Sclerotherapy with use of doxycycline after percutaneous drainage of postoperative lymphoceles.

PURPOSE: To assess the use of doxycycline as a sclerosing agent after percutaneous drainage of postoperative lymphoceles. MATERIALS AND METHODS: Symptomatic postoperative lymphoceles (n = 21) in 18 patients were treated by percutaneous tube drainage for an average of 10.8 days. Sclerosis was performed when the patient became asymptomatic, drainage had slowed to less than 30 mL/d and follow-up imaging (CT or US) showed either near complete or total resolution of the lymphocele. Doxycycline (500 mg) combined with 1% lidocaine (5 mL) was instilled into the cavity with use of a syringe after any remaining lymphocele fluid was removed through the tube. When possible, patients were instructed to perform a series of maneuvers for the next hour to distribute the sclerosing agent evenly throughout the cavity. After 1 hour, the sclerosing agent was aspirated from the cavity and the drainage tube was removed. Three patients with four lymphoceles underwent sclerotherapy immediately after percutaneous insertion of a drainage tube and aspiration of the lymphocele. No patients underwent previous sclerosis with any agent. RESULTS: Successful treatment of postoperative lymphoceles was achieved in 17 of 18 patients. Primary success was achieved in 17 of 21 lymphoceles treated. There were four lymphocele recurrences in three patients. Three of the four recurrences were successfully treated by means of repeated drainage and sclerotherapy. One recurrent lymphocele persisted after re-treatment with 1 g of doxycycline. This patient underwent successful surgical repair. There were no complications related to doxycycline sclerosis. The mean duration of drainage for initial and recurrent lymphoceles was 10.8 days (range, 0-30 days). CONCLUSION: Sclerotherapy with use of doxycycline after percutaneous drainage is an easy, safe, inexpensive, and effective means of treating postoperative lymphoceles.

Hepatic rupture in pregnancy associated with cocaine use.

BACKGROUND: Hepatic rupture during pregnancy has a high rate of maternal and fetal mortality. Most cases occur as a complication of severe pregnancy-induced hypertension, and maternal survival has been highest in patients managed with conservative surgical therapy. CASE: A woman in late pregnancy experienced hepatic rupture associated with cocaine use. She underwent emergency cesarean delivery and was treated with topical hemostatic agents, perihepatic packing, and hepatic artery embolization. Reexploration with perihepatic packing was performed three times during the first 48 hours after delivery to control hepatic hemorrhage. Vasopressor support, blood product replacement, and prolonged assisted ventilation were used, and the patient was discharged on hospital day 42. CONCLUSION: Liver damage may result from the potent vasoconstrictor property of cocaine, leading to vasospasm and ischemia. Conservative surgical management of hepatic rupture and supportive measures resulted in maternal survival.

A courtroom lesson in physician-assisted suicide.

Physician participation in euthanasia and assisted suicide has been the subject of long-standing debate and is unlikely to be resolved easily or soon. The Pennsylvania Medical Society's Medical Student Section explored this topic recently in a second "mock trial" held in conjunction with the Temple University School of Law and co-sponsored by the Pennsylvania Medical Society Liability Insurance Company. This is an account and essay from that trial.

Annual testicular activity in the gray partridge (Perdix perdix L.).

Seasonal changes in plasma androgens, testicular total protein content, gonosomatic index, and spermatogenic activity were studied in the grey partridge, Perdix perdix. Moreover, testicular androgen output after stimulation with ovine LH (oLH) was tested in vitro during different periods of the sexual cycle. Androgens and the gonosomatic index peaked in April, during which all the spermatogenic stages were observed. Total protein content in the testes was highest in January and March. Gonadal responsiveness to oLH was found to increase in the period April-May in coincidence with the hormone peak in the plasma, while February testes were irresponsive.

Iron intakes and serum ferritin levels in developmentally delayed children. An assessment of maternal knowledge and attitudes.

A survey conducted on a quota sample of 42 developmentally delayed children included assessment of maternal nutrition knowledge and attitudes. A 24-hour recall was combined with a two-day food record for calculation of dietary iron intakes of the children. Serum ferritin levels were used to assess subjects' iron stores. Maternal education was positively correlated with maternal nutrition knowledge, attitude toward meal planning, and stricter attitudes toward feeding children. Maternal nutrition knowledge and strictness attitudes significantly correlated with dietary iron intake. Relative feeding skills and age correlated with serum ferritin levels.

Field experience for community nutrition students.

A cooperative project was undertaken by university community nutrition students and Montgomery County, Maryland, school food service personnel. Although such projects can be extremely beneficial as learning experiences for students, care must be taken to limit their scope to the level and the time available to the students. School food service staffs cannot expect such projects to provide manpower resulting in detailed scientific studies; however, school food service programs can benefit from the observations made by students.

Effects of castration, 5 alpha-dihydrotestosterone and cyproterone acetate on enzyme activity in the mouse epididymis.

The influence of castration, androgen replacement therapy and cyproterone acetate on the activity of beta-glucuronidase, acid and alkaline phosphatases and glucose-6-phosphate dehydrogenase was studied in the caput, corpus and cauda epididymidis of the mouse. The results add further evidence that the epididymis is not uniform but has regional differences in activity. Thus beta-glucuronidase was found to be androgen-dependent only in the cauda epididymidis, whereas glucose-6-phosphate dehydrogenase was under androgenic control in the caput epididymidis. The response of alkaline and acid phosphatases to castration and to androgen replacement was different in different segments.

A study of the enzyme activity in the seminal vesicles of castrated and hormone-replaced castrated mice.

Castration provokes a time-related decrease in weight, protein, beta-glucuronidase and glucose-6-phosphate dehydrogenase activity of seminal vesicles. A dose-dependent stimulation of these parameters is obtained with 5alpha-DHT. Cryproterone acetate counteracts the stimulatory effects due to androgen. Acid and alkaline phosphatases remain largely unaffected by these treatments.