[Pleuroperitoneal communication: pleural effusion subsequent to the initiation of peritoneal dialysis, about a case]. / Communication pleuro-péritonéale : épanchement pleural consécutif à la mise en route d'une dialyse péritonéale, à propos d'un cas.

We report the case of a patient with pleural effusion occurring after initiation of a peritoneal dialysis. This phenomenon is favoured by the existence of a pleuroperitoneal communication. The latter is described at the origin of other diseases like catamenial pneumothorax and pleural effusion in connection with cirrhotic ascites. We describe this rare complication of peritoneal dialysis in order to draw attention of nephrologists, pulmonologists and surgeons.

Nous rapportons le cas d'un patient présentant un épanchement pleural après mise en route d'une dialyse péritonéale. La cause de ce phénomène est l'existence d'une communication pleuro-péritonéale. Cette dernière est décrite à l'origine d'autres pathologies comme le pneumothorax cataménial et l'épanchement pleural dans le cadre d'ascite cirrhotique. Nous décrivons cette complication rare de la dialyse péritonéale dans le but d'attirer l'attention des néphrologues, pneumologues et chirurgiens sur celle-ci.

Carotid endarterectomy in a low volume vascular centre.

BACKGROUND: Carotid endarterectomy (CEA) is considered the golden standard of treatment for carotid artery disease in selected patients. METHODS: We studied retrospectively 246 CEAs performed in our centre from 2000-2008, and assessed the complications occurring during the first 30 days postoperatively. Surgical indications included symptomatic carotid stenosis > or = 60% and asymptomatic carotid stenosis > or = 75%. All patients underwent CEA with systematic use of a shunt, under general anesthesia. All arteriotomies were patched. All patients were transferred to ICU for 24 hours postoperatively. Mean hospital stay was 4.2 +/- 0.9 days. Ultrasound was performed 1 month postoperatively. RESULTS: Death, stroke, myocardial infarction (MI) and transient ischemic attack (TIA) were considered as major postoperative complications during the first 30 days after surgery. One death (0.4%), one nonfatal MI (0.4%) and two TIAs (0.81%) were recorded, while no stroke was present. CONCLUSIONS: We demonstrated that carotid endarterectomy can be safely performed in our low volume vascular centre. (246 CEAs in a nine year period).

Should every patient undergoing laparoscopy for clinical diagnosis of appendicitis have an appendicectomy?

In cases of clinically suspected acute appendicitis, the rate of negative laparoscopic exploration ranges from 8 to 15%. In that situation, should we remove an apparently normal appendix or should we leave it in place? If there is no evidence of another cause to explain the acute right iliac fossa pain, it seems reasonable to proceed with an appendicectomy even if the appendix looks normal, because the rate of re-operation for recurrent symptoms is up to 6% and an endo-appendicitis which is defined as inflammation of the appendicular mucosa can be present in 11% to 26% of the cases. Anyway, the therapeutic decision is also influenced by the discussion between the physician and the patient before operation as well as by his past medical history. Good information about the risks and advantages of removal and nonremoval of an apparently normal appendix must be given.

Laparoscopic treatment of gallbladder duplication. A plea for removal of both gallbladders.

BACKGROUND: Gallbladder duplication is a rare congenital condition, which can now be detected preoperatively by imaging studies. METHODS: We report a case of duplicated gallbladder with symptomatic unilobar gallstones. Appropriate biliary workup (ultrasound, oral cholecystography, and intravenous cholangiography) allowed a correct preoperative diagnosis. RESULTS: Laparoscopic treatment included selective removal of the diseased accessory gallbladder. However, postoperative acute cholecystitis and symptomatic gallstone occurred in the remaining main gallbladder, and laparoscopic reintervention was required 27 months later. CONCLUSIONS: This case illustrates the need for complete removal of both gallbladders during initial surgery. Precise intraoperative recognition of vascular and biliary anatomy-including abnormalities-is highlighted to avoid mistakes during surgery.