[Acute appendicitis in a boy with an earlier appendectomy and a second appendix]. / Voor de 2e maal acute appendicitis bij een jongen met eerdere appendectomie.

A 17-year-old boy who had already undergone appendectomy, presented with a one-day history of severe pain in his right lower abdomen. Physical examination and other investigations indicated acute appendicitis. On exploratory laparotomy, a second, inflamed appendix was found. Appendectomy was carried out, and the patient made a good recovery. Pathological examination of the organs removed at each operation confirmed that during both procedures an intact and clearly inflamed appendix had been removed. A double appendix is a rare clinical entity and may be associated with other congenital abnormalities. Doctors should be aware of the possibility of appendiceal duplication to avoid delay in diagnosis and treatment.

Tuberculous aortitis with an aortoduodenal fistula presenting as recurrent gastrointestinal bleeding.

Tuberculous aortitis with a tuberculous mycotic aneurysm and an aortoduodenal fistula was diagnosed in a 38-year-old man with tuberculous cervical lymphadentitis and a 3-month history of recurrent gastrointestinal bleeding, in whom extensive investigation of the digestive tract had not revealed a bleeding lesion. Either by septic embolism or by direct extension from a neighboring focus, tuberculous infection can cause a mycotic aortic aneurysm with subsequent fistulation to the duodenum.

Angioleiomyoma of the diaphragm.

We report a case of a large symptomatic angioleiomyoma of the diaphragm. The tumor was diagnosed by computed tomography and videothoracoscopic biopsy. We removed the tumor through a left thoracolaparotomy. Three months later, a local recurrence was removed through an upper midline laparotomy. The patient remains without evidence of a recurrence 48 months after the second operation.

Detection of arterial intimal lesions: an experimental study comparing ultrasonography and arteriography.

In an experimental study the diagnostic value of intra-operative ultrasonography in the detection of arterial intimal lesions was investigated. A human carotid artery was placed in a pulsatile circuit with a roller pump and tubes. Intimal lesions (1-5 mm) were created and ultrasonography and biplane arteriography were performed. The ultrasonograms and arteriograms obtained were interpreted by three observers, who were blind to the procedures performed and the results were compared to the macroscopic defects. The mean sensitivity between observers for ultrasonography was 84% with a specificity of 95.7%. For biplane arteriography the mean sensitivity was 42% with a specificity of 94.5%. The differences between ultrasonography and biplane arteriography were statistically significant (p less than 0.02). It is concluded from this is concluded from this in vitro study that ultrasonography provides more accurate information concerning intimal lesions of the arterial wall than biplane arteriography.

In-situ saphenous vein bypass graft for popliteal artery aneurysm.

Popliteal artery aneurysms are dangerous and limb threatening; they can present with various ischemic symptoms. Surgical treatment is advised to avoid thromboembolic complications. In most cases the aneurysm is bypassed with a tunnelled reversed saphenous vein or with a prosthetic graft followed by ligation of the popliteal artery. In the popliteal fossa, the close relation between the graft and the aneurysm may cause graft failure. Four patients with symptomatic popliteal artery aneurysms were treated with an extra-popliteal in-situ saphenous vein graft, so far without failures. An additional advantage of an in-situ graft is the better result in case of a distal anastomosis.

Traumatic anterior dislocation of the hip.

A discussion is presented of traumatic anterior dislocation of the hip joint on the basis of three representative case reports. One patient had an iliac or pubic dislocation, the other two were obturator dislocations, including one with an associated femoral head fracture. All three patients were treated without surgery. After an average follow-up time of twenty-seven months, the results were excellent. Therapeutic guide-lines and recommendations are given for this infrequent type of injury.

Segmental air plethysmography in the diagnosis of deep vein thrombosis.

The diagnostic accuracy of segmental air plethysmography using a pulse volume recorder in the detection of deep vein thrombosis (DVT) was assessed. Measurements in 25 limbs with phlebographic proof of DVT and 25 limbs with normal phlebographic examination results were used to develop criteria. With these criteria, a prospective analysis of 50 limbs of patients suspected of having DVT was done. High sensitivity and specificity rates were found for proximal DVT. An accurate plethysmographic diagnosis could not be obtained for nonocclusive DVT or thrombosis confined to calf veins. The accuracy of the segmental air technique was comparable with that of other plethysmographic techniques.