Biomedical subjects
Publications and source records attributed to E Antebi.
Laparoscopy using carbon dioxide has been a standard gynecological procedure for many years. During the past 3 years, it has become commonly used in general surgery as well. Laparoscopic cholecystectomy is rapidly spreading world-wide. Although minor and major complications have been attributed to this procedure, their frequency is low. We report a case of subcutaneous emphysema following laparoscopic cholecystectomy.
This study was undertaken to determine the effect of various lipid emulsions on the hepato-biliary system in rats. Rats were randomly divided into six groups and infused continuously for 48 hr with either long-chain triglycerides (LCT), medium-chain triglycerides (MCT) or a mixture of MCT and LCT. One group infused with physiological saline solution served as controls. Throughout this period the rats received a fat free diet ad libitum. During the last hour of lipid infusion bile was collected for determination of bile flow and composition. Subsequently, the rats were sacrificed and the morphology and lipid content of the liver determined. Only LCT lipid emulsions induced morphological changes and increased liver cholesterol content. In two rats infused with radiolabeled LCT, no labeled cholesterol was found in the liver, indicating that the excess hepatic cholesterol level may originate from enhanced cholesterol mobilization to the liver. Biliary cholesterol and phospholipid concentrations in LCT-treated rats were also elevated, as was the lithogenic index, whereas the other emulsions had no such effects. None of the emulsions affected the plasma liver function tests or bile flow. We therefore conclude that the lithogenicity of the bile in rats is directly related to the lipid components of the total parenteral nutrition and the type of triglyceride infused.
A prospective study was performed to investigate the effect of short term lipid infusion on bile composition and its lithogenicity in humans. Thirty five patients shown to be free of cholesterol gall stones participated in the study. Starting 48 hours before surgery they were infused randomly with a lipid emulsion of either long chain triglycerides (LCT) or a mixture of medium and long chain triglycerides (MCT/LCT) (50%/50%) for six hours each 24 hours. A group of patients infused with a solution of 5% glucose in NaCl 0.9% served as a control. Bile samples were obtained by puncture of the gall bladder during operation. Both lipids caused an increase in biliary cholesterol and phospholipids but this effect was more pronounced and significant (p < 0.001) only with the MCT/LCT emulsion. The fatty acid composition of biliary phospholipids was not affected by either lipid infusion. The cholesterol saturation index increased significantly (p < 0.005) with the MCT/LCT emulsion and there was shortening in the nucleation time but this was not significant. There was no effect on the distribution of cholesterol between micelles and vesicles. This study shows that infusion of MCT/LCT lipid emulsion can cause lithogenic changes in bile composition in humans and may thus contribute to sludge formation and cholelithiasis during long term parenteral nutrition.
Auditory brainstem evoked response-(ABR) may be affected by changes in cerebral blood flow. Apart from its primary indications for prevention of stroke and transient ischemic attacks-(TIA's), internal carotid endarterectomy-(ICE) has been shown to improve cognitive function and cause diminution of tinnitus and vertigo. A one-week postoperative ABR previous study of patients undergoing ICE demonstrated no change in ABR recordings. In order to evaluate possible late changes, we have conducted a prospective study of the delayed effects of ICE on ABR in 13 patients. No initial pathology was noted and no significant change found in any of the absolute and interpeak latencies of ABR waves.
Subcutaneous venous catheter devices were implanted in 104 patients between January 1989 and June 1991. In 90% the implantation was performed under local anesthesia as an ambulatory procedure. In 85% the catheter was implanted for long-term chemotherapy and in 15% for intravenous feeding, antibiotic treatment or dialysis. There were postoperative complications in about 10%, the most frequent being infection of the surgical wound or of the catheter canal. Venous thrombosis, cutaneous necrosis and catheter occlusion were observed in only 5%. The main advantages of the method are its convenience for the patient, ease of installation and low rate of complications. From our experience we conclude that the implanted subcutaneous venous catheter is a simple and effective procedure for prolonged intravenous treatment.
