Combined preemptive and preventive analgesia in morbidly obese patients undergoing open gastric bypass: A pilot study.

Purpose: It is difficult to balance adequate pain control against the risk of sedation and depressed breathing in severely obese patients. This study assesses the effects of combined preemptive and preventive analgesia on narcotic use after open gastric bypass.

Methods: Twenty patients were randomized in this prospective double-blind trial comparing preoperative 30 mg intravenous ketorolac (Toradol), 0.

Geometry and reproducibility in 360 degrees fundoplication.

Background: In this study, we set out to precisely define two symmetrical points-a on the anterior fundic wall and b on the posterior fundic wall. These points, when advanced around a 60-Fr bougie-filled esophagus, will meet on the right side, to the right of the anterior vagus nerve, to create a reliable, reproducible, loose (i.e.

Mini-laparoscopic cholecystectomy: validating a new approach.

Advances in instrumentation have led to the development of 2-mm laparoscopic equipment. The purpose of our investigation was to validate the safety and efficacy of laparoscopic cholecystectomy (LC) using one 10-mm and three 2-mm ports (mini-LC). Mini-LC was performed using a 2-mm fiberoptic videolaparoscope inserted via a midepigastric port, 2-mm graspers inserted via right upper quadrant ports, and standard dissection, clipping, and cautery instruments inserted via the umbilical port.

Thoracoscopic repair of a recurrent diaphragmatic hernia four years after initial trauma, laparotomy, and repair.

Traumatic diaphragmatic hernia is not an uncommon problem and has been noted after either penetrating or blunt trauma. A high index of suspicion must be maintained in order to identify patients with this injury, as delay in identification may result in significant morbidity and death. It is essential that a thorough evaluation be performed, and if a diaphragmatic hernia is found, surgical repair is necessary.

Feasibility of laparoscopic cholecystectomy with miniaturized instrumentation in 50 consecutive cases.

A new technique utilizing miniaturized (2 mm) instrumentation to perform laparoscopic cholecystectomy (LC) is introduced. The safety and efficacy of this mini-LC were assessed. Fifty consecutive mini-LCs were performed using one 10-mm port and three 2-mm ports (cumulative port size 16 mm).

Ischemic preconditioning decreases oxidative stress during reperfusion: a chemiluminescence study.

The mechanism responsible for ischemic preconditioning (IPC) is still unknown but may involve the induction of antioxidant enzymes decreasing oxidative stress during subsequent periods of ischemia (I) and reperfusion (RP). The purpose of this study was to determine whether, in fact, an antioxidant mechanism is involved in the protection afforded by IPC. Lucigenin-enhanced chemiluminescence (LEC), a direct, continuous, nondestructive, on-line method was used to monitor the net amount of free oxygen radicals (FOR) produced during perfusion of rat hearts.

Coenzyme Q10 protects coronary endothelial function from ischemia reperfusion injury via an antioxidant effect.

Background: Cardiac ischemia reperfusion (I/R) injury causes coronary vascular dysfunction. Coenzyme Q10 (CoQ), which preserves cardiac mechanical function after I/R, recently has been recognized as a free radical scavenger. We hypothesized that CoQ protects coronary vascular reactivity after I/R via an antioxidant mechanism.

Elucidation of a tripartite mechanism underlying the improvement in cardiac tolerance to ischemia by coenzyme Q10 pretreatment.

Coenzyme Q10, which is involved in mitochondrial adenosine triphosphate production, is also a powerful antioxidant. We hypothesize that coenzyme Q10 pretreatment protects myocardium from ischemia reperfusion injury both by its ability to increase aerobic energy production and by protecting creatine kinase from oxidative inactivation during reperfusion. Isolated hearts (six per group) from rats pretreated with either coenzyme Q10, 20 mg/kg intramuscularly and 10 mg/kg intraperitoneally (treatment) or vehicle only (control) 24 and 2 hours before the experiment were subjected to 15 minutes of equilibration, 25 minutes of ischemia, and 40 minutes of reperfusion.

Nitric oxide as a positive inotropic agent in isolated rat hearts.

The purpose of this study was to examine the inotropic effects of nitroprusside (NP), a direct nitric oxide (NO) donor, in isolated rat hearts. Langendorff-perfused hearts (n = 5), paced at 6 Hz, were subjected to 15 min of equilibration (EQ) followed by infusion of NP, producing a coronary artery concentration of 1 x 10(-5) M. Coronary flow, left ventricular developed pressure (DP), end-diastolic pressure, and contractility and compliance (+/- dP/dt) were monitored throughout the experiment by a computerized data acquisition system.

The cumulative nature of pyruvate's dual mechanism for myocardial protection.

Pyruvate (PYR) supplementation protects myocardium from ischemia reperfusion injury. This study was designed to characterize and quantify the mechanism underlying this protection: specifically whether this ability resides in PYR's metabolic effect or in its antioxidant effect. Isolated perfused rat hearts (n = 6/group) were subjected to 15 min of equilibration (EQ), 25 min of ischemia, and 10 min of reperfusion (RP).