Response of serum cytokines in patients undergoing laparoscopic cholecystectomy

The clinical observation that a laparoscopic cholecystectomy is a minimally invasive operation has not been demonstrated on a biochemical basis. Interleukin-6, a known endogenous pyrogen and hepatocyte-stimulating protein, correlates with the significance of surgical trauma. Utilizing the IL-6 immunoassay, we studied this biochemical parameter of trauma to compare its response in laparoscopic vs open cholecystectomy. Sixteen patients who underwent only laparoscopic cholecystectomy showed peak IL-6 concentrations of 51 pg/ml (22-86) vs a peak IL-6 concentration of 124 pg/ml (56-225) for open cholecystectomy. Six additional patients who underwent an ERCP followed by laparoscopic cholecystectomy showed a dramatic rise in peak IL-6 concentration to 315 pg/ml (15-634). These results biochemically confirm the true minimal invasiveness of laparoscopic cholecystectomy. The findings in the ERCP-followed-by-laparoscopic-cholecystectomy group support the theory that two invasive procedures in close proximity may prime the cytokine system in its response to surgical trauma.     

R.b.e. for d(42MeV)-Be neutrons based on chromosome-type aberrations induced in human lymphocytes and scored in cells at first division

The irradiation of human lymphocytes with five doses of 250 kV X-rays and five doses of d(42MeV)-Be neutrons was performed in order to obtain dose-response curves for both radiation qualities. By using the FPC technique, aberration scoring was confined to first division cells only and dose-response curves were obtained at three sampling times. Sampling time independence was observed for chromosome-type aberrations and common curves could be fitted, confirming homogeneity of the initial lymphocyte population. R.b.e. values between 1x1 and 8x8 were obtained for dicentric yields between 0x01 and 2x0 per cell. Some variabilities were encountered for other aberration types. Mitotic delay showed an r.b.e. of 1x75. There was no evidence for any induction of SCE by either X-rays or neutrons, up to the highest doses used.     

Chlamydial pneumonia of infancy: further clinical observations

Two patients with chlamydial pneumonia of infancy are described. One recovered spontaneously without any specific antichlamydial treatment. The other, prior to a belated antimicrobial therapy, developed a persistent and protracted respiratory illness characterized by wheezing. Our observations suggest that: (1) untreated chlamydial pneumonia of infancy may spontaneously resolve, or may become a persistent and protracted disease, and (2) wheezing may be a very prominent manifestation of the disease and should be differentiated from wheezing due to bronchiolitis and bronchial asthma.     

Filaroides hirthi in a dog: fatal hyperinfection suggestive of autoinfection

Progressive dyspnea in a dog began 1 month after it had been hit by a car. Radiographs revealed diffuse interstitial and alveolar pneumonia. Large numbers of embryonated eggs were observed in bronchial washings; and many small nematodes, later identified as Filaroides hirthi, were found in the fine needle aspirates of pulmonary tissue. Numerous nematode larvae were demonstrated on fecal flotation. The severe hyperinfection strongly suggested autoinfection, probably associated with depressed immunologic competence due to chronic stress.     

Clinical applications of signal-averaged electrocardiography in patients after myocardial infarction

In conclusion, signal-averaged electrocardiography is a useful, noninvasive technique to identify patients after myocardial infarction at risk for future arrhythmic events, especially in conjunction to existing tools, such as 24 hour ambulatory monitoring, echocardiography, nucleotide angiography and coronary angiography. It has a limited positive predictive value, but has an excellent negative predictive value. The optimum time to do signal-averaged electrocardiograms after myocardial infarction is unclear, 6 to 14 days after myocardial infarction has the highest sensitivity. Time domain analysis remains the most common method used to record late potentials. The definition of late potential and the scoring of a high resolution electrocardiogram as normal and abnormal have not yet been resolved. The criteria proposed by the Task Force Committee of the European Society of Cardiology, the American Heart Association and the American College of Cardiology (see introduction) should be observed at present. Many studies on signal-averaging were done in the prethrombolytic era. In patients who have received thrombolytic therapy, the positive predictive value of signal-averaged electrocardiograms has decreased. There are other limitations in applying signal averaging technique. The faster the ventricular tachycardia is induced in electrophysiological studies, the shorter is the late potential. Thus, a faster tachycardia which causes sudden cardiac death may not be detected by late potentials. The management strategies for patients who have abnormal signal-averaged electrocardiograms after myocardial infarction have not be defined. One should note that any management strategy has to prove that it improves prognosis. More prospective, randomized clinical trials are required to address these issues.     

Aberrant reinnervation following hypoglossal nerve damage

Hypoglossal nerve damage is a known complication of carotid endarterectomy, occurring in approximately 5% of endarterectomies. The vast majority of these patients recover without functional disability from this injury even if the tongue remains hemiplegic. We report 2 patients who suffered hypoglossal nerve section during neck surgery. Although they were initially mildly symptomatic, they developed increasingly severe dysarthria and dysphagia beginning 4 months after surgery. EMG revealed abnormal coactivation of the genioglossus and styloglossus muscles on the affected side, suggesting aberrant reinnervation. Aberrant reinnervation is a well-known complication of facial nerve injury, but has not been previously recognized in hypoglossal nerve injury. Like the face, the tongue is composed of many muscles that must perform complex movements. Normally, injury to one hypoglossal nerve causes little or no disability, but when aberrant reinnervation occurs, the tongue no longer moves in a coordinated manner, and significant dysarthria ensues.     

Melatonin binding sites in the harderian gland of the rat and Syrian hamster

Specific melatonin binding sites in the harderian gland of both rat and Syrian hamster were studied using [125I]melatonin. In both species, binding of [125I]melatonin by harderian gland membranes exhibited properties such as dependence on time, temperature, membrane concentration, saturability, and high specificity. Only one class of high-affinity binding sites was found with a Kd of 0.19 and 6.47 nM for the rat and Syrian hamster, respectively. The binding capacity in the rat harderian gland was 4.00 fmol/mg protein; in the Syrian hamster it was 7.58 fmol/mg protein. In the rat, no sex differences were found in the binding of the tracer to the membranes. However, in the Syrian hamster, binding of [125I]melatonin by the harderian gland was twice higher in the female than in the male. No changes were found in the Kd values (6.47 vs. 6.94 nM), while binding capacity was significantly increased in the female (13.50 fmol/mg protein) when compared to the male hamster (7.58 fmol/mg protein). Binding of [125I]melatonin by the harderian gland of male hamsters was modified by castration but not by melatonin treatment. Castration induced an increase of binding up to the level of females. However, chronic melatonin administration did not alter the [125I]melatonin binding in either intact or gonadectomized male hamsters. Binding studies also showed diurnal variations. There was a diurnal rhythm of [125I]melatonin binding by Syrian hamster harderian glands with the peak at the end of the light period and the trough late in the dark period. This rhythm in the binding is observed in both male and female hamsters, although binding in females was always higher than that in males.(ABSTRACT TRUNCATED AT 250 WORDS)