Local steroids in dialysis-associated pericardial effusion. A single intrapericardial administration of triamcinolone.

Five patients receiving maintenance hemodialysis for end-stage renal disease underwent therapeutic pericardiocentesis for pericarditis manifested by either cardiac tamponade or effusion unresponsive to conservative therapy. Pericardiocentesis was followed by a one-time instillation of triamcinolone hexacetonide, a nonabsorbable corticosteroid, into the pericardial space with subsequent needle withdrawal. All patients had prompt hemodynamic and symptomatic improvement. Serial echocardiograms showed resolution of the pericardial effusion in all patients. Follow-up evaluation for six months to six years has shown no clinical or postmortem evidence of recurrence. This procedure appears safe and effective and potentially can obviate the need for prolonged catheter drainage or more invasive surgical procedures as therapy for these patients.

Varices of the common bile duct as a surgical hazard.

In the case of a 78-year-old woman with three common duct stones is reported. The most striking finding at operation, was extensive varices of the common duct. There was no evidence of varices elsewhere nor of an arteriovenous fistula. The varices are assumed to be idiopathic or a unique manifestation of a chronic cholangitic venous disorder. The situation, although unique, is readily recognized. Methods of management directed at avoiding intraoperative bleeding are suggested.