Postoperative pulmonary function after laparoscopic and open cholecystectomy

In this prospective, randomized study, we compared 42 patients undergoing laparoscopic cholecystectomy and 40 undergoing open cholecystectomy to determine if laparoscopic cholecystectomy results in less respiratory impairment and fewer respiratory complications. Pulmonary function tests, arterial blood-gas analysis and chest radiographs were obtained in both groups before operation and on the second day after operation. Postoperative pain scores and analgesic requirements were also recorded. After operation, a significant reduction in total lung capacity, functional residual capacity (FRC), forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and mid-expiratory flow (FEF25-75%) occurred after both laparoscopic and open cholecystectomy. The reductions in FRC, FEV1, FVC and FEF25-75% were smaller after laparoscopic (7%, 22%, 19% and 23%, respectively) than after open (21%, 38%, 32% and 34%, respectively) cholecystectomy. Laparoscopic cholecystectomy was also associated with a significantly lower incidence (28.6% vs 62.5%) and less severe atelectasis, better oxygenation and reduced postoperative pain and analgesia use compared with open cholecystectomy. We conclude that postoperative pulmonary function was impaired less after laparoscopic than after open cholecystectomy.      

Epithelial mucin expression in bladder cancer: correlation with pathological and clinical parameters

Recently, attention has been drawn to the role of polymorphic epithelial mucin (PEM) as a possible target for cancer immunotherapy. To investigate the expression of this molecule in bladder tissue, we used two mouse monoclonal antibodies (HMFG1 and HMFG2) raised against the core protein of the PEM. The localization of these two anti-PEM antibodies was examined in normal (n=10), inflammatory (n=10) and malignant (n=67) bladder tissue samples with the use of a three-step avidin-biotin method. For HMFG1 and HMFG2 localization was successful in 78% and 60% of the bladder cancer samples, respectively, where as they were localized only in 30% and 40% of normal bladder tissue samples, respectively. Staining of either antibodies did not correlate with the grade, stage, or survival of bladder cancer patients. We conclude that PEM is frequently overexpressed by bladder cancer cells and HMFG1 is the antibody of choice to be used as a carrier of a cytotoxic agent for application of intravesical targeted therapy of bladder cancer. Received: 25 August 1999 / Accepted: 1 March 2000     

A record of skin creases and folds

The skin creases of the human body are features of great anatomical, morphological, and surgical interest and important for the maintenance of the contour of each anatomic area. In the literature, when referring to a skin crease, there is variation of terms used other than “crease,” such as “fold” and “sulcus,” but these terms do not accurately reflect their histology structure nor their function. In the review of literature, a record of the creases of the human body for each anatomic area, including the synonyms that are used for each crease in the literature, has been attempted. The skin crease as a fixed and permanent line, according to their histology, is related to connective tissue attachments with the underlying structures or extensions of the underlying muscle fibers in the dermis of the crease site. The skin fold is characterized by skin redundancy that is responsible partly, often in combination with connective tissue attachments, for the skin crease. It is essential to use appropriate terms that accurately reflect the anatomic structure and histology when referring to the skin lines.     

Circulating VEGF levels in the serum of gastric cancer patients: correlation with pathological variables,patient survival,and tumor surgery

OBJECTIVE: To evaluate the clinical usefulness of serum vascular endothelial growth factor (VEGF) levels in gastric cancer patients. SUMMARY BACKGROUND DATA: Vascular endothelial growth factor plays an important role in the formation of new blood vessels involved in the growth and metastatic spread of solid tumors, but there is limited information regarding the clinical significance of serum VEGF levels in cancer patients. METHODS: Serum VEGF concentrations were measured by an enzyme linked immunosorbent assay in 61 healthy controls and in 58 gastric cancer patients before surgery, and then again at 7 and 30 days after surgery. The association between preoperative serum VEGF levels, clinicopathological features and patient survival, and their changes following surgery were evaluated. RESULTS: Serum VEGF levels in gastric cancer patients were significantly higher than those in controls. There was a significant association between serum VEGF levels and disease stage, as well as invasion depth of the tumor and the presence of distant metastases. Serum VEGF levels decreased significantly after radical resection of the primary tumor and increased in patients with unresectable tumors. Multivariate regression analysis showed that serum VEGF level is an independent prognostic factor for survival. CONCLUSIONS: Serum VEGF levels in gastric patients are significantly higher compared with normal controls and correlate with local tumor extent, disease stage, and the presence of distant metastases. Preoperative serum VEGF concentration decreases significantly after radical resection of the primary tumor and is an independent prognostic factor for patient survival suggesting that determination of serum VEGF levels may be clinically useful.     

An unusual cause of delayed presentation of laparoscopic common bile duct injury

We describe an unusual case of a laparoscopic common bile duct (CBD) injury that presented with cholangitis 2 years after an apparently uneventful laparoscopic cholecystectomy. Preoperative ultrasound and endoscopic retrograde cholangiography suggested choledocholithiasis, showing proximal and intrahepatic duct dilatation with an inability to relieve the obstruction. At surgery, a lateral injury of the CBD wall with partial wall loss was found, adherent to an amorphous pigmented mass with the appearance of a knitted fabric causing CBD obstruction. The CBD was successfully reconstructed with a Roux-en-Y end-to-side hepaticojejunostomy, where the end of the Roux loop was anastomosed to the lateral CBD defect.     

Laparoscopic cholecystectomy in a patient with previous open cholecystostomy

We report the case of a successful elective interval laparoscopic cholecystectomy in a patient with a previous tube cholecystostomy that had been performed surgically 8 weeks earlier for an attack of acute calculous cholecystitis. At surgery, the major omentum was adherent to the right lateral abdominal wall, completely covering the liver edge, the gallbladder, and the inserted tube. The gallbladder and the tube within it were dissected free from the abdominal wall and the greater omentum, the cholecystostomy tube was removed, and the operation was completed successfully without any further difficulties.     

Adhesion molecules as targets for the treatment of neoplastic diseases

The quest for therapeutic specificity is implicit in all branches of medicine. In cancer treatment, cytotoxic agents, such as chemotherapy and radiotherapy, comprise the current therapeutic modality. Unfortunately, when used against most solid malignancies, their therapeutic indices are relatively low due to the significant damage they inflict on normal tissues. Furthermore, cure rates have remained essentially static over the last two decades. Specificity in killing neoplastic cells, while sparing healthy ones is therefore the only alternative approach, with several molecules qualifying as candidates for targeting therapy. Reduction of cell-cell and cell-matrix adhesion are, early tumorigenesis events also implicated in the invasive and metastatic process. The fact that abnormal adhesive marker expression is a feature commonly shared by most malignancies, along with its tendency to occur as both an early and late event in neoplastic development, makes these molecules potential candidates for antineoplastic targeted therapies. This review presents the perspectives of specific anti-adhesion molecule targeting as a possible therapeutic approach in neoplastic diseases.