Tuberculous pericarditis. A review of 100 cases.

A retrospective survey of 100 Black patients with presumed tuberculous paricarditis showed that 82 presented with pericardial effusion while 18 had constrictive pericarditis. The mortality rate was 17%. Of the 82 patients with pericardial effusion, 15 developed 'constricting pericarditis' within 4 months; 12 required pericardiectomy. Sixteen patients died of cardiac tamponade; the effusion had been confirmed by a radio-isotope heart pool scan but had not been aspirated. This emphasizes the need for early and repeated pericardial aspiration. The fate of 38 rural patients with pericardial effusion was not known. Of the 18 patients with constrictive pericarditis, 7 underwent pericardiectomy, while 3 refused operation.     

Heparin coating on ureteral Double J stents prevents encrustations: an in vivo case study

PURPOSE: To evaluate the ability of heparin coating to inhibit Double J stent encrustation and compare it with the classic polyurethane Double J stent. PATIENTS AND METHODS: The study involved five patients with bilateral obstructions, who required bilateral ureteral Double J stent placement. Every patient received a heparin-coated Double J stent and a traditional polyurethane Double J stent for 1 month. After removal, the stents were analyzed using field emission scanning electron microscopy (FESEM), energy dispersive spectroscopy (EDS), and micro-infrared spectrophotometry (Micro-IR). These same techniques were used to analyze the heparin-coated and uncoated stents before insertion. The thickness, extension, and composition of encrustation of the coated and uncoated stents were compared. Moreover, two heparin-coated stents were analyzed with the same techniques after they had been in place for 10 and 12 months. RESULTS: FESEM analysis showed that the difference in encrustation thickness and extension between the two groups was significant. EDS and Micro-IR confirmed that in the heparinized stents the encrustations were not as uniform and compact as those in the uncoated stents. The stents that were left in place long-term were free of encrustations and had no changes in the heparin layer. CONCLUSIONS: Heparin coating reduces stent encrustation. Moreover, as no changes were seen in the heparin layer, we concluded that covalent heparin bonding enhances its adhesion to the polyurethane surface and ensures its stability for long periods. The heparin-coated stent appears to be a useful tool for long-term urinary drainage.     

A review of 100 Attenborough stabilised gliding knee prostheses.

We have reviewed 100 Attenborough total knee replacements in eighty-two patients with a follow-up of one to four years and conclude that this prosthesis has a valuable place in the surgical management of patients suffering from rheumatoid arthritis and osteoarthritis with severe involvement of the knee. In 85 per cent of these knees a good result was obtained with relief from pain, and in 77 per cent a useful range of movement with a stable knee. Only two patients with loosening and three with deep infection were seen in this series.     

Surgical treatment of thoracic hydatidosis. A review of 100 cases

Hydatid cystic disease continues to hold an important place in chest disease in our country. The authors review their experience from 1977 to 1987 of 100 patients who underwent surgery for pulmonary hydatidosis. Mean age was 36.21 years. Fifty-nine cases were ruptured cysts (RC) and 41 were unruptured cysts (UC). The diagnosis was based on epidemiological, radiological and mainly serological and endoscopic criteria. The indirect haemagglutination test was positive in 100% of RC and 80% of UC, while 70.2% of the patients who underwent fiberoptic bronchoscopy showed pathological changes. The most commonly used surgical procedure in UC was open subtotal cystopericystectomy (89.09%), while wedge resection (41.81%) was the most commonly used technique for the RC. There were no operative deaths and no recurrences were observed for a mean follow-up of 5.4 years. The indications for adjuvant chemotherapy with mebendazole are presented.     

输尿管留置双J管患者生活质量的初步调查

目的 探讨输尿管留置双J管对患者生活质量的影响因素.方法 60例留置输尿管双J管患者,平均年龄53岁.平均置管时间(21.4±3.8)d.患者门诊膀胱镜下拔管时应用输尿管支架管特殊调查问卷调查,包括泌尿系统症状、国际前列腺症状评分(IPSS)、生活质量评分(QoL)和视觉疼痛评分(VAS).按麻醉方式分为3组,局麻组(12例),局麻加静脉复合麻醉组(10例)和全麻组(38例)进行疼痛评分比较.结果 膀胱镜下置管或拔管时患者疼痛感分别为,局麻组11例(91%),局麻加静脉复合麻醉组8例(80%),全麻组38例均无疼痛感.带管期间54例(90%)患者有泌尿系统症状,依次为夜尿42例(70%)、尿频39例(65%)、尿急36例(60%)、尿不尽35例(58%)、排尿困难31例(52%)、肉眼血尿21例(35%)、尿失禁18例(30%);患者有腰腹痛和下腹痛45例(75%).QoL"不满意"29例(48%),其中由继发性膀胱过度活动症(OAB)所致18例(62%),疼痛所致5例(17%).结论 输尿管支架管引起的泌尿系症状和疼痛严重影响患者日常生活,48%的患者感觉生活质量下降.继发性OAB是引起患者生活质量下降的主要原因.     

