Ruptured abdominal aortic aneurysm in a 24-year-old African woman. Unusual presentation--unknown aetiology.

CASE REPORT: 24-year-old black female presenting with progressive paralysis of the left lower limb. The clinical examination and investigations describe an extensive retroperitoneal mass. An exploratory laparotomy reveals a ruptured saccular infrarenal aortic aneurysm, a narrowing of the distal aorta and a complete obstruction of the left common iliac artery. The aneurysm was resected, an aortoiliac bypass and femorofemoral crossover bypass were performed, with success. The clinical presentation of this ruptured abdominal aneurysm is unusual. Its etiology is discussed: the findings are suggestive of Takayasu's disease.

Evaluation of efficacy of cefoxitin in the prevention of abdominal trauma infections.

Recent studies showed high populations of both aerobes and anaerobes in penetrating abdominal trauma infections. Combined aminoglycoside-clindamycin therapy has resulted in infection rates of 7 to 10 per cent. However, high side-effect incidences of nephrotoxicity and ototoxicity have been attributed to the aminoglycosides. Cefoxitin is reportedly free of these side effects. In our study, 62 penetrating abdominal trauma patients requiring laparotomy were treated with cefoxitin pre- and postoperatively. The majority of the injuries, 75.8 per cent, involved small bowel and large bowel. Infections occurred in four patients of the total 62 (6.5%). Two side effects, a fever and a rash, subsided immediately after discontinuing cefoxitin; no ototoxicity or nephrotoxicity occurred. The safety and efficacy of cefoxitin alone versus aminoglycoside-clindamycin combination therapy was statistically compared in intestinal injuries only among two historical controls and our subgroup. Our infectious rate, 8.5 per cent, was comparable to 7.4 per cent and 10.4 per cent of the historical controls. We concluded that pre- and postoperative use of cefoxitin alone is as effective in the prevention of penetrating abdominal trauma infections as combined aminoglycoside-clindamycin therapy. Experience to date suggests that the use of a beta-lactam antibiotic such as cefoxitin may allow the physician to avoid the more serious side effects associated with the use of aminoglycosides in these patients.

Excluded loop syndrome: a complication of jejuno-ileal bypass for obesity.

Excluded loop syndrome may develop in patients who undergo jejuno-ileal bypass surgery with the excluded small intestine drained via an ileosigmoidostomy. A unique case of a morbidly obese male who underwent the procedure while on methadone maintenance therapy is presented. The major factor in the development of this disorder appears to be the high intraluminal pressures within the sigmoid colon which prevent adequate egress from the excluded loop. Narcotic medications tend to induce or intensify the syndrome.

Human spinal fluid methadone levels.

Cerebral spinal fluid (CSF) levels of methadone were measured in nine methadone maintenance patients requiring lumbar punctures for medical or surgical treatment. Concurrent serum methadone levels were also determined. The CSF concentration of methadone in all cases was a fraction of the corresponding serum level--ranging from 2 to 73%. The CSF concentrations of methadone ranged from 0.010 to 0.097 ng%. Peak methadone levels in CSF appeared approximately 3 - 8 hours after methadone administration.