Intestinal infarction: report of 98 cases

The Authors conducted a retrospective study on 98 patients with intestinal infarction observed from 1987 to 1999 in the Emergency Care Unit of the Loreto Hospital, Naples. In our hospital there are over 20,000 admissions, 3,900 of whom in the Emergency Care Unit. Intestinal infarction accounts for 0.049% of all admissions and 0.45% of emergency surgery admissions. About 500 laparotomies are performed annually, 1% of which for intestinal infarction. All patients in this series were operated on within 10 hours of admission. The following procedures were performed: 31 jejuno-ileal resections; 26 right hemicolectomies associated with small intestine resection; 5 upper mesenteric artery embolectomies plus wide gut resections (3 also underwent second-look operations within 36 hours of the initial surgery with further gut resection); 1 Hartmann's and 5 Volkmann's operations (all of these patients had colonic gangrene); 30 (30.5%) underwent exploratory laparotomy due to massive infarction. The prognosis of intestinal infarction is still ominous. Our mortality rate is 68%. Both clinical and laboratory data are non-specific and delayed diagnosis is the main cause of this mortality rate. Abdominal CT is an accurate and sensitive diagnostic tool. TPN enables us to achieve good nutritional support even for wider resections.

[Non-surgical treatment of liver trauma]

The aim of the study was to assess the role of non-operative treatment in haemodynamically stable patients with liver trauma. Over the period from 1996 to July 2000, out of a total of 2,048 patients with abdominal trauma, 124 open and 1,924 closed, we observed 77 hepatic lesions, consisting of 55 closed traumas and 22 penetrating traumas. Non-operative treatment was implemented in 18 patients (32.7%) with closed liver traumas. In addition to serial clinical examinations of the abdomen, the patients receiving non-operative treatment were submitted to thorough haemodynamic monitoring and complete blood counts in the intensive care unit. After an abdominal CT scan at entry, patients were submitted to abdominal ultrasonography 6, 12 and 24 hours after admission. Only two patients required transfusions, one presenting a pelvic fracture and the other a triple fracture of the femur, tibia and fibula. There was no mortality. A biloma was present in one case, successfully treated by means of a US-guided drainage puncture. It is patients with major cranial traumas that pose most problems for conservative treatment. Fifty percent of non-therapeutic laparotomies in our series were performed in patients with severe cranial traumas. It is precisely in these patients that an improvement in diagnostic capability is most desirable.

Clinical value of plasma creatine kinase and uric acid levels during first week of life

Levels of creatine kinase and uric acid in cord blood were variable but similar to those in maternal blood. During the first 24 hours of life there was a rise in the concentration of both substances, particularly of creatine kinase, to reach levels well above those normally found in later childhood. Thereafter there was a steady fall to stable levels around the fifth day. The causes of these obvious changes in concentration are not known. Uric acid levels during the first 24 hours were higher after a longer labour. Creatine kinase levels were lower, and uric acid levels higher in low birthweight babies. The plasma creatine kinase originated from non-cardiac muscle. Plasma creatine kinase and uric acid levels may help in the early diagnosis of rare specific disorders such as muscular dystrophy and the Lesch-Nyhan syndrome, but do not help in the diagnosis of other neurological disorders at this time of life, and give no indication of the child's prognosis, despite their occasional help in adult patients. Even with the specific syndromes, however, interpretation must be guarded. It is not known whether the high creatine kinase levels associated with Duchenne muscular dystrophy would be lost in the upper limits of the normal range for the first few days of life or whether they would be higher still. In the Lesch-Nyhan syndrome uric acid levels are well above the normal range defined in this investigation.