Report of a documented case of encapsulating peritoneal sclerosis in Iran

Encapsulating peritoneal sclerosis [EPS] is a rare, acquired condition that has been described interchangeably with peritoneal encapsulation [PE] as well as abdominal cocoon. EPS causes complications for peritoneal dialysis [PD] patients. In EPS, the small intestine is covered by a fibrotic and inflammatory peritoneal capsule that either partially or completely encases the bowel. For EPS, there is no agreement in the literature as to whether the treatment of choice should be surgery or conservative therapy. However in the obstructive phase the treatment of choice is surgery due to the impossibility of conservative treatment. Here, we report the case of a 64-year-old woman who presented with several episodes of intestinal obstruction and peritonitis. Computed tomography [CT] of the abdomen did not show significant characteristic features of EPS. Exploratory laparotomy was performed, freeing the small bowel of adhesions and encapsulation. For EPS, adequate clinical knowledge and a high degree of suspicion are crucial for a correct diagnosis and appropriate management

[Prediction of early failure of vascular-access arteriovenous fistula based on immediate postsurgical evaluation]

For patients requiring chronic hemodialysis, the preferred site for vascular access is an autogenous arteriovenous fistula. Although a properly formed fistula is advantageous because it is less susceptible than other types of vascular accesses to infection and clot formation and can last longer than any other types of vascular access, AV fistula has a high rate of early failure that can increase immediate cost and complications. In this study, the prognostic value of physical examination of arteriovenous fistula by the surgeon at the end of the surgery was evaluated. In the general surgery ward of Imam Khomeini Hospital in 326 chronic renal failure patients, 354 arteriovenous fistula operations were accomplished by two surgeons from 1377 to 1381 [ca. 1998 to 2002]. The performance of each fistula was divided into the following groups by the surgeon at the end of operation: 1] systolic and diastolic thrill, 2] systolic thrill 3] souffle 4] pulse 5] not functional. Clinical function of the fistula was evaluated by the same surgeon in the following days if no souffle or thrill, early failure was detected on initial inspection.: In the 354 cases of arteriovenous fistula, the total early failure rate was 12.7%. The lowest early-failure rate was 3.5% in the systolic and diastolic thrill group. The highest early-failure rate was in the not functional group [P<0.001]. There was no correlation between early failure and age, sex, surgeon and location of fistula. Optimally, an arteriovenous fistula has a thrill with a soft compressible pulse. At the end of each operation, if the surgeon cannot detect a thrill at the fistula site, can find only pulse, or if the function is otherwise unsatisfactory, considering of a new arteriovenous fistula may be required, however it is better to postpone the surgery