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Pleuroperitoneal communication is a complication of continuous ambulatory peritoneal dialysis (CAPD) that can necessitate cessation of CAPD. Hemodialysis was started on a 52-year-old woman and shifted to CAPD 1 month later. However, 18 days after initiation of CAPD, her chest radiograph showed a right-side hydrothorax. Thoracentesis yielded a colorless pleural effusion with markedly higher glucose levels than in her serum, indicating the presence of pleuroperitoneal communication. Three days later, thoracoscopic surgery was performed. A colored dialysis solution preoperatively injected into the abdominal cavity identified intraoperatively leakage from the diaphragm. The leakage points were closed by a no-knife-type automatic stapler with absorbable polyglycolic acid felt and fibrin glue. CAPD was restarted on the operative day, and there was no recurrence of the right hydrothorax. We conclude that this simple method can be used effectively to treat pleuroperitoneal communication. [ABSTRACT FROM AUTHOR]

Objective: Cytokine induction can occur routinely in cardiac surgery with cardiopulmonary bypass. We have studied the relationships between the kinetics of pro-inflammatory cytokine release and the postoperative organ function. Methods: Ten adult patients (6 men and 4 women) undergoing elective cardiac surgery with cardiopulmonary bypass, at Hiroshima University Hospital were studied. Patients with acute infection, insulin-dependent diabetes, acute or chronic respiratory failure, renal or hepatic failure, acute cardiogenic shock, and emergency patients were not included. The age of the patient ranged from 44 to 78 years (mean 69±2.0 years). The type of surgical intervention performed was coronary artery bypass grafting in four patients, mitral valve plasty or replacement with modified maze procedure in another five patients, and both procedures in the other one patient. Plasma cytokine levels until 48 hours after aortic declamping were measured in blood samples. The Respiratory Index and the serum levels of choline esterase and creatinine were also measured. The plasma levels of the pro-inflammatory cytokines (interleukin-6 and interleukin-8) were measured. Results: The highest interleukin-6 levels were significantly correlated with hepatic dysfunction (r=−0.80, p=0.0) and with renal dysfunction (r=0.78, p=0.009). The highest interleukin-8 levels were significantly correlated with respiratory dysfunction (r=0.86, p=0.001). Conclusion: The highest proinflammatory cytokines levels at 1 hour after aortic declamping were related to damage to postoperative organ functions, involving the lung, kidney and liver. [ABSTRACT FROM AUTHOR]