RESUMEN
Introduction: Previous studies comparing tomotherapy (TOMO) and three dimensional (3D) conformal radiotherapy (3DCRT) in gastric radiotherapy are limited and tend to be based on dosimetry. The aim of the present study was to evaluate the clinical outcomes of these two treatment modalities. Methods: A total of 51 patients diagnosed with gastric cancer who were treated with postoperative adjuvant chemoradiotherapy and had subtotal/total gastrectomy and D2 lymphatic dissection were recruited to the present study: 30 patients were treated with TOMO and 21 patients were treated with 3DCRT. Results: The 3DCRT and TOMO treatment regimens were compared. There was no difference in planning target volume (PTV) 95%, but TOMO was statistically significant in regard to PTV 105% (P<0.05). TOMO was also significantly different when compared with 3DCRT when evaluating liver mean dose, liver V40, right/left kidneys mean dose, right/left kidneys V20 and spinal cord mean dose values (P<0.05). Grade 2 acute side effects were more frequent (85.7%) following 3DCRT. In addition, the median overall survival time for TOMO treated patients was 62 months while in 3DCRT treated patients it was 22.05 months. The difference in disease free survival was also significantly increased in patients treated with TOMO (66.7% vs. 19.0%; P<0.05). Conclusion: TOMO treatment resulted in lower acute side effects with better patient survival following gastric cancer radiotherapy.
Asunto(s)
Adenocarcinoma/radioterapia , Carcinoma de Células en Anillo de Sello/radioterapia , Radioterapia Conformacional/métodos , Radioterapia de Intensidad Modulada/métodos , Neoplasias Gástricas/radioterapia , Adenocarcinoma/patología , Carcinoma de Células en Anillo de Sello/patología , Estudios de Seguimiento , Humanos , Pronóstico , Dosificación Radioterapéutica , Estudios Retrospectivos , Neoplasias Gástricas/patología , Tasa de SupervivenciaRESUMEN
OBJECTIVE: The objective of the present study was to determine the malignancy risk for nodules categorised as atypia or follicular lesions of undetermined significance atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) and to investigate the predictors of malignancy. METHODS: All nodules diagnosed as AUS/FLUS on fine needle aspiration (FNAs) performed between January 2011 and December 2015 were retrospectively reviewed. Clinical data, ultrasonographic features, follow-up data and the final pathological results were recorded. After further exclusion, only nodules that underwent surgical excision were included in the final analysis. The malignancy rate and the range of malignancy rates were calculated. Clinical and ultrasound features were examined to determine the predictors of malignancy. RESULTS: During the study period, FNA was performed on 9938 nodules, and 1019 (10.2%) nodules were diagnosed as AUS/FLUS. After further exclusion, 976 nodules were evaluated. After the initial diagnosis of AUS/FLUS, 139 (14.2%) patients underwent surgery, 518 (53.1%) had repeated FNAs. A total of 305 (31%) had undergone surgical excision at different time points. For surgically confirmed nodules, the malignancy rate after the initial FNA was 34.5% (the lower and upper thresholds for the malignancy rate were 19.3% and 66.3%, respectively), and 37.9% after the repeated FNA. No ultrasound feature was determined as a predictor, whereas age (>55 years) was a predictor for malignancy. CONCLUSIONS: The overall malignancy rate for nodules diagnosed as AUS/FLUS and the malignancy rate for nodules that underwent repeated FNA after AUS/FLUS were higher than the expected malignancy rates of the National Cancer Institute. It is, therefore, suggested that the current recommendations should be reconsidered.
