Faculty Bibliography

Acute appendicitis is still a difficult diagnosis to make. Reports place the rate of incorrect diagnosis--the rate of negative laparotomy--at 15 to 42 per cent. This study is a prospective analysis of barium enema (BE) examinations performed upon 101 patients who presented with a history accompanied by signs and symptoms suggestive of, but not clearly diagnostic of, acute appendicitis. The over-all accuracy rate was 91.5 per cent. Sensitivity and specificity rates were 83 and 96 per cent, respectively. BE had a positive predictive value of 88 per cent and a negative predictive value of 95 per cent in this study. No complications resulted from the use of BE in this study, which included three instances of perforated appendicitis. We conclude that emergent BE is an inexpensive, safe and readily available adjunct to the diagnosis of acute appendicitis. Its use in the presence of a clear-cut presentation of acute appendicitis is not necessary. When clinical data were equivocal, BE reduced the rate of negative laparotomy to 7.2 per cent.

A unique case of exercise-induced spontaneous thrombosis of the spermatic vein that presented as an incarcerated left inguinal hernia is described. This entity may be clinically indistinguishable from many surgical conditions. Venography of the spermatic vein can be diagnostic but it should not delay surgical intervention.

A patient with a large tumor of the head and body of the pancreas had a Whipple procedure performed after the intraoperative diagnosis of "mesenchymal tumor" was made. The final histopathologic diagnosis was malignant fibrous histiocytoma arising in the pancreas. The patient died of postoperative complications, and no metastatic disease was found at autopsy. This is the first detailed description of a primary pancreatic malignant fibrous histiocytoma.

The effect of a failed lower limb vascular procedure on the ultimate level of amputation in patients presenting with end-stage ischemia is an issue of ongoing controversy. A series of 71 patients with 75 lower extremity amputations over a 3-year period was reviewed to compare the level of amputation and morbidity between two groups of amputees: one that had vascular operations before amputation and the other undergoing primary amputations. Failed vascular reconstructions led to increased morbidity and poor healing, statistically significant increases in the level of amputation, and prolongation of hospital stay. The high price of failure must be considered in the evaluation of vascular operations in patients with tissue loss or infection.