INTERNATIONAL ABSTRACTS

tions. Emergency surgery was performed in all cases. The locations of the perforations were C in three, A in one, T in one, D in one, S in seven, and R in one. In cases of free perforations, Palliative resections were performed in three patients, all of whom died within three to 24 months after surgery. Radical operations were performed in the other three patients, of whom two are still alive at two years and one year, respec- tively; however, one patient died three years after sur- gery because of recurrence. In eight patients with ab- scess formation, six palliative resections and one rad- ical operation were performed. One patient died 20 days after surgery because of liver failure. Five pa- tients survived from seven to 24 months for an average of 14.2 months. The patient with a radical operation is alive and well three years and seven months after surgery.

Foreign bodies in the upper alimentary tract: An anal- ysis of 64 patients. T. Chishiro, T. Taniguchi, T. Ya- mamoto, Y. Kitazawa, M. Kojima, T. Tanaka. Jpn J Acute Med 1986;10:351-356.

During the last six years, 64 patients with foreign bodies in the upper alimentary tract have been man- aged at Kansai Medical University Hospital in the De- partment of Critical Care Medicine. The foreign bodies were coins (36%), alkaline batteries (14%), fish bone (ll%), PTP (5%), and others. In 18 patients, the foreign bodies were removed by gastric fiberscope and in 15 patients by the balloon catheter technique. In 16 patients, the foreign bodies passed spontane- ously. Balloon and magnetic techniques are recom- mended as safe and easy procedures for removal of foreign bodies in the upper alimentary tract.

Evaluation of abdominal CT in the initial treatment of abdominal trauma. S. Wantanabe, T. Ishii, K. Ku- wata, C. Yoneyama, K. Kitamura, Y. Sasaki, M. Kamachi, H. Nishiguchi, Jpn J Acute Med 1986;10:357-363.

During the last four years, 102 patients with abdom- inal trauma were examined with CT for pre-operative

evaluation at the authors’ hospital. In 35 patients (34%), the CT scans revealed no abnormal findings. They were all managed conservatively except for one case of perforated small bowel. In 67 patients (66%), CT revealed evidence of substantial abdominal or retroperitoneal trauma. In 30 of the patients, CT findings were confirmed by surgery. Hepatic Injury is easily recognized using CT; CT is also useful for de- tection of renal or splenic injuries. The majority of those parenchymatous organ injuries were success- fully managed with conservative therapy, despite trau- matic lesions revealed by CT. Repeat CT scans proved to be very useful to follow the changes of these traumatic lesions. The authors conclude that applica- tion of abdominal CT is very useful in the initial deci- sion-making in treatment of patients with abdominal trauma and for the follow-up observation of injured organs.

Acute abdomen in aged patients. H. Minamida, M. Tot- suka, T. Ebata, M. Akiyama, K. Asaishi, H. Haya- saka. Jpn J Acute Med 1986;10:365-369.

A clinical analysis of 55 patients over 70 years old who have had emergency abdominal operations was conducted with the following results. 1) Many of these cases were poor surgical emergencies, such as perfo- rations, acute obstructions, and massive bleedings of the gastrointestinal tract, most caused by malignant diseases. 2) Of the 55 patients, 31 were found to have had post-operative complications, and 13 patients died within a month after the operation. Aged patients un- dergoing emergency abdominal operations can easily develop post-operative complications that will further advance to multiple organ failure. Facilities to ensure intensive care are mandatory when aged patients with surgical emergencies are treated. 3) Five of the 13 post-operative deaths were considered to have been caused by endotoxin shock. The authors believe that measures to protect aged patients from endotoxin shock should be instituted during and after the opera- tion.

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