Asunto(s)
Adenocarcinoma Folicular/diagnóstico , Biopsia con Aguja Fina , Neoplasias de la Tiroides/diagnóstico , Nódulo Tiroideo/diagnóstico , Adenocarcinoma Folicular/clasificación , Adenocarcinoma Folicular/patología , Adenocarcinoma Folicular/cirugía , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias de la Tiroides/clasificación , Neoplasias de la Tiroides/patología , Neoplasias de la Tiroides/cirugía , Nódulo Tiroideo/clasificación , Nódulo Tiroideo/patología , Nódulo Tiroideo/cirugía , UltrasonografíaRESUMEN
AIM: There is no definitive consensus on the best treatment for pilonidal sinus. The Bascom cleft lift technique has been reported to produce successful results. This study presents the results of a modified cleft lift procedure in which the sinus tissue was excised and the lower end of the incision was kept outside the intergluteal sulcus by extending the lower end of the incision laterally. METHOD: Between August 2010 and January 2012, 141 consecutive patients who presented with primary or recurrent pilonidal sinus disease were included in the study, which was conducted at a single tertiary academic medical centre. Prospectively collected data were recorded, including complications, pain score, satisfaction level, primary healing rate, length of hospital stay and early recurrence. RESULTS: The mean operating time was 30 min and the mean length of hospital stay was 1.2 days. The most common surgical-site complication was a collection followed by partial wound dehiscence and superficial infection. The primary healing rate was 88%, the mean time for functional recovery was 13 days and the mean follow-up time was 14 months. No recurrence was observed within this follow-up period. CONCLUSION: The modified Bascom cleft lift technique is effective and reliable. It is applicable to all pilonidal sinus cases and has low complication rates, high satisfaction scores, rapid early recovery and low recurrence rates.
Asunto(s)
Seno Pilonidal/cirugía , Colgajos Quirúrgicos , Técnicas de Sutura , Adolescente , Adulto , Enfermedad Crónica , Estudios de Cohortes , Femenino , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Tempo Operativo , Estudios Prospectivos , Dehiscencia de la Herida Operatoria/epidemiología , Infección de la Herida Quirúrgica/epidemiología , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND: Technical modifications and methods for gallbladder dissection to minimize the risk of gallbladder perforation during laparoscopic cholecystectomy (LC) are described. The authors aimed to investigate the effects of gallbladder aspiration during LC on the operative and postoperative course of patients. METHODS: For this study, 200 patients undergoing LC for symptomatic cholelithiasis were randomly divided into two groups. Gallbladders were aspirated before dissection in group A (n = 100), and they were not aspirated in group B (n = 100). Operative and postoperative data on the patients were collected. RESULTS: The rate of gallbladder perforation was significantly lower in group A than in group B (p = 0.0003). The operative time was significantly shorter in group A (46.70 +/- 15.93 min) than in group B (60.75 +/- 22.09 min) (p = 0.047). Postoperative complications were more numerous in group B. The hospital stay was significantly longer in group B (1.55 +/- 0.81 days) than in group A (1.3 +/- 0.5 days; p = 0.004). CONCLUSION: The findings demonstrate the advantages of gallbladder aspiration in elective cases.
Asunto(s)
Colecistectomía Laparoscópica/métodos , Vesícula Biliar , Complicaciones Intraoperatorias/prevención & control , Succión , Colecistectomía Laparoscópica/efectos adversos , Colelitiasis/cirugía , Femenino , Vesícula Biliar/lesiones , Humanos , Masculino , Persona de Mediana Edad , Heridas Penetrantes/etiología , Heridas Penetrantes/prevención & controlRESUMEN
OBJECTIVE: To examine the effects of dopexamine on pancreatic tissue oxygen tension (PtO2) and the extent of acinar injury in rats with acute necrotising pancreatitis DESIGN: Laboratory study. SETTING: Medical school, Turkey. ANIMALS: 68 Sprague Dawley rats. MAIN OUTCOME MEASURES: Cardiorespiratory measurements, pancreatic PtO2, effects on activity of serum amylase and concentration trypsinogen activation peptide (TAP). and histological picture. RESULTS: The four study groups (sham + saline, sham + dopexamine, acute pancreatitis and acute pancreatitis + dopexamine) were each divided into two; in 9 rats in each, pancreatic biochemistry was studied, and in the remaining 8 in each group serum biochemistry and histology were studied. The groups were comparable with regard to mean arterial pressure, heart rate, arterial blood gases, packed cell volume, and serum amylase activity. The use of dopexamine increased pancreatic PtO2 in the sham + dopexamine group without the important blood pressure changes. The induction of pancreatitis resulted in a significant reduction in pancreatic PtO2 in the pancreatitis groups. The use of dopexamine did not increase pancreatic PtO2. There were no significant differences in plasma TAP concentration and the extent of acinar cell injury in the animals in the pancreatitis groups. CONCLUSION: Treatment with dopexamine does not improve the pancreatic microcirculation or reduce the extent of acinar cell injury in acute necrotising pancreatitis and is therefore unlikely to be of benefit in patients with pancreatitis.
