Mark J. Noble

Management of abdominal aortic aneurysm and invasive transitional cell carcinoma of bladder.

Between January 1980 and June 1990 we treated 21 patients with invasive carcinoma of the bladder and abdominal aortic aneurysm. Three distinct groups of patients were identified. Group 1 comprised 8 patients who were initially diagnosed with invasive bladder cancer and during cancer staging a concomitant abdominal aortic aneurysm was found. Group 2 consisted of 10 patients previously treated for invasive bladder cancer who had aneurysmal disease at a later date. Group 3 included 3 patients who underwent a previous aneurysm repair and subsequently had invasive carcinoma of the bladder. Total survival was 9 of 21 patients (43%) with a mean of 84 months of followup after initial diagnosis. This finding is comparable to long-term (greater than 5 years) survival in patients with invasive carcinoma of the bladder alone. In fact, none of the 21 patients studied experienced rupture of the aneurysm and/or died of aneurysmal disease. We found that patients with abdominal aortic aneurysm and invasive bladder cancer have a poor overall prognosis. Although aneurysm repair presents technical challenges, mortality is dependent upon the carcinoma and other vascular or medical diseases, and does not bear direct relationship to abdominal aortic aneurysm.

A Comparison of End Versus Loop Stomas for Ileal Conduit Urinary Diversion

We compared the loop and end stoma techniques for ileal conduit urinary diversion in 54 and 27 adults, respectively, with serious bladder disease during a 3-year interval. Followup by trained enterostomal therapists averaged nearly 2 years for all patients. Stenosis occurred in 12 end stomas (44 per cent) but not in any loop stomas. We believe that this result reflects the inherently better blood supply of the loop stoma, which we recommend over the end ileostomy for patients undergoing ileal diversion.

The Douglas County Model in Western Colorado

ABSTRACT In 2012 the Marmot Library Network implemented the Douglas County Library Model of ebook collection and circulation. By 2014 Marmot had loaded 838 ebooks purchased direct from publishers and independent authors to an Adobe Content Server, and made them available in an open source discovery layer based on VuFind. In late 2015, after 3 years of disappointing circulation and tedious acquisition processes, Marmot decided to move some of this collection to OverDrive and abandon the local ACS. This article reports lessons learned from that experiment. Column Editor’s Note This column focuses on formal collaboration and networking among libraries through consortia. It offers in-depth examinations of issues facing modern library consortia including (but not limited to) e-resource licensing, ebooks, next generation integrated library systems, shared print programs, shared digital repositories, governance, cooperative services and other relevant topics. Contributions are accepted for this column and must be submitted to George Machovec (george@coalliance.org). Contact the column editor for suggested topics, deadlines and formatting.

Iatrogenic hepatic subcapsular biloma following PCNL: Diagnosis and management.

After the first description in 1976, percutaneous nephrolithotomy (PCNL) remains the treatment of choice for large renal stones. Adjacent organ injuries are rare complications, with pulmonary and colonic representing the most common, while hepatic represents one of the rarest. We describe our case of hepatic subcapsular biloma following a subcostal PCNL, conservatively managed by percutaneous drainage and endoscopic biliary stenting.