Adventitial cystic disease of the popliteal artery.

In a 27-year-old man with claudication, computed tomography (CT) demonstrated a popliteal cyst and an adventitial cyst of the popliteal artery. Adventitial cystic disease was unexpected because the patient had a diminished pedal pulse on plantar flexion of the foot, a physical finding suggesting popliteal artery entrapment syndrome. CT was useful in the initial examination of this young patient with suspected popliteal vascular disease because of its accuracy and noninvasiveness.

Elective splenectomy in the elderly patient.

This report reviews 10 years' experience with elective splenectomy in patients over 55 years of age. Of 55 patients, 25 were over the age of 65. The majority of splenectomies (41) were performed for hematological disorders exclusive of lymphoma, but including ITP, hypersplenism (both primary and secondary), Felty's syndrome and myeloid metaplasia. Sixty-eight per cent of these patients responded to splenectomy with sustained elevation of platelet counts while 70 per cent responded to sustained elevation of leukocyte counts. Sixteen of the hematological patients received a preoperative trial of steroid therapy in an attempt to alleviate leukopenia or thrombocytopenia with a 37.5 per cent (6 of 16) success rate. There was no correlation between the response to preoperative steroid therapy and response to splenectomy. These data correspond favorably to previous published material in the younger aged patients. There was no difference in the postoperative complication rate related to drainage or nondrainage of the splenic bed. However, eight other complications occurred for a morbidity rate of 14.5 per cent in addition to complications related to drainage of the splenic bed (8%). A 9 per cent (5 of 55) mortality rate was related to the patients' pre-existing diseases and appears acceptable in light of hematological response rate and quoted mortality rates for splenectomy over age 65.

Brunner gland adenoma of the duodenum: resection through the fiberoptic endoscope.

We present a case of polypoid adenoma of the Brunner glands of the duodenum. The patient had upper gastrointestinal bleeding. Correct diagnosis of a polypoid mass in the first portion of the duodenum as the cause of bleeding was made, and the lesion was resected endoscopically via an endoscope, using a cautery snare. To our knowledge this is the first reported case of resection of a Brunner gland adenoma with endoscopy, and we hope to encourage the use of this technique for removal of polypoid lesions of the upper gastrointestinal tract.