'Essential' hypertension with hypokalemia. Caused by aldosterone-secreting adrenal adenoma.

Primary aldosteronism is a potentially curable cause of hypertension; it occurs in about 1% of hypertensive patients. In the case reported here, persistent hypokalemia developed in a 72-year-old man who had been treated for 13 years for essential hypertension. Investigation revealed elevated aldosterone level and reduced plasma renin activity. Computed tomography and selective angiography showed a tumor in the right adrenal gland. Aldosterone-secreting adenoma of the adrenal gland was diagnosed, and right adrenalectomy was performed. At a six-month follow-up examination, the patient's blood pressure and potassium level were normal.

Unusual presentation of carcinoma of the vermiform appendix: a report of two cases.

Two unusual presentations of perforated mucoid adenocarcinoma of the appendix are described. One patient presented with a large periappendicular abscess that extended into the gluteal region, the other with a retroperitoneal abscess and abscesses in the right flank and groin. Recognition of the source of the abscess may be difficult but is essential for the prevention and elimination of the sepsis which may be life-threatening. The presence of mucin in the drained pus is highly suggestive for perforated bowel carcinoma. A high index of suspicion and the performance of prompt diagnostic procedures may bring early surgical treatment and better results.

Granulomatous peritonitis caused by glove starch.

Corn starch particles are used as a surgical glove lubricant. At present there is no better alternative for this lubricant. Implantation of corn starch particles into the peritoneal cavity can induce foreign body reactions, starch peritonitis and starch granulomata, and may cause adhesions and intestinal obstruction. Starch peritonitis should be treated conservatively.

Smooth muscle tumors of the alimentary tract.

Smooth muscle tumors (SMT) of the alimentary tract are uncommon. A series of 32 cases (16 leiomyomas and 16 leiomyosarcomas) are presented. The most common presenting clinical signs are bleeding or obstruction. These are caused mainly by degenerative changes within the lesion or its enlargement. The endoluminal SMT cause symptoms early and are more easily detectable. However, the extraluminal SMT, producing an extrinsic mass, can remain asymptomatic for a long time. Thus, such SMT may be found incidentally during operation. The larger SMT are mostly malignant. Microscopically it is sometimes difficult to determine if the SMT is benign or malignant.

Endometriosis of the umbilicus.

Endometriosis is a common phenomenon. Most cases reported are pelvic endometriosis which cause typical symptoms. Cutaneous endometriosis is rare, usually appearing in surgical scars or following surgical procedures. Umbilical endometriosis can occur after surgery but is generally spontaneous. Six cases of spontaneous umbilical endometriosis are presented.

Leiomyosarcoma of the colon and rectum.

Leiomyosarcoma of the colon is an uncommon lesion and may appear throughout the colon. Early diagnosis is seldom accomplished before complications such as bleeding or obstruction appear. Sometimes it is histologically difficult to distinguish between a benign and a mlaignant leiomyoma. Some leiomyomas have biologic evidence of malignancy. Five cases of leiomyosarcoma are described, one of which was histologically diagnosed as a leiomyoma, but two years later, at laparotomy, metastases were found.

Thromboendarterectomy combined with femoropopliteal bypass.

Most complications that appear within 5-6 weeks after femoropopliteal bypass (FPB) are associated with the surgical procedure in the groin. Destruction of lymphatic structures in the presence of an open foot infection and crushing of the intima by clamping the common and deep femoral arteries are significant predisposing factors in producing early infection or occlusion of the graft. To avoid these predisposing factors, a combined procedure of a short thromboendarterectomy of the proximal superficial femoral artery and an autogenous or prosthetic bypass graft was used, without application of clamps to the common and deep femora arteris. In a series of 45 patients, this combined procedure was used and a significant reduction of complications was achieved. Indications, technique, and advantages of this combined method are discussed.

Colonic cancer and associated diverticulitis.

In a total group of 385 cases of colonic cancer, there was evidence of associated diverticulitis in 42 cases. Of these, 92% of the patients were over 60 years of age. In 45% of the cases the coexisting lesions were located in the sigmoid colon. It is suggested that cancer of the colon contributes to the development of diverticulosis and diverticulitis; this is confirmed by the finding of 52.8% of the total group of diverticulosis (98 cases) complicated by diverticulitis. Signs of diverticulitis may mask the presence of cancer, and the diagnosis of associated lesions is sometimes difficult. The patient's history and repeated radiographic studies play an important role in the detection of associated cancer. The final diagnosis is confirmed by pathologic examination.

Skin petechiae and ecchymoses (vasculitis) due to anticoagulant therapy.

The appearance of petechiae and ecchymoses following anticoagulant and fibrinolytic therapy is an unusual and rare complication. The mechanism of the vasculitis is obscure but may be related to a chemical vasotoxic reaction. During anticoagulant and fibrinolytic therapy, 6 patients developed petechiae and ecchymoses which was accompanied by pain and fever. There were no disturbances of blood clotting factors. In spite of the varied action of the different anticoagulants and fibrinolytic drugs, the clinical course and the histological examination demonstrated a similar identical vasculitis.

Fournier's gangrene complicating perinal abscess: report of two cases.

Two cases of Fournier's gangrene in which toxemia and gangrene of the scrotum developed due to perianal abscesses are described. Cultures of anaerobic gram-negative Bacteroides with a mixed flora of Pseudomonas, E. coli and Proteus were obtained. Early diagnosis, wide and deep incisions, debridement of the necrotic tissue, and adequate antibiotic therapy can prevent a fatal outcome of this disease. A high mortality rate is still prevalent.

Acute myocardial infarction and arterial embolectomy.

Emboli of a main artery cause serious complications in patients suffering from acute myocardial infarction, in whom the surgical risk is high. In order to save the limb, embolectomy is indicated and should be considered. Early diagnosis and prompt surgical intervention with the use of the Fogarty catheter simplify the embolectomy procedure and enable restoration of circulation to the ischaemic limb. Thirty-two embolectomies were performed in twenty-eight patients suffering from acute myocardial infarction. Patients with cardiac compensation survived the surgery and recovered. However 50% of the patients in whom acute myocardial infarction was accompanied with congestive heart failure and arrhythmias died. The cause of death was the underlying disease. Considering the severity of the acute myocardial infarction this group of patients represents the expected mortality.

Rupture of a hydatid cyst of the liver into the biliary tract.

Rupture of a hydatid cyst into the biliary tract occurs in 5% to 10% of patients with hydatid disease of the liver. The communication between the hydatid cyst cavity and the biliary tree may produce intermittent or progressive obstructive jaundice. The presence of such jaundice complicates the diagnosis since it resembles other biliary disorders such as stone or infection. We treated six patients with hepatic hydatid cysts, four with minute fissures and two with wide ruptures into the biliary tract. The pathophysiologic mechanisms, diagnostic procedures and treatment are discussed.