Recurrent ileal conduit hemorrhage in an elderly cirrhotic man.

One recognized complication of portal hypertension in a patient with an ileal urinary conduit is variceal hemorrhage. The definitive treatment for this rare complication is controversial. Local measures, sclerotherapy, stomal revision and various operative portacaval shunts have been described but they have had limited long-term success. Using a recently developed interventional radiological technique, a transjugular intrahepatic portosystemic shunt was created in a cirrhotic man who had recurrent massive ileal conduit variceal hemorrhage. After the procedure the patient experienced no further life threatening stomal hemorrhage. He died of hepatic failure 6 months later.

Current use of inferior vena cava filters.

To study possible changes in the clinical use of inferior vena cava (IVC) filters caused by the introduction of percutaneous delivery systems, we reviewed all patients who underwent placement of IVC filters at our institution from 1988 to 1991. Eighty-four patients (52 men and 32 women) ranging in age from 18 to 90 years (mean 67 years) were identified. Filters were required because of contraindications to anticogulation in 64% anticoagulation failure in 25%, and preoperative prophylaxis in 11% of patients. The underlying disease was lower extremity deep vein thrombosis in 50% and pulmonary embolism in 45% of patients. Five percent of patients received prophylactic filters without documented thromboembolism. All filters were placed percutaneously by interventional radiologists, 77 through the common femoral vein and 7 through the internal jugular vein. Three types of filters were used. One procedure-related death occurred because of acute IVC occlusion. Fatal pulmonary embolism within 48 hours after filter placement was documented in one patient and suspected in one late death. No other clinically apparent pulmonary embolism or leg swelling occurred after filter placement. Minor complications related to filter placement occurred in 13 patients, but none required operative intervention. Analysis of complication rates of the three filter types was precluded by the small sample size. After a mean follow-up of 11 months, 42 patients (50%) had died of malignancy (n = 25), multisystem organ failure (MSOF; n = 7), cardiovascular events (n = 4), recurrent pulmonary embolism (n = 2), cerebrovascular events (n = 4), or an unknown cause (n = 1). Twenty-three patients (27%) died before hospital discharge.(ABSTRACT TRUNCATED AT 250 WORDS)

The effect of maternal diabetes on the synthesis and secretion of phosphatidylcholine in fetal and maternal rat lungs in vitro.

Incorporation of (methyl-14C)choline into phosphatidylcholine and the release of prelabelled phosphatidylcholine was investigated in vitro using lung slices from pregnant rats and their offspring near term. Tissue from normal, diabetic and insulin-treated diabetic pregnant rats and their offspring was utilized to assess the effects of maternal diabetes on fetal lung maturation. The results show that the synthesis of phosphatidylcholine in fetal/newborn lungs through the cytidine 5'-diphosphocholine pathway was not affected by maternal diabetes. However, secretion of phosphatidylcholine from the lungs of fetuses of diabetic mothers was very much suppressed one day after parturition. Insulin treatment of the diabetic pregnant rats restored secretion of phosphatidylcholine from the fetal/newborn lungs to control values. These results suggest that an impaired secretion of phosphatidylcholine from the lungs of fetuses of diabetic mothers may be partly responsible for the higher incidence of respiratory distress syndrome among children of diabetic mothers. The results also revealed some correlation between the secretion of phosphatidylcholine from maternal lungs, maternal serum phospholipids and synthesis of phosphatidylcholine by fetal lungs during late gestation, suggesting a possible relationship between maternal phospholipid metabolism and fetal lung maturation.