Marlex mesh in gas gangrene

Clostridial gas gangrene is a well recognized complication of traumatic and surgical wounds, and is associated with an overall mortality rate of 25% (5, 22). Gas gangrene of a limb results in a mortality rate approximately half that of gas gangrene of the trunk (4, 7, 8, 9, 11, 12, 13, 15, 16, 19, 24). Radical debridement and antibiotic therapy or high amputation of involved limbs are accepted traditional approaches to the problem. The role and value of hyperbaric oxygenation (OHP) remains controversial despite intense study over the past few decades. Patients with gas gangrene involving all layers of the abdominal wall as well as an extremity pose major resuscitative, operative, supportive, and rehabilitative problems. A report is presented of two such patients with comments on the therapeutic modalities employed.

Amylase isoenzyme clearances in normal subjects and in patients with acute pancreatitis

Renal clearances of amylase isoenzymes, expressed as percentages of creatinine clearances, were determined in 20 normal subjects and in 8 patients with acute pancreatitis. The isoenzyme assay employed thin layer isoelectric focusing, starch iodine staining, and densitometry. Normal clearance of pancreatic-like amylase (mean +/- SE: 3.00 +/- 0.40%) was greater than the clearance of salivary-like amylase (0.51 +/- 0.06%) in ea ch individual (P less than 0.001). However, the amount of pancreatic amylase in the serum was not the major determinant of amylase clearance. Normal clearance of pancreatic-like amylase was significantly (P less than 0.001) less than the clearance of total serum amylase in acute pancreatitis (6.49 +/- 1.07%). In pancreatitis the clearance of pancreatic-like amylase (7.29 +/- 1.19%) and the clearance of salivary-like amylase (4.55 +/- 1.02%) were both elevated compared to normal (P less than 0.001). These findings indicate that the increased clearance of amylase in pancreatitis results from a change in renal function rather than a change in serum amylase. Renal changes not reflected by increased serum creatinine or more than mild proteinuria may be manifestations of the systemic toxicity of acute pancreatitis.

Zinc and wound healing

A review of the literature on zinc and wound healing shows the many gaps of knowledge which still exist. This study of the histologic appearance of wound healing in rats fed various diets demonstrates the serum zinc levels achieved by such diets. No significant improvement was observed in the rate of healing for any one group, but a number of histologic differences were observed.

Marked alkaline phosphatase elevation with partial common bile duct obstruction due to calcific pancreatitis

This study characterizes a syndrome of partial common bile duct obstruction and marked elevation in serum alkaline phosphatase in 6 male alcoholic patients with calcific pancreatitis. In each patient, a marked elevation in serum alkaline phosphatase was associated with minimal, if any, elevation in serum bilirubin. In all cases, the alkaline phosphatase was hepatic in origin, and intravenous or operative cholangiography showed a dilated common bile duct. Liver biopsy showed canalicular bile stasis in 4 patients and bile duct proliferation in 2 patients. This study demonstrates that calcific pancreatitis may cause partial bile duct obstruction which differentially increases serum alkaline phosphatase without altering bilirubin or bromsulphthalein excretion.

Alcohol intoxication and serum osmolality

The relation between serum osmolality and blood-alcohol was studied prospectively in 565 acute trauma patients. The two measurements were closely correlated. It is therefore possible to estimate the blood-alcohol from serum osmolality to assist in the clinical management of acutely injured patients.

Abdominal lavage in blunt trauma

A technique for abdominal lavage is described and was used to evaluate the abdomen of 671 multiple trauma victims. In 44 per cent (299 cases) there was a bloodstained return and these were regarded as positive. Patients with a positive result underwent exploratory laparotomy which revealed that 89 per cent had significant intra-abdominal trauma requiring a surgical procedure, 8 per cent had trauma which did not require any active surgical correction and 3 per cent had no abdnormal findings. Of all the lavages performed, there were 0-11 per cent false positive and 0-03 per cent false negative results. The value of the test in the context of multiple trauma is emphasized.