The efficiency of magnetic resonance imaging (MRI) and that of transrectal ultrasound (TRUS) were compared in preoperative staging of 15 patients with rectal cancer and in postoperative follow-up of 12 patients. Thirteen of the 15 patients evaluated for preoperative staging were operated on. Preoperative staging and pathologic finding were identical in 11 patients (84.6 percent) examined by TRUS and in 10 patients (76.9 percent) examined by MRI. Recurrent cancer was detected in 3 of 12 patients in the follow-up group. MRI was able to diagnose correctly 10 of 12 patients (83.2 percent), one patient was misdiagnosed, and in one patient the MRI could not distinguish between fibrous tissue and recurrent cancer. TRUS diagnosed correctly only 5 of 12 patients (41.6 percent). One was falsely diagnosed, and, in 6 patients (50 percent), this examination could not differentiate between fibrous tissue and recurrent tumor. According to our results, both MRI and TRUS have a place in the preoperative staging of patients with rectal cancer. The main differences between the two methods were in the differential diagnoses of fibrous tissue and recurrent cancer. MRI being more specific in detection of recurrence.
The standard treatment for cholelithiasis is cholecystectomy at open operation, which requires relatively long hospitalization and long absence from work. These socio-economic factors and a desire to avoid operative trauma and its complications led to the development of noninvasive therapy. The methods used so far, stone dissolution and extracorporeal shock wave lithotripsy, have proven unsatisfactory. The first takes a long time and has a high recurrence rate, the second has relatively frequent complications. Furthermore, both methods leave the diseased gallbladder in place. During the past year laparoscopic cholecystectomy has been developed in various centers and has been adopted in our department. We describe our initial experience with the technique in 70 cases aged 18-79 years.
Duodenal duplication cysts are rare and are usually found in neonates or young children who present with obstructive symptoms. It accounts for 4-12% of all duplications in the gastrointestinal tract. The rate of other developmental abnormalities has been reported as high as 38%. In few instances have duodenal duplication cysts been described in adults. A case of duodenal duplication cyst in a 46-year-old woman is presented. The diagnosis was established preoperatively by computerized tomography and ultrasound examination.
False aneurysm of the carotid artery is a rare complication of carotid endarterectomy. We present a 65-year-old woman and a 68-year-old man with this condition. In 1 the artery had been closed with a Dacron patch graft, and in the other by direct suture. In the first case the aneurysm was successfully repaired with an expanded GoreTex (PTFE) patch graft sutured with monofilament nylon. In neither case was an organism grown from cultures taken at operation. The incidence of false carotid aneurysm as a complication of endarterectomy is only 0.3%. Usually infection is the main cause. It is therefore surprising that closure with a synthetic patch-graft is not a predisposing factor in the development of false carotid aneurysms, neither according to the literature nor in our own very limited experience with this complication.
Spontaneous biliary cutaneous fistula is a rare complication of inflammatory perforation of the gallbladder. We describe a 70-year-old woman who developed a fistula between the gallbladder and the skin following drainage of an abdominal wall abscess. In such cases primary drainage of the abscess alone is advisable. Only after the active infection has subsided should definitive cholecystectomy and excision of the fistulous tract be carried out.
A duodenal duplication cyst containing enteroliths in an adult patient is presented. The preoperative diagnosis was established by computed tomographic (CT) and ultrasound (US) examinations. To the best of our knowledge this is the first description of enteroliths in a duodenal duplication cyst.
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A possible involvement of chromosomal heterochromatic polymorphisms in propensity to cancer has been considered and discussed by several investigators who studied groups of patients presenting with different forms of malignancy. We report a cytogenetic study on the circulating lymphocytes of patients suffering from colorectal carcinoma, most of whom were of European origin. Significantly increased incidence of polymorphisms of chromosomes #1 and #9 was found, especially partial inversions (PI). Emphasis is given to the problem of selecting adequate controls, which must be as homogeneous as possible.
Sclerotherapy has a useful part in the conservative management of anal fissure. When compared with results obtained with routine forms of local treatment, it leads to a higher incidence of successful outcome and reduced number of patients coming to operation. The complication rate was almost nonexistent and in no instance led to any permanent effects. It is an outpatient procedure and can be done with a minimum amount of equipment, technical skill and expertise, resulting in immediate relief. It does not lead to accelerated healing; this is of no consequence since the patient is asymptomatic. We recommend this procedure for acute anal fissures which cause moderate to marked symptoms, particularly when other conservative methods have failed.
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