Safe laparoscopic cholecystectomy in a community setting, N = 762.

Laparoscopic cholecystectomy (LC) can be introduced into a community with morbidity and mortality rates equal to that of open cholecystectomy. The entire general surgical community of Greensboro, NC, learned the technique of LC on animal models prior to offering this innovation to the community. Over the ensuing 12 months, they served as surgeons or assistant surgeons to each other on 762 LCs with morbidity and mortality rates comparable to open cholecystectomy. This retrospective study examined the first 1 year of experience beginning 8/13/90. This work represents all of the LCs performed in Greensboro, and all of the surgeons participated in this review. All of the surgeries were done with an electrocautery and utilized a 0 degree forward-viewing scope. Cases were performed at two hospitals with a surgeon as both operator and assistant, and no effort was made to exclude high-risk or elderly patients from this procedure. Patients averaged 50 years of age and ranged from 14 to 96 years. Static cholangiograms were performed in 27% of patients. Conversion to open cholecystectomy was seen in 4.8%. There were two cardiac deaths (0.26%) and significant complications were seen in 3.4%. Seven patients required reoperations. There were no major common bile duct injuries. This retrospective review indicates that this new procedure can be introduced into a community setting by novice laparoscopic surgeons acting both as operators and assistant with a morbidity and mortality rate comparable to that reported for open cholecystectomy.

Congenital retraction of the upper lid.

A 6-year-old boy with congenital retraction of the left upper lid was treated with guanethidine without result. Recession of the levator with release of the lateral expansion of the levator resulted in the normal position of the left upper lid.

Ischemic optic neuropathy secondary to intestinal hemorrhage.

A 70-year-old man presented with bilateral ischemic optic neuropathy. Workup revealed anemia that proved to be secondary to blood loss from an occult small bowel sarcoma. Ischemic optic neuropathy is an uncommon complication of gastrointestinal hemorrhage. It is important to recognize the association of visual loss and severe blood loss when they occur concurrently, so that proper treatment may be promptly instituted.

Primary dacryocystitis causing orbital cellulitis.

A patient was examined who had acute dacryocystitis that caused true orbital cellulitis. The symptoms of the cellulitis receded after treatment with cephalothin sodium and hot compresses. A dacryocystorhinostomy was performed three weeks later. Delay of the surgery until the acute episode had resolved was probably responsible for the good surgical results.

Subconjunctival lymphoma: a review of six suspected cases and the use of immunologic surface markers.

Six cases of subconjunctival tumor clinically compatible with the appearance of subconjunctival lymphoma were evaluated. Two of the patients, Cases 1 and 2, were under treatment with either prednisone or gold therapy for severe rheumatoid arthritis. Patient 3 manifested further evidence of systemic disease (auxillary lymph node). Of the remaining cases, patient 4 had no further evidence of systemic involvement, whereas patient 5 was suspected of having a gastrointestinal tumor. The last case, a patient known to have pulmonary lymphoma, presented with dry eye and multiple subconjunctival lymphomatous masses. Immune surface marker studies demonstrated a B-cell monoclonal subconjunctival lymphoma, suggestive of an improved survival when compared to null cell-type lesions. Immune surface marker studies offer a new commercially available method for classifying and prognosticating subconjunctival lymphomas.

Listeria endophthalmitis.

Listeria endophthalmitis developed in a patient who was being treated for extensive metastases of carcinoma of the breast. At the time of admission she was receiving cobalt therapy, chemotherapy, and high doses of oral steroids. The early identification of organisms with an immediate paracentesis and the early institution of broad-spectrum antibiotics is recommended.

A simplified technique for macrodacryocystography.

A simple method for radiographic visualization of the lacrimal drainage apparatus is presented. Equipment necessary is explained and normal radiographic anatomy of the system illustrated. Several cases of high- and mid-level obstructions are shown via this technique and a discussion follows.

Further experience with trabeculectomy.

Trabeculectomies performed on 33 eyes were compared to 28 standard filtering procedures done at the same institution during a 4 year period. The success rates in the two groups of patients whether white or black were statistically comparable, 92% in the trabeculectomy group and 77% in the standard filtering surgical group. Only cases of phakic open angle glaucoma, chronic angle closure and combined mechanism glaucoma were considered. Cases of secondary glaucoma, previous surgical failure and aphakic nonpupillary block glaucoma did uniformly poorly. When trabeculectomy was performed with "enhanced cyclodialysis" early results in a few cases were successful. The incidence of flat anterior chamber and cataracts with permanent reduction in visual acuity was significantly less in the trabeculectomy group than in the standard filtering procedure group. These results support previous studies which support trabeculectomy as successful as standard filtering procedures with the advantage of having fewer permanent serious complications.