A 62-year-old male had repeated episodes of aortic bifurcation occlusion by malignant masses of the same histologic type as the previously excised adenocarcinoma of the ascending colon. In spite of an extensive investigation of the lungs, heart and aorta no trace of the origin and the route of dissemination of the carcinomatous masses was found. Severe suspicion arises of massive malignant direct invasion of the aorta from the local recurrence of the tumor of the descending colon excised 3 years previously.
Surgical experience over a period of three years referring to 40 cases of hemophiliacs, with special reference to rare surgical complications, is presented. Critical evaluation of the postoperative results suggests that two main points should be equally taken into consideration for a successful surgical treatment, a) Hematology-substitution treatment, b) Surgery-local hemostasis. Substitution therapy is adjusted according to the nature and severity of the defect. Full preoperative correction of missing factor to normal levels. A level over 30% should be maintained post-operatively for at least 15 days, particularly in major abdominal surgery. The intensity of substitution treatment must be related to the kind of operation. Regarding Surgery meticulous local hemostasis using fine silk ligatures and atraumatic needle chrome cat-gut, for the gastrointestinal system, preferably with interrupted sutures. Electrocoagulation is avoided. Removal of skin sutures should be delayed, as well as peroral alimentation in gastrointestinal tract Surgery.
BACKGROUND: Synchronous neoplasms of the rectum are an uncommon condition. The situation becomes more rare when tumors are of different origin. To the authors' knowledge, synchronous anorectal melanoma and adenocarcinoma of the rectum have not been reported in the literature before. METHODS AND RESULTS: A 67-year-old female patient with synchronous anorectal malignant melanoma and adenocarcinoma of the rectum is described. She had preoperative colonoscopic diagnosis. The different neoplasms' origin was histologically proven. Surgical management consisted of abdominoperineal resection of the rectum. Postoperatively, the patient received adjuvant chemotherapy of six cycles duration. At present, the patient has completed 32 months of follow-up. There is no evidence of recurrent disease or distant metastases. CONCLUSION: Review of the literature confirms the rarity of anorectal malignant melanoma. On the other hand, the rectum represents the most common site for development of colonic adenocarcinoma. We were unable to trace synchronous presentation of these two tumors. Prognosis should be defined by the most malignant neoplasm; therefore, management should be focused on treating the melanoma.
We reviewed the records of 31 patients with smooth muscle tumors of the stomach seen at the First Surgical Department, Medical School, University of Athens, Greece, between the years 1961 and 1981 with special emphasis on the clinical data, diagnosis, and pathology. The majority of patients were symptomatic and were preoperatively diagnosed by radiology and/or endoscopy, but accurate histologic diagnosis was obtained in only three cases. The tumors varied in size, were relatively equally distributed throughout the stomach, and their management required 35 operations, consisting of 18 Billroth II gastrectomies, 15 local excisions, and two total gastrectomies. Histologically, the tumors proved to be leiomyoma in 23 cases, leiomyosarcoma in ten, and leiomyoblastoma in two. The difficulty of histologic classification in the absence of metastasis is clearly shown by the fact that three tumors recurred and were subsequently characterized as leiomyosarcoma one to three years after they were initially classified as leiomyoma.
Fifty patients with chronic empyema thoracis, without bronchopleural fistula, were treated by drainage and twice-daily instillations of 2% taurolidine (Taurolin; Continental Ethicals) for 14 days. No antibiotics were used. Forty-three patients completed the treatment and 7 were withdrawn from the trial, 3 because of evidence of bronchopleural fistula and 1 each because of pain during instillation, associated chest-wall cellulitis, an unexplained, acute epilepsy-like episode during instillation, and inadvertent administration of antibiotics. All 43 patients who completed the trial showed an excellent clinical response with control of the local and systemic toxic effects of sepsis. A rapid falling-off in the volume and purulence of pleural drainage fluid was noted. Twenty-four of the 43 patients (55,8%) were rendered bacteriologically sterile by the treatment. Instillation of 2% taurolidine was therefore an effective form of monotherapy in cases of chronic empyema thoracis without bronchopleural fistula.
Three patients with juxtapyloric ulcers and hypergastrinemia are presented. Fasting and food-stimulated serum gastrin concentration (SGC) were measured in 1970, 1972 and 1973 before the primary ulcer operation (selective gastric vagotomy and Jaboulay gastroduodenostomy; SGV + GD). Fasting SGC were 105, 149 and 158 pg/ml and the postprandial concentrations were 400, > 800 and > 800 pg/ml, respectively. The pentagastrin-stimulated acid secretion was within the normal range. After SGV + GD, only a slight decrease in acid secretion was observed. The hypergastrinemia persisted unchanged or decreased slightly in 1 patient. A recurrent ulcer developed and a precise antrectomy was carried out. Postoperatively, the fasting SGC was markedly reduced and the postprandial gastrin response abolished. The resected specimens were subjected to immunocytochemical gastrin cell quantitation. The number of gastrin cells was elevated in all 3 patients and the gastrin cell topography was distorted, with cells being present both in the lower and upper thirds of the antropyloric glands.
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