Balloon tamponade of the pharynx in transnasophenoidal operations: technical note.

The authors present a new technique for tamponade of the nasopharynx after the performance of a transnasophenoidal approach to the hypophysis. This technique consists of placing a Foley balloon catheter in each nasal cavity, extending to the nasopharynx. The position of the balloons and the adequacy of the amount of radiopaque substance used to fill them is determined with x-ray films or a television image intensifier. Among the advantages of the method over tamponade with Vaseline-covered gauze are: (a) better tamponade; (b) the possibility of testing the position and volume of tamponade; (c) the absence of trauma to the nasopharyngeal mucosa upon removal of the catheters after deflation of the balloons; (d) the availability of two airways for respiration in addition to the mouth; and (e) the absence of blood gas alterations and infections.

[Peritoneal pseudocysts as a complication of cerebrospinal fluid shunt. Report of 3 cases and contribution for diagnosis]. / Pseudo-cistos peritoneais como complicação de derivações liquóricas: relato de 3 casos e contribuição para o diagnóstico.

Three cases of peritoneal pseudocysts are reported with guidelines for the diagnosis of this type of complication. The authors point out the value of the following signs: 1--increase of ventricular pressure with worsening of the clinical picture; 2--localized pain in the abdomen; 3--difficulty to depress the capsule; 4--occurrence of subcutaneous collection of CSF around the pathway of the catheter. In some occasions it is possible to palpate the mass of the pseudocyst. The presence of subcutaneous collection of CSF around the pathway of the catheter is an important warning sign of peritoneal pseudocyst and must be differentiated from that originated by the disconnection between the capsule and the catheter. In this condition however, the accumulation of liquid begins in the cervical region. Also in this case the capsule depresses easily. The most precise diagnosis is achieved by X-Ray. The authors describe a method that consists in introducing a needle through the capsule and injecting 8cc of Dimer-X contrast. The catheter and the cavity of pseudo-cyst appear contrasted in the X-Ray film, establishing the definitive diagnosis. The authors discuss the physiopathology of CSF accumulation; once the pseudocyst is formed, the intracranial pressure increases, and the fontanelle bulges, this leads to repeated pumping by the relatives and subsequent rising of pressure within the pseudo-cyst. At this point the patient refers pain at the location of the pseudo-cyst and the CSF tends to lead around catheter. In babies the abdominal pain leads to crying, thus increasing once more the intra-cystic pressure which favors the leakage of CSF from the pseudo-cyst around the catheter.