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Foodstuff of the Brain
GELLER AND FOGLE
184
Diagnosis: Traumatic Hemiation of the Liver Through Right H emidiaphragm Fluoroscopy of the diaphragm and GI x-ray series with follow through into the colon were normal. Diagnostic pneumoperitoneum suggested that the thoracic mass arose below the diaphragm. At operation, there was a 7 em laceration near the dome of the diaphragm through which protruded a smooth, rounded, otherwise normal segment of liver. The herniated liver substance was replaced within the abdominal cavity and the diaphragmatic laceration repaired. The postoperative course was uneventful. Traumatic right-sided diaphragmatic hernia is relatively infrequent. Peck's! review of the literature up to 1957 disclosed 19 cases, to which he added four of his own. Occasional cases have since been reported. 2 Difficulty in recognizing hepatic herniation that occurs long after rupture of the right hemidiaphragm (Peck's type II hernia) is usually attributable to absence of symptoms and to the physician's unawareness of earlier injury. Frequently there is a latent period ranging from a few months
to as long as 32 years during which the patient may be completely asymptomatic. 1.3 The diaphragmatic injury and lower thoracic mass are then discovered when a chest film is made for other reasons. If the possibility of a late traumatic diaphragmatic injury is entertained, a systematic plan of roentgen and Huoroscopic studies, including a GI series with small bowel study and follow through to the transverse colon and diagnostic pneumoperitoneum will usually provide sufficient information to establish the diagnosis. I. 3 An upright film of the abdomen when the barium has reached the colon is helpful for the diagnosis of omental hernia since it will show upward traction on the transverse colon. REFERENCES
1 Peck WA Jr: Right-sided diaphragmatic liver hernia following trauma. Amer J Roentgen 78:99, 1957 2 Leung WM, Guilfoil PH: Traumatic rupture of right hemidiaphragm. Dis Chest 52:243,1967 3 Carter BN, Giuseffi J, Felson B: Traumatic diaphragmatic hernia. Amer J Roentgen 65:56, 1951 Reprint requests: Dr. Geller, San Pedro and Peninsula Hospital, San Pedro, California 90732.
Foodstuff of the Brain It is generally acknowledged that the brain uses carbohydrate almost exclusively for maintenance of structure and function. Arteriovenous oxygen difference of the human brain usually averages 6.3 volume percent. This indicates a glucose oxidation of approximately 8.4 mg percent. Thus the amount of glucose removed by the brain in each circulation is more than enough to explain the utilization of cerebral oxygen consumption. It is not improbable, however, that other substances are oxidized, not only the metabolites of the Krebs cycle. But it should
be noted that all food stuffs other than glucose are not consumed in sufficient quantities to support brain metabolism during hypoglycemia, which is therefore associated with a marked fall in the cerebral metabolic rate of oxygen and the production of coma. Himwich, W A and HE: Neurochemistry of Aging, in Birren, J E (ed): Handbook of Aging and the Individual -Psychological and Biological Aspects. Chicago, University of Chicago Press, 1959
CHEST, VOL. 60, NO.2, AUGUST 1971
184
Diagnosis: Traumatic Hemiation of the Liver Through Right H emidiaphragm Fluoroscopy of the diaphragm and GI x-ray series with follow through into the colon were normal. Diagnostic pneumoperitoneum suggested that the thoracic mass arose below the diaphragm. At operation, there was a 7 em laceration near the dome of the diaphragm through which protruded a smooth, rounded, otherwise normal segment of liver. The herniated liver substance was replaced within the abdominal cavity and the diaphragmatic laceration repaired. The postoperative course was uneventful. Traumatic right-sided diaphragmatic hernia is relatively infrequent. Peck's! review of the literature up to 1957 disclosed 19 cases, to which he added four of his own. Occasional cases have since been reported. 2 Difficulty in recognizing hepatic herniation that occurs long after rupture of the right hemidiaphragm (Peck's type II hernia) is usually attributable to absence of symptoms and to the physician's unawareness of earlier injury. Frequently there is a latent period ranging from a few months
to as long as 32 years during which the patient may be completely asymptomatic. 1.3 The diaphragmatic injury and lower thoracic mass are then discovered when a chest film is made for other reasons. If the possibility of a late traumatic diaphragmatic injury is entertained, a systematic plan of roentgen and Huoroscopic studies, including a GI series with small bowel study and follow through to the transverse colon and diagnostic pneumoperitoneum will usually provide sufficient information to establish the diagnosis. I. 3 An upright film of the abdomen when the barium has reached the colon is helpful for the diagnosis of omental hernia since it will show upward traction on the transverse colon. REFERENCES
1 Peck WA Jr: Right-sided diaphragmatic liver hernia following trauma. Amer J Roentgen 78:99, 1957 2 Leung WM, Guilfoil PH: Traumatic rupture of right hemidiaphragm. Dis Chest 52:243,1967 3 Carter BN, Giuseffi J, Felson B: Traumatic diaphragmatic hernia. Amer J Roentgen 65:56, 1951 Reprint requests: Dr. Geller, San Pedro and Peninsula Hospital, San Pedro, California 90732.
Foodstuff of the Brain It is generally acknowledged that the brain uses carbohydrate almost exclusively for maintenance of structure and function. Arteriovenous oxygen difference of the human brain usually averages 6.3 volume percent. This indicates a glucose oxidation of approximately 8.4 mg percent. Thus the amount of glucose removed by the brain in each circulation is more than enough to explain the utilization of cerebral oxygen consumption. It is not improbable, however, that other substances are oxidized, not only the metabolites of the Krebs cycle. But it should
be noted that all food stuffs other than glucose are not consumed in sufficient quantities to support brain metabolism during hypoglycemia, which is therefore associated with a marked fall in the cerebral metabolic rate of oxygen and the production of coma. Himwich, W A and HE: Neurochemistry of Aging, in Birren, J E (ed): Handbook of Aging and the Individual -Psychological and Biological Aspects. Chicago, University of Chicago Press, 1959
CHEST, VOL. 60, NO.2, AUGUST 1971