An Unusual yet “Mg”nificent Indication for Hemodialysis

Hypermagnesemia is an uncommon electrolyte abnormality, due to the fact that magnesium toxicity is only seen in the setting of a massive exposure to exogenous magnesium, often in the setting of renal insufficiency. Here, we report a case of severe hypermagnesemia that resulted in complete paralysis that was secondary to Renacidin administration, a rarely used agent used for intra‐renal pelvic or intra‐vesicular instillation dissolution of struvite stones. The patient also had concurrent acute kidney injury (AKI). The patient's magnesium was as high as 16.7 mg/dL, and he initially received hemodialysis followed by continuous venovenous hemodialysis. These therapies resulted in a rapid reduction in magnesium levels and eventual resolution of the muscular weakness. The case discussion highlights several key aspects of magnesium homeostasis, the limited mechanistic understanding of Renacidin‐induced hypermagnesemia, and the role of renal replacement therapies in the treatment of hypermagnesemia.     

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.     

An unusual “giant” lipofibroma in the palm

A case is described of an unusually large lipofibromatous hamartoma arising from the tendon sheath of flexor pollicis longus.     

“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”.     

“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.     

“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.