Intravascular tumor: a previously unreported finding of glucagonoma.

Glucagonoma is a relatively rare pancreatic islet cell tumor. Historically, these tumors present a typical constellation of symptoms including diabetes, weight loss, anemia, necrolytic migratory erythematous rash, and propensity for thrombosis. This clinical presentation is described as the glucagonoma syndrome.

Comparison of parathyroid imaging with technetium-99m-pertechnetate/sestamibi subtraction, double-phase technetium-99m-sestamibi and technetium-99m-sestamibi SPECT.

Unlabelled: The ability of 99mTc-pertechnetate/sestamibi subtraction, double-phase 99mTc-sestamibi and 99mTc-sestamibi SPECT imaging to localize abnormal parathyroid tissue was compared.

Methods: Fifty-five consecutive patients had parathyroid imaging before surgery for hyperparathyroidism. Imaging consisted of 99mTc-pertechnetate pinhole images of the neck followed by 99mTc-sestamibi pinhole images of the neck and parallel-hole images of the neck and chest (early images).

Identification and characterization of the pckA gene from Staphylococcus aureus.

The Staphylococcus aureus pckA gene was identified and characterized. A pckA mutant lacked detectable phosphoenolpyruvate carboxykinase activity and grew poorly in the absence of glucose. Both enzymatic activity and pckA promoter activity in wild-type cells grown in the absence of glucose were at least 22-fold greater than activities in cells grown in the presence of glucose.

Laparoscopic cholecystectomy and common bile duct stones. The utility of planned perioperative endoscopic retrograde cholangiography and sphincterotomy: experience with 63 patients.

Objective: Planned perioperative endoscopic retrograde cholangiography (ERC) and sphincterotomy (ES) for suspected or proven common bile duct stones (CBDS) has been attempted in 63 of 540 consecutive patients undergoing laparoscopic cholecystectomy (LC). Experience with this intervention has been studied with respect to accuracy, efficacy, and safety.

Summary Background Data: The optimal management of CBDSs in the era of LC is not defined.

Laparoscopic general surgery: current status and future prospects.

The capability of performing major abdominal surgery while avoiding a large abdominal incision has clear benefits for patient care. Laparoscopic cholecystectomy can reduce hospital stays and the length of the recovery period, as well as decrease postoperative pain, diminish scarring, and provide significant cost savings.

Laparoscopic cholangiography. Results and indications.

One hundred sixty-five operative cholangiograms were attempted in 364 patients who underwent laparoscopic cholecystectomy (45%). Laparoscopic cholangiography was successful in 150 of 165 attempts (91%). Eighty-nine per cent of studies were normal (134/150) and 11% were abnormal (16/150).

Laparoscopic cholecystectomy. Experience with 375 consecutive patients.

Three hundred seventy-five consecutive patients underwent laparoscopic cholecystectomy from September 1989 to January 1991. Three hundred forty-one (91%) presented on an elective basis, and the remaining 34 patients (9%) were admitted for acute cholecystitis (24), gallstone pancreatitis (9), and cholangitis (1). Of the 375 patients, 20 were converted to laparotomy and cholecystectomy, for an overall success rate of 95% for patients undergoing laparoscopic cholecystectomy.

The Baltimore experience with laparoscopic management of acute cholecystitis.

Laparoscopic cholecystectomy has rapidly emerged as a popular alternative to traditional laparotomy and cholecystectomy. Acute cholecystitis has been considered to be a relative or absolute contraindication to laparoscopic surgery. After gaining extensive experience in laparoscopic biliary tract surgery, this procedure was attempted in 15 patients with acute cholecystitis.

Fate of retained foreign bodies in the peritoneal cavity.

Two patients with retained laparotomy pads after laparotomy had pain, abscess formation, and bleeding, with erosion of the pad into the small bowel and colon.

Colonic diverticulum perforation: report of two cases as a complication of coronary artery bypass (perforated diverticulum after coronary artery bypass).

Perforation of a sigmoid diverticulum occurred in two patients in the immediate postoperative period after coronary artery surgery. Etiological factors leading to diverticular perforation after coronary artery bypass grafting are discussed. The significance of pneumoperitoneum on the postoperative chest radiograph, which prompted diagnosis in these cases, is also discussed.

Vagotomy plus Bilroth II gastrectomy for the prevention of recurrent alcohol-induced pancreatitis.

Three retrospective reviews documenting a lessened frequency of acute recurrent alcohol-induced pancreatitis following vagotomy, with or without gastrectomy or gastroenterostomy, prompted a prospective evaluation of truncal vagotomy with Bilroth II gastrectomy as a means of preventing such exacerbations. Randomization between operation and encouragement to abstain from alcohol in patients with a history of more than one, but less than ten, acute bouts of alcohol-induced pancreatitis was set by odd-even digits in the hospital number. Of 176 patients admitted with acute alcoholic pancreatitis during 23 months of study, 49 were excluded because of too few or too many prior attacks.

