A retrospective wound review of standard four-port laparoscopic cholecystectomy: is there need for single-port laparoscopic surgery?

BACKGROUND: This study was designed to assess the satisfaction or otherwise of a proportion of the U.K. population who have undergone standard four-port laparoscopic cholecystectomy within the past 18 months. The results should indicate whether there is potential demand for a new, improved approach to surgery. METHODS: Patients who underwent laparoscopic cholecystectomy between October 2008 and October 2009 in two geographically separated general hospitals were identified from hospital databases. Notes were reviewed to confirm the technique and lack of conversion to an open procedure. Those who had immediate complications were excluded. A telephone questionnaire was conducted to answer questions related to long-term cosmetic and general satisfaction of the current procedure. RESULTS: Of the patients surveyed, 93% were happy or extremely happy with the current procedure, 48% experienced some wound-related issues (pain, infection), and 65% of those were at the umbilicus (a possible reflection of location and retrieval site for gallbladder). Cosmesis was rated less important than hospital cleanliness and experience of the surgeon. CONCLUSIONS: Overall satisfaction was high with the existing technique. The high rate of umbilical wound problems is an issue that will not be eradicated by introduction of single-port laparoscopic surgery.

Effect of NaCl and NaHCO3 on serum ionised calcium and blood gas status during sprinting.

Sodium bicarbonate is often administered to horses before racing in an attempt to delay fatigue and improve performance. We examined the effect of acid-base status on serum ionised calcium concentration (iCa) during high intensity exercise in 8 Standardbred mares. In a randomised, blinded, cross-over study, mares were administered each of 3 treatments, NaCl (0.7 g/kg bwt), NaHCO3 (1 g/kg bwt) in 3 l water, or 3 l of water only, 4 h before performing a standardised exercise test to fatigue on a treadmill. Mixed venous blood samples were collected as the horses ran for 5 min at 3 m/s, to fatigue at a predetermined speed (approximately 113% VO2max) and for 5 min at 3 m/s. There was no effect of treatment on time to fatigue (P = 0.744). NaHCO3 attenuated (P<0.05) the exercise-induced decrease in venous pH (mean +/- s.e. 6.97, 6.95 and 7.06 +/- 0.02 at end of sprint for water, NaCl and NaHCO3, respectively). Both serum total calcium concentration (tCa) and iCa increased (P<0.05) with running. NaHCO3 decreased iCa (P<0.05) compared to water; iCa of 1.58 and 1.44 +/- 0.04 mmol/l before exercise and 1.69 and 1.49 +/- 0.05 end sprint, for water and NaHCO3 treatments, respectively. These results demonstrate an effect of NaHCO3 on iCa during exercise. Further study is necessary to determine the effect of alterations in iCa on exercise performance.

Ureteral ligation prevents the haemodynamic effect of frusemide in pentobarbitol anaesthetised horses.

Frusemide reduces pulmonary vascular pressures in resting horses and attenuates exercise-induced increases in these pressures in exercising horses. The mechanism underlying these effects of frusemide is unclear. We tested the hypothesis that the haemodynamic effects of frusemide are dependent on diuresis by examining the effect of frusemide in anaesthetised horses in which diuresis was prevented by ligation of ureters. Twenty four horses were assigned randomly to one of 4 treatments: 1) frusemide (1 mg/kg bwt i.v.) and intact ureters; 2) frusemide and ligated ureters; 3) saline placebo and ligated ureters; and 4) frusemide and phenylbutazone (4.4 mg/kg bwt i.v. 12 h and 15 min before frusemide) and ligated ureters. Frusemide administration to anaesthetised horses with intact ureters increased plasma total protein concentration and reduced mean right atrial, pulmonary artery and aortic pressures. There was no significant effect of frusemide administration on haemodynamic variables or plasma total protein concentration in horses with ligated ureters. The combination of frusemide and phenylbutazone increased mean right atrial, pulmonary artery and aortic pressures in horses with ligated ureters. This study demonstrates that, in anaesthetised horses, the haemodynamic effect of frusemide is dependent upon diuresis. We interpret these results as providing further evidence that the haemodynamic effect of frusemide in horses is attributable to a reduction in plasma and blood volume.

Nephrosplenic entrapment in the horse: a retrospective study of 174 cases.

The clinical findings and outcome of 161 horses diagnosed with 174 episodes of nephrosplenic entrapment (NSE) were reviewed retrospectively. The median age at presentation was 5 years (9 months to 24 years), and duration of colic was 2-92 h. Nasogastric reflux was present in 49 of 113 horses (43.4%) and was significant (> or = 21) in 32 (28.3%) horses. The recurrence rate was 13/161 (8.1%). Thirteen horses (13/174, 7.5%) had other lesions including small intestinal obstruction (4), 360 degrees large colon torsion (5), gastric rupture (2), thromboembolic colic (1) and small colon infarction (1). Of 115 cases, in 107 horses treated by surgery alone, 2 horses required a large colon resection, and 8 (8/107, 7.5%) horses died or were subjected to euthanasia. Twenty-six of 35 horses (74%) were successfully corrected by rolling under general anesthesia and, of the 9 horses taken to surgery after rolling, 4 had other lesions and 2 were corrected at surgery. Phenylephrine was used in 20 of 35 horses that were rolled and 2 horses required surgery after rolling with phenylephrine. Five horses were jogged after phenylephrine administration and all were successfully corrected. Eleven horses presented with the left colon located between the spleen and the body wall were treated successfully by fasting and/or i.v. fluids. One horse had a gastric rupture after rolling. The overall success rate was 92.5%. In conclusion, NSE is a condition associated with a good prognosis for medical or surgical correction. A small number of horses may have additional gastrointestinal lesions, which may affect outcome.

