Relationships of gastrin to duodenal ulcer disease in man and the effects of surgery

There is well documented evidence indicating inappropriately high basal gastrins in patients with duodenal ulcer disease. After stimulation by protein meals, calcium infusion, and insulin-induced hypoglycemia there appears to be an exaggerated release of gastrin in patients with duodenal ulcers compared to control subjects. Vagotomy in general tends to increase serum gastrin by decreasing acid secretion and allowing less inhibition for antral gastrin release. This increase appears less with selective vagotomy and parietal cell vagotomy compared to truncal vagotomy, suggesting vagal inhibition of gastrin release outside the antrum. Antrectomy may decrease serum gastrins by removing a major source of the hormone. However, extra antral gastrin sources, if stimulated properly, may result in little postoperative change.     

Mortality and complications after stoma closure

HYPOTHESIS: This study was undertaken to evaluate factors contributing to hospital mortality and complications of stoma closure. DESIGN: Retrospective cohort study. SETTING: Department of Surgery of a 2500-bed university hospital. PATIENTS: Consecutive eligible patients who underwent stoma closure were selected from a local registry containing 30 219 patients. The medical records of 587 adult patients were reviewed according to a predefined extraction form. Patients with additional, unrelated surgical interventions or younger than 18 years were excluded. Follow-up was complete for all included patients. MAIN OUTCOME MEASURES: The primary outcome variable was 30-day mortality; the secondary outcome variable was presence of surgery-related complications within 30 days. RESULTS: We analyzed 533 patients with stoma closure between 1993 and 2001. The overall stoma closure-related mortality rate was 3% (15 patients); the overall stoma closure-related surgical complications rate was 20% (107 patients). Wound infections (9%) and anastomotic leakage (5%) were the most common surgical complications. Age was the only significant risk factor for survival (P = .02). Use of a soft silicone drain for intraperitoneal drainage (odds ratio, 1.62 [95% confidence interval, 1.07-2.45]; P = .03) was the only significant risk factor for complications. In patients with carcinoma as the primary disease (odds ratio, 0.61 [95% confidence interval, 0.40 to 0.93]; P = .02), we observed significantly fewer complications. CONCLUSIONS: We found considerable mortality and complications after stoma closure. Apart from age, we could not identify any predictor for mortality in patients with stoma closure. Randomized studies are needed to determine whether certain types of drains influence outcome.     

Hepatocyte function in a radial-flow bioreactor using a perfluorocarbon oxygen carrier

The aims of this study were, first, to indicate the metabolic activity of hepatocytes in a radial-flow polyurethane foam matrix bioreactor relative to monocultures, and second, to evaluate the effect on the hepatocytes of including a synthetic perfluorocarbon (PFC) oxygen carrier to the recirculating medium. The efficient O2-carrying ability of PFCs may be beneficial to bioreactors employed in stressed cellular environments. Thus, they may also be useful in the treatment of an acute liver failure patient with a bioartificial liver support system (BALSS). Data on the function of three-dimensional (3-D) hepatocyte cultures exposed to emulsified PFCs are lacking. RESULTS: the metabolic functions of the 3-D hepatocyte cultures were improved relative to monocultures. Three-dimensional cultures with and without PFC behaved similarly, and no adverse effects could be detected when PFC was included in the recirculating medium. The addition of PFC significantly improved lidocaine clearance possibly due to the presence of higher O2 tension in the medium. Imaging indicated that large aggregates formed and that seeding had followed flow through the matrix. Simulations indicated first, that the cell numbers used in this study had been insufficient to challenge the bioreactor O2 supply explaining the similarity in performance of the 3-D cultures, and second, that the benefit of adding PFC would be more pronounced at the cell densities likely to be used in a BALSS bioreactor.     

Depot local anesthetic in polymethylmethacrylate bone cement: a preliminary study

Acrylic bone cement has been used successfully as a slow-release depot for antibiotics after orthopaedic surgery. The feasibility of administering local anesthetics in this way was examined in this preliminary in vitro study. Discs weighing approximately 4 g were prepared from five brands of acrylic cement (40 g) containing as much as 2 g of anesthetic base. Elution of the anesthetics into saline was measured during 72 hours. Prilocaine eluted the fastest and bupivacaine the slowest, with lidocaine between them. The elution rates were greatest in the first hour, declining thereafter. Rates also depended on the brand of cement with the quickest elution from CMW3 and the slowest from Surgical Simplex P. Using cement as a depot, therapeutic levels of a drug should be achievable in vivo at a negligible risk of toxicity. Before in vivo trials it is necessary to optimize elution of drugs in relation to the cement (brand, microstructure, method of preparation) and the concentration of a drug in the cement above which the cements' mechanical and adhesive properties are compromised.     

Pattern of diabetic neuropathic arthropathy associated with the peripheral bone mineral density

The relationship between the bone mineral density (BMD) and Charcot arthropathy is unclear. Prospectively, 55 consecutive diabetic patients presenting with a Charcot arthropathy of the foot or ankle were classified as having a fracture, dislocation, or a combination fracture-dislocation pattern of initial destruction. In these groups we used dual-energy x-ray absorptiometry to compare the peripheral bone of the affected and unaffected limbs. The clinical data relating to diabetes and related major comorbidities and the site of the arthropathy (ankle, hindfoot, midfoot, forefoot) were also compared. There were 23 patients with a fracture pattern, 23 with a dislocation pattern, and nine with a combination. The age-adjusted odds ratio for developing a Charcot joint with a fracture pattern as opposed to a dislocation pattern in patients with osteopenia was 9.5 (95% confidence interval 2.4 to 37.4; p = 0.0014). Groups also differed as to the site of the arthropathy. Fracture patterns predominated at the ankle and forefoot whereas dislocations did so in the midfoot. Diabetic Charcot arthropathy of the foot and ankle differs according to the pattern of the initial destruction. The fracture pattern is associated with peripheral deficiency of BMD. The dislocation pattern is associated with a normal BMD.     

Laparoscopic surgery in situs inversus: a literature review and a report of laparoscopic sigmoidectomy for diverticulitis in situs inversus

Background Situs inversus (SI) is a rare autosomal recessive congenital defect in which the position of abdominal and/or thoracic organs is a mirror image of the normal one, in the sagittal plain. In 25% of these cases, SI is part of the Kartagener syndrome, together with bronchiectasis and chronic sinusitis.Methods We present a case of a patient with Kartagener syndrome and complete SI that was laparoscopically operated on for diverticulitis. We also review the published English information available on this rare condition.Results A review of the literature revealed another single case of laparoscopic sigmoidectomy and 27 cases of other laparoscopic interventions in the presence of SI. Those laparoscopic procedures included basic procedures such as explorations and cholecystectomies, as well as advanced procedures such as gastrectomy and gastric bypass.Conclusion The laparoscopic approach is feasible in cases of SI, although technically more complicated because of the different position of the organs and the different laparoscopic view of the anatomy.