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Congenital diaphragmatic hernia
All cases healed well and subsequent, repeated proctoscopy could not demonstrate a fistulous opening. In most cases there was a complete return to normal; in the others there persisted a residual process characterized by induration on palpation and a higher sedimentation rate, but without subjective manifestations worthy of consideration. When opening into the rectum becomes imminent, in the presence of a grave toxic picture with evident danger, it may be advisable to help evacuation through the rectum with the object of eliminating as soon as possible the cause of the toxemia which may kill the patient. If spontaneous evacuation is incomplete, proctoscopy to locate the orifice, enlarge it, and obtain better drainage may be advisable. J. P. G~EENHILL.
Thompson, 67:
J. W., and Le Blanc, L. J,: 123,
Congenital
Biaphragmatic
Hernia,
Am.
cl. Burg.
1945.
Following spontaneous delivery of a uormal infant, the patient, w-hose case is here reported, a gravida ii, suddenly experienced severe epigastric pain five hours after parkiCon, and showed signs of marked distress referred to the chest. In addition to the usual supportive measures instituted, bedside x-ray revealed the stomach displaced into the left thorax. A diagnosis of left diaphragmatic hernia with strangulation was made and, because of the continued alarming condition of the patient, laparotomy was decided UPOIL At operation most of the hollow abdominal viscera were found to have migrated into the left chest through a large opening in the diaphragm. The mesenteries of the stomach and intestine were elongated, and there was counterclockwise rotation of the viscera causing torsion of the pancreas which was acutely inflamed and covered with a fibrinoplastic exudate with numerous areas of fat necrosis. The only organs remaining in the abdomen were The viscera were easily replaced, the marthe spleen, the liver, and the descending colon. gins of the hernial ring freshened with scissors, and approximated and overlapped with one layer of chromic catgut and another of heavy black silk. With the aid of parenteral glucose-saline and small transfusions, the patient made a good r’ecovery. The literature is reviewed, and the authors, besides calling attention to the possibility of this condition which often remains undiagnosed, stress the importance of immediate surgical Where the diagnosis is made early in pregnancy, intervention as in any strangulated hernia. they favor immediate repair because of the grave danger of strangulation during the latter months or as a complication of delivery or of the puerperium. FRANK SPIEL&UN. Trillat,
I?., and
Puerperal
Netter, A.: Bacteriologic Study of Pyelonephritis State, Gyrkc. et obst. 46: 491, 1939.
Associated
Wit21
the
The authors observed 60 cases of pyelonephritis, 37 of which began during pregnancy, and 23 began post partum. In 27 cases the colon bacillus was isolated; in 3 cases, staphylococci; and in 2 cases, the Friedlander bacillus; all in pure culture. In the remaining28 eases there were mixed groups of bacteria. In 67 per cent of these 28 cases the colon bacillus was associated wit.h the enterococcus. In others streptococci, staphylococci, and Among the 60 cases there were 13 cases of albuminuria. pseudodiphtheria were present. There were no maternal deaths in this series and only one fetal death. There were four premature babies in the entire group. The cases with pure strains of bacteria were less serious than those with associated organism. All the patients were treated with autovaccinotherapy and in no case was ureteral catheterization necessary. J. P. GILEENHILL.
Keymer, Sot.
Eduardo : ehilena
Two de obst.
Cases of Grave Puerperal y ginee.
Infection
Treated
With Penicillin,
&.A
9: 287, 1944.
The author states that his first case, which he regards as one of chronic pyemia, presented two episodes of fourteen days each, which were treated with 66 and 57 Gm, of These episodes were separated by three days of relative imsulfadiazine, respectively.
Thompson, 67:
J. W., and Le Blanc, L. J,: 123,
Congenital
Biaphragmatic
Hernia,
Am.
cl. Burg.
1945.
Following spontaneous delivery of a uormal infant, the patient, w-hose case is here reported, a gravida ii, suddenly experienced severe epigastric pain five hours after parkiCon, and showed signs of marked distress referred to the chest. In addition to the usual supportive measures instituted, bedside x-ray revealed the stomach displaced into the left thorax. A diagnosis of left diaphragmatic hernia with strangulation was made and, because of the continued alarming condition of the patient, laparotomy was decided UPOIL At operation most of the hollow abdominal viscera were found to have migrated into the left chest through a large opening in the diaphragm. The mesenteries of the stomach and intestine were elongated, and there was counterclockwise rotation of the viscera causing torsion of the pancreas which was acutely inflamed and covered with a fibrinoplastic exudate with numerous areas of fat necrosis. The only organs remaining in the abdomen were The viscera were easily replaced, the marthe spleen, the liver, and the descending colon. gins of the hernial ring freshened with scissors, and approximated and overlapped with one layer of chromic catgut and another of heavy black silk. With the aid of parenteral glucose-saline and small transfusions, the patient made a good r’ecovery. The literature is reviewed, and the authors, besides calling attention to the possibility of this condition which often remains undiagnosed, stress the importance of immediate surgical Where the diagnosis is made early in pregnancy, intervention as in any strangulated hernia. they favor immediate repair because of the grave danger of strangulation during the latter months or as a complication of delivery or of the puerperium. FRANK SPIEL&UN. Trillat,
I?., and
Puerperal
Netter, A.: Bacteriologic Study of Pyelonephritis State, Gyrkc. et obst. 46: 491, 1939.
Associated
Wit21
the
The authors observed 60 cases of pyelonephritis, 37 of which began during pregnancy, and 23 began post partum. In 27 cases the colon bacillus was isolated; in 3 cases, staphylococci; and in 2 cases, the Friedlander bacillus; all in pure culture. In the remaining28 eases there were mixed groups of bacteria. In 67 per cent of these 28 cases the colon bacillus was associated wit.h the enterococcus. In others streptococci, staphylococci, and Among the 60 cases there were 13 cases of albuminuria. pseudodiphtheria were present. There were no maternal deaths in this series and only one fetal death. There were four premature babies in the entire group. The cases with pure strains of bacteria were less serious than those with associated organism. All the patients were treated with autovaccinotherapy and in no case was ureteral catheterization necessary. J. P. GILEENHILL.
Keymer, Sot.
Eduardo : ehilena
Two de obst.
Cases of Grave Puerperal y ginee.
Infection
Treated
With Penicillin,
&.A
9: 287, 1944.
The author states that his first case, which he regards as one of chronic pyemia, presented two episodes of fourteen days each, which were treated with 66 and 57 Gm, of These episodes were separated by three days of relative imsulfadiazine, respectively.