadaver kidney. Increasing warm ischemia time decreases the ability of the organ to utilize oxygen and therefore lowers its SDHG activity. The addition of perfusing solutions further decreases the SDHG activity; saline has a more adverse affect than either Perfudex or albumin.