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Familial Retroperitoneal Fibrosis
0022-534 7/88/1396-1377$02.00/0 Vol. 139, June Printed in U.S.A.
THE J'OURNAL OF UROLOGY
Copyright© 1988 by The Williams & Wilkins Co.
ABSTRACTS INFECTIONS AND ANTIBIOTICS Familial Retroperiton.eal Fibrosis K J. DOOLIN, H. GOLDSTEIN, B. KESSLER, C. VINOCUR AND M. B. MARCHKLDON, Department of Surgery, Cooper Hospital/University Medical Center, Camden, New Jersey
abscesses and diffuse infections may be candidates for use of the zipper. Only selection of moderately ill patients will demonstrate the efficacy of these treatments and only a multicenter randomized stratified trial will prove efficacy or failure. 3 figures, 3 tables, 27 references Francisco T. Aledia, M.D. Columbus, Ohio
Ped. Surg., 22: 1092-1094 (Dec.) 1987 Two sisters with biopsy proved retroperitoneal fibrosis presented with weight loss and abdominal pain. The father of both had known juvenile rheumatoid arthritis. The father and both siblings had elevated erythrocyte sedimentation rates, antinuclear antibody titers and serum immunoglobulin E levels. 'rhe father and 1 sister had elevated immunoglobulins G and M. levels. 3 figures, 1 table, 5 references George W. Kaplan, M.D. San Diego, California
Leave the Abdomen Open for Peritonitis: Yes, No, Maybe?
NL A. MADDAUS AND R. L. SIMMONS, Departments of Surgery and Microbiology, University of Minnesota Hospital and Minneapolis, Minnesota 21: 1-17, 1988 A number of techniques to leave the abdomen open for have been used during the last 7 to 10 years. Several theoretical advantages are that it should promote drainage of fluid containing microbes and infection-potentiating agents (necrotic tissue, fluid and hemoglobin), cause less pulmonary corn.promise because the bowel, which is distended, edematous and filled with fluid, compresses the diaphragm and promotes vv,.""""'" of the lung, and provide access to and visualization of the abdominal contents. However, there are several potential serious disadvantages, such as massive fluid and protein losses from the inflamed, exposed surfaces of the intestine, formation of intestinal wound fistulas, evisceration of abdominal contents with subsequent need for ventilatory support and large wound hernias. Several techniques consist of packing the wound with gauze, dressing the wound with nonstick petrolatum and antibi.otires, placement of large moistened gauze over the viscera, into the right and left lateral colonic gutters and use of Marlex mesh. Also, instead of using Mar lex mesh others the bowel with large tubing to hold it in place and then several retention sutures across the wound. The rates ranged between 20 and 60 per cent. Because of the development of deep abscesses and failure to r<0solve the infections by leaving the abdomen open, planned abdominal re-exploration at regular, well defined intervals is a P"''"''"u'" means to overcome these problems. The theoretical nu,u.u,,~5,oc, of this procedure are intermittent removal of fluid, microbes and infection-potentiating agents; early detection of sepsis, intestinal leakage or necrosis; diminished fluid and protein losses, and, most important, the possibility of ,,v,mu,ac.uu, the persistence or eradication of the infectious process. The potential disadvantages are repeated use of anesthesia, fascial disruption and fistula formation. Patients with localized
Open Treatment of Pe:ritonitfo: An Argument Against E. V. KINNEY AND H. C. POLK, JR., Department of Surgery, University of Louisville School of Medicine, Louisville, Kentucky Adv. Surg., 21: 19-27, 1988 Open peritoneal drainage is an alternative method for peritoneal lavage and intraperitoneal antibiotics in the treatment of generalized peritonitis. While some investigators observed improved peritoneal drainage and easy access for repeated intra-abdominal debridement with open peritoneal drainage, others have been unable to achieve the same results. Frequent complications were observed, such as fistula formation, incomplete peritoneal drainage, wound closure problems, fluid loss from the wound, skin excoriation, evisceration, septic shock, renal failure and respiratory failure. Several investigators demonstrated that continuous peritoneal lavage was associated with low morbidity. However, this method needs prospective randomized assessment. The authors believe that a better alternative for future controlled study is the sporadically espoused but impressively effective continuing peritoneal lavage with dilute antibiotic solutions. 2 tables, 43 references Francisco T. Aledia, M.D. Columbus, Ohio
Placebo-Cont:rolled Trial of Topical Interferon in Labial and Gen.ital Herpes
M. GLEZERMAN, E. LUNENFELD, V. COHEN, I. SAROV, M. MOVSHOVITZ, T. DOEMER, J. SHOHAM AND M. REVEL, Division of Obstetrics and Gynecology, and Institute of Urology, Soroka Medical Center, Ben Gurion University, Beer Sheva; Department of Dermatology, Chaim Sheba Medical Center, Tel Hashomer; InterYeda Ltd., Ness Ziona, and Department of Virology, Wiezmann Institute of Science, Rehovot, Israel Lancet, l: 150- 152 (Jan. 23 ) 1988 A study was done of 25 patients with herpes of the lips or genitals who completed a 2-year followup in a double-blind trial of topical interferon-/3 ointment versus placebo. The results showed that application of interferon-/3 ointment 4 times daily during eruptions (about 10 days) significantly reduced the rate of recurrences and the duration of eruptions, while placebo had no effect. Itching, burning, pain and severity were improved in 11 of 12 patients treated with interferon-/3 ointment and in only 1 in the placebo group. No side effects were noted. This study seems to justify consideration of topical interferon-/3
1377
THE J'OURNAL OF UROLOGY
Copyright© 1988 by The Williams & Wilkins Co.
