Single breath diffusing capacity for carbon monoxide in stable asthma.

BACKGROUND: Single breath diffusing capacity for carbon monoxide (Dco) is commonly used as a simple method of assessing overall pulmonary gas exchange properties. Studies of Dco in bronchial asthma have yielded conflicting results. OBJECTIVE: To study Dco and to determine the factors influencing Dco in patients with asthma. METHODS: Dco was prospectively measured in 80 consecutive never-smoker patients with uncomplicated stable asthma. The topographic distribution of lung perfusion was determined in 10 asthmatics and 10 controls, with a 133Xe radionuclide scan. RESULTS: The mean (SD) value of Dco was increased to 117 (17) percent of predicted values; individual values were either within or above normal limits; diffusion was also elevated at 116 (19) percent after correction for alveolar volume (transfer coefficient, D/VA). The Dco was not correlated with atopic status, duration of asthma, or results of spirometric tests; there was a weak negative correlation between D/VA and FEV1 or residual volume. There was a better perfusion of the upper zones of the lungs in asthmatics as compared with controls. Among the asthmatics, there was a strong positive correlation between Dco and the apex to base perfusion ratio (r = 0.975). CONCLUSIONS: Dco is normal or high among never smoker patients with uncomplicated asthma; elevated Dco may be attributed to a better perfusion of the apices of teh lungs; the latter could result from two mutually nonexclusive mechanisms: an increase in pulmonary arterial pressure and/or a more negative pleural pressure generated during inspiration as a consequence of bronchial narrowing. The unexpected finding of high Dco should raise the possibility of bronchial asthma in patients with otherwise undiagnosed conditions.

Is laparoscopic splenectomy a justified approach in hematologic disorders? Preliminary results of a prospective multicenter study. Belgian Group for Endoscopic Surgery.

The feasibility and safety of laparoscopic splenectomy were evaluated in a prospective multicenter study of 50 patients operated on for idiopathic thrombocytopenic purpura (ITP) (n = 31), hereditary spherocytosis (n = 6), hemolytic anemia (n = 4), Hodgkin's disease or lymphoma staging (n = 5), benign splenic tumors (n = 3), and wandering spleen (n = 1). Conversion to laparotomy was required in 10%. An accessory spleen was routinely searched for, although the lesser sac was opened during surgery in only 10%; the overall incidence was 14%. Hospital mortality was 2% and postoperative morbidity 22%. Postoperative hospital stay and home rehabilitation were improved when exclusively laparoscopic splenectomy was performed. In ITP patients, at a mean follow-up of 8.2 months, 8 patients (27%) had recurrence of thrombocytopenia, which was transient in 7% and permanent in 20%. Laparoscopic splenectomy is feasible and safe when performed in selected patients by expert laparoscopic surgeons. Adequate selection of patients and routine, careful search for accessory spleen are critical. The recurrence rate (20%) for ITP was high at 8.2 months, and this factor is the major limitation of laparoscopic splenectomy at present.

Laparoscopic splenectomy for idiopathic thrombocytopenic purpura.

Laparoscopic splenectomy was performed on eight patients with idiopathic thrombocytopenic purpura refractory to medical treatment. Preoperative infusion of immunoglobulin G gamma-globulin was used to boost the platelet count. Accessory spleens were sought by preoperative computed tomography and peroperative examination of the usual anatomical locations. Seven patients underwent successful laparoscopic splenectomy, with a mean postoperative stay of 3.6 days. One patient with an accessory spleen detected before operation but not during laparoscopy required conversion to open surgery for control of haemorrhage from the splenic hilum. Another patient had a transient pancreatic fistula. Laparoscopic splenectomy is feasible and sfe in patients with idiopathic thrombocytopenic purpura. Long-term results require evaluation as detection of accessory spleens can prove difficult during laparoscopy.

Testicular torsion after previous orchidopexy for undescended testis.

We report one case of acute testicular torsion following orchidopexy for an undescended testis. A review of the literature reveals only ten similar cases. History of a previous testicular surgery should not preclude the possibility of a torsion in that testicle. We conclude that at orchidopexy for an undescended testis, eversion of the tunica vaginalis is an essential step to avoid any future torsion.

Is adrenalectomy part of radical nephrectomy?

Standard radical nephrectomy entails en bloc removal of the kidney together with Gerota's fascia and the ipsilateral adrenal. Thanks to the refinement of imaging techniques (ultrasound, CT and MRI), smaller tumors are being diagnosed. In addition, direct extension to the adrenal gland or adrenal metastasis can be detected in most cases. This is why several authors reserve adrenalectomy for large and/or upper pole tumors or abnormal appearing glands on preoperative CT-scan. However, preoperative diagnosis is not always accurate. Furthermore, micrometastatic adrenal invasion at the time of nephrectomy and late recurrences in the persistent adrenal have been documented, so that partisans of adrenalectomy only spare the adrenal in exceptional cases. The authors have reviewed several series in the litterature as well as there own, and conclude that ipsilateral adrenalectomy can be omitted for small middle- or lower pole tumors when the adrenal appears normal on CT and during the surgical intervention.

[Correction of severe median hypospadias. Review of 77 cases treated by the onlay island flap technic]. / Correction des hypospades de gravité moyenne. Revue de 77 cas traités par la technique du "onlay island flap".

Seventy-seven hypospadias, selected from a series of 504 treated in our institution, were operated using the pediculated transverse "onlay" preputial graft. We try to demonstrate that this technique produces excellent functional and cosmetic results. Chordee can be corrected using extensive dissection of the urethral plate with association, if necessary, of a Nesbit type of dorsal plication. Complications rate, in our hands, is lower in comparison to the technique described by John Duckett, where the urethral plate is divided and a complete urethral tube is performed. We report 4 fistulas, one distal end breakdown of the repair and one postoperative hematoma that had to be revised. Because of this low complication rate, in many cases, the "onlay" pediculated graft replaces advantageously the Duckett type of repair.