Theodor Wiznitzer

Biliary colic treatment and acute cholecystitis prevention by prostaglandin inhibitor

Sixty patients were treated in the emergency ward for biliary colic. Cholelithiasis was proven by ultrasonography. Twenty patients (group I) were treated by placebo. Twenty patients (group II) were treated by papaverine, and 20 patients were treated by diclofenac sodium (Voltaren) (group III). Twenty more patients (group IV) with low back pain (LBP) were treated with diclofenac sodium (Voltaren) as a control to assess the analgesic effect of Voltaren. Two interesting observations were made: Voltaren was proven more efficient for pain relief (P<0.002), and none of the patients treated with Voltaren were in need of hospitalization and immediate surgery. In comparison, nine patients of the other two groups progressed to acute cholecystitis and needed surgical intervention. The possible anticolic and anti-biliary inflammation properties and the indications for use of Voltaren are discussed.

Postsplenectomy Splenic Activity

Evidence of recurring activity of splenic tissue was investigated in patients who had undergone splenectomies. Methods included technetium 99m sulfur colloid scan, serum tuftsin assay, serum immunoglobulin concentration, blood cell counts, and search for Howell-Jolly bodies. Positive scans were observed together with normal levels of tuftsin in 54% of the patients. In 46% of the patients, no splenic activity was detected by scanning and low levels of tuftsin were noticed. The difference in tuftsin levels between the two groups was statistically significant. Howell-Jolly bodies and decreased serum levels of IgM featured all patients. The possible application of combined splenic scan and tuftsin assessment for screening recurring splenic activity in the postsplenectomy population at great risk is suggested.

Common bile duct stone caused by a foreign body.

Foreign bodies are very rare in the common bile duct. We report a patient with incomplete obstruction of the common duct, due to stone formation around an ingested fish bone.

Irradiation-induced colonic stricture and colitis cystica profunda: Report of a case

SummaryA 57-year-old patient was operated upon for a colonic stricture that appeared 18 years after removal of a clear-cell carcinoma of the kidney, followed by irradiation therapy. In addition to typical irradiation-induced changes and fibrotic stricture, colitis cystica profunda was discovered. Review of the literature showed no similar case.

Leukergy in inflammatory bowel disease

In the phenomenon of leukergy, white blood cells agglomerate in peripheral blood slides. This agglomeration has been described in inflammatory infections of various causes. This study assesses this phenomenon in inflammatory bowel disease. A correlation was found between the severity of inflammatory bowel disease activity and the percentage of leukergy. Leukergy was found to parallel the clinical and endoscopic findings of inflammatory bowel disease. Furthermore, leukergy was found to be more accurate than white blood count and erythrocyte sedimentation rate. It is also found to accurately assess the course of the disease when clinical and other laboratory tests were masked by steroid and antibiotic administrations Leukergy is a quick, inexpensive test that can easily be performed at the patients bedside.

Lipase turbidimetric assay and acute pancreatitis.

The simplified turbidimetric assay for lipase activity was used for the differential diagnosis of acute pancreatitis. Serum lipase levels were found to be increased in a group of 17 patients in whom acute pancreatitis was clinically suspected and confirmed by a high ACCR and decreased uptake of the radionuclide in the pancreas scan. The lipase levels were within normal limits in a control group of 14 patients suffering from diseases other than acute pancreatitis. The turbidimetric test was helpful for rapid quantitative determination of serum lipase and thus for the early and accurate diagnosis of acute pancreatitis.The simplified turbidimetric assay for lipase activity was used for the differential diagnosis of acute pancreatitis. Serum lipase levels were found to be increased in a group of 17 patients in whom acute pancreatitis was clinically suspected and confirmed by a high ACCR and decreased uptake of the radionuclide in the pancreas scan. The lipase levels were within normal limits in a control group of 14 patients suffering from diseases other than acute pancreatitis. The turbidimetric test was helpful for rapid quantitative determination of serum lipase and thus for the early and accurate diagnosis of acute pancreatitis.

Recurrent spontaneous perforation of the colon

A 58-year-old man with recurrent spontaneous perforations of the colon is reported. The first two events were of the sigmoid colon, and a sigmoidectomy was performed after the second perforation. The third spontaneous perforation had occurred in the transverse colon, however, although a patent sigmoid colostomy was present. Neither primary colonic pathology nor elevated intraluminal pressure were found, which means that the cause and pathogenesis of these perforations are unknown. Six months later, a subtotal colectomy with ileosigmoid anastomosis was performed with an apparent satisfactory result.

Free perforation of the colon in Crohn's disease:

Free perforation of the colon in Crohns disease is a very rare complication. An additional case, the 17th in the literature, is described, and previous reports are reviewed.

Acute necrotizing pancreatitis: An experimental model

A simple, easily reproducible model of experimental pancreatitis is presented. By means of a catheter implanted in the pancreas, interstitial injections were performed in order to produce acute pancreatitis in guinea pigs. Injection of a sodium taurocholate solution with 50 mg/ml cephalothin produced lethal necrotizing pancreatitis similar to that obtained by the interstitial injection of the bile-salt solution incubated with trypsin. Acute pancreatitis of varying severity can be produced according to the concentration of the injected solution.

Intrarectal Bypass Graft in Low Anterior Resection and Sigmoid Obstruction – An Experimental Study

The most common causes for morbidity and mortality in colorectal resections are anastomotic leaks. In low anterior resection, the incidence of anastomotic leakage ranges from 17 to 50%. With the use of the stapler technique, leakage incidence rate remains high and ranges from 10 to 25%. Colostomy formation and closures are associated with considerable morbidity and mortality. Due to the high incidence of anastomotic leakage rate in low anterior resection, and the additional complications of diverting colostomy formation and closure, the use of a rectal stent-intrarectal bypass graft has been instituted. This is carried out by means of a silastic graft, which prevents the fecal stream and gas pressure from coming into contact with the anastomotic site at the low rectum. The efficacy of intrarectal bypass graft was examined in two high-risk surgical situations, the first in very low anterior resection and the other, after early sigmoid obstruction. In both situations the intrarectal bypass graft provided for a safe anastomosis. Even when dehiscence and early obstructions occur, the tube may prevent leakage. This procedure presents effective practical implications which obviate the need for a proximal colostomy formation, thereby eliminating the physical and psychological stress that accompanies colostomies.