A novel means of securing a laparoscopic port in the obese patient

Advanced interventional laparoscopy has necessitated the development of a vast array of new equipment, but inevitably some of this equipment has had to be adapted to specific patient needs. Standard laparoscopic ports may be too short for use in obese patients. We describe a technique using a Portex endotracheal tube as an over-tube, which will overcome this problem.     

Distal thermal injury from monopolar electrosurgery

Lysis of infrahepatic adhesions during laparoscopic cholecystectomy was attempted by using monopolar electrocautery. The flow of current was seen to follow an unpredictable pathway and almost causing a thermal injury to an adjacent small bowel loop. A brief discussion of pertinent bioelectrical principles is also presented.     

Atrial septal pacing: a method for pacing both atria simultaneously

By pacing both atria simultaneously, one could reliably predict and optimize left-sided AV timing without concern for IACT. With synchronous depolarization of the atria, reentrant arrhythmias might be suppressed. We studied four male patients (73 +/- 3 years) with paroxysmal atrial fibrillation and symptomatic bradyarrhythmias using TEE and fluoroscopy as guides; a standard active fixation screw-in lead (Medtronic model #4058) was attached to the interatrial septum and a standard tined lead was placed in the ventricle. The generators were Medtronic model 7960. The baseline ECG was compared to the paced ECG and the conduction time were measured to the high right atrium, distal coronary sinus and atrial septum in normal sinus rhythm, atrial septal pacing, and AAT pacing. On the surface ECG, no acceleration or delay in AV conduction was noted during AAI pacing from the interatrial septum as compared with normal sinus rhythm. The mean interatrial conduction time for all 4 patients was 106 +/- 2 ms; the interatrial conduction time measured during AAT pacing utilizing the atrial septal pacing lead was 97 +/- 4 ms (P = NS). During atrial septal pacing, the mean conduction time to the high right atrium was 53 +/- 2 ms. The mean conduction time to the lateral left atrium during atrial septal pacing, was likewise 53 +/- 2 ms. We conclude that it is possible to pace both atria simultaneously from a single site using a standard active fixation lead guided by TEE and fluoroscopy. Such a pacing system allows accurate timing of the left-sided AV delay.     

Nitric oxide in the contractile action of bradykinin, oxytocin, and prostaglandin F2 alpha in the estrogenized rat uterus

Experiments were performed on uteri from estrogen-primed female rats. Bradykinin (BK) (10(-8) M) significantly augmented biosynthesis of prostaglandin F2 alpha (PGF2alpha) and prostaglandin E2 (PGE2), and this synthesis was completely blocked by NG-monomethyl L-arginine (NMMA) (300 microM), a competitive inhibitor of nitric oxide synthase (NOS). Blockade of prostaglandin synthesis by indomethacin caused rapid dissipation of isometric developed tension (IDT) induced by BK. Blockade of NOS with NMMA had similar but less marked effects. Combining the two inhibitors produced an even more rapid decay in IDT, suggesting that BK-induced NO release maintains IDT by release of prostanoids. The decline of frequency of contraction (FC) was not significantly altered by either indomethacin or NMMA but was markedly accelerated by combination of the inhibitors, which suggests that PGs maintain FC and therefore FC decline is accelerated only when PG production is blocked completely by combination of the two inhibitors of PG synthesis. The increase in IDT induced by oxytocin was unaltered by indomethacin, NMMA or their combination indicating that neither NO nor PGs are involved in the contractions induced by oxytocin. However, the decline in FC with time was significantly reduced by the inhibitor of NOS, NMMA, suggesting that FC decay following oxytocin is caused by NO released by the contractile process. In the case of PGF2alpha, NMMA resulted in increased initial IDT and FC. The decline in FC was rapid and dramatically inhibited by NMMA. Receptor-mediated contraction by BK, oxytocin, and PGF2alpha is modulated by NO that maintains IDT by releasing PGs but reduces IDT and FC via cyclic GMP.     

Necropsy survey of metacarpal fusion in the horse

Paired metacarpi obtained at necropsy from 100 horses ranging in age from term fetus to 35 years were examined to estimate the prevalence and sites of metacarpal fusion. Metacarpal fusion was seen in 192 of 200 metacarpi, and 78% of all horses 2 years or older had 2 or more fusions. Fusion of the second metacarpal bone to the third metacarpal bone was significantly (P < 0.001) more common than was fusion of the fourth to the third metacarpal bone. Fusions appeared for the most part in pairs and were bilaterally symmetric. Rooney-Prickett type-A carpometacarpal joint configurations (in which there is no measurable articulation between the third carpal and second metacarpal bones) were rare in this population, and Rooney-Prickett type-B configurations (in which there is a measurable articulation between the third carpal and second metacarpal bones) were observed in 98.5% of metacarpi. Medial metacarpal fusion was positively correlated with age, occupation, and proportion of the proximal projection of the carpometacarpal distal joint surface that was taken by the second metacarpal bone. Lateral metacarpal fusion was positively correlated with age and the proportion of the proximal projection of the carpometacarpal distal joint surface taken by the fourth metacarpal bone. Horses in performance careers (racing, race training, or show ring occupations) had an earlier development of the first 2 fusions than did horses in other or unknown occupations; development of the third and fourth fusions were not significantly different between occupation groups. The rate of metacarpal fusion per horse-year appeared to be at least 10 times higher than a clinically evident rate. A variety of gross morphologic features was observed in the fusions from this sample, some of which were small, subtle, and possibly difficult to detect in vivo. It is hypothesized that many instances of metacarpal fusion may be a result of functional adaptation of the metacarpus to increased or changed loading conditions, rather than a response to isolated traumatic events.     

Neuropeptide Y phase shifts the circadian clock in vitro via a Y2 receptor

The suprachiasmatic nuclei (SCN) contain a circadian clock whose activity can be recorded in vitro for several days. This clock can be reset by the application of neuropeptide Y. In this study, we focused on determination of the receptor responsible for neuropeptide Y phase shifts of the hamster circadian clock in vitro. Coronal hypothalamic slices containing the SCN were prepared from Syrian hamsters housed under a 14 h:10 h light:dark cycle. Tissue was bathed in artificial cerebrospinal fluid (ACSF), and the firing rates of individual cells were sampled throughout a 12 h period. Control slices received either no application or application of 200 nl ACSF to the SCN at zeitgeber time 6 (ZT6; ZT12 was defined as the time of lights off). Application of 200 ng/200 nl of neuropeptide Y at ZT6 resulted in a phase advance of 3.4 h. Application of the Y2 receptor agonist, neuropeptide Y (3-36), induced a similar phase advance in the rhythm, while the Y1 receptor agonist, [Leu31, Pro34]-neuropeptide Y had no effect. Pancreatic polypeptide (rat or avian) also had no measurable phase-shifting effect. Neuropeptide Y applied at ZT20 or 22 had no detectable phase-shifting effect. These results suggest that the phase-shifting effects of neuropeptide Y are mediated through a Y2 receptor, similar to results found in vivo.