Dislodged Nephrostomy Catheter: An Unusual Case of Idiopathic Transposition of Nephrostomy Catheter From Transplanted Kidney to Adjacent Small Bowel Loop: A Case Report

A 72-year-old man with a past medical history notable for deceased renal transplant presented to the interventional radiology department for routine right lower quadrant renal transplant nephroureteral catheter exchange. The nephroureteral catheter was placed in 2016 because of the presence of a hematoma causing partial page kidney and hydronephrosis.An antegrade nephrostogram was notable for opacification of the small bowel instead of the renal collecting system. The patient then subsequently developed urinary retention and intractable abdominal pain. Because of the combination of events, it was deemed necessary for laparotomy and surgical repair of the small bowel. Intraoperative findings were notable for small bowel adhesion to the abdominal wall but otherwise no evidence of acute inflammatory changes. In this case report, we describe the first case of an idiopathically dislodged nephrostomy catheter to the small bowel from a transplanted kidney and its successful management.     

An experimental study of the vibrator in postoperative tracheobronchial clearance

Thirty-eight piglets underwent thoracotomy and endobronchial installation of thick tenacious material. External vibrations enhanced tracheal bronchial clearance significantly. The study suggests that vibrating the chest in postoperative subjects with an inexpensive commercially available vibrator may be an important aid in the prevention and treatment of postoperative respiratory complications.     

Gastrinoma associated with common bile duct obstruction and the ectopic production of ACTH.

A case of adrenocortical hyperfunction due to ectopic production of ACTH by a gastrin-producing tumor of the pancreas is described. Cushing's syndrome preceded the appearance of the overt Zollinger-Ellison syndrome by 2 years and was treated by bilateral adrenalectomy. The Zollinger-Ellison syndrome was initially treated with cimetidine, which successfully reduced the secretion of gastric acid. Because the pancreatic gastrinoma continued to grow, causing obstruction of the common bile duct, biliary diversion and total gastrectomy were performed. There is evidence that the pancreatic gastrinoma was the source of the ectopic production of ACTH and possibly secretion. The role of Histamine-2 blocking agents as therapy in the Zollinger-Ellison syndrome is discussed.     

Similar degree of intimal hyperplasia in surgically detected stenotic and nonstenotic arteriovenous fistula segments: a preliminary report

Background

Intimal hyperplasia has been historically associated with improper venous remodeling and stenosis after creation of an arteriovenous fistula. Recently, however, we showed that intimal hyperplasia by itself does not explain the failure of maturation of 2-stage arteriovenous fistulas. We seek to evaluate whether intimal hyperplasia plays a role in the development of focal stenosis of an arteriovenous fistula.

Loss of c-Kit function impairs arteriogenesis in a mouse model of hindlimb ischemia

Background

Arteriogenesis is a process whereby collateral vessels remodel usually in response to increased blood flow and/or wall stress. Remodeling of collaterals can function as a natural bypass to alleviate ischemia during arterial occlusion. Here we used a genetic approach to investigate possible roles of tyrosine receptor c-Kit in arteriogenesis.

A functional treatment method for interphalangeal pyogenic arthritis

A treatment plan for pyogenic arthritis has been devised in which the accessory collateral ligaments are resected through radial and ulnar midaxial incisions. The surgical wound is debrided and copiously irrigated with an antibiotic solution, and intravenous antibiotics are instituted before operation and continued after operation. Physical therapy is begun within 24 hours of surgery and includes active range of motion (ROM) of all joints, dynamic splinting, and hand therapy to ensure both full flexion and extension. Forty patients were treated with this method within a 6-year period. Of five interphalangeal (IP) joints of the thumb, four regained 0 degree to 60 degrees full ROM and one gained 15 degrees to 65 degrees limited ROM. Of the two distal IP joints, one regained full ROM and the other became fused. Among the 33 proximal IP joints, 13 regained full ROM of 110 degrees and 13 regained limited ROM. Good functional results were obtained with this treatment plan in lieu of amputation, which previously was the most likely treatment.     

