Gastroscopic-assisted laparoscopic wedge resection of B-cell gastric mucosa-associated lymphoid tissue (MALT) lymphoma.

Helicobacter pylori has been implicated as an etiologic agent for B-cell gastric mucosa-associated lymphoid tissue (MALT) lymphoma. This tumor is considered a low-grade entity with an associated indolent course. Some instances of tumor regression with adequate antibiotic treatment and irradication of H. pylori have been reported. Gastric malignancy and more specifically, lymphoma, should be considered in all patients with recurrent or nonhealing ulcers. Diagnostic and treatment strategies for these patients remain controversial. Two patients were evaluated, one for recurrent disease, another for a 3-cm nonhealing ulcer. Both patients refused total gastrectomy. Both patients underwent gastroscopy with simultaneous laparoscopic visualization. The mucosal lesions were identified and removed via laparoscopic stapled wedge resection. A combined endoscopic and laparoscopic approach can be considered as an alternative to radical surgery in the treatment strategy of these tumors. Wedge resection allows for staging and thorough pathologic classification. Further studies are necessary to define the natural history and the role of laparo-endoscopy in the diagnosis, staging, and treatment of B-cell gastric MALT lymphoma.

Intraoperative cholangiography in laparoscopic cholecystectomy: a review of 734 consecutive cases.

Intraoperative cholangiography was first introduced by Mirizzi in 1931. He recommended its routine use. The debate over the appropriate role of intraoperative cholangiography was renewed by the widespread acceptance of laparoscopic cholecystectomy in 1988. We reviewed our experience to determine the most appropriate use of intraoperative cholangiography. Seven hundred thirty-four consecutive cases of laparoscopic cholecystectomy performed between January 1, 1991 and December 31, 1993 were reviewed. The Routine Group of 276 cases, performed by 3 surgeons practicing routine cholangiography, was compared to the Selective Group of 458 cases, performed by 16 surgeons practicing selective cholangiography. The groups were similar in terms of age, sex, and extent of disease. No statistically significant difference was found between the two groups in number of successful cholangiograms, filling defects, misinterpretation of cholangiograms, complications, or length of hospitalization. One common duct injury occurred in the Routine Group. The rate of conversion to open cholecystectomy was higher in the Routine Group. A cholangiogram added 14 minutes to the average duration of surgery and $737 to the average cost. We found that routine cholangiography did not increase common duct stone detection, did not decrease common duct injury, and did not increase technical skill, but it did increase cost. We feel that intraoperative cholangiography should be used selectively where choledocholithiasis is suspected or biliary anatomy is unclear.

Vestibular and oculomotor abnormalities in vertebrobasilar insufficiency.

The early diagnosis of vertebrobasilar insufficiency in patients with vertigo as their only symptom was attempted using a battery of vestibulo-oculomotor tests. With this testing procedure, we were able to find abnormal vestibulo-oculomotor mechanisms that could account for the vertigo in 41 of 42 patients. These abnormalities, however, did not fall into an easily recognizable pattern that could be considered characteristic of vertebrobasilar insufficiency. The large intersubject variability probably arises from the very different and widespread lesions that occur at the vestibular and neurological levels as a consequence of vertebrobasilar insufficiency.

Traveling waves demonstrated by a revolving helix: a simple teaching aid.

A simple procedure for the demonstration of traveling waves in actual motion in the classroom is described. Using a matched set of experimental data on a) peak amplitude of basilar membrane oscillations, and b) phase-lag along the membrane, both for a given frequency of stimulation, it is possible to construct a solid spiral, or helix, of constantly changing diameter and pitch. When projected on a screen, the helix will look like a longitudinal amplitude gradient along the basilar membrane; as the helix is rotated, the projection will appear as a traveling wave. It is suggested that the device, because of its inherent simplicity, is a useful aid in a teaching laboratory for future otolaryngologists, audiologists and other professionals related to the field of hearing.

[Temporal cochlear changes evoked by prolonged exposure to low intensity noise. Electrophysiological study in guinea pigs]. / Alteraciones cocleares transitorias provocadas por la exposición prolongada a ruido de baja intensidad. Estudio electrofisiológico en cobayos

Behavioral temporal threshold shifts (TTS) have been shown in the chinchilla, to be correlated with cochlear microphonic (CM) and whole-nerve action potential (AP) losses in the sensitivity as well as in maximum voltage. The Guinea-pig's ear differs significantly both anatomically and physiologically from the chinchilla's; as a result, it does not seem to be as susceptible to TTS at non-injurious noise levels, except at those frequency bands were middle-ear impedance and other factors are more favorable. At times varying from 2 hrs to 48 hrs after termination of noise exposures of 48 hrs duration to an octave-band of noise (7-14 KHz) with a sound-pressure level of 95 dB, the CM from the first three cochlear turns as well as the whole-nerve AP were measured in Guinea pigs. Losses in sensitivity as well as in maximum voltage were found in the CM recorded from the first turn. CM recovered gradually with time, reaching normal levels at about 40 hrs after termination of noise exposures. The AP +showed similar losses. Microscopic examination of the organ of Corti showed no loss of hair cells.