An alternative technique for laparoscopic cholangiography

The current methods utilized for laparoscopic cholangiography involve cystic duct cannulation and present practical difficulties and potential hazards. An alternative method for intraoperative cholangiography is described which is easy, quick, and safe. The Kumar clamp (a gift from Sabi Kumar, M.D.) is placed across the infundibulum. A 23-gauge sclerotherapy needle is introduced through a side port in the clamp and directed into the infundibulum. The cholangiogram is obtained prior to any dissection in the triangle of Calot, thereby avoiding iatrogenic common bile duct injuries due to misidentification of the cystic duct or anomalous anatomy. To date no pathology has been missed and no complications have resulted from this technique.     

Maternal deaths from neurological complications of hypertensive crises in pregnancy

Fourteen maternal deaths from eclampsia or severe pre-eclampsia where disturbed cerebral function, as evidenced by prolonged unconsciousness, was given as the main cause of death are reviewed. Prolonged duration of seizures, hypotensive/hypoxic episodes, cerebral oedema and intracranial haematomas were most frequently identified as causative agents in the development of cerebral dysfunction. Failure to maintain an airway and iatrogenically induced hypotension were the two most important contributory factors to the patients' deaths. Management recommendations to prevent this type of maternal death are given.     

Clenched-fist injury complicated by methicillin-resistant Staphylococcus aureus

Hand infections are a common sequela of clenched-fist injuries. The majority of these infections are due to Staphylococcus and Streptococcus species. Methicillin-resistant Staphylococcus aureus (MRSA) is increasingly being isolated in Canadian health care facilities. In addition, MRSA now needs to be considered in community acquired hand infections that fail to respond to common empiric therapy. A 51-year-old man with MRSA due to a hand injury was treated successfully with vancomycin. The prevalence, mechanism of resistance and treatment of MRSA are briefly reviewed.     

Novel C3 nephritic factor activity in the glomerulonephritis of staphylococcal endocarditis

A case of glomerulonephritis complicating staphylococcal endocarditis is presented. Hypocomplementaemia and a C3-activating factor in the serum suggested that the patient might have mesangiocapillary glomerulonephritis in association with C3-nephritic factor. Renal biopsy showed that this was not so and further examination of the serum factor showed that it differed from classical C3-nephritic factor because it was not an immunoglobulin. It is postulated that complement activation and glomerulonephritis in staphylococcal endocarditis may be the direct result of a bacterial product. A substance in the serum which activates C3 should be confirmed to be an immunoglobulin before the presence of classical C3-nephritic factor is assumed.     

Two levels of alliance formation among male bottlenose dolphins (Tursiops sp.)

In Shark Bay, Western Australia, male bottlenose dolphins (Tursiops sp.) cooperate in pairs and triplets to sequester and control the movements of females. We refer to this behavior as "herding" and to the male pairs and triplets as alliances. During a 25-month study (1987-1989) on the social relationships of males, we documented herding in 10 alliances. Males preferentially herded nonpregnant females likely to be in estrus. Alliance members associated with one another consistently when not herding females. Each alliance associated preferentially with one or two other alliances. Occasionally, two alliances combined and took females from another alliance or defended females against such efforts. This study documents multiple-level male alliances within a social group outside of humans.     

Chloride fluxes in crab muscle fibres

1. Isotopic techniques were used to study the efflux of Cl(-) from single cannulated muscle fibres of the crab Maia squinado.2. The efflux of (36)Cl(-) was found to be exponential with steady rate constants ranging from 0.01 to 0.07 min(-1). The steady efflux was ca. 1000-2000 pM cm(-2) sec(-1). The efflux was slightly depressed by K(+)-free saline and was unaffected by 40 mM-K(+) saline and NO(3) (-) saline. The influx and efflux of Cl(-) were presumed independent.3. The membrane conductance calculated from (36)Cl(-) flux data was consistent with that determined by the method of electrotonic spread for other marine crustacean muscle fibres. Cl(-) accounted for most of the membrane conductance.