Colloid versus crystalloid resuscitation in experimental bowel obstruction

The physiologic effects of fluid resuscitation were studied in 20 piglets with advanced small bowel obstruction. Two solutions were compared: 5% albumin in normal saline and normal saline. Animals resuscitated with albumin-containing solution showed higher serum colloid oncotic pressure, greater loss of peritoneal fluid, lower urine output, and progression of muscular dehydration, when compared to animals resuscitated with similar volumes of normal saline solution.     

Gastrografin-induced hypertonicity. The pathogenesis of a neonatal hazard

Operative mortality in meconium ileus approaches 50 per cent. Recently, operation has been obviated by the administration of high Gastrografin enemas. However, the nonoperative therapy causes hypertonicity, manifested by rising hematocrit and serum osmolality and a decreased cardiac output and pulse rate. The suggested mechanism for hypertonicity is the attraction of plasma water into the gut by the concentrated “nonabsorbable” material. An alternate explanation involves absorption into the vascular system of osmolar active substances from Gastrografin. The purpose of this study is to clarify the pathogenesis of acute hyperosmolality.High Gastrografin enemas were administered to twenty-one neonatal puppies and serial blood studies were performed. A disproportionate rise in measured osmolality as compared to the calculated osmolality suggested significant absorption of the contrast material or its components through the puppy's intact gut wall. The results indicate that the hyperosmolar state is due to a combination of agent absorption and plasma water decrease.     

Changing trends in the surgical treatment of coarctation of the aorta

From 1974 through 1983, 107 patients 4 days to 27 years old underwent 115 operations for treatment of coarctation of the aorta. Thirty-two patients were infants (1 year old or younger), and 28 of them were newborns. All newborns were seen with congestive heart failure. Seventy-one patients were seen with hypertension. Associated anomalies were present in 72 patients (67%). Resection was performed in 48 patients, patch aortoplasty in 16, bypass of the coarcted segment in 15, and left subclavian artery flap angioplasty (LSAFA) in 36. Ligation of a patent ductus arteriosus was simultaneously performed in 28 patients and pulmonary artery banding, in 4. Follow-up was 6 months to 9.2 years. There was a significant difference in aortic cross-clamp time between 26 patients who had resection (37.9 +/- 12.9 minutes) (mean +/- standard deviation) and 32 patients who had LSAFA (22.9 +/- 7.7 minutes) (p less than 0.05). Six patients died within thirty days after operation; 5 of them had resection, and 1 had bypass. Major postoperative complications included bleeding requiring exploration in 3 patients (2 after resection and 1 after LSAFA) and paraplegia in 1 patient after reoperation (resection) for recurrent coarctation 3 years after patch aortoplasty. Paradoxical hypertension was observed in 13 patients, and sustained systemic postoperative hypertension developed in 11 after effective repair of coarctation. There was no significant difference in early postoperative arm-leg pressure gradients between the types of operation or the various age groups.(ABSTRACT TRUNCATED AT 250 WORDS)     

Hypercalcemia in epidermoid carcinoma of the head and neck.

Hypercalcemia occurs rarely at the time of diagnosis in patients found to have epidermoid carcinoma of the head and neck. It is particularly unlike in those patients who present with potentially curable lesions. Only 2 of our 307 patients who presented with potentially curable lesions were hypercalcemic at the time of diagnosis. Two hundred thirty-eight of these patients were followed up for two years or until death. Of the 139 who did not remain free of disease, hypercalcemia of clinical significance developed in ten (7.2 per cent). Pseudohyperparathyroidism was the suspected cause in seven of twelve patients. Debilitating symptoms were present in all patients with serum calcium levels greater thn 12.0 mg/100 ml. Treatment, when given, was effective in alleviating gastrointestinal and central nervous system problems. Although usually temporary, symptomatic improvement was appreciated by most patients and family members.