Significance of repeating diagnostic peritoneal lavage

The value of repeating diagnostic peritoneal lavage (DPL) when initial results are indeterminate or negative has not been defined. From January 1974 to June 1980, 1884 patients underwent DPL. Ninety-six had repeat DPL. Eighty-eight (4.7%) patients with indeterminate initial DPL results had repeat DPL. Results were true positive in 20, false positive in non, false negative in three, and true negative in 64 patients. If results for all 88 patients had initially been considered positive and all had undergone operation, the additional yield would have been low, three patients (3.4%); 64 patients would have undergone unnecessary laparotomy. If all 88 results had been considered negative, 20 patients (23%) with intra-abdominal injuries would have been diagnosed late or not at all. Eight patients with initial negative DPL but with persistent abdominal pain underwent repeat DPL. Results were true positive in three, false negative in one, and true negative in four. Repeat lavage has an accuracy of 95.8%, sensitivity of 85.2%, and specificity of 100%; with repeat lavage, DPL overall has high accuracy (98.4%), sensitivity (94.2%), and specificity (99.7%). Repeat lavage can be helpful in evaluating patients with initial negative lavage but with persistent abdominal pain. Repeat lavage is also indicated when initial results are indeterminate.

Evaluation of abdominal trauma by computed tomography

Computed tomography (CT) was used in the evaluation of 100 patients suffering abdominal trauma. The type of trauma was blunt in 78 patients, penetrating in eight, and iatrogenic in 14. Forty per cent of cases had normal CT scans, while 60% showed substantial abdominal or retroperitoneal injuries. Surgery, clinical follow-up, and repeated radiologic examinations confirmed the accuracy of CT, and there were no cases in which medical or surgical management was inappropriately guided by CT. A wide variety of injuries was detected, including 19 splenic, eight hepatic, six pancreatic, 13 renal, 13 retroperitoneal or abdominal wall, and one intraperitoneal. CT has major advantages over plain radiography, radionuclide imaging, and angiography in assessment of trauma-induced injuries.

[Nucleoli of mesothelial cells during regeneration after injuries inflicted at different times of the day]

Quantitative changes in nucleoli of the mesothelial cells of the rabbit parietal peritoneum have been studied under regeneration when trauma is performed at 8--10 or at 20--22 o'clock. The animals are killed every 3 h after the operation, for 5 days. The nucleoli are studied continuously along 12.8 mm from the edge of the defect in film preparations. Under conditions of posttraumatic regeneration in the mesothelium the number of cells containing 2--3 nucleoli increases. It is connected with the process of synthesis activation which has a wave-like character in time and space. Dynamics of changes in the number of the nucleoli depends on the time when the operation is performed. The operation performed in the morning provokes more intensive and rhythmical reaction. It corresponds to the dynamics of mitotic activity which is also subjected to greater effects of the circadian mechanisms after morning performance of the operation.

CT of blunt abdominal trauma in childhood

Computed tomography (CT) was performed on 23 children who had sustained moderate or severe blunt abdominal trauma. The major advantages of CT over excretory urography, sonography, and radionuclide imaging include superior anatomic detail and ability to visualize all organs, the peritoneal cavity, and retroperitoneum simultaneously. In suspected renal injury, CT best defines the extent of parenchymal injury and provides an easy method for accurate follow-up when conservative management is elected. Angiography is necessary for direct demonstration of vascular injury, for demonstration of active bleeding, and in therapeutic embolization of active bleeding sites. CT seems well suited to evaluation of the liver and retroperitoneum. Evaluation of the spleen has been satisfactory, but may be less accurate because of potential pitfalls. Duodenal hematomas are best evaluated by the upper gastrointestinal series. For CT scanning of the traumatized child to be of maximum value, intravenous contrast enhancement and meticulous attention to technique is necessary.

Urologic injuries associated with penetrating wounds to the buttock

The clinical syndrome of penetrating injuries to the buttocks at the Medical College of Virginia has been reviewed. This syndrome may present with a spectrum of injuries, from minor soft tissue damage to serious bowel, genitourinary, or vascular damage. Careful history and physical examination along with preliminary plan X rays and appropriate contrast radiographs should be performed. Additional diagnostic studies such as proctoscopy and cystoscopy are helpful when additional preoperative information is required. When retroperitoneal and intraperitoneal injury is suspected, prompt exploration with aggressive intraoperative management is recommended.

Why do surgical packs cause peritoneal adhesions?

Our experiments in the Porton rat have shown that the foreign debris from surgical sponges left in the peritoneal cavity after use is not the cause of peritoneal adhesions. Instead, the abrasive effect of introducing the sponge produces mesothelial trauma. This is the stimulus for an inflammatory response, followed by adherence of adjacent involved peritoneal surfaces. Adhesions formation did not occur between the abraded peritoneal surfaces of mobile intraabdominal viscera, which suggests that intestinal motility in the early postoperative period is important in the prevention of adhesions.

