Intrapleural regional analgesia for pain management in cholecystectomy

Fifty patients undergoing cholecystectomy either electively or urgently were treated in the postoperative period with the intrapleural injection of 30 mL of 0.75% bupivacaine hydrochloride with epinephrine (1:200,000). The frequency of narcotic administration and the postoperative stay were compared with those of 50 historical controls. The group receiving intrapleural regional analgesia had significant, prolonged pain relief requiring minimal narcotic analgesics in the first 24 hours postoperatively and had a significantly shortened hospital stay. There were no complications related to catheter insertion or bupivacaine toxic effects. This technique is safe and effective in controlling perioperative pain.

Aortic injury occurring after minor trauma in ankylosing spondylitis

Lethal aortic injury as a result of fracture of the lumbar spine in a patient with ankylosing spondylitis is reported. This complication is a direct result of the pathophysiologic changes of ankylosing spondylitis that cause the aorta to become firmly adherent to the anterior longitudinal ligament. Recognition of the potential for this injury in patients with ankylosing spondylitis should prompt early investigation of the integrity of the aorta and planned reconstructive surgery for this potentially lethal injury.

Surgical management of the chronic venous ulcer: the Rob procedure

Eighteen operations for venous ulceration were performed through a stocking seam incision with only one recurrence and minimal wound problems. The prolonged morbidity of venous ulcer disease can be alleviated with the method described. By a history and clinical examination followed by venography, a group of patients with venous ulcers can be identified who will benefit from an aggressive surgical approach.