A tale of two stents: perioperative management of patients with drug-eluting coronary stents

Drug-eluting stents were introduced into clinical practice to decrease coronary stent restenosis rates. Though remarkably effective in reducing this complication, recent data reveal that drug-eluting stents pose a significant risk for late stent thrombosis, an event strongly correlated with discontinuation of anti-platelet therapy. Because anti-platelet agents are often discontinued perioperatively, patients with DES are at risk for perioperative stent thrombosis and myocardial infarction. Along with a review of the recent literature, we present two cases of patients with drug-eluting stents scheduled for renal transplantation. Two distinct antithrombotic management strategies illustrate the risk of either approach-bleeding and transfusion versus stent thrombosis and myocardial infarction.     

Febrile complications following insertion of 100 double-J ureteral stents

BACKGROUND AND PURPOSE: Implanted foreign bodies are associated with a higher risk of infection. Little has been published on infectious complications associated with ureteral double-J stents. The aim of this study was to define risk factors and characterize the febrile complications of the insertion of double-J stents. PATIENTS AND METHODS: One hundred consecutive cases of retrograde stent insertion (55 men and 45 women) were evaluated retrospectively. Eighty-one patients had an obstructing stone, either in the ureter or at the ureteropelvic junction; 10 had an obstructing tumor; and 9 had hydronephrosis and pain without calculi. Risk assessment was calculated for two major categories: urgent (N = 47) and elective (N = 53) insertion. Potentially confounding factors such as age, sex, accompanying medical problems, and types of prophylaxis were assessed. All but six patients received prophylactic antibiotics prior to stent insertion. RESULTS: All thirteen patients who had fever at the initial evaluation underwent urgent stent insertion. Of the 87 afebrile patients (53 elective and 34 urgent insertions), 22 (25%) developed fever (> or = 38 degrees C) after the procedure. Fever developed in 19 (56%) of the 34 urgent-insertion group who were not originally febrile as opposed to 3 (6%) of the elective-insertion group (P < 0.001). Six of these 22 patients (27%) had a positive urine culture after insertion. None had a positive blood culture, including the 13 patients who underwent the procedure while febrile. CONCLUSIONS: Urgent insertion of a double-J stent is associated with a high risk of fever but a favorable outcome.     

A review of 100 renal and perinephric sonograms with anatomic diagnoses.

Sonography is a non-invasive safe, convenient, quick and pain-free diagnostic modality, which can differentiate fluid masses from solid tumors and give a 3-dimensional representation of organs and masses in the retroperitoneum by biplanar sections. Sonography depends on the fact that high frequency sound has many characteristics of light and is, in fact, a sophisticated method of transillumination. A review of the first 100 consecutive patients who had sonography and anatomic diagnosis of the renal or perinephric abnormality shows the versatility and potentials of sonography. Of these 100 sonograms of renal and perinephric abnormalities 92 were correct by anatomic diagnosis.     

Primary hyperparathyroidism. A study of 100 patients in Johannesburg

This study comprised 100 white patients with primary hyperparathyroidism treated between 1975 and 1984. Of these, 75 attended Johannesburg Hospital and 25 were managed by private practitioners. The mean age was 56.4 +/- 1.4 years at the time of diagnosis. There were almost twice as many women as men. In patients attending Johannesburg Hospital there was a progressive increase in the detection rate after 1979, which corresponded with the introduction of automated multichannel serum analysis. The commonest major complications were renal stones (54%), renal insufficiency (27%), a history of skeletal fractures (12%), radiographic evidence of osteopenia (38%) and peptic ulcers (20%). Bone disease was particularly common in postmenopausal women (64%). Other notable features were the frequency of weakness and fatigue (40%) and hypertension (45%). Coincidental thyroid abnormalities were frequent (18%). Ninety-three patients were treated surgically; 76 (81.7%) had a single adenoma. Our findings are compared with those of other large series. This study indicates the need for a greater awareness of this condition and earlier diagnosis to forestall the development of its harmful complications, and for the collection of additional information from a prospective study.     