ABSTRACTS INFECTIONS AND ANTIBIOTICS Familial Retroperiton.eal Fibrosis K J. DOOLIN, H. GOLDSTEIN, B. KESSLER, C. VINOCUR AND M. B. MARCHKLDON, Department of Surgery, Cooper Hospital/University Medical Center, Camden, New Jersey
abscesses and diffuse infections may be candidates for use of the zipper. Only selection of moderately ill patients will demonstrate the efficacy of these treatments and only a multicenter randomized stratified trial will prove efficacy or failure. 3 figures, 3 tables, 27 references Francisco T. Aledia, M.D. Columbus, Ohio
Ped. Surg., 22: 1092-1094 (Dec.) 1987 Two sisters with biopsy proved retroperitoneal fibrosis presented with weight loss and abdominal pain. The father of both had known juvenile rheumatoid arthritis. The father and both siblings had elevated erythrocyte sedimentation rates, antinuclear antibody titers and serum immunoglobulin E levels. 'rhe father and 1 sister had elevated immunoglobulins G and M. levels. 3 figures, 1 table, 5 references George W. Kaplan, M.D. San Diego, California
Leave the Abdomen Open for Peritonitis: Yes, No, Maybe?
NL A. MADDAUS AND R. L. SIMMONS, Departments of Surgery and Microbiology, University of Minnesota Hospital and Minneapolis, Minnesota 21: 1-17, 1988 A number of techniques to leave the abdomen open for have been used during the last 7 to 10 years. Several theoretical advantages are that it should promote drainage of fluid containing microbes and infection-potentiating agents (necrotic tissue, fluid and hemoglobin), cause less pulmonary corn.promise because the bowel, which is distended, edematous and filled with fluid, compresses the diaphragm and promotes vv,.""""'" of the lung, and provide access to and visualization of the abdominal contents. However, there are several potential serious disadvantages, such as massive fluid and protein losses from the inflamed, exposed surfaces of the intestine, formation of intestinal wound fistulas, evisceration of abdominal contents with subsequent need for ventilatory support and large wound hernias. Several techniques consist of packing the wound with gauze, dressing the wound with nonstick petrolatum and antibi.otires, placement of large moistened gauze over the viscera, into the right and left lateral colonic gutters and use of Marlex mesh. Also, instead of using Mar lex mesh others the bowel with large tubing to hold it in place and then several retention sutures across the wound. The rates ranged between 20 and 60 per cent. Because of the development of deep abscesses and failure to r<0solve the infections by leaving the abdomen open, planned abdominal re-exploration at regular, well defined intervals is a P"''"''"u'" means to overcome these problems. The theoretical nu,u.u,,~5,oc, of this procedure are intermittent removal of fluid, microbes and infection-potentiating agents; early detection of sepsis, intestinal leakage or necrosis; diminished fluid and protein losses, and, most important, the possibility of ,,v,mu,ac.uu, the persistence or eradication of the infectious process. The potential disadvantages are repeated use of anesthesia, fascial disruption and fistula formation. Patients with localized
Open Treatment of Pe:ritonitfo: An Argument Against E. V. KINNEY AND H. C. POLK, JR., Department of Surgery, University of Louisville School of Medicine, Louisville, Kentucky Adv. Surg., 21: 19-27, 1988 Open peritoneal drainage is an alternative method for peritoneal lavage and intraperitoneal antibiotics in the treatment of generalized peritonitis. While some investigators observed improved peritoneal drainage and easy access for repeated intra-abdominal debridement with open peritoneal drainage, others have been unable to achieve the same results. Frequent complications were observed, such as fistula formation, incomplete peritoneal drainage, wound closure problems, fluid loss from the wound, skin excoriation, evisceration, septic shock, renal failure and respiratory failure. Several investigators demonstrated that continuous peritoneal lavage was associated with low morbidity. However, this method needs prospective randomized assessment. The authors believe that a better alternative for future controlled study is the sporadically espoused but impressively effective continuing peritoneal lavage with dilute antibiotic solutions. 2 tables, 43 references Francisco T. Aledia, M.D. Columbus, Ohio
Placebo-Cont:rolled Trial of Topical Interferon in Labial and Gen.ital Herpes
M. GLEZERMAN, E. LUNENFELD, V. COHEN, I. SAROV, M. MOVSHOVITZ, T. DOEMER, J. SHOHAM AND M. REVEL, Division of Obstetrics and Gynecology, and Institute of Urology, Soroka Medical Center, Ben Gurion University, Beer Sheva; Department of Dermatology, Chaim Sheba Medical Center, Tel Hashomer; InterYeda Ltd., Ness Ziona, and Department of Virology, Wiezmann Institute of Science, Rehovot, Israel Lancet, l: 150- 152 (Jan. 23 ) 1988 A study was done of 25 patients with herpes of the lips or genitals who completed a 2-year followup in a double-blind trial of topical interferon-/3 ointment versus placebo. The results showed that application of interferon-/3 ointment 4 times daily during eruptions (about 10 days) significantly reduced the rate of recurrences and the duration of eruptions, while placebo had no effect. Itching, burning, pain and severity were improved in 11 of 12 patients treated with interferon-/3 ointment and in only 1 in the placebo group. No side effects were noted. This study seems to justify consideration of topical interferon-/3
1377