“Repeat” High Ligation

This paper describes a method for the safe and expeditious exposure of the saphenofemoral junction when recurrent varicose veins in the groin are due to a previous incomplete “high ligation”.     

“Double‐barrel endocarditis”

We report a case of an 18‐year‐old woman who presented with infective endocarditis (IE), in two conduits percutaneously delivered in the right ventricle outflow tract (“double‐barrel endocarditis”). The patient's clinical presentation, echocardiogram findings, infectious agent, clinical management, surgical approach, and follow‐up assessment are described. Percutaneous pulmonary valve implantation has emerged as a viable therapy for conduit dysfunction in the right ventricular outflow tract. Although the percutaneous approach has several advantages, this strategy and the valves used are not complication‐free. IE after transcatheter valve deployment has evoked the growing concern, as there is a higher incidence in these patients compared with patients with surgically repaired pulmonary valves. As a result, this type of surgical treatment is especially important.     

“Deflected” calyx sign

Despite the introduction of nephrotomography and renal angiography, routine excretory urography still is the main diagnostic tool in radiology that provides the necessary evidence for the diagnosis of renal tuberculosis. The “deflected” calyx sign results from stricture of an infundibulum which ultimately leads to complete obstruction and a space-occupying (pseudotumor) mass produced by a debris filled dilated calyx. Since no contrast medium enters the obstructed calyx, the normal middle calyx frequently appears to be “deflected”. When other typical radiographic evidence is absent, this sign should suggest renal tuberculosis.     

Gastric outlet obstruction after omentopexy for perforated “acute” and “chronic” duodenal ulceration

One hundred and eighty-seven men, aged twenty to eighty years with an average of forty-eight years, underwent surgery for perforated duodenal ulcer. Seventeen received an immediate definitive procedure; none died. Nine (5 per cent) of the remaining 170 who had omentopexy died one to fifteen days postoperatively. They were older and waited longer. One hundred and twenty-one patients (76 per cent) were adequately followed. Thirty-nine (32 per cent) had "acute" perforation and eighty-two had "chronic" perforation. Twenty-four (30 per cent) of the latter underwent definitive operation within three months without mortality. Overall, 25 per cent of the ninety-nine patients followed after omentopexy required reoperation within twelve months. However, only three (8 per cent) of the thirty-nine with "acute" perforation required operation as compared with twenty-one (37 per cent) of the fifty-eight with "chronic" perforation. The main reason for early operation in the "chronic" group was obstruction; 21 per cent failed to empty their stomach immediately or soon after omentopexy and half as many either had pain or bled severely within twelve months and also required reoperation. The "acute" and "chronic" groups continued to differ in their need for further operation. Overall, 57 per cent of the ninety-seven patients required a definitive operation one to twenty-four years later. However, only ten of the thirty-nine patients (26 per cent) in the "acute" group required definitive operation as compared with forty-five of the fifty-eight patients (77 per cent) in the "chronic" group. Outlet obstruction of the stomach was the main indication for definitive surgery in twenty-six of the fifty-five (47 per cent) reoperations. This high incidence of gastric obstruction after omentopexy was not peculiar to our institution since, over the past six years, eighteen patients having omentopexy elsewhere had to be operated on for this complication. We recommend that patients with "chronic" perforation should not undergo omentopexy but rather immediate vagotomy and a drainage procedure.     

Comparison of “subjective” and “objective” measures of severity of urinary incontinence in women

The aims of this study were to compare “subjective” measures of severity of urinary incontinence to similar “objective” measures, establish their statistical correlation, and determine the effect of specific urodynamic diagnosis on such correlations. Baseline data was available from 265 women entered into a clinical trial studying pharmacologic and behavioral interventions for urinary incontinence. The “subjective” measures of incontinence were obtained by patient recall during history taking and included: the number of incontinent episodes in I week, the number of perincal pads used during I week, and the number ot clothing changes required due to wetness. The “objective” measures of severity included: the number of incontinent episodes per week as recorded on a 7-day diary, the number of perineal pads used per week, also recorded on a diary, and the amount of fluid lost during a standardized pad test Analysis consisted of Pearson correlations and linear regressions to determine equations for the prediction of objective measurement on the basis of the corresponding subjective measure. Significant positive correlations were seen between “subjective” and “objective” measurements for the comparisons of number of weekly incontinent episodes (R = 0.63), and tor the weekly number of pads used (R = 0.81). The comparison between the number of clothing changes and the amount of fluid lost during pad testing was also significantly but less strongly correlated (R = 0.24). For the correlations between subjective and objective determinations of urinary incontinent episodes and for those between clothing changes and pad testing, the urodynamic diagnosis had no effect on the correlation coefficients, but did have a statistically significant effect on the intercept. “Subjective” measures of severity of urinary incontinence will provide a reasonable estimate of “objective” measures of severity of urinary incontinence in women. Therefore in a clinical setting, it seems logical to use “subjective” measures to assess both baseline severity and response to intervention. © 1995 Wiley-Liss, Inc.     

“Burried strip” versus “tube” in hypospadias repair: Analysis of 82 consecutive cases

The goal of this study was to analyze, discuss, and compare risks and results obtained with the “buried strip” and two “tube” techniques for hypospadias repair in a personal series. From 1976 through 1982, 82 patients underwent complete two-stage repair of hypospadias using either the Denis Browne procedure (23 patients) or the Belt-Fuqua technique (41) and Byars procedure (18), respectively. Only those patients with originally distal and mid shaft hypospadias plus chordee were included in this series. The mean age at the time of repair was 4.9 years, with a range of two to sixteen years. The overall complication rate was 13.4 per cent (11 of 82 The tube procedures alone had a complication rate of 6.8 per cent (4 of 59) compared with 30 per cent (7 of 23) with the Denis Browne technique. Complications noted were: fistulas 6 (Denis Browne 5, Belt-Fuqua 1); meatal stenosis 4 (Denis Browne 2, Byars 2); urethral stricture 1 (Belt-Fuqua Our results confirm the general belief that tube techniques have a higher reliability than does the Denis Browne procedure. Each procedure improves with the experience of the surgeon, although the tube technique appears to cause less trouble in our hands. The running subcutaneous and intracutaneous sutures give a far smoother healing. We believe this study supports the virtues of two-stage tube repairs.