Asunto(s)
Dopamina/farmacología , Páncreas/irrigación sanguínea , Pancreatitis Aguda Necrotizante/tratamiento farmacológico , Amilasas/efectos de los fármacos , Animales , Análisis de los Gases de la Sangre , Ceruletida , Modelos Animales de Enfermedad , Dopamina/análogos & derivados , Hemodinámica/efectos de los fármacos , Masculino , Microcirculación/efectos de los fármacos , Microcirculación/fisiología , Consumo de Oxígeno/efectos de los fármacos , Páncreas/efectos de los fármacos , Pancreatitis Aguda Necrotizante/inducido químicamente , Probabilidad , Ratas , Ratas Sprague-Dawley , Valores de Referencia , Sensibilidad y Especificidad , Estadísticas no ParamétricasRESUMEN
OBJECTIVE: To find out the effects of the octreotide on the course of acute pancreatitis in rats. DESIGN: Prospective laboratory study. SETTING: Medical school, Turkey ANIMALS: 184 Sprague-Dawley rats, 120 of which were randomly allocated into 8 groups of 15 each for the survival study, and the remainder of which were randomly allocated into 8 groups of 8 rats each for assessment of biochemical variables and histological score. INTERVENTIONS: The same 8 groups were used for the two parts of the study: saline alone (control), octreotide alone (control), oedematous pancreatitis induced by cerulein with and without octreotide, moderate pancreatitis induced by low-dose glycodeoxycholic acid and cerulein with and without octreotide, and severe pancreatitis induced by high-dose glycodeoxycholic acid and cerulein with and without octreotide. MAIN OUTCOME MEASURES: Mortality, results of biochemical tests, and histological score. RESULTS: No rats in the control groups died. Of those with oedematous pancreatitis 1 died that had not been given octreotide (7%) and 2 that had (13%). In the moderate pancreatitis groups 4 that had not been given octreotide died (27%) compared with one that had (7%). In the severe pancreatitis group 7 that had not had octreotide died (46%) compared with 6 that had (40%). Octreotide caused a reduction in serum amylase and lactate dehydrogenase activity in all groups, but reduced aspartate aminotransferase only in those rats with moderate pancreatitis. It prevented hypocalcaemia in rats with severe pancreatitis, but had no effect on serum electrolyte concentrations, alkaline phosphatase activity, or blood gas analyses. Rats with moderate pancreatitis that had been given octreotide had less tissue oedema, acinar necrosis, and inflammatory cell infiltration. In those with severe pancreatitis there was less tissue oedema but more acinar necrosis. CONCLUSION: If octreotide is given early in the course of the disease it may result in improved outcome, but it seems to be ineffective in severe pancreatitis in which acinar necrosis is already established.
Asunto(s)
Fármacos Gastrointestinales/uso terapéutico , Octreótido/uso terapéutico , Pancreatitis/tratamiento farmacológico , Enfermedad Aguda , Animales , Masculino , Ratas , Ratas Sprague-Dawley , Factores de TiempoRESUMEN
The main purpose of this study was to investigate the influence of nimodipine, a calcium channel blocker (CCB) and thyroid-releasing hormone (TRH) on acute necrotizing pancreatitis (ANP) induced by glycodeoxycholic acid in rats. CCB decreased blood pressure in rats in the control and pancreatitis groups. TRH corrected this decrease. CCB alone had no effect on PO2 serum amylase activity, calcium concentration, liver transaminases, lactate dehydrogenase or the degree of pancreatic damage, except for the serum concentration of creatinine. CCB+TRH reduced the concentrations of serum urea and creatinine, the degree of pancreatic damage, and increased PO2 and serum calcium concentration. CCB and CCB+TRH had no effect on pancreatic myeloperoxidase activity. CCB alone had no effect on the course of ANP, but CCB+TRH had beneficial effects on the course of the ANP and various systems.
