Laparoscopic pericardial window.

The patient with a malignant pericardial effusion can be extremely difficult to treat and provide optimal palliation. The performance of transabdominal laparoscopic pericardial window may prove to be a significant advance in the management of these individuals. No previously reported description of this procedure has been found in the world literature as far back as 1966. A presentation of the case, description of the surgical procedure, and discussion of the therapeutic implications are provided.

Gallbladder disease in young women.

The records of 96 young women 25 years of age and less, who underwent cholecystectomy in the years 1977 to 1980 inclusive, were reviewed looking for correlations among obesity, parity, oral contraceptive usage and gallbladder disease. The main risk factor in this population was the presence, either past or present, of pregnancy. Oral contraceptive usage and obesity did not result in an increased risk of having gallbladder disease develop in this population. It is believed that this population is too young to demonstrate such an association. It was only when coupled with pregnancy that obesity or oral contraceptive usage resulted in an increased risk of having gallbladder disease develop.

PIP: The records of 96 women aged 25 or under who underwent elective or urgent cholecystectomies between 1977-80 in a university-affiliated community hospital were analyzed to identify a possible correlation between obesity, pregnancy, use of oral contraceptives (OCs), and cholelithiasis. The control population was a randomly selected sample of women patients of comparable age and race who underwent appendectomy in the same period. In a comparison of the groups as a whole, obesity, parity, and OC usage were found to be more prevalent in those who had had a cholecystectomy, with differences statistically significant at the .05 level for each factor. Analysis of 1 variable demonstrated that only parity was more common in those who had had a cholecystectomy, and obesity alone or OC use alone were about equally frequent in both groups. When dual combinations were reviewed, pregnancy and obesity and pregnancy and OC use were more common in the cholecystectomy group. The most striking finding was the high proportion of women in the cholestectomy group, 72.9%, who were or had been pregnant, compared to 22.9% in the control group. OC use and obesity did not result in increased risk of gallbladder disease, probably because the population was too young to demonstrate such an association. Parous patients with gallbladder disease should be strongly encouraged to lose weight if obese, and, whether obese or not, should not be given estrogen-containing OCs.