The case for laparoscopic common bile duct exploration

The modern surgeon's approach to choledocholithiasis depends his or her view of cholangiography. During the early 1990 there was a swing away from cholangiography, which had previously been common practice. This was because of perceptions of difficulty with the technique, the time it took, and perhaps an implied increase in costs because of the time factor. There was no evidence on which to base this decision. This led to a marked upswing in the use of endoscopic retrograde cholangiopancreatography (ERCP). There were a large number of ERCPs with normal results performed prior to laparoscopic cholecystectomy. This paper states the case for intraoperative cholangiography and common bile duct clearance at the time of cholecystectomy. It is hoped that this technique will be adopted so patients can undergo a single procedure to remove their gallstones and common bile duct stones if they exist and to decrease the incidence of normal preoperative ERCPs and the need for a second procedure postoperatively to clear stones if they are found.     

Review of novel particulate antigen delivery systems with special focus on treatment of type I allergy.

For the treatment of infectious diseases, cancer and allergy, the directed induction of an appropriate immune response is the ultimate goal. Therefore, with the development of pure, often very small proteins, peptides or DNA by molecular biology techniques, the research for suitable adjuvants or delivery systems became increasingly important. Particle formulations are made of a variety of materials, including lipids, proteins or amino acids, polysaccharides, polyacrylic substances or organic acids. Microparticles serve as vehicles and provide a depot for the entrapped or coupled antigen. The release occurs in a pulsatile or continuous manner, a feature, which is well controllable for many particulate systems. Particles attract antigen presenting cells to the administration site, thereby guaranteeing the efficient presentation of the antigen to the immune system. Importantly, particles also protect the entrapped substance. This is especially necessary after oral application to avoid gastric or tryptic breakdown. In this article, the design and construction of different antigen delivery systems and their immune effects, with special focus on the suitability for allergy treatment, are discussed.     

Successful management of intra-abdominal hemorrhage in the presence of severe alcoholic liver disease with activated recombinant factor VII (rFVIIa; NovoSeven): a case report and review of the literature on approved and off-label use of rFVIIa.

A 37-year-old male with history of alcohol abuse presented to us with nausea, vomiting, and abdominal pain with ascites. He was diagnosed with alcoholic liver disease with coagulopathy and pancreatitis. During hospitalization, the patient developed intra-abdominal hemorrhage. He was treated with platelets, packed red blood cells and fresh frozen plasma without any improvement. Following this he was treated with activated recombinant factor VII (90 microg/kg), which resulted in normalization of the prothrombin time and the activated partial thromboplastin time and stabilization of hematocrit within a few hours. We review the current literature on the approved and off-label use of activated recombinant factor VII.     

A case of recurrence of synovial chondromatosis of the temporomandibular joint.

This is a case study of a patient with recurrent synovial chondromatosis. It shows some relevant images. It also provides possibilities for why this patient may have had a recurrence and how this was managed.     

Disorders in high-density metabolism with insulin resistance and chronic kidney disease.

Cardiovascular risk increases with each decrement in renal function. Low-density lipoprotein (LDL) cholesterol levels are not associated with increased mortality, but high-density lipoprotein (HDL) levels are inversely associated with cardiovascular risk. Lipoprotein composition with increased abundance of small dense LDL and HDL and reduced levels of more buoyant isoforms is similar to what is found in states of insulin resistance and in the metabolic syndrome (MS). In both cases, high triglyceride levels are associated with reduced HDL levels. Chronic kidney disease (CKD) is itself associated with increasing insulin resistance as renal function fails. In both instances, decreased levels of apo A-I and apo A-II are a consequence of increased fractional catabolic rate (FCR), resulting from a predominance of small HDL particles. HDL maturation is impaired in CKD through decreased activity of lecithin:cholesterol acyltransferase (LCAT), and increased cholesterol ester transfer protein (CETP) activity in MS shuttles triglycerides back into HDL, thereby destabilizing it. Whether insulin resistance is entirely responsible for disorders of HDL metabolism in CKD, or whether the process is a result of unrelated pathophysiology, is currently unknown.