Simplification of cryoprecipitate coagulum choledocholithotomy by deletion of thrombin. Prevention of retained biliary duct stones.

Conventional removal of stones from the biliary ducts can be difficult and may result in retained stones. We developed a modified tenacious coagulum that entraps biliary duct stones, resulting in a more complete extraction. Coagulum choledocholithotomy was simplified by mixing 20 parts of cryoprecipitate with one part of 10% calcium chloride solution without thrombin.

Opsonic fibronectin after operation or trauma: effect of hemodilution and duration of operation.

Fibronectin is an essential opsonin for phagocytosis of nonbacterial particulate matter by the reticuloendothelial system (RES). Fibronectin deficiency causes RES phagocytic depression and repletion of fibronectin reverses RES depression. Fibronectin depletion has been linked with multiple organ failure after surgery and trauma in patients with intra-abdominal infection.

Reversal of fibronectin and opsonic deficiency in patients. A controlled study.

Plasma fibronectin is an opsonic glycoprotein which augments reticuloendothelial phagocytic clearance of nonbacterial particulates. We evaluated the influence of intravenous infusion of plasma cryoprecipitate on circulating immunoreactive fibronectin and associated opsonic activity at 0.5, 2.

Lung vascular permeability after reversal of fibronectin deficiency in septic sheep. Correlation with patient studies.

Plasma fibronectin deficiency and opsonic dysfunction exist in critically ill septic surgical, trauma, and burn patients with multiple organ failure. Fibronectin deficiency can be reversed by infusion of fresh plasma cryoprecipitate. The influence of therapy with human cryoprecipitate on lung vascular permeability in septic sheep with plasma fibronectin deficiency following surgery was evaluated.

Opsonic fibronectin deficiency in patients with intra-abdominal infection.

The reticuloendothelial system provides host defense functions by the intravascular phagocytosis of bacteria and nonbacterial particulates. Fibronectin is opsonic for reticuloendothelial phagocytosis. Plasma fibronectin was measured before and after operation in patients with intra-abdominal infection.

Acute renal failure associated with increased intra-abdominal pressure.

Anuric renal failure developed in four patients in association with increased intra-abdominal pressure from postoperative hemorrhage. Polyuria and resolution of the renal failure occurred in each patient in response to operative decompression of the abdomen. Renal failure secondary to increased intra-abdominal pressure has been previously produced experimentally in dogs by the intraperitoneal installation of graded amounts of saline.

Effects of dopamine, ethanol, and mannitol on cardiopulmonary function in patients with adult respiratory distress syndrome.

Dopamine, ethanol, and mannitol were investigated to determine if they could increase pulmonary blood flow and oxygen delivery without significantly increasing intrapulmonary shunt. These drugs were studied in adult patients with respiratory distress following trauma, operation, or sepsis. Intravascular pressure, cardiac output, oxygen consumption and delivery, and limb blood flow and peripheral oxygen delivery were measured in all patients.

Opsonic glycoprotein (plasma fibronectin) levels after burn injury. Relationship to extent of burn and development of sepsis.

The time course of immunoreactive and bioassayable opsonic alpha 2-SB glycoprotein (plasma fibronectin), as well as its relationship to both the extent of injury and development of postburn sepsis, was evaluated following burn injury. Immunoreactive opsonic fibronectin was depleted acutely within hours following burn; its maximal depletion occurring 12 hours postburn injury. The magnitude of depletion was correlated with the body surface area burned, and normal levels were restored at 24 hours postinjury.

Increased oxygen uptake following phlebotomy and simultaneous fluid replacement in polycythemic patients.

To study the isolated effects of decreased hemoglobin concentration without volume loss, eight patients with the diagnosis of polycythemia were studied following acute phlebotomy and simultaneous volume replacement. These patients had been treated previously by repeated phlebotomy, without volume replacement, to a hemoglobin level of 14.8 +/- 0.

Increased creatinine clearance following cryoprecipitate infusion in trauma and surgical patients with decreased renal function.

Deficiency of opsonic alpha 2 surface binding (SB) glycoprotein (cold-insoluble globulin, plasma fibrinectin) is related to depressed reticulendothelial function as well as to multiple organ failure after tissue injury and sepsis. Cryoprecipitate (250 ml), extracted from 10 units of human plasma, was infused over 60 minutes into 11 hypo-opsonemic patients with decreased renal function. Cardiac output, mean arterial pressure, creatinine clearance, and limb blood flow were measured before and at intervals of 14 to 20, 35 to 44, and 60 to 66 hours following cryoprecipitate infusion.

Increased cardiac output and oxygen transport after intraoperative isovolemic hemodilution. A study in patients with peripheral vascular disease.

The effects of isovolemic hemodilution on cardiac output and oxygen transport in 11 patients during elective vascular surgery were evaluated. Mean hemoglobin level was decreased from 12.5 +/- 0.