Jesse H. Meredith

Sclerosing Encapsulating Peritonitis: Report of a Case With Small Bowel Obstruction Managed by Long-Term Home Parenteral Hyperalimentation, and a Review of the Literature

Sclerosing peritonitis has recently emerged as a complication of peritoneal dialysis associated with a high morbidity and mortality. These patients experience the characteristic syndrome of nausea, vomiting, abdominal pain, partial small bowel obstruction, and impaired ultrafiltration. A pathologic finding is the replacement of mesothelial cells with a thick layer of nondistensible fibroconnective tissue. We report here a 58-year-old white woman who developed peritoneal sclerosis after 4 years of peritoneal dialysis, including 3 years of continuous ambulatory peritoneal dialysis. Risk factors included peritoneal exposure to low concentrations of formaldehyde and a 1-week exposure to long-dwell acetate dialysate. Laparotomy for partial small bowel obstruction with resection of the involved segment was complicated by enterocutaneous fistulae, which improved only on cessation of oral intake and treatment with home parenteral nutrition. We have reviewed the literature to find 20 cases of sclerosing peritonitis in patients on peritoneal dialysis. A 78% mortality rate is reported in cases that had surgical intervention. We conclude that the use of long-term parenteral nutrition with cessation of oral intake may be necessary in the management of sclerosing encapsulating peritonitis.

Dormia basket entanglement with a T tube: management with interventional radiologic techniques

the sigmoid to be pneumatically distended and to occupy the left lower quadrant. Adjacent viscera are displaced, and the wall of the colon abuts the peritoneum. In such a situation, endoscopic sigmoidopexy becomes feasible. Our patient was subjected to full bowel preparation before the endoscopic sigmoidopexy. This allowed a colonoscopic view of the colon to rule out concomitant pathologic conditions.

Ticlopidine versus aspirin and dipyridamole: influence on platelet deposition and three-month patency of polytetrafluoroethylene grafts.

In an attempt to establish a specific drug regimen that would retard neointimal fibrous thickening (NFT) and promote patency of small arterial grafts, we studied acute platelet accumulation and 3-month patency of 4 mm polytetrafluoroethylene (PTFE) grafts in dogs treated with oral aspirin (2 mg/kg/day) in combination with dipyridamole (5 mg/kg/day) (ASA/D) or ticlopidine (25 mg/kg/day) (T). After 3 days of treatment, 15 dogs were given indium 111-labeled autologous platelets and then had bilateral femoral artery grafts placed (control, 10 grafts; each drug group, 10 grafts). The calculated graft radioactivity expressed as average counts per 10 minutes +/- standard error of the mean (SEM) was as follows: control = 542,003 +/- 63,991; ASA/D = 135,163 +/- 14,443 (p less than 0.001, Students t test); T = 104,650 +/- 14,004 (p less than 0.001). Bilateral femoral artery and carotid artery grafts were placed in 15 other dogs (control, 20 grafts; each drug group, 20 grafts). Three months later the 60 grafts were excised and their patency recorded: control = 20% (4 of 20 grafts); ASA/D = 70% (12 of 17 grafts) (p less than 0.01, chi-square analysis); T = 30% (6 of 20 grafts) (p greater than 0.05). Mean anastomotic NFT +/- SEM of each graft was measured with an ocular micrometer: control = 1.6 +/- 0.2 mm; ASA/D = 0.7 +/- 0.2 mm (p less than 0.001, Students t test); T = 1.3 +/- 0.2 mm (p greater than 0.1).(ABSTRACT TRUNCATED AT 250 WORDS)

Prospective, randomized, controlled trial of ticarcillin and cephalothin as prophylactic antibiotics for gastrointestinal operations

The effectiveness of ticarcillin (one 6 g dose at the start of the operation) and cephalothin (three 2 g doses given at 4 hour intervals from the start of the operation) as prophylactic antibiotics in operations on the colon, stomach, small bowel or obstructed biliary tract was determined in a prospective, randomized, blind study of 190 patients. Data from the 152 patients forming the definitive study revealed a significant reduction in the rate of wound and peritoneal infections with the use of ticarcillin (3.4 percent) and cephalothin (5.3 percent) over that with the use of a placebo (27.8 percent). Cultures showed no evidence of antibiotic resistance in the contaminant organisms of patients who later developed infections. Both antibiotic regimens offered excellent protection against infection after gastrointestinal operations; neither produced untoward side effects. The very short duration of treatment, particularly with ticarcillin, conferred the additional benefits of low cost, simplicity of drug administration, and negligible risk of the emergence of resistant bacterial strains.

Comparative study of arterial transmission velocity

Abstract For the purpose of determining the arterial transmission velocity experiments were performed on anesthetized mongrel dogs by recording arterial pressure measured simultaneously at two positions along the axis of the abdominal aorta. Four independent methods: pulse wave velocity (PWV), apparent phase velocity (APV), ‘true’ phase velocity (TPV) and correlation propagation velocity (CPV) were used for comparison and for the future purpose of providing a reliable index with which to relate and to compare changes of elastic constants of the arterial wall with arterial disease. Of these four velocity determinations, the PWV proved to be the least reliable. The relationship between the APV and TPV suggests the experimental differences may be related to arterial reflections. On the other hand, the CPV, as measured by the cross correlation technique, was less subject to beat-to-beat variations than was the PWV, in actual determination; although the CPV is a much easier method and a more consistent measure of the arterial pressure pulse transmission velocity. In these studies, the apparent terminal vascular impedance of the arterial transmission line appears to match the apparent characteristic impedance of the large arteries.