Single-Incision Laparoscopic Cholecystectomy: our experience and review of literature

Aim

After the revolution in the surgery of gallbladder stones represented by the laparoscopic cholecystectomy, we tried a new technique that further maximize the aesthetic results and that at the same time is of easy learning for young surgeons.

Patients and methods

From January 2011 to December 2012 we performed at our department 320 cholecystectomy: 27 in laparotomy and 293 in laparoscopy. Of these, 88 underwent to Single Incision Laparoscopic Surgery (SILS), namely the Single Incision Laparoscopic Cholecystectomy (SILC), in recruited patients aged between 19–65 years; 56 patients were females and 32 were males.

Results

The laparoscopic cholecystectomy with the SILS methodology is a safe technique. Respect to multi-port Laparoscopic Cholecystectomy (LC), we have cosmetic advances. The pain is less in extra-umbilical sites, and the major umbilical pain can be prevented by local anaesthesia.The times are slightly longer, especially at the beginning of training, but after a few of operations it is reduced to about one hour.We didn’t found any other difference in vantage and advantage between the two technics, only a case of postoperative umbilical hernia in SILS.

Conclusion

We found the SILS a safe and effective technique for the cholecystectomy.     

Effect of Ionophore Challenge on Hamster Egg Penetration and Acrosome Reaction of Antibody-Coated Human Sperm

PROBLEM: Following the demonstration that antisperm antibodies do not affect the spontaneous acrosome reactions (AR) of human sperm used for the hamster egg penetration assay (HEPA), we evaluated the effect of the ionophore challenge on HEPA and AR of antibody-coated sperm. METHOD: Motile sperm suspensions from donors were exposed to serum and seminal plasma samples with sperm-head-directed antibodies, washed, capacitated, and challenged with ionomicin. RESULTS: The proportion of acrosome-reacted sperm, assessed by fluoresceinated Pisum sativum agglutinin and supravital stain Hoechst 33258, was significantly higher in the antibody-exposed sperm than in the controls (47.0 ± 13.2% vs. 39.3 ± 12.1, respectively; P < 0.05). However, the hamster egg penetration rate and index were not significantly different between antibody-exposed sperm and controls (98.0 ± 3.7% vs.85.9 ± 16.2% and 6.64 ±4.1 vs. 6.81 ± 4.8, respectively). Only one of eight test samples with antisperm antibodies, where the highest increase of AR rate compared with controls was observed (55.0% vs. 35.6%) produced a substantial increase of penetrations per oocyte (7.4 vs. 4.1). CONCLUSION: The ionophore challenge enabled us to recognize a subtle effect of antisperm antibodies on the dynamics of acrosomal loss, the clinical relevance of which needs to be elucidated.     

Carcinoembryonic Antigen as a Monitor in Breast Cancer

ABSTRACT: Carcinoembryonic antigen (CEA) levels were serially determined in 125 patients with breast cancer in order to study the diagnostic and prognostic use of serum CEA levels before and/or after surgery and during treatment with hormonal and chemotherapy. Serum CEA levels were elevated in 15.5% of nonmetastatic patients. Carcinoembryonic antigen increased according to stage (TNM classification); and a direct relationship between positive CEA levels and subsequent recurrence was found. After a three-year postoperative interval a 50% survival rate was exhibited in CEA-positive patients vs an 88% survival rate in those patients found to be CEA negative. There is a definite correlation between the trend of serial CEA values and the response to therapy and the development of metastases despite the fact that metastases occurred in CEA-negative patients. Therefore CEA assay is a useful and simple adjuvant test of monitoring metastatic and nonmetastatic breast cancer.     

Immunological Screening of a Male Population with Infertile Marriages

Summary: Four hundred not preselected male partners of infertile marriages were screened for the presence of anti-sperm antibodies. Serum and seminal plasma specimens from each patient were tested by the modified slide agglutination test (MSAT) and by the sperm-immobilization test. In addition, the IgG MAR test was performed on fresh ejaculates. Thirteen per cent of patients showed sperm agglutinating activity in serum and 5.7% also in seminal plasma. Sperm-immobilizing activity was found in 4.7% of serum and 1% of seminal plasma specimens, always associated with a high titre of sperm agglutinating activity. A highly significant linear correlation was found between the results of the MAR test and serum sperm-agglutinating activity; the presence of sperm-agglutinating activity in seminal plasma was always associated with MAR test positivity > 50%. The incidence of anti-sperm antibodies was not significantly different in patients with normo-, oligo- and azoospermia. The effectiveness and the easiness of both the MAR test and the MSAT do not justify, in our opinion, the utilization of more complex and expensive techniques for the detection of anti-sperm antibodies. Zusammenfassung: Immunologische Screening-Untersuchungen einer männlichen Population aus sterilen Ehen Vierhundert nicht ausgewählte männliche Partner steriler Ehen wurden auf das Vorhandensein von Spermaantikörpern untersucht. Serum- und Spermaplasmaproben eines jeden Patienten wurden anhand des modifizierten Slide-Agglutinationstests (MSAT) und Sperma-Immobilisationstests untersucht. Zusätzlich wurde der IgG MAR Test am frischen Ejakulat vorgenommen. 13% der Patienten wiesen Spermaagglutinations-Aktivitát im Serum und 5,7% ebenso im Spermaplasma auf. Spermaimmobilisierungsaktivität wurde in 4,7% der Serum- und in 1% der Spermaplasmaproben gefunden, jeweils in Verbindung mit einem hohen Sperma-Agglutinations-Aktivitäts-Titer. Zwischen den Ergebnissen des MAR-Tests und der Spermaagglutinationsaktivität wurde eine hochsignifikante lineare Korrelation gefunden. Das Vorhandensein spermaagglutinierender Aktivität im Spermaplasma trat immer in Verbindung mit einem positiven MAR Test von über 50% auf. Das Auftreten der Antisperma-Antikörper war nicht signifikant unterschiedlich bei Patienten mit Normo-, Oligo- und Asthenozoospermie. Die Effektivität und Leichtigkeit sowohl des MAR-Tests als auch des MSAT rechtfer-tigen unserer Meinung nach nicht die Benutzung komplexerer und teurerer Techniken, urn Antisperma-Antikorper nachzuweisen.