William R. Olsen

Emergency intravenous cholangiography in patients with acute abdominal pain

Abstract A prospective study of diagnostic emergency intravenous cholangiography was conducted in fifty-five selected patients with acute abdominal pain. When hepatic function was adequate, opacification of all or part of the biliary system occurred in 96 per cent of patients. The presence of pancreatitis rarely precluded a successful study. At least 85 per cent of the cholangiograms were considered diagnostically helpful, whereas 38 per cent significantly altered the admitting diagnosis.

Gastric leiomyoblastoma in an adolescent

Abstract Gastric leiomyoblastomas are rare, usually benign acting tumors which most frequently involve the stomach of patients forty years of age or more. A case in a sixteen year old girl is presented, and she is thought to be the fourth patient less than twenty years old reported with this disease. Diagnostic features and prognosis are discussed and a plan of management is presented.

Vagotomy, gastric blood flow, and hemorrhage from gastritis

Abstract A series of sixteen patients who had vagotomy for acute hemorrhage from gastritis is reviewed. Fourteen patients had concomitant pyloroplasty and two patients had subtotal gastrectomy. Although hemorrhage was controlled initially in each patient, massive hemorrhage recurred postoperatively in eight patients. Three of these patients died of hemorrhage and four required reoperation. The effect of vagotomy on gastric blood flow was determined in anesthetized and nonanesthetized dogs using radioactive potassium. The results indicate that acute operative vagotomy produces a 77 to 87 per cent decrease in nutritive capillary blood flow to the gastric mucosa. However, these findings are not present thirty minutes after vagotomy. These data indicate that, although vagotomy initially may cause gastric mucosal ischemia and cessation of hemorrhage from gastritis, this effect of vagotomy is transient and prolonged prevention of recurrent hemorrhage is not assured.

Peritoneal lavage in blunt abdominal trauma

The detection and treatment of significant intra-abdominal injury following blunt trauma is fraught with problems. The search for signs of hemoperitoneum by paracentesis is unrellable, additional delays for observation or anglography increase morbidity and mortality, while early cellotomy may yleld negative findings in one patient in five. Peritoneal lavage provides a solution to these problems with an accurate, sensitive, rapid, and safe diagnostic test for the presence or absence of hemoperitoneum. It should be performed at the time of emergency department evaluation on all patients suffering blunt trauma with possible intra-abdominal injury. A peritoneal dialysis catheter is piaced through a small stab wound and 20 ml/kg lactated Ringers solution infused and subsequently dralned. A 20 ml blood return correlates with significant injury in 98% of patients. A weakly positive result (less than 20 ml of blood) occurs in one third of patients with injury requiring surgery. Patients with this finding, if stable, are subjected to anglography and further observation before cellotomy is contemplated. A qualitative method for determining the amount of blood is based on turbidity of the returned lavage fluid in the infusion tubing. Printed material cannot be read through the fluid when more than 20 ml of blood is present. Complications of the procedure are a rarity. It has permitted a 50% reduction in time of preoperative evaluation, a limitation on the need for angiographic studies and a sharp reduction in unnecessary surgery.