Pneumoperitoneum has been reported in 11-34% of patients undertaking CAPD, usually in the absence of symptoms. 2-4 It is only the small minority with abdominal symptoms who create a diagnostic dilemma. Among general surgical patients with gastrointestinal perforation 60-80% have free subdiaphragmatic air on an erect chest X-ray. 5 In CAPD patients the specificity of this sign is much lower. Some workers have suggested that a large pneumoperitoneum is indicative of visceral perforation 3-4 but this is not always so. 6 Furthermore, peritoneal dialysis fluid may dilute the initial intraperitoneal contamination that follows gastrointestinal perforation and, together with intraperitoneal antibiotics, mask clinical signs. 7 Regular assessment is essential in those treated conservatively. In addition, the content of the CAPD effluent can be revealing: it may contain faeces, food or bile. If it does not, microscopy and Gram stain can be done quickly. Mixed Gram-negative or anaerobic organisms suggest perforation; a single organism, particularly if a staphylococcus, is more consistent with CAPD peritonitis (as in cases 1 and 2). Individuals with ESRF are often elderly, with co-morbidity, 8 and laparotomy presents a substantial risk. 9 Also it may necessitate termination of this mode of dialysis, as in case 3. The decision to operate should be based on microbiological evidence and the clinical judgment of the surgeon.

Objective The objective of this study was to determine the prevalence of benign vocal fold lesions (BVFLs) in patients with chronic cough over a 1-year period. Study Design Case series with chart review. Setting Tertiary academic medical center. Subjects and Methods A retrospective cohort study of patients with chronic cough seen in our tertiary multidisciplinary cough clinic from 2016 to 2017 was conducted. Patient characteristics, presence of BVFLs by laryngoscopy, and Leicester Cough Questionnaire (LCQ) were recorded. Results A total of 419 patients were included (average age: 61 years), and 67% of patients were female. Ten percent of patients had BVFLs: granuloma (5%), leukoplakia (3%), nodules (2%), and polyps (1%). Median cough duration was 2.9 years (interquartile range [IQR], 0.7-8.5); no significant difference in median cough duration was observed between patients with BVFLs and those with no lesions (2.6 vs 3.0 years, P = .86). In total, 178 patients (42%) had available LCQ data: median score of 10.2 (IQR, 7.9-13.9); no significant difference in median LCQ was observed between patients with BVFLs and those with no lesions (10.5 vs 10.1, P = .54). Conclusion Prevalence of BVFLs in our cohort of patients with chronic cough was 10%, with posterior glottic lesions—granuloma—being the most common (5%). Prevalence of midmembranous lesions was as follows: vocal fold nodules (2%) and vocal fold polyps (1%). BVFLs were not associated with longer cough duration or more severe cough. We cannot determine a causative or noncausative relationship between BVFLs and chronic cough at this time due to lack of a control group.

Pneumoperitoneum has been reported in 11-34% of patients undertaking CAPD, usually in the absence of symptoms. 2-4 It is only the small minority with abdominal symptoms who create a diagnostic dilemma. Among general surgical patients with gastrointestinal perforation 60-80% have free subdiaphragmatic air on an erect chest X-ray. 5 In CAPD patients the specificity of this sign is much lower. Some workers have suggested that a large pneumoperitoneum is indicative of visceral perforation 3-4 but this is not always so. 6 Furthermore, peritoneal dialysis fluid may dilute the initial intraperitoneal contamination that follows gastrointestinal perforation and, together with intraperitoneal antibiotics, mask clinical signs. 7 Regular assessment is essential in those treated conservatively. In addition, the content of the CAPD effluent can be revealing: it may contain faeces, food or bile. If it does not, microscopy and Gram stain can be done quickly. Mixed Gram-negative or anaerobic organisms suggest perforation; a single organism, particularly if a staphylococcus, is more consistent with CAPD peritonitis (as in cases 1 and 2). Individuals with ESRF are often elderly, with co-morbidity, 8 and laparotomy presents a substantial risk. 9 Also it may necessitate termination of this mode of dialysis, as in case 3. The decision to operate should be based on microbiological evidence and the clinical judgment of the surgeon.