Biomedical subjects
Publications and source records attributed to M Iuchtman.
Neonatal appendicitis is so unusual that is has been considered nonexistent. We present the case of a 6 day old male with acute scrotal swelling who was found to have a perforated appendicitis inside a hernia sac. A literature review supports the impression that neonatal appendicitis is rare; however, when it occurs inside a hernia sac, it has a good prognosis.
Perforation of a mesenteric cyst is a very rare complication of a very unusual lesion. Acute presentation is the rule in half of all affected children. Ultrasonography and computed tomography are the best preoperative diagnostic tools. The treatment of choice is an urgent laparotomy and complete cyst removal. Results are good in cases that are operated on in a timely manner.
One hundred and twenty-five arteriovenous fistulas for chronic hemodialysis are reviewed and their patency is related to the etiology of terminal uremia and other factors. A significant difference was found between the patency of fistulas of patients with chronic glomerulonephritis (CGN) and those of patients with chronic pyelonephritis (CPN). The average number of A-V fistulas in the CGN group was 1.30, while in those with CPN, 2.14 fistulas per patient necessitated construction. A pattern similar to that of the CGN group was observed in a third group of patients, who had an unclear diagnosis. The average number of fistulas was the same, and the mean survival 20 months in both groups, compared with the four months mean survival in the CPN group. Higher blood pressure levels were observed in the groups with a higher patency rate. The survival of patients with A-V fistulas appears to be related more directly to the etiology of the terminal uremia and care taken during hemodialysis than to the type of vascular connection. Anticoagulation and larger anastomoses are advisable in patients with increased risk of fistula deterioration. These patients should be included in the transplantation priority list.
Diverticulitis and carcinoma with abscess formation following perforation of the redundant sigmoid colon was erroneously diagnosed as acute appendicitis in nine patients over a period of five years. As te inflammatory process develops in the right lower quadrant of the abdomen, lack of previous colonic pathology may lead to a misdiagnosis, usually of acute appendicitis. It should be borne in mind, however, that acute appendicitis decreases with age, whereas diverticula and carcinomas increase, and that the sigmoid colon is often a redundant organ with a tendency to migrate to the right side of the abdomen. In elderly patients with acute right abdominal pathology, it is important to operate through a transrectal or paramedian incision. A two-stage operation is preferable to a three-stage one.