Surgical complications of peritoneal dialysis catheters

Peritoneal catheters are relatively easy to insert but are associated with specific complications. Proper placement and appropriate management reduce the problems associated with these complications, reduce morbidity and mortality, and increase catheter survival. On the basis of our findings the following procedures are recommended: placement of the catheter in the operating room, use of a paramedian incision, closure of the fascia with a running nonabsorbable suture, use of small exchanges initially to allow for healing, cessation of peritoneal dialysis for a limited time when leaks occur, performance of omentectomy when necessary, repair of abdominal wall hernias preoperatively or whenever they occur, maintenance of meticulous asepsis, removal of the catheter after fungal peritonitis or multiple episodes of peritonitis with the same organism, and early operation if there is any doubt of an intraabdominal catastrophe.     

Low-dose dopamine preserves renal blood flow in endotoxin shocked dogs treated with ibuprofen

Drugs that inhibit prostaglandin (PG) biosynthesis improve hemodynamics and survival in experimental endotoxic and septic shock. The therapeutic utility of these agents in the management of septic patients may be limited, however, by their tendency to decrease renal blood flow (RBF) in animals and humans stressed by experimental manipulations or disease states that promote renal vasoconstriction. In the present study, we addressed this question: can low-dose intravenous (iv) dopamine (4 micrograms/kg/min), a known renal vasodilator, improve renal perfusion in endotoxin-shocked dogs treated with the PG synthesis inhibitor, ibuprofen. RBF was measured in pentobarbital anesthetized dogs using an electromagnetic flow meter. After obtaining baseline hemodynamics, Escherichia coli endotoxin (1.5 mg/kg) was given iv. The dogs were randomized 30 min later into three groups: Group I received saline; Group II received ibuprofen (12.5 mg/kg, iv); Group III received ibuprofen plus dopamine. Comparison of Groups I and II revealed that ibuprofen increased mean arterial pressure (MAP) and systemic vascular resistance (SVR) (P less than 0.0001 and P = 0.002, respectively) and decreased RBF (P = 0.019). Adding low-dose dopamine (Group II vs Group III) did not significantly affect MAP or SVR, but did augment RBF (P less than 0.001). We conclude that low-dose dopamine improves renal hemodynamics in ibuprofen-treated endotoxemic dogs.     

Electrolysis and thermolysis for permanent hair removal

The historical, legal, and theoretical aspects and clinical technics of both electrolysis and thermolysis are critically reviewed. The pitfalls of electronic tweezers and the dangers of self-electrolysis are discussed. Complications of electrolysis and thermolysis and the pathophysiology of hair regrowth are presented. In the United States, the lack of uniform training requirements and standards for electrologists may pose an unrecognized risk to public health. It is suggested that more responsible state legislation be enacted in order to decrease the present potential threat to the public health and safety.     

Recertification in allergy and immunology: an historical review with special emphasis on the 1983 examination

Recertification offers a method of evaluating a diplomate's cognitive knowledge of allergy and immunology. In 1983 candidates for the American Board of Allergy and Immunology recertification examination were offered the entire certifying examination but were informed that they would, for recertification purposes, be held responsible only for a subset of questions judged to be particularly clinically relevant. All 40 candidates elected to take the entire certifying examination. Differences between the performance of certifying and recertifying candidates on the recertifying questions were small. Except for the five-choice questions, the differences in performance between the two groups on the remaining questions were also small in an absolute sense. Recertification performance was not related to the time of original certification. Ninety-eight percent of the candidates completed a questionnaire after the examination. Ninety percent stated that they would encourage their colleagues to participate in the recertification process.     

Anesthesia and postoperative care for cardiac operations.

Almost three decades have passed since the establishment of open-heart surgery, and in such a short life span the specialty has established itself scientifically and reached a certain maturity. New techniques, better understanding of the pathophysiology of cardiac problems, and the effective use of new drugs constantly improve the results of operation. Greater experience in anesthetic management and improved postoperative care will contribute much to the success of this youngest surgical specialty. This review outlines the current principles of anesthesia and postoperative care of patients undergoing cardiac operations. Preanesthetic evaluation provides guidance for anesthetic management, supportive techniques, and postoperative care. During operations, light anesthesia is usually sufficient for patients with cardiac disease and minimizes myocardial depression. Monitoring must provide data on the physiological changes that are taking place from moment to moment during and after operations. Perfusion produces a highly abnormal state, and the severity of complications varies with its duration. Introduction of new drugs has also facilitated hemodynamic management during and after operations. Postoperative care is based on careful observation of the patient and early detection of trends, both of which lead to preventive rather than curative treatment wheneven possible.     

Acute transmural myocardial infarction associated with active Coxsackie virus B infection.

Out of a total of 233 patients suffering from transmural myocardial infarction, 20 patients were found to have serologic evidence of a concurrent active Coxsackie virus B infection. While the infection may have been coincidental, it is also possible that the virus may have played some part in the illness. Conceivably, myocarditis could be mistaken for infarction or, by some mechanism as yet unknown, the virus might precipitate infarction in susceptible subjects.