Splenectomy in kala-azar.

At the beginning of the century, splenectomy was used in the treatment of kala-azar, but now is rarely needed, the major indication being for drug resistant kala-azar. Inadvertent splenectomy prior to the diagnosis of kala-azar continues to occur, probably because of a reluctance to perform splenic aspiration in the investigation of splenomegaly. Five Kenyan children underwent splenectomy for drug resistant kala-azar. All were immediately improved, but one died of overwhelming post splenectomy infection (OPSI) two months later and another of a malignant lymphoma seven months after surgery. The other three patients appear to be cured. Splenectomy was considered in a sixth child with kala-azar because of a Salmonella abscess in the spleen, but the abscess ruptured catastrophically before surgery could be arranged.

Percutaneous catheterisation of the axillary vein and proximal basilic vein.

Percutaneous catheterisation techniques for the axillary vein and proximal portion of the basilic vein based on venepuncture on a visible or palpable vein are described. Results are presented on 73 catheterisation attempts on axillary veins and 68 on proximal basilic veins, in which the failure rate was 4-9% and 6-9% respectively. The advantages of the techniques include simplicity and the absence of acute life-threatening complications. The incidence of phlebitis from indwelling catheters maintained for an average of 5 days (range 1-28 days) is less than 2%. Several aspects of the techniques including background anatomy and anticipated risks are discussed.