Mark M. Ravitch

The Pancreas in Infants and Children

With the probable exception of alcoholic pancreatitis, all the lesions of the pancreas seen in adults also occur in infants and children. However, their frequency, mode of clinical presentation, and treatment are substantially different in children, as are their clinical manifestations and differential diagnosis.

Contemporary Stapling Instruments and Basic Mechanical Suture Techniques

This article provides a description and demonstration of the basic linear staple closures and anastomoses, as well as of circular anastomoses. Depending on the technique used, bowel may be closed in a mucosa-to-mucosa or serosa-to-serosa fashion, and comparable results with either modality are demonstrated.

Evaluation of the Safety of End-to-End (EEA) Stapling Anastomoses Across Linear Stapled Closures

An experimental study involving circular stapled anastomoses across linear stapled closures is presented. Although the staples were deformed, cut in two, and sometimes uninjured, no complications were found. These data support the use of this technique, which is currently employed in clinic practice.

En Bloc Chest Wall Resection for Candidal Costochondritis in a Drug Addict

A case of Candida costochondritis seen initially as a chest wall tumor in a narcotic addict is reported. Bone and cartilage are rare sites of Candida infection from whatever cause. Since 1973, only 6 cases of Candida costochondritis have been reported; 5 were complications of thoracic operations and the other, of intravenous hyperalimentation. Treatment by a one-stage en bloc resection of chest wall, and reconstruction by rib graft and Marlex mesh resulted in cure in our patient, without complications.

Varieties of Stapled Anastomoses in Rectal Resection

This article presents numerous illustrations that show a variety of techniques for the restoration of intestinal continuity after low anterior resection. The conclusion is that, at extremely low levels, the EEA stapler anastomosis can be securely performed at levels at which manual anastomosis would not be possible.

Effects of jejunoileal bypass on the enterohepatic circulation of bile acids, bacterial flora in the upper small intestine, and absorption of vitamin B12

Eleven morbidly obese patients were studied before and at various time intervals after jejunoileal bypass (JIB). Bile acid deconjugation was assessed with the bile acid breath test and bile acid absorption by analyzing the fecal excretion of both radioactively labeled and unlabeled bile acids. In addition, aerobic and anaerobic cultures of upper small intestinal aspirates, the Schilling vitamin B12 absorption test, and fecal fat analysis were performed. All patients developed marked diarrhea and steatorrhea after JIB. The bile acid breath test was positive in all 11 patients after JIB. In 7 of the 11 patients, this test was already slightly positive before JIB. In every instance, however, the bile acid breath test became significantly more abnormal after the bypass operation. The fecal excretion of labeled bile acids increased significantly. However, the increase in the quantitative excretion of the bile acids did not reach statistical significance. The concentrations of bile acids in fecal water were considerably below the levels required to induce diarrhea. This was mainly the result of a low fecal pH and consequent low aqueous solubility. Jejunoileal bypass effected a major shift in fecal bile acids from the secondary bile acids, lithocholic acid and deoxycholic acid, to the respective primary compounds, chenodeoxycholic acid and cholic acid. There were no significant changes in the small bowel bacteriologic findings after JIB. In 5 out of the 9 patients in whom bacteriologic studies were performed, the cultures were positive before the operation. The Schilling vitamin B12 absorption test showed in all patients a significant drop in the 24-hour urinary 57Co excretion rate after JIB.(ABSTRACT TRUNCATED AT 250 WORDS)

Hirschsprung's disease: Long-term results of resection of the proximal dilated segment

Summary Three patients who had resection, principally of the proximal dilated colon, in the 1940s for subsequently proven Hirschsprungs disease have maintained adequate bowel function for 8, 24, and 24 yr. One has had satisfactory function for 24 yr and has required no further procedure. Gradual decompensation has required definitive operation in the other two; a Swenson procedure was performed in one, and a combined resection and rectal myotomy in the other, both with satisfactory results. These cases underscore the unpredictability of Hirschsprungs disease, and suggest the importance of compensated, tonic proximal bowel in maintaining adequate function even in face of the physiologic obstruction due to persisting distal aganglionosis. Although adequate long-term function may be possible with left colectomy alone, recurrence of symptoms is likely. Operations directed specifically at the problem of the aganglionic distal bowel are recommended.

Effects of ligation of the pulmonary vasculature in the rabbit fetus

Abstract Ligation of the pulmonary vessels in the rabbit fetus is compatible with a good yield of surviving animals (more than 60%). Ligation of the pulmonary artery, or pulmonary artery and vein, results in infarction, with some preservation of islands of pulmonary tissue in the periphery. Ligation of all the pulmonary veins to the left lung results in death within a few hours.

Experimental Pulmonary Venous Occlusion

Complete interruption of pulmonary venous return from the left lung in rabbits is compatible in some instances with prolonged survival with little systemic effect. The main cause of death less than 48 hours after interruption of pulmonary venous return is pulmonary-pulmonary aspiration and respiratory insufficiency due to spillover of frothy, bloody fluid, after which infection may play a part. Marked anemia after unilateral pulmonary venous ligation attests to the loss of blood into the lung. Death from unilateral pulmonary venous ligation did not occur if the corresponding main bronchus was ligated to prevent pulmonary-pulmonary aspiration; Despite ligation of the pulmonary veins the corresponding pulmonary artery remained patent.