Asunto(s)
Bloqueadores de los Canales de Calcio/uso terapéutico , Nimodipina/uso terapéutico , Pancreatitis Aguda Necrotizante/tratamiento farmacológico , Hormona Liberadora de Tirotropina/uso terapéutico , Animales , Ceruletida , Ácido Glicodesoxicólico , Infusiones Intravenosas , Masculino , Monitoreo Fisiológico , Páncreas/efectos de los fármacos , Páncreas/patología , Pancreatitis Aguda Necrotizante/inducido químicamente , Pancreatitis Aguda Necrotizante/enzimología , Peroxidasa/análisis , Ratas , Ratas Sprague-Dawley , Estadísticas no ParamétricasRESUMEN
Second-look operations after massive intestinal resections secondary to mesenterovascular occlusion are a frequent practice. In about one half of patients who undergo second-look procedures, no intraabdominal intervention is necessary. We present a laparoscopic abdominal observation method to prevent unnecessary laparotomies. In the first operation, two laparoscopic trocars, 5 and 10 mm in diameter, were left in the abdominal wall. After an appropriate time interval, the abdomen was explored laparoscopically through these trocars without anesthesia. If obvious intestinal gangrene and anastomotic leaks were observed laparoscopically, the patients were reoperated on while under general anesthesia; otherwise, the procedure was terminated with removal of the trocars. This method was performed on six patients. Unnecessary relaparotomies were prevented in four patients; intestinal gangrene and anastomotic leaks were not missed in the remaining two patients. A larger patient sample is needed to assess the advantages of this method in preventing unnecessary laparotomies.
Asunto(s)
Laparoscopía/métodos , Oclusión Vascular Mesentérica/cirugía , Complicaciones Posoperatorias/prevención & control , Procedimientos Innecesarios , Anestesia , Colectomía/métodos , Femenino , Humanos , Masculino , Monitoreo Fisiológico/métodos , Pronóstico , Segunda Cirugía , Prevención Secundaria , Sensibilidad y Especificidad , TurquíaRESUMEN
The main purpose of this study was to investigate the influence of total parenteral nutrition enriched with branched-chain amino acids (BCAA) on acute pancreatitis (AP) induced by sodium taurocholate in rats. Total parenteral nutrition (TPN) increased the survival rate and serum calcium, and reduced serum urea, liver transaminase, acid phosphatase and lactate dehydrogenase levels, but it did not change the degree of pancreatic damage or serum amylase. Total plasma amino acid concentration and the concentrations of glutamate, glycine, alanine, taurine, valine, leucine, isoleucine, phenylalarine increased significantly after the induction of AP, but there was no difference between the control and therapy groups. Hyperglycemia occurred during the use of TPN. BCAA-enriched TPN can be used in the treatment of AP with few side effects.
Asunto(s)
Aminoácidos de Cadena Ramificada/administración & dosificación , Pancreatitis/terapia , Nutrición Parenteral Total , Aminoácidos/sangre , Animales , Masculino , Concentración Osmolar , Páncreas/patología , Pancreatitis/sangre , Pancreatitis/patología , Ratas , Ratas Sprague-Dawley , SolucionesRESUMEN
This article aims to define the incidence of complications in 867 thyroidectomies performed by residents with attending surgeons' supervision as part of a training programme, in a region of endemic goiter. Seven hundred and nine patients were female and 158 were male. The age of the patients ranged between 6 and 76 and mean age was 32.5. Cases were divided into two groups according to their disease nature. Group 1 included 805 patients with nodular colloidal goiter (NCG) and adenomas. The remaining 62 cases, 25 with recurrence of goiter (RG), 21 with thyroid malignancy (TM) and 16 with thyroiditis formed group 2. While the overall complication rate was 11.3% (93 cases) in group 1, it was 20.9% (13 cases) in group 2. The mortality rate was zero in both groups. The incidence of complications of 867 thyroidectomies performed by residents with the attending surgeons' supervision was within acceptable limits especially as far as group 1 was concerned. However we suggested that attending surgeons themselves, disregarding residents training, should perform the operation in special cases such as recurrent goiters, thyroid carcinomas with positive regional lymph nodes and thyroiditis with regional adhesions.
Asunto(s)
Bocio Endémico/cirugía , Complicaciones Posoperatorias/etiología , Tiroidectomía , Adolescente , Adulto , Anciano , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Traumatismos del Nervio Laríngeo Recurrente , Factores de Riesgo , TurquíaRESUMEN
Torsion of a wandering spleen is rare, usually presenting as acute abdomen, and is commonly misdiagnosed. In special cases, ultrasonography, arteriography, and additional scintigraphy are extremely valuable in the preoperative diagnostic management. We herein present an unusual case of torsion of a wandering spleen in a 19-year-old female. The presenting symptom was acute gastrointestinal obstruction due to pressure of the enlarged and ptotic spleen in the pelvis. The intestinal obstruction with signs of peritonitis made a laparatomy with removal of the infarcted spleen imperative. After the operation, the patient made a complete recovery.
