How Useful Is Peritoneal Lavage Amylase?

Prospectively for 23 months, 289 patients with penetrating and 317 patients with blunt trauma to the lower chest and/or abdomen had amylase determinations in the peritoneal lavage as part of their initial evaluation. In nine (1.5%) of the 606 patients, the amylase in the lavage was higher than normal serum values and, when elevated, it identified intra-abdominal injury. Intra-abdominal injuries usually involved a hollow viscus injury—either isolated or combined with solid organ injuries—rather than pancreatic injury. Although elevation of the lavage amylase was a reliable indication of intra-abdominal injury in this series, we feel that routine use of this test ought to be abandoned because the lavage fluid content of red or white blood cells, or both, was also elevated in all but one patient (1/606)

Peritoneal Lavage Red Blood Cell and White Blood Cell Count: A Prospective Comparison of Usefulness

Prospectively, 637 patients with blunt or penetrating trauma to the lower chest or abdomen had quantitative peritoneal lavage red blood cell (RBC) and white blood cell (WBC) counts as part of their initial diagnostic evaluation. Statistically, the lavage RBC count (error rate: 6.8%) was a superior test to the lavage WBC count (error rate: 9.7%) (chi sq=9.2564, p=0.0024). See Appendix. When the lavage RBC and WBC tests agreed, the predictive value was high: 94% (46/49) when both were positive and 95% (521/549) when both were negative. When the lavage RBC test was positive and the lavage WBC test was negative, 96% (23/24) of patients had intraabdominal injury. When the lavage WBC test was positive and the lavage RBC test was negative, 60% (9/75) had intraabdominal injury. Six of these patients had injuries only to a hollow viscus (small bowel, 5; colon, 1). Both lavage RBC and WBC tests were useful in this series. When they agreed, each was a good corroborative test. When they did not agree, the lavage RBC test was superior when it was positive. Laparotomy should be considered for the trauma patient whose lavage WBC test is positive

Intrahepatic-Cutaneous Biliary Fistulas Secondary to Trauma

Biliary fistula is an unusual complication after operations for hepatic trauma, but only scant information is available concerning its management. This report describes biliary fistulas and presents two cases of their successful resolution, by external drainage in one case and internal drainage in the other. These cases illustrate aspects of fistula management and prevention described in the literature and suggest individualized approaches

Vertebral Artery Injury: Case Report and Review of Operative Approaches

Traumatic injury to the upper third of the neck, cephalad to the angle of the mandible, distorts the complexity of normal anatomy and underscores the importance of preoperative arteriography when possible. This report describes the case of a young man who was brought to the Emergency Room of our hospital suffering from a severe gunshot wound to the cervical spine, vertebral artery, and maxillofacial skeleton. His injury was successfully managed by combining a standard arterolateral incision with a procedure that has been described for exposing retro maxillary tumors. This operative technique provided the surgeon with direct access to the injury, controlled the loss of blood, and permitted repair of accompanying pharyngeal and facial injuries. Our report also reviews the technical considerations and pertinent surgical anatomy of this rare combination of Injuries

Multiple Small Bowel Perforations Secondary to Cytomegalovirus in a Patient with Acquired Immunodeficiency Syndrome

Cytomegalovirus gastroenteritis can be a life-threatening infection in patients with the acquired immunodeficiency syndrome. Although gastrointestinal ulcerations from cytomegalovirus have been widely reported, our patient is only the second case reported with actual perforations in the small bowel

Chronic Idiopathic Thrombocytopenic Purpura: Effective preoperative preparation and long-term results of splenectomy

A retrospective review of 98 patients seen at Henry Ford Hospital from 1953 through 1977 demonstrated that splenectomy for chronic idiopathic thrombocytopenic purpura provided a good response which usually was sustained on long-term follow-up (72% at 15 years). Although splenectomy for this condition had a low mortality, morbidity was significant in patients older than 40 years. When compared to patients whose response to splenectomy was sustained, patients who relapsed had significantly lower platelet counts preoperatively both when they were untreated (mean: 9,194 per cc versus 18,524 per-cc) and/or when they were treated with steroids (mean: 85,647 per cc versus 142,590 per cc). Another significant risk factor for relapse was a longer interval from splenectomy to the maximum postoperative platelet count. In the immediate preoperative preparation of the patient for splenectomy, corticosteroids temporarily increased the platelet count, but high doses were necessary in many patients. A platelet count of greater than 40,000/cc usually was achieved with a dose of 60 to 80 mgs of prednisone per day for several days. Platelet infusion rarely was needed if patients were prepared adequately with steroids. There should be no hesitation to give large doses of steroids for a few days, and a delay in proceeding with the operation, once indicated, should be avoided. Because the response of the platelet count to splenectomy may be variable or fluctuating and late relapses can occur, patients should be re-evaluated periodically

Fulde-Ferrell-Larkin-Ovchinnikov State in Heavy Fermion Superconductors

The Fulde-Ferrell-Larkin-Ovchinnikov (FFLO) state is a novel superconducting state in a strong magnetic field characterized by the formation of Cooper pairs with nonzero total momentum (k \uparrow, -k+q \downarrow), instead of the ordinary BCS pairs (k \uparrow, -k \downarrow). A fascinating aspect of the FFLO state is that it exhibits inhomogeneous superconducting phases with a spatially oscillating order parameter and spin polarization. The FFLO state has been of interest in various research fields, not only in superconductors in solid state physics, but also in neutral Fermion superfluid of ultracold atomic gases and in color superconductivity in high energy physics. In spite of extensive studies of various superconductors, there has been no undisputed experimental verification of the FFLO state, mainly because of the very stringent conditions required of the superconducting materials. Among several classes of materials, certain heavy fermion and organic superconductors are believed to provide conditions that are favorable to the formation of the FFLO state. This review presents recent experimental and theoretical developments of the FFLO state mainly in heavy fermion superconductors. In particular we address the recently discovered quasi-two-dimensional superconductor CeCoIn_5, which is a strong candidate for the formation of the FFLO state.Comment: 17 pages, 12 figures with jpsf2.cls, to be published in J. Phys. Soc. Jpn. (Special Topics - Frontiers of Novel Superconductivity in Heavy Fermion Compounds