SUMMARY Nineteen cases of pneumatosis cystoides intestinalis all affecting adults and all involving the small intestine have been collected in two centres of Iran (Shiraz and Tehran) over a 20 year period, the pathological findings being divided into three groups: pure submucosal, combined submucosal and subserosal, and pure subserosal cysts. Experimental PCI was produced in cadavers using high pressure oxygen insuflation of the lungs, thus lending support to the theory that it has a mechanical origin. Othet theories of aetiology include tumour, nutritional deficiencies, gasforming organisms, alveolar rupture, and acid-base disturbance. In most of the cases presented high intraluminal pressure produced by obstruction appeared to force intraluminal gas through a breach in the mucosa into either the lymphatics or perivascular tissue to produce PCI. It is concluded that the aetiology in the vast majority of adult cases is mechanical in nature and that bacteria seem to play very little part, unlike their role in the PCI of infants.Pneumatosis cystoides intestinalis (PCI) is a condition in which air is found, characteristically, in encysted form in any part of the gastrointestinal tract. However, although it is a rare disease, a steady stream of reports on it have been appearing in the literature since Du Vernoi (1783) first noticed the condition and Bang (1876) who reportedly gave a complete description of the first case observed in human necropsy. The extensive review by MacKenzie (1951), Koss in 1952, Romeo (1967, and the more recent review by Ecker et al. (1971) and the experience of the Mayo Clinic, reported by Shallal et al. (1974), give an idea of the accumulated world experience of this condition. As far as the aetiology of this 'disease' is concerned the reader should refer to the works of Finney
Elevated serum transaminase levels after surgery may confirm the clinical and electrocardiographic (ECG) diagnosis of myocardial infarction. This useful aid to accurate diagnosis is even more important if the cardiac muscle has been the focal point of the operation when the ECG changes may not be as reliable as in other post-operative surgical cases. Similarly in the clinical evaluation the pain of myocardial origin may be confused with wound pain. If the serum transaminase does not rise more than 50 units per ml. after closed cardiac surgery, it may be considered that myocardial infarction has not occurred and that low cardiac output or severe chest pain probably has another cause. In this clinical investigation no significant difference was found between the post-operative serum transaminase levels of closed mitral valvotomy and a control thoracotomy series.
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