Use of CO2 to move structures as an aid to percutaneous procedures

By injecting small amounts of CO2 through a needle, one can move bowel or bladder from the intended path of instruments during interventional procedures. The technique worked well in six of seven cases in the pelvis and retroperitoneum; it was not effective in the mediastinum or midabdomen (n = 6).     

外科手术中产生的烟气:仅仅是大量的热空气吗?

外科医生和手术室人员经常接触手术设备产生的烟气,病人也会暴露于烟气中,特别是腹腔镜手术中产生的烟气滞留于腹腔内这一密闭空间并被吸收.这些烟气是一种与香烟烟气相似的毒性物质,然而对这种毒性物质的影响还未引起足够重视.应该采取必要措施尽可能减少手术中烟气的不良影响.     

Influence of thyroid hormones on rat cerebellar cell aggregation and survival in culture

In order to study the effect of thyroid hormones on rat cerebellar granule cells, cerebellar perikarya isolated from 5-7-day-old rats were cultured in the presence of normal fetal calf serum, fetal calf serum treated with Dowex-2 ion exchange resin to remove thyroid hormones, or ion exchange-treated serum resupplemented with physiological concentrations of T4 and T3. Granule cells grown under hypothyroid conditions showed abnormal cellular aggregation, neurite fasciculation and cell survival. Cell aggregation, which may be an in vitro correlate of cerebellar granule cell migration to the internal granule layer, was reduced by over 50% under hypothyroid conditions. The rate of protein synthesis in hypothyroid cultures was stimulated by as much as 3-fold compared to thyroid hormone-containing cultures consistent with a proposal that the normal developmental pattern of diminishing protein synthesis specific activity is delayed or prevented under hypothyroid conditions. In addition ultrastructural studies revealed abnormalities in the density of cold-stable microtubules in thyroid hormone-deficient cultures. These results demonstrate that thyroid hormones can influence granule neuron behavior in the absence of Purkinje cells. Furthermore, the observed defects bear numerous similarities to documented abnormalities within the hypothyroid cerebellum, suggesting that this in vitro culture system may serve as a useful model for studying the mechanism of action of thyroid hormones on the cells of the cerebellum.     

Calciphylaxis – a topical overview

'Calciphylaxis', a calcification syndrome associated with ischaemic cutaneous necrosis, is acquired naturally in humans in disease states. It is a life and limb-threatening complication, usually observed in patients with renal disease and secondary hyperparathyroidism, but known to occur in the absence of renal or parathyroid disease. The reported mortality rate, which ranges from 60-80%, relates to wound infection, sepsis and organ failure. It is a small-vessel vasculopathy, which is estimated to occur in about 4% of haemodialysis patients. Clinically, violaceous, reticulate areas of cutaneous necrosis and eschar may be evident, particularly in the extremities. In addition to the clinical picture, a raised calcium phosphorous product, an elevated parathyroid hormone level, radiographic evidence of vessel and soft-tissue calcification and the finding of mural calcification affecting small arteries and arterioles on histopathology help to confirm the diagnosis of this entity which generally has a poor prognosis. A high index of suspicion and an active multidisciplinary management approach, with rigorous attention to wound care and prevention of sepsis, are vital in the management of these patients. In this overview, we discuss the pathophysiology, clinical features and associations, risk factors, diagnosis and management issues relating to calciphylaxis.     

The Sigma-trial protocol: a prospective double-blind multi-centre comparison of laparoscopic versus open elective sigmoid resection in patients with symptomatic diverticulitis

Backround  

Diverticulosis is a common disease in the western society with an incidence of 33–66%. 10–25% of these patients will develop diverticulitis. In order to prevent a high-risk acute operation it is advised to perform elective sigmoid resection after two episodes of diverticulitis in the elderly patient or after one episode in the younger (< 50 years) patient. Open sigmoid resection is still the gold standard, but laparoscopic colon resections seem to have certain advantages over open procedures. On the other hand, a double blind investigation has never been performed. The Sigma-trial is designed to evaluate the presumed advantages of laparoscopic over open sigmoid resections in patients with symptomatic diverticulitis.