ABSTRACT
Background: Appendicitis continues to be the most common acute abdominal condition that requires immediate surgical treatment. Methodology: A prospective study was performed in SRM Medical College and Hospital of all patients who underwent laparoscopic appendectomy (LA) during (May 2013 to October 2015) was performed. The LAs were performed by 12 trained certified surgeons. The decision to convert to open was made by the individual surgeon, and the reason for conversion was extracted from the patient’s medical record (operative report) prospectively. The inclusion and exclusion criteria defined. All operations were performed with the patient under general anesthesia with endotracheal intubation using either a 3- or 4-trocar technique. Results: In our study, females were the main sufferers of appendicitis. There was a preponderance of cases in the 2nd and 3rd decades of life. Most of the patients presented with the chief complaint of pain abdomen in the right iliac fossa pain. Conclusion: The mean operation time was 81.7 min, and the average length of post-operative hospital stay was 3.6 days. Among a total of 36 male patients, 5 were converted (13.8%), whereas among 46 female patients, 7 were converted (15.2%). Out of 112 patients studied, 12 cases were converted to open appendectomy. The conversion was more common in diabetic patients. The main intra-operative cause of conversion from LA to open was difficulty in identifying the anatomy as a result of mass formation and dense adhesions followed by hemorrhage from the appendicular artery.
ABSTRACT
The modulation of apolipoprotein Β synthesis and secretion by fatty acids in rat hepatocytes was studied· Maximum apolipoprotein Β production was obtained in the case of oleic acid followed by linoleic, stearic and palmitic/linolenic acid when compared to control which was not supplemented with any fatty acids. Oleic acid was found to exert a concentration dependent increase in the secretion of [3H] apolipoprotein Β into the medium while that associated with the cell layer was not affected. Pulse chase experiments in the presence of oleic acid showed that it caused an increase in the secretion of apolipoprotein Β into the medium. 14C-acetate incorporation into cholesterol and cholesteryl ester associated with the cell layer and secreted very low density lipoproteins also showed an increase in the presence of oleic acid indicating an increase in cholesterogenesis. The effect of oleic acid on [3H] apolipoprotein Β and very low density lipoproteins secretion appeared to be mediated through cholesterol as (i) ketoconazole, an inhibitor of cholesterol synthesis caused significant reduction in the stimulatory effect of oleic acid on apolipoprotein secretion and (ii) mevinolin, another inhibitor of cholesterol synthesis also reversed the stimulatory effect of oleic acid on apolipoprotein Β secretion. These results indicated that oleic acid may influence apolipoprotein Β synthesis and secretion in hepatocytes probably by affecting cholesterol/cholesteryl ester formation which may be a critical component in the secretion of apolipoprotein Β as lipoproteins.