J. Raymond Hinshaw

Gastrointestinal foreign bodies

Over a 20 year period 26 patients were admitted because of ingesting foreign bodies. Ten patients, mostly children, remembered swallowing a metallic foreign body. Most of the patients were asymptomatic and were admitted for observation. Sixteen patients underwent operation. The distal large bowel was the area most commonly involved, not the ileocecal region as in the reviews published a number of years ago. Blunt as well as pointed foreign bodies caused bowel perforations, probably through slow pressure necrosis. Most of the patients had signs of localized peritonitis.. Unlike previous studies, roentgenographic studies were found helpful in the preoperative diagnosis.

Cholecystostomy: A place in modern biliary surgery?

Cholecystostomy retains a place in the general surgical armamentarium. In this series of 115 patients undergoing cholecystostomy between 1967 and 1977, 68 percent had acute cholecystitis, whereas in the remaining patients biliary drainage was undertaken as part of another procedure. The in-hospital mortality rate was 6 percent for the group with acute cholecystitis and 37 percent for the other patients. Forty-five patients subsequently had elective cholecystectomy, 29 of these for radiographically documented retained calculi. Thirty-four patients without retained calculi remained asymptomatic for more than 1 year. On the basis of this experience and the literature cited, we recommend that subsequent to cholecystostomy, cholecystectomy be performed if the patient is in good general health and has a long life expectancy. Conversely,in the aged, ill patient without evidence of retained stones, cholecystostomy may be a lifesaving and curative procedure and the only one needed.

Cost-effectiveness of operative cholangiography.

(1) Three hundred seventy-seven of 1,616 patients undergoing cholecystectomy between January 1, 1971 and December 31, 1975 had intraoperative cholangiograms and form the basis for this study. (2) The cholangiograms of thirty-seven patients were interpreted as positive for ductal disease, but only twenty-three had confirmed disease on common bile duct exploration. The average false-positive rate was 38 per cent per year. (3) One hundred nine patients had cholangiograms because of small stones in the gallbladder, and only one study was true-positive. (4) One hundred nineteen patients had cholangiograms without any clinical indication for the study. Only one was true-positive for intraductal disease. (5) Operative cholangiograms done routinely or for multiple small stones rarely reveal intraductal disease (2 of 228, or 0.9 per cent). (6) Of 149 cholangiograms in patients with clinical indications other than multiple small stones, twenty-one of twenty-six positive cholangiograms were true-positive, for an 81 per cent accuracy. (7) Operative time was prolonged an average of 31 minutes when cholangiography was performed. (8) The 377 cholangiograms cost

The effect of site and technique of splenic tissue reimplantation on pneumococcal clearance from the blood.

21,866. Of the 228 studies done routinely or for only multiple small stones, two were positive, for a cost of

Beneficial effects following carbon dioxide laser excision on experimental neuroblastoma

6,612 per positive examination. (9) Therefore, to be cost-effective, the use of intraoperative cholangiography is indicated only when standard criteria for ductal exploration, with the exception of the presence of small calculi, are present.

Comparison of continuous-wave, chop-wave, and super pulse laser wounds

The technique and site of reimplantation of splenic tissue influences survival of laboratory animals following intravenous injection of pneumococci. Splenic tissue was prepared by slicing, mincing, or grating the spleen. The tissue was placed subcutaneously, intraperitoneally, retroperitoneally, or in an omental pouch. This study was designed to determine the rate of pneumococcal clearance from the blood stream 16 weeks following splenic reimplantation by four different methods. All animals were challenged with an intravenous 1 mL bolus containing 10(7) bacteria. The New Zealand white rabbits were divided into six groups: intact spleen; splenectomized; spleen slices in an omental pouch; minced spleen in an omental pouch; splenic tissue implanted subcutaneously; and bits of spleen dropped into the peritoneal cavity. Animals with an intact spleen and those with spleen slices implanted into an omental pouch cleared bacteria during the first hour and all bacteria had disappeared at three hours. Bacteremia persisted longer than three hours in the other groups. Splenic tissue had regenerated in all animals with omental pouch implants, in four of six with minced spleen dropped into the peritoneal cavity but in only one with a subcutaneous implant. Reimplanted splenic tissue clears pneumococci from the blood stream best when thin slices of spleen are placed in an omental pouch. This technique also assures successful regeneration of splenic tissue.

The effect of CO2 laser excision on local tumor recurrence.

Treatment of neuroblastoma in children consists of primary excision with adjuvant radiation and chemotherapy. When the tumor invades surrounding structures that cannot be safely excised or when distant metastasis is present, the patient has a poor prognosis. Because the CO2 laser can be used to excise malignant tumors without seeding the surrounding tissue and because the defocused beam can vaporize malignant cells, we compared partial scalpel excision and partial laser excision of C1300 murine neuroblastoma to the growth rate of residual tumor. In 25 mice, 75% of the tumor was excised with a scalpel, and in another 25, the same percentage was excised with the CO2 laser (10 W). CO2 laser excision significantly decreases the growth of residual neuroblastoma (P less than .01). However, the effect appears to be a function of increased tumor immunogenicity after laser excision rather than the increased tumor kill. We conclude that CO2 laser excision of neuroblastoma may prove to be superior to scalpel excision for primary surgical treatment of neuroblastoma.