Malignant melanoma arising during pregnancy. A study of 100 patients.

Melanoma is often diagnosed in young adults, a significant proportion of whom are women of child-bearing age. The prognosis of women diagnosed with melanoma during a pregnancy continues to be debated. One hundred patients, ages 19 to 40 years, have been identified who were pregnant at the time of diagnosis of their melanoma. All were treated with local excision. Sixteen per cent underwent elective lymph node dissections. Immunotherapy was administered to 83% of patients. Mean follow-up was 6.8 years from the date of diagnosis. The patients were compared to an age-matched group of 86 women who were not pregnant at the time of diagnosis. Overall mortality during the follow-up period was 25% in the pregnant group and 23% in the control group. Among the pregnant group, there was an increased incidence of lymph node metastases during the follow-up period (39% versus 26%, p = 0.053). Among stage I patients, there was a significantly shorter DFI for the pregnant group (p = 0.039), with 50% of pregnant patients and 67% of control patients free of disease at 10 years. Similarly, among stage 1 patients, the time to development of lymph node metastases was shorter in the pregnant group (p = 0.021). Multivariate analysis demonstrated that pregnancy at diagnosis was significantly associated with the development of metastatic disease (p = 0.008), when controlling for tumor site, thickness, and Clark level. Patients who developed melanoma during pregnancy did not, however, have a significant decrease in survival.     

Total thyroidectomy. A review of 213 patients.

During a 10.5-year period ending in June 1982, total thyroidectomy was performed on 213 patients at the Vanderbilt University Medical Center. A nonfunctioning nodule on technetium scan was the primary indication for operation. Twenty-one of 213 patients had undergone previous partial thyroidectomy. The pathologic changes in the excised thyroids were carcinoma (81 patients), thyroiditis (27 patients), multiple benign adenoma (16 patients), thyrotoxicosis (27 patients), multinodular goiter (56 patients), and C-cell hyperplasia (three patients). Three total thyroidectomies were performed in search of a parathyroid adenoma. Fourteen patients had coexistent primary hyperparathyroidism. Excluding 12 patients with medullary carcinoma, 25% of all other patients with carcinoma would have had unrecognized tumor left in the remaining lobe had a total thyroidectomy not been performed. Calcium supplements were required in 59 patients during hospitalization, but only 2.8% of the patients developed permanent hypoparathyroidism. Since the adoption of Thompson's technique of total thyroidectomy, only one of the 128 patients (0.8%) has sustained permanent hypoparathyroidism. Two patients exhibited transient recurrent laryngeal nerve palsies without permanent nerve damage. There were no operative deaths. The low morbidity of total thyroidectomy appears to justify its use in all patients with differentiated thyroid malignancy. With surgeons experienced in this technique, total thyroidectomy should also be considered as the primary treatment for many other patients requiring thyroidectomy.     

Urological complications of renal transplantation: the impact of double J ureteric stents.

In a 10 year series of 350 consecutive renal transplant operations, the overall urological complication rate was 7.7%. During this period double J stents were introduced and were used either in the treatment of actual urological complications or as a prophylactic measure to protect ureters which had been damaged at retrieval. A total of 34 double J stents were used in 33 patients. The indications were: ureteric obstruction (n = 13), urinary leak (n = 5), short transplant ureter anastomosed using an extravesical ureteroneocystostomy (n = 10) and ureteric injury at the time of organ retrieval (n = 6). Thirty-two double J stents were inserted at open operation and two were inserted by an antegrade method after percutaneous nephrostomy. Improvement in renal function occurred in 16 out of the 18 cases of urological complications. No kidneys were lost and there were no deaths as a direct result of these complications. In a number of cases the insertion of a double J stent was the only treatment, thus eliminating the need for more complex surgery. All 16 patients who had a ureteric stent inserted as a prophylactic measure at the time of transplantation made uncomplicated postoperative recoveries. Urinary tract infection was relatively common (27%) after double J stent insertion, but other complications were rare. In conclusion, double J stents have proved to be a useful adjunct in the management of renal transplant related urological complications.