Spiral cystic duct: beware.

Laparoscopic cholecystectomy (LC) is currently the most popular operation performed for gallbladder disease. Our objective is to emphasize the superiority of the "critical view technique" over the "infundibular technique" in case of inflammation or aberrant anatomy. We present a case of a 21-year-old female who was taken to the operating room for LC.

Concurrent immune thrombocytopenic purpura and Guillain-Barre syndrome in a patient with Hashimoto's thyroiditis.

Immune thrombocytopenic purpura (ITP), Guillain-Barre syndrome (GBS), and Hashimoto's thyroiditis (HT) are autoimmune disorders caused by impaired self-tolerance mechanisms triggered by interaction between genetic and environmental factors. ITP is an immune-mediated destruction of platelets resulting in mucocutaneous bleeding, GBS is an ascending motor paralysis caused by an inflammatory demyelination of peripheral nerves, and HT is characterized by autoimmune-mediated destruction of the thyroid gland. The concurrent development of ITP and GBS has only rarely been reported in the literature, and GBS itself rarely occurs with other autoimmune disorders.

The shape of the epiglottis reflects improvement in upper airway obstruction after weight loss.

Obstructive sleep apnea (OSA) is a sleep disorder characterized by recurrent episodes of closure of the upper airway during sleep, and is highly prevalent among overweight individuals. A significant percentage of patients with OSA remain undiagnosed. This condition creates chronic nighttime hypoxemia that can result in significant complications including systemic and pulmonary hypertension, cor pulmonale, and stroke.

Do support groups play a role in weight loss after laparoscopic adjustable gastric banding?

Background: Surgical intervention represents the only treatment with long-term efficacy for morbid obesity. Laparoscopic adjustable gastric banding (LAGB) is a minimally invasive operation that is increasing in popularity. We hypothesized that attending support groups is beneficial to achieve optimal weight loss after LAGB.

Laparoscopic sigmoid colectomy for chronic diverticular disease.

Background: The feasibility of laparoscopic sigmoid colectomy for diverticular disease has now been well established. We report herein our experience with laparoscopic sigmoid colectomy in 100 patients who underwent laparoscopic colectomy for chronic diverticular disease.

Methods: A retrospective review was performed of a 7-year period from January 1995 to June 2002.

Enterocutaneous fistula: a rare complication of laparoscopic adjustable gastric banding.

Morbid obesity is a refractory disease with serious co-morbidities. Laparoscopic adjustable gastric banding (LAGB) has generally been a safe and effective method for achieving sustained weight loss. We report a man who presented after LAGB with persistent wound infection at the access port-site, which failed conservative management.

Effects of surgical gloves on postoperative peritoneal adhesions and cytokine expression in a rat model.

Background: Postoperative intraperitoneal adhesions are a major cause of morbidity. We studied the effects of synthetic and latex gloves, and their powders, on postoperative adhesions and cytokine expression in a rat model.

Methods: Rats underwent laparotomy and cecal abrasion.

Efficacy of laparoscopic cholecystectomy in acalculous gallbladder disease: long-term follow-up.

Objective: Our aim was to determine the efficacy of laparoscopic cholecystectomy in symptomatic patients with ultrasound negative and abnormal gallbladder ejection fractions; Patients with gallbladder ejection fractions less than 35% on hepatobiliary scan were offered laparoscopic cholecystectomy.

Methods: Between January 1995 and January 2001, 1564 patients underwent laparoscopic cholecystectomy at our institution: 256 were confirmed to have acalculous gallbladder disease by pathology report and reconfirmation of abnormal hepatobiliary scan data. A 30-day postoperative follow-up was obtained by retrospective medical record review.

Intestinal obstruction following biliopancreatic diversion.

In our opinion biliopancreatic diversion patients require particular care, especially in the emergency room setting. Due to the changes in anatomy following surgery, there are many changes in physiology. These changes result in different clinical manifestations than in the general population.

The laparoscopic challenge of cholecystitis.

Objective: To evaluate the efficacy of laparoscopic cholecystectomy (LC) in acute and chronic cholecystitis and compare it with the open procedure.

Methods: This is a 5-year retrospective analysis performed at our hospital. Surgical treatment of gallbladder disease was performed in 1003 patients.

The implications of lighted ureteral stenting in laparoscopic colectomy.

Objective: The placement of indwelling ureteral catheters during colorectal surgery has been recommended for prevention of ureteral injuries. With the advent of laparoscopic colectomy (LCo), the role of preoperative placement of lighted ureteral stents (LUS) has also become commonplace. We sought to evaluate the value of lighted ureteral stent placement in laparoscopic colectomy.

Abdominal wall endometriomas.

Endometriosis is a condition in which uterine mucosal tissue is located outside the uterus. Endometriosis may be pelvic or extrapelvic. The term endometrioma is used when endometriosis appears as a circumscribed mass.

Multiple small bowel metastasis after laparoscopically assisted abdominoperineal resection.

Long-term outcome after laparoscopic surgery for colorectal cancer is still unknown. Trocar-site implantation and local recurrence has raised concerns about this new method. We present a case of a laparoscopically assisted abdominoperineal resection (APR) with small bowel recurrence 19 months after the APR.

Gastric phytobezoar: treatment using meat tenderizer.

In summary bezoars are rarely symptomatic. CT scan of the abdomen is rapidly becoming the first tool of diagnosis, while endoscopy still remains the best diagnostic test. Medical treatment is usually successful, as in this case and rarely do patients require surgery.

Cyclic guanine monophosphate (cGMP) an intracellular mediator of cavernosal smooth muscle relaxation following penile vascular surgery.

Background: We describe a new surgical method for treatment of male impotence. This procedure allows preservation of erectile tissues and avoids the need for implantable devices. It was demonstrated, that after this procedure sustained and reproducible erections were feasible.

Angiosarcoma of the breast following breast preservation therapy and local radiation therapy for breast cancer.

This is a case of angiosarcoma following breast preservation therapy and local radiation therapy over a 3-year period.

In-flight continuous vital signs telemetry via the Internet.

Background: Current methods available to assess a passenger's life threatening medical condition during in-flight emergencies are inadequate. Critical communication channels between the airplane and ground control rely only on voice communication via a two-way radio. The purpose of this study was to test the efficacy of cellular telephone technology via the Internet as a cost-effective way to obtain the "linking" pathway from an aircraft to a ground medical facility by conducting a simulated on line triage.

The efficacy of laparoscopy in acute cholecystitis.

Objective: To evaluate the role of laparoscopic cholecystectomy in acute cholecystitis and establish the outcomes of this treatment modality at North Oakland Medical Centers.

Methods: This was a retrospective analysis over a three-year period (January 1, 1994 to December 31, 1996), performed at a University-affiliated urban teaching hospital, North Oakland Medical Centers, Pontiac, Michigan. Five hundred and fifty-seven patients underwent surgical treatment for gallbladder disease; 88 patients had acute cholecystitis, and 469 patients had chronic cholecystitis.

Androgens in preeclampsia.

Objective: The purpose of the study was to determine whether maternal serum levels of androgens, especially testosterone, are higher in patients with preeclampsia than in matched normotensive control subjects.

Study Design: Serum testosterone, dehydroepiandrosterone sulfate, sex hormone binding globulin, and estradiol levels were measured in 16 subjects in the third trimester of pregnancy with documented preeclampsia and 26 healthy, normotensive women with similar maternal and gestational ages. All subjects were primigravid women with singleton pregnancies who were seen in the labor and delivery department at North Oakland Medical Centers in Pontiac, Mich.