Penetrating wounds of the buttock

Results of a study of 15 patients with penetrating wounds of the buttock managed during a recent five year period suggest that penetrating trauma to the buttock is a distinct injury syndrome accompanied by serious intestinal, bladder or vascular damage. Following a complete history, physical examination and appropriate roentgenograms, most injuries can be anticipated, but proctoscopy and cystography should be performed upon all patients at risk. Intravenous pyelography, a poor test of bladder integrity, may be misleading and should by supplemented by additional techniques. If a retroperitoneal or intraperitoneal injury is suspected, preoperative antibiotic therapy, followed promptly by aggressive intraoperative management of all injuries, is recommended.

[Differentiation of mesothelial cells during their reparative regeneration]

The investigation on regenerative processes of mesothelium of the parietal peritoneum was performed in 120 white mice under the effect of certain irritants producing lesions various in depth and intensity. Nuclear-cytoplasmic relations and ultramicroscopic cellular rearrangement were studied during the process of differentiation of the mesothelial regenerate. Two periods of the regenerative process are stated and it is demonstrated that rearrangement of the mesothelial cells and the mode of their division depend on intensity of the lesions. When the peritoneal lesion is severe, at the first stages of regeneration (the 1st period) rearrangement of cells towards their hypertrophy and increased functional activity is predominant in the mesothelium. Further (the 2d period), the number of mitotically dividing cells is increasing in the mesothelial regenerate and in rearrangement of the mesothelial cells the processes connected with a partial loss of their signs of specialization predominate. The transition from one period into another is gradual and duration of each depends on intensity of the lesion.

[Effect of the time of the day when the lesion was produced on the course of mesothelial proliferation]

The course of mitotic activity in the rabbit mesothelium of parietal peritoneum was studied depending upon the daytime when the lesion was produced. In the first series of experiments (I) the operation was performed from 8 to 10 a. m., and in the second series (II) - from 8 to 10 P. M. After the operation the animals were sacrifieced: one animal every 3 h during 5 days. Mitotic activity was investigated along 13 mm from the edge of the wound in flat film preparations. The data obtained were statistically treated applying approximation of the process course by the method of weighed sliding averages. The first mesothelial mitoses appeared: in the first series (I) of experiments - in 24 h, in the second series (II) of experiments - 21 h. Further, proliferation of the mesothelium appeared in different parts of the tissue with various intencity and was of wavy character. Regardless of the time when the lesion was produced, mitotic activity was the greatest in the first zone, 4.8 mm wide its maximum 33 h after the operation. The character of the regenerative process in the mesothelium depends on the circadian phase of the organism at the time of the operation, that influences the time when mitotic activity begins, its quantitative indices, the area of the tissue involving into the reaction, expressiveness of the rhythmicity of the process. During 5 days, in the II series of experiments three waves were noted, and in the I series - five waves were noted and their periods were near the diurnal.

Perforation of the peritoneum and intra-abdominal hemorrhage: a complication of umbilical vein catheterizations

We report a major hemorrhage into the peritoneal cavity caused by perforation of the umbilical vein by a venous catheter in a critically ill neonate. A lateral roentgenogram was necessary to confirm the position of the umbilical vein catheter and the peritoneal perforation. Conservative management, including replacement of lost volume and correction of coagulation abnormalities, controlled the hemorrhage, and surgical intervention was not necessary.

[Effect of polyvinylpyridine-N-oxide on the state of phagocyte-lymphoid elements in aseptic inflammation]

Cytochemical study of NAD-diaphorase and acid phosphatase (mitochondria and lysosomes markers) in the cells of the abdominal cavity exudate with aseptic inflammation and additional action of polyvinylpyridne-N-oxide with molecular weight in the range of from 2000 to 150 000 formed a background for demonstrating the possibility of stabilizing by means of the latter compound of mitochondrial and lysosomal membranes of macrophages, neutrophils and lymphocytes. The most pronounced stabilizing effect is produced by polyvinylpyridine-N-oxide with a molecular weight of 50 000 with its intramuscular introduction in a dose of 100 mg/kg.

Implantation of a tissue-binding material in the female genital tract: a preliminary study on oviduct occlusion and the prevention of adhesions in baboons

Studies conducted in adult female baboons have documented the potential usefulness of a new alloplastic substance, Proplast, when applied to the genital tract of the human female. Two areas of likely application are in the prevention of adhesions in infertility surgery and in reversible or permanent tubal occlusion.

Jaundice and wound healing: an experimental study

Obstructive jaundice was induced in rats by ligation and division of the common bile duct. The healing of a standard gastric incision and a parietal peritoneal defect in these animals showed histological evidence of delayed healing compared with controls. The bursting strength of the abdominal incision was also lowered, but not that of the stomach, probably because of the adhesions which reinforced the gastric incisions. Angiography did, however, reveal delay in angiogenesis in the gastric wounds of jaundiced animals. The possible causes of this delay in healing and its clinical implications require further investigations.

[A rare complication of the acetabulum: incarceration of a small intestine loop in the fracture area]

The authors report an exceptional case of fracture of the acetabulum complicated by tear of the small intestine due to injury to the loop of intestine by a piece of the fractured acetabulum. As it is rare, such a complication is often undiagnosed. Discovered in time, an operation avoids a fatal issue due to peritonitis.