The importance of peritoneal imaging in the workup of genital edema in patients on continuous ambulatory peritoneal dialysis.

BACKGROUND: Genital edema is a well-reported complication of peritoneal dialysis. This phenomenon has been associated with extravasation of dialysate from the peritoneal cavity through a defect in the abdominal wall or through an wall or through an inguinal hernia (or patent processus vaginalis, persistent sac). In the first case, fluid tracks through the soft tissues of the abdominal wall and settles in the dependent genitalia. In the second, fluid tracks through the inguinal hernial defect and infiltrates into the tissues distal to the defect. It is difficult to precisely diagnose the etiology of many of these cases but it is obviously important. METHOD: We report a case of a patient who presented with penile and scrotal edema and was eventually found to have bilateral patent processus vaginalae. We used computed tomography and peritoneal scintigraphy in order to ascertain the diagnosis. RESULTS/CONCLUSIONS: We believe that computed tomography and peritoneal scintigraphy are extremely helpful in the workup of genital edema in patients on continuous ambulatory peritoneal dialysis.

Complications of subcutaneous injection ports.

Subcutaneous injection ports have become widely used for patients who require prolonged central venous access. Complications of their placement and use are well documented in the existing literature. We report two previously undocumented complications occurring in Port-a-Cath units, and suggest methods to lessen the likelihood of recurrence of these problems.

149 ambulatory laparoscopic cholecystectomies.

BACKGROUND: The purpose of this study was to compare ambulatory laparoscopic cholecystectomy (LC) with overnight LC and to determine its safety and the factors which will predict its success. METHODS: Ambulatory LC was defined as LC followed by less than a 12-h stay in the ambulatory surgery unit; overnight LC was defined as LC followed by a hospital admission of less than 24 h. A retrospective chart review was completed. RESULTS: One hundred forty-nine ambulatory LC, were performed in an 18-month period. Ninety-one were successful (61%); 58 patients required overnight admission for pain management, control of nausea, or their reluctance to be discharged. There were five complications and no mortalities. The duration of the surgical procedure was the only significant objective factor we could find in predicting success of ambulatory LC. CONCLUSIONS: We conclude that ambulatory LC is safe and effective in treating patients requiring cholecystectomy. The duration of the procedure and the patient's own motivation are key factors in predicting success of early discharge.

Hemoperitoneum as a result of coital injury to the liver. A case report.

A young woman presented in hypovolemic shock shortly after coitus. Hemoperitoneum occurred from a liver laceration produced by the disruption of an adhesion between the colon and liver during coitus. This is the second case of a coital injury to an extragenital organ.

Creation of a pericardial window using thoracoscopic techniques.

The aforementioned minimally invasive technique allows the surgeon to create a large pericardial window with minimal morbidity. Adequate long term drainage is provided and sufficient specimen for pathologic examination is obtained.

Bilateral spontaneous pneumothoraces caused by metastatic ovarian granulosa cell tumor.

A case is presented of a woman with bilateral spontaneous pneumothorax and pulmonary metastases originating from an ovarian granulosa cell tumor. It is the first known case report of an association between these two entities described in the English literature.

Barium enema in the diagnosis of acute appendicitis.

Acute appendicitis is still a difficult diagnosis to make. Reports place the rate of incorrect diagnosis--the rate of negative laparotomy--at 15 to 42 per cent. This study is a prospective analysis of barium enema (BE) examinations performed upon 101 patients who presented with a history accompanied by signs and symptoms suggestive of, but not clearly diagnostic of, acute appendicitis. The over-all accuracy rate was 91.5 per cent. Sensitivity and specificity rates were 83 and 96 per cent, respectively. BE had a positive predictive value of 88 per cent and a negative predictive value of 95 per cent in this study. No complications resulted from the use of BE in this study, which included three instances of perforated appendicitis. We conclude that emergent BE is an inexpensive, safe and readily available adjunct to the diagnosis of acute appendicitis. Its use in the presence of a clear-cut presentation of acute appendicitis is not necessary. When clinical data were equivocal, BE reduced the rate of negative laparotomy to 7.2 per cent.

Small-bowel obstruction caused by a long-term indwelling urinary catheter.

The first known case report of a small-bowel obstruction caused by a long-term indwelling Foley catheter is presented. The balloon of the catheter passed into and obstructed the lumen of the distal ileum through a vesicoenteric fistula created by chronic irritation. With the exception of recurrent urinary-tract infections, complications of urinary catheters are rare. The patient presented a diagnostic dilemma that was solved with a preoperative computed tomographic scan.

Disruption of the proximal anastomosis of axillobifemoral grafts: two case reports.

The use of axillobifemoral grafting in the treatment of infected aortic prostheses or in the treatment of patients at high risk for aortoiliac occlusive disease has become a widely accepted treatment modality. Few complications involving the proximal anastomosis have been reported. The present report describes two patients who suffered proximal anastomotic dehiscence several weeks after surgery when they fully extended and raised the affected arm.