The effect of supramaximal exercise on equine platelet function.

When blood is collected into sodium citrate in the proportion of 9 parts blood:1 part sodium citrate, the concentration of plasma sodium citrate in the sample will depend on the packed cell volume (PCV) of the blood sample. This difference in plasma sodium citrate concentration secondary to alterations in PCV significantly affects human platelet aggregation responses. Since horses attain a high PCV in response to high-intensity exercise we investigated the effect of differences in sample plasma sodium citrate concentration on equine platelet aggregability. In addition, low molecular weight heparin (LMWH) was evaluated as an alternative anticoagulant for assessment of platelet aggregability during strenuous exercise in horses. Blood samples were collected pre-exercise and at fatigue after supramaximal treadmill exercise into either 3.8% sodium citrate (9 parts blood:1 part sodium citrate) or 20 u LMWH/ml of blood. Platelet aggregation responses to 1.25 mumol/l adenosine diphosphate (ADP) were measured via optical aggregometry. For samples collected into sodium citrate, aggregability was significantly less than pre-exercise values in samples collected at fatigue and in pre-exercise samples in which sodium citrate concentrations were adjusted to equal those in fatigue samples. However, samples collected into LMWH showed significantly increased platelet aggregability in samples collected at fatigue when compared to pre-exercise samples. In conclusion, higher plasma sodium citrate concentration had a marked inhibitory effect on equine platelet aggregation responses. Low molecular weight heparin was a good alternative anticoagulant for assessment of equine platelet function and results indicate that equine platelet aggregability was enhanced in response to supramaximal exercise.

Body temperatures and activity patterns of Tasmanian devils (Sarcophilus harrisii) and eastern quolls (Dasyurus viverrinus) through a subalpine winter.

During a field study of carnivorous dasyurid marsupials in subalpine Tasmania, the trapping success for Tasmanian devils (Sarcophilus harrisii), but not for spotted-tailed quolls (Dasyurus maculatus) or eastern quolls (Dasyurus viverrinus), was significantly lower when winter weather conditions turned to sleet or snow or when deep snow lay on the ground. This field study was instigated to determine if devils and eastern quolls spend more time in burrows in severe weather conditions and if they enter torpor. Torpor is known to occur in eutherian mammals as large as devils and in a similar-sized congeneric marsupial, the western quoll (Dasyurus geoffroyi). Using radiotelemetry, body temperatures of Tasmanian devils and eastern quolls ranging freely in their natural habitat were monitored throughout winter. Neither species was observed in torpor, even under prolonged severe weather conditions, and the number of hours spent active not did differ between summer and winter or between moderate and severe winter weather conditions. Body temperatures averaged 36.5 degrees C (SD = 0.079, range of 33.5 degrees-38.6 degrees C) for the three male eastern quolls and 35.7 degrees C (SD = 0.575, range of 31.3 degrees-37.5 degrees C) for the four (male and female) devils. A diel cycle in body temperature occurred in both species; temperatures rose each evening when animals became active, remained high throughout the night despite ambient temperatures falling to the diel minima, and were lower during the day when the individuals were inactive in dens. The amplitude of this cycle was greater in eastern quolls (1.1 degrees C, SD = 0.142) than in devils (0.6 degree C, SD = 0.252).

Hibernation in a monotreme, the echidna (Tachyglossus aculeatus).

The body temperatures of five echidnas in Australia's Southern Alps were monitored by radio telemetry from February to December 1987. All five hibernated throughout the winter, showing very low body temperatures (4-9 degrees C, close to ambient) when torpid, compared with 28-33 degrees C in a typical day during the active season. Spontaneous arousals from hibernation occurred every 2-3 weeks, during which body temperatures rose rapidly to over 30 degrees C for several hours before dropping to be close to ambient again. The identification of "classical" hibernation in a monotreme, with a similar pattern to that seen in Eutheria and in an animal as large as the largest eutherian hibernator, has important implications for current ideas about the evolution of endothermy.

Sonographic depiction of endometrial changes occurring with ovulation induction.

Endometrial thickness and texture were evaluated with serial pelvic sonograms in ten normal, menstruating women and 107 patients undergoing ovulation induction for in vitro fertilization. Serial sonograms were performed in the control group every other day throughout the menstrual cycle, whereas the sonographic examinations of the ovulation induction patients were performed daily in a four- to eight-day time interval after their medications were completed and prior to laparoscopy for follicular aspiration. Endometrial thickness increased (defined as a persistent change greater than or equal to 1 mm) in 21 of 53 women (40 percent) who received human menopausal gonadotropin (HMG). Of the 54 women treated with clomiphene citrate (CC), five of 12 (42 percent) at 50 mg daily, 13 of 33 (39 percent) at 100 mg daily, and one of nine (11 percent) at 150 mg daily were found to have endometrial thickening. Although the frequencies of endometrial thickening in the high-dose CC and HMG groups were not significantly different (P = 0.09), the peak estradiol (E2) levels in the CC (150 mg) group (E2 = 944 +/- 165 pg/ml) were significantly higher (P less than 0.001) than those in the HMG group (E2 = 584 +/- 26 pg/ml). The relatively low frequency of endometrial thickening in women receiving CC (150 mg) despite very high E2 levels, and the decreased incidence of endometrial thickening relative to increasing dosages of CC may reflect an antiestrogenic effect of CC on the endometrium. In those patients undergoing ovulation induction, the texture of the endometrium remained the same in 98 cycles and changed during nine.(ABSTRACT TRUNCATED AT 250 WORDS)