Asunto(s)
Obstrucción Intestinal/etiología , Obstrucción Intestinal/cirugía , Infarto del Bazo/complicaciones , Infarto del Bazo/cirugía , Adulto , Femenino , Humanos , Bazo/anomalías , Anomalía TorsionalRESUMEN
The effect of sucralfate on gastric emptying, gastric mucus production, and ulcer formation in cold-restraint rats was studied. The rats were treated with sucralfate in doses of 100 mg/kg, 250 mg/kg and 500 mg/kg. Sucralfate prevented ulcer formation dose dependently. This effect was maximum at doses of 500 mg/kg (P < 0.001). Administration of sucralfate lowered the increased gastric emptying rate and increased gastric mucus production. This effect was not dose dependent. It was found that the ulcer-preventive effect of sucralfate was due to a lowered gastric emptying rate and increased mucus production in addition to other mechanisms.
Asunto(s)
Vaciamiento Gástrico/efectos de los fármacos , Mucosa Gástrica/efectos de los fármacos , Úlcera Gástrica/prevención & control , Sucralfato/farmacología , Azul Alcián/metabolismo , Animales , Frío , Mucosa Gástrica/metabolismo , Masculino , Moco/metabolismo , Ratas , Ratas Sprague-Dawley , Estrés Fisiológico , Sucralfato/uso terapéuticoRESUMEN
We report a case of solitary extramedullary plasmocytoma of the breast in a 85 year old woman. This is the third case of solitary breast plasmocytoma in the world's literature. This disorder is very rare and it was associated with a serum monoclonal protein. A similar case is presented and its clinical presentation and pathology discussed.
Asunto(s)
Neoplasias de la Mama/patología , Cadenas kappa de Inmunoglobulina , Paraproteinemias/complicaciones , Plasmacitoma/patología , Anciano , Anciano de 80 o más Años , Neoplasias de la Mama/complicaciones , Femenino , Humanos , Plasmacitoma/complicacionesRESUMEN
The main purpose of this study was to investigate the effects of (i) truncal vagotomy + pyloroplasty, (ii) proximal cell vagotomy and (iii) anterior proximal cell vagotomy + posterior truncal vagotomy on the gastric secretion and gastric emptying in rats. After vagotomy basal and 2-deoxy-glucose stimulated gastric secretion decreased significantly in all three vagotomy groups. Gastric secretion on the other hand was significantly higher in the proximal cell vagotomy group than on the other vagotomy groups. The rate of gastric emptying in proximal cell vagotomy and anterior proximal cell vagotomy + posterior truncal vagotomy groups was delayed. The best results were found in the truncal vagotomy + pyloroplasty group when the gastric secretion and the rats of gastric emptying are concerned.
Asunto(s)
Ácido Gástrico/metabolismo , Vaciamiento Gástrico , Vagotomía/métodos , Animales , Desoxiglucosa/farmacología , Píloro/cirugía , Ratas , Ratas Sprague-Dawley , Estómago/inervaciónRESUMEN
During a period of 10 years, 10 cases of marginal ulcer (MU) after surgery for duodenal ulcer were evaluated retrospectively. The most common cause of MU was inadequate gastric resection plus incomplete vagotomy; the second common cause was incomplete vagotomy. In one case, the MU could be ascribed to malignant gastrinoma. In eight of the ten cases epigastric pain was a major symptom. MU was complicated with perforation, massive bleeding, gastrojejunocolic fistula and afferent loop obstruction in 2, 2, 2, and 1 cases, respectively. Gastroscopy was very useful for the diagnosis except in emergency cases. Hollander test was used in six of the 10 patients to evaluate if the vagotomy had been complete. The mean acid output by insulin induction was found 32 meq/h. As a surgical therapy, total gastrectomy (2 cases), truncal vagotomy (2 cases), truncal vagotomy plus 60% gastric resection or reresection and Roux Y gastrojejunostomy were performed. Postoperative complications (enterocutaneous fistula, intraabdominal abscess and delayed gastric emptying) occurred in 33 patients. One patient was lost after total gastrectomy in the malignant gastrinoma and gastrojejunocolic fistula case, due to sepsis. The patients were followed up for 4.4 years on the average. No recurrence was seen.
