Cholecystostomy

The role of cholecystostomy in the sugical treatment of gallstones has been considered. In a consecutive series of 558 patients who underwent surgery for gallstones, 30 (5-4 per cent) had cholecystostomy alone and a further 17 (3-1 per cent) cholecystostomy combined with exploration of the bile ducts. Cholecystostomy was done because cholecystectomy was technically very hazardous in 15 patients. In the remaining patients cholecystostomy was preferred to cholecystectomy because o f the poor general condition of the patient or the presence of pancreatitis. Of the 47 patients submitted to cholecystostomy, 2(4-2 per cent) died postoeratively and 4(8-4 percent) subsequently underwent cholecystectomy. Of 24 patients who were available for long term follow-up, only 1 patient had pain which was definitely considered to be due to gallstones, although 3 other patients also had abdominal pain, while 7 patients showed radiological evidience of gallstones. It is contended that cholecystostomy has a small but definite part to play in the immediate surgical treatment of gallstones and that the long term results of the operation are sufficiently good to justify its use in selected patients.     

The effect of body fluids on polynucleotide-induced fibroblast interferon and virus-induced leukocyte interferon

Micalite (microcapsulated lithium carbonate with a retarded action) was used for the treatment of manic states and the prevention of attacks of manic-depressive psychosis in 40 patients. The preparation was administered once daily. This provided the necessary concentration of lithium in the blood on a stable level. According to its therapeutical effectiveness and the frequency of side-effects micalite does not differ from other lithium preparations with a simgle daily administration of micalite there are much less distubrances in the treament regime.     

Current directions in research on understanding and preventing intoxicated aggression

The present paper describes promising research directions that emerged from a recent international conference on intoxication and aggression and from the scientific literature generally. In this overview, intoxicated aggression is seen as arising from an interactional process involving multiple contributing factors or causes. This model helps to define research directions that can further understanding and prevention. First, the societal/cultural framing of intoxication and aggression exerts a powerful influence on drinking behaviour and needs to be better understood. Another important area for research is the moderating role on alcohol-related aggression of personal factors such as predisposition to aggression and individual differences in expectations about alcohol and aggression. Research on the role of basic pharmacological effects of alcohol in increasing the likelihood of aggressive behaviour is also a critical aspect of understanding intoxicated aggression. Drinking contexts and environments play a considerable role in the relationship between intoxication and aggressive behaviour and need to be better understood. Another critical direction for future research is the study of intoxicated aggression as a process involving the interaction of the person, the situation and the effects of alcohol in natural and experimental settings. Finally, the paper highlights promising directions for research on interventions to prevent intoxicated aggression and violence.     

Clinical impact of transcutaneous bilirubinometry as an adjunctive screen for hyperbilirubinemia

BACKGROUND: Advanced carcinoma of the lower neck with direct extension to the superior mediastinum is a major therapeutic challenge. Complete removal of the tumors requires a radical operation in order to remove the larynx, portions of trachea and esophagus, and to construct a tracheostomy stoma with intrathoracic trachea. METHODS: We present our experience and technique for removal of difficult tumors in this region and construction of mediastinal tracheostomy. A technique for reconstruction of a very short segment of distal trachea is also proposed. Twelve mediastinal tracheostomies were performed; all except 3 patients underwent total laryngopharyngectomy and resection of tumor with gastric pullup. RESULTS: There were 2 operative deaths, 1 from tracheoinnominate artery fistula and the other from cerebral infarction. Complications included pharyngeal fistula (2 patients), respiratory failure (1), and osteomyelitis of sternum (1). Postoperative survival was disease-dependent. All patients who survived the operation achieved good airway patency and relief of dysphagia. CONCLUSIONS: The method of airway reconstruction by mediastinal tracheostomy is an advance in surgical treatment of malignancies in the cervicothoracic region. By careful selection of patients, successful operation resulted in good palliation and sometimes cure with acceptable quality of life.     

A simplified system for generating recombinant adenoviruses

Recombinant adenoviruses provide a versatile system for gene expression studies and therapeutic applications. We report herein a strategy that simplifies the generation and production of such viruses. A recombinant adenoviral plasmid is generated with a minimum of enzymatic manipulations, using homologous recombination in bacteria rather than in eukaryotic cells. After transfections of such plasmids into a mammalian packaging cell line, viral production is conveniently followed with the aid of green fluorescent protein, encoded by a gene incorporated into the viral backbone. Homogeneous viruses can be obtained from this procedure without plaque purification. This system should expedite the process of generating and testing recombinant adenoviruses for a variety of purposes.