ABSTRACT
Objective:To investigate the safety and feasibility of endoscopic cholecystolithotomy after endoscopic ultrasonography (EUS)-guided lumen-apposing metal stent (LAMS) implantation in animals.Methods:Six miniature pigs of 30-35 kg were selected to laparotomy under intravenous anesthesia. Two to four sterile human stones with diameter of 0.8-2.0 cm were implanted in their gallbladder. After successful modeling, LAMS was implanted between the stomach and gallbladder under the guidance of EUS. Ultrafine endoscope was used to search and remove stones after passing the gastric stent into the gallbladder. Endoscopic sphincterotomy (EST) and endoscopic retrograde biliary drainage (ERBD) was performed to prevent bile leakage. And then ordinary endoscope was used to remove LAMS and close the wound. The success rate, operation time, and incidence of complications were analyzed.Results:Five pigs were successfully implanted with LAMS, and the ultrafine endoscope entered the gallbladder smoothly. Small stones were removed from the stone basket, and large stones were completely removed after laser lithotripsy. The total operation time was 87-128 min. No postoperative complications such as bleeding, perforation, infection, or biliary fistula were observed. Failure in 1 pig was due to the first EST plus ERBD, resulting in rapid reduction of gallbladder volume and away from the gastric cavity leading to puncture difficulties.Conclusion:Endoscopic cholecystolithotomy after EUS-guided LAMS implantation is safe and feasible, and may provide animal experimental evidence for potential therapeutic approach for patients with difficulty in cholecystectomy.
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10.3969/j.issn.1007-3969.2013.04.008
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Objective To evaluate the feasibility of laparoscopic procedures in pregnant women. Methods A retrospective analysis was made on 12 pregnant women with an acute abdominal emergency resulted from adnexal mass from 1997 to 2002.Results All the 12 patients were laparoscopically diagnosed as having pregnancy associated with torsion or necrosis of adnexal mass. There were 2 cases of unwinding of the twisted fallopian tube and oophorocystectomy, 3 cases of oophorocystectomy, and 7 cases of adnexectomy. All the patients were cured. No miscarriage or infant malformation happened. Follow-up for 8～12 months in 11 infants revealed normal development. Conclusions In pregnant patients the laparoscopic procedure is relatively contraindicated. Satisfactory curative effects can be obtained if the patients are properly selected.
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In order to induce heavy Pneumocystis pneumonia, rats were treated with dexame-, thasone twice a week for 14 weeks. Mature cysts, immature cysts and ruptured cysts were, identified on lung imprints. By phase-contrast microscopy mature cysts were spherical in, shape containing intracystic bodies both spherical and irregular, small to large trophozoites having polymorphic shapes, one nucleus and many vacuoles. Elcctro-microscopically, large amount of irregular trophozoites adhered to the surface of the type I alveolar epithelial cells in the alveolar cavity were observed. The above histological findings were typical features of Pneumocystis pneumonia (Figs. 1-8).