Asunto(s)
Úlcera Duodenal/cirugía , Úlcera Péptica/cirugía , Complicaciones Posoperatorias/cirugía , Adulto , Anciano , Úlcera Duodenal/patología , Duodeno/patología , Femenino , Estudios de Seguimiento , Gastrectomía , Humanos , Masculino , Persona de Mediana Edad , Úlcera Péptica/patología , Complicaciones Posoperatorias/patología , Reoperación , Estudios Retrospectivos , Estómago/patología , Vagotomía TroncalRESUMEN
The main purpose of this study was to investigate the influence of thyroid releasing hormone on acute sodium-taurocholate-induced pancreatitis in rats. Thyroid-releasing hormone did not change the survival rate, serum amylase, glucose calcium, liver transaminases levels or the degree of pancreatic damage, but reduced lactate dehydrogenase. Our findings suggest that the use of thyroid-releasing hormone has no beneficial effect on the course of acute experimental pancreatitis.
Asunto(s)
Pancreatitis/tratamiento farmacológico , Hormona Liberadora de Tirotropina/farmacología , Enfermedad Aguda , Amilasas/sangre , Animales , L-Lactato Deshidrogenasa/sangre , Masculino , Páncreas/efectos de los fármacos , Páncreas/patología , Pancreatitis/sangre , Pancreatitis/inducido químicamente , Ratas , Ratas Sprague-Dawley , Ácido Taurocólico/toxicidadRESUMEN
The intrabiliary rupture of hydatid cyst of the liver is a severe and relatively frequent complication. In this study six similar cases are presented. 4 of the cases had hydatid cyst surgery before the admission. The obstructive jaundice, cholangitis and unclosed bile fistula are the most frequent clinical findings. Ultrasound is very useful for the diagnosis. In the cases of space occupying lesions of the liver with wide choledochus (1.1 cm >) the intrabiliary rupture of hydatid cyst can be suspected by ultrasonographic examinations. Surgical therapy as the capitonnage combined with the resection of the projecting dome of the cyst and T tube application remains a method which gives good results and has low mortality and morbidity.
Asunto(s)
Enfermedades de los Conductos Biliares/patología , Equinococosis/patología , Parasitosis Hepáticas/patología , Adulto , Anciano , Anciano de 80 o más Años , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Rotura EspontáneaRESUMEN
We describe herein a new modified technique for performing the anterior gastropexy step of the Stamm gastrostomy procedure. In this method, anterior gastropexy was carried out with four 2-0 silk or propylene sutures. These sutures were secured through the whole layer of the abdominal wall from out to within. Then, after passing the seromuscular layer of stomach, they return to skin through the abdominal wall from within to out and tied over the skin surface. This modified technique which provided better exposure and an excellent seal of the stomach and parietal peritoneum, was successfully performed on 23 patients, none of whom developed any peritoneal leakage and peritonitis. The only complications that arose were wound infection in one case and skin excoriation in two others, and these were easily managed.
Asunto(s)
Gastrostomía/métodos , Técnicas de Sutura , Adulto , Niño , Femenino , Humanos , MasculinoRESUMEN
During a period of nine years, all patients with enterocutaneous fistula who received parenteral nutrition as part of therapy were evaluated retrospectively. Twenty-three patients were studied. Peptic ulcer was the most common primary disease, with the fistula arising in 78 percent of the cases from the breakdown of an anastomosis and in the remainder from a direct trauma to the bowel. The most common site of the fistulas was the ileum followed by the duodenum. All the patients were treated conservatively with total bowel rest and parenteral nutrition, and in 56.5 percent of the cases spontaneous closure occurred within an average of 29.6 days. In five patients, the fistula failed to close, and surgery was performed. The mean surgical closure time overall 36.4 days, but this varied from 20.8 days for the duodenum to 39 days for the jejunum and ileum, and 19.7 days for the large intestine. Five patients (22.7%) died, four from sepsis, the fifth from systemic malignancy. Mortality was related to the location and output of the fistula, with jejuno-ileal high-output fistulas in particular figuring prominently in the mortality.