Comparison of routine and selective endoscopic retrograde cholangiography before laparoscopic cholecystectomy

To evaluate the role of endoscopic retrograde cholangiography (ERC) before laparoscopic cholecystectomy, we compared the frequency of concomitant common bile duct stones, their clinical outcome, and the frequency of bile duct injury between a group of 128 patients with routine preoperative ERC (group A) and 1010 patients with selective ERC (group B). Overall, 48 patients (4.2%) had duct stones, but the predictive signs were absent in six of them (12.5%). The stones were demonstrated by ERC and removed by sphincterotomy in all 11 patients in group A. Of 37 patients in group B, 22 were diagnosed by selective ERC and underwent endoscopic removal. Of four patients whose stones were found by operative cholangiography, one had immediate open surgery, another passed a stone spontaneously, and the other two underwent postoperative sphincterotomy, which failed in one. The stones were not recognized until pain recurred in the remaining 11 patients. Sphincterotomy was successful in nine patients but failed in the other two. Thus postoperative sphincterotomy failed in 3 of 13 patients (23%), necessitating open surgery. Forty-two patients overall (3.7%) had aberrant biliary tract anatomy, which did not lead to bile duct injury in any of the patients. Morbidity of routine ERC (3.1%) was lower than that of selective ERC (7.4%) (p < 0.05). It should be noted that a certain proportion of duct stones may be missed by selective ERC, necessitating laparotomy when sphincterotomy fails. The routine use of preoperative ERC may be justified at institutions where the expertise is available, at least until laparoscopic lithotomy becomes easy.     

Involvement of the Fas/Fas ligand pathway in activation-induced cell death of mycobacteria-reactive human gamma delta T cells: a mechanism for the loss of gamma delta T cells in patients with pulmonary tuberculosis

Although the identity of T cells involved in the protection against Mycobacterium tuberculosis (Mtb) in humans remain unknown, patients with pulmonary tuberculosis (TB) have reduced numbers of Mtb-reactive, V gamma 9+/V delta 2+ T cells in their blood and lungs. Here we have determined whether this gamma deltaT loss is a consequence of Mtb Ag-mediated activation-induced cell death (AICD). Using a DNA polymerase-mediated dUTP nick translation labeling assay, 5% or less of freshly isolated CD4+ alpha beta or gamma delta T cells from normal healthy individuals and TB patients were apoptotic. However, during culture Mtb Ags induced apoptosis in a large proportion of V gamma 9+V delta 2+ peripheral blood T cells from healthy subjects (30-45%) and TB patients (55-68%); this was increased further in the presence of IL-2. By contrast, anti-CD3 did not induce any significant level of apoptosis in gamma delta T cells from healthy subjects or TB patients. Mtb Ag stimulation rapidly induced Fas and Fas ligand (FasL) expression by gamma delta T cells, and in the presence of metalloproteinase-inhibitors >70% of gamma delta T cells were FasL+. Blockade of Fas-FasL interactions reduced the level of Mtb-mediated gamma delta T cell apoptosis by 75 to 80%. Collectively, these findings demonstrate that Mtb-reactive gamma delta T cells are more susceptible to AICD and that the Fas-FasL pathways of apoptosis is involved. AICD of gamma delta T cells, therefore, provides an explanation for the loss of Mtb-reactive T cells during mycobacterial infection.     

Schiff's bases of polyallylamine

Summary Schiffs bases of polyallylamine were synthesized by the reaction with four aldehydes. Salicylaldehyde (S)- and 2-pyridinecarboxaldehyde (P)-Schiff's base could be used as reverse osmosis membranes when crosslinked with divinyl sulfone, diacetyl or ethylene glycol diglycidyl ether. S-base membrane had a high mechanical strength but poor water permeability (K₁), while P-base membrane showed a high rejection, particularly against CoCl₂, and a high K₁ because of chlate formation, but poor strength. The membranes of P-base and a hybrid PS-base exhibited a possibility of separating alkali metal salts and transition metal salts from each other.     

Properties of poly(4-vinylpyridine-co-methyl vinyl ketone) membranes for reverse osmosis

The copolymer prepared from 4-vinylpyridine and methyl vinyl ketone could form a dense and tough membrane which is stronger than cellulose acetate when crosslinked with malonyl dihydrazide (MD) or 2-phenyl-4,6-dihydrazino-s-triazine (PDT), showing a fair performance in reverse osmosis for NaCl and CoCl₂ feed. The relationship between the content of MD or PDT and the membrane performance was investigated. An increase in MD or PDT led to an increase in membrane thickness and water content as well as the performance. A maximum rejection was obtained at ca. 30 mol % MD and ca. 13 mol % PDT based on MVK, and a maximum membrane strength at 20–30 mol % crosslinking agent. A membrane of a lower NaCl rejection tended to be permselective due to the complexation of the CoCl₂ with membrane. About 1:1 copolymer gave membranes of a higher rejection, which may be related to monomer arrangement in the copolymer chain. There methods for the flux improvement were presented and discussed: preparation of a copolymer blend membrane containing a hydrophilic monomer, crosslinking quaternization of membranes with diiodobutane, and oximation of the membrane material in order to introduce hydrophilic groups.     

Simultaneous absorption with reaction in a slurry containing fine particles

The simultaneous absorption of two gases accompanied by chemical reaction into a slurry of fine suspended particles was numerically analysed using the model obtained with some extension of the corresponding single gas absorption.Experiments were performed for the simultaneous absorption of sulfur dioxide and carbon dioxide with a plane gas—liquid type stirred tank absorber. The experimental results were satisfactorily elucidated by the proposed model and it is suggested that when accompanied by sulfur dioxide absorption, carbon dioxide may almost be regarded as an inert gas.     

Interfacial turbulence accompanying chemical absorption

Absorption rates for carbon dioxide into aqueous solutions of EDA and MEA with and without adding surface active agent were measured in a laminar liquid-jet apparatus to check and verify the Marangoni effect. In addition, experiments were conducted for the tracer desorption of ethylene from aqueous EDA and MEA solutions into carbon dioxide or nitrogen stream. It has been concluded that the Marangoni effect cannot be neglected for such short contact times as in a laminar liquid-jet. The Marangoni instability accompanying the present chemical absorptions is attributed to combinated effects of the presence of ionic products, the depletion of the reactant liquid near the interface and an increase in interfacial temperature.     

Rates of gas absorption with interfacial turbulence caused by micro-stirrers

Rates of absorption of CO₂ into water, a 0.2 mol/L NaOH solution and a 40 wt% glycerol solution with and without the interfacial turbulence caused by micro-stirrers, made of a magnetic material, were measured with use of a stirred vessel with known gas-liquid interfacial area. The effect of the interfacial turbulence on the rate of gas absorption was remarkable in the lower range of the bulk turbulence. The enhancement factors due to the interfacial turbulence were calculated with use of the age distribution function of the Danckwerts type and they agreed well with the experimental results.     

Gas absorption with consecutive chemical reaction: Absorption of carbon dioxide into aqueous amine solutions

Experiments were carried out over a wide range of contact time for the absorption of carbon dioxide into aqueous amine solutions. It was suggested from the experimental results with a laminar liquid-jet, a wetted wall column and a quiescent liquid absorber that the present absorption processes should be analyzed by a gas absorption with the consecutive reaction of the form of A + 2B →k_I R and A + R →k_II Products. The values of rate constants for the second-order first reaction step (k₁) for the diethanolamine and triethanolamine were estimated as 1340 and 16.8 1/mol-sec, respectively. The value of rate constant for the second reaction step was found to be constant irrespective of the liquid reactant.