[Video-laparoscopic cholecystectomy: first years of experience]. / Colecistectomia videolaparoscopica: primi anni di eperienza.

Laparoscopic cholecystectomy is became the elective operation in the treatment of symptomatic lithiasis of gallbladder, and it represent the surgical choice in 96% of cases. The authors on the base of their first years experience analyzes the results of literature with particular reference to the complications, like lesion of principal biliary tract and of other organs or vessels, underlining how the right selection of patients can be reduce morbidity. In this direction the subdivision of contraindication, in relative and absolute, already described in literature, represent an obliged chose to respect the mini-invasive principle which laparoscopic technique mean.

Early diagnosis of acute myocardial infarction based on assay for subforms of creatine kinase-MB.

Thrombolytic therapy for patients with acute myocardial infarction (AMI) has produced the need for an accurate early diagnostic marker. We previously developed and assessed an assay for the creatine kinase (CK)-MB subforms; assay time is 25 minutes. Plasma MB2 (tissue subform) activity, MB1 (plasma-modified subform) activity, and MB2/MB1 ratio in 56 healthy individuals were 0.61 +/- 0.33 units/l, 0.63 +/- 0.33 units/l, and 0.94 +/- 0.39, respectively. Only one individual had both an MB2 activity greater than 1.0 units/l and an MB2/MB1 ratio of more than 1.5. Similar results were obtained in 50 hospitalized patients without cardiac disease; two of these patients had both an MB2 activity and an MB2/MB1 ratio greater than the cutoff values. Among 49 patients with AMI, MB2 activity and the MB2/MB1 ratio began to increase 2 hours after AMI; the ratio reached a plateau of 3.1 by 4-6 hours. The first available plasma sample was abnormal by the subform assay in 67% of patients and by a conventional MB assay in 27% of patients. Assay sensitivities in samples collected at 2-4, 4-6, and 6-8 hours after AMI were 59%, 92%, and 100% for the subform assay and 23%, 50%, and 71% for the conventional assay (p less than 0.03 versus subform assay at each time interval). False-negative results were obtained by the subform and conventional assays in 15 and 45 samples at a mean of 2.3 and 5.8 hours, respectively. Subform assay provides rapid and reliable diagnosis of AMI within 4-6 hours after the onset of symptoms, which is 6 hours before conventional CK-MB assays are accurate.

Sensitive, rapid assay of subforms of creatine kinase MB in plasma.

The subforms of creatine kinase (CK; EC 2.7.3.2) in plasma have received recent attention as potential markers for the early diagnosis of acute myocardial infarction. Because changes in CK-MM subforms are not specific for myocardial injury, we developed an assay, based on high-voltage electrophoresis, that is sufficiently sensitive to detect the CK-MB subforms at concentrations substantially below the upper limit of normal (14 U/L). The assay can detect 1.25 U of either MB subform per liter with a precision of 0.20 U/L and gives responses that vary linearly with activity concentration from 0.0 through 30.0 U/L, with an identical signal response for both subforms. When both subforms are present in a serum sample, the assay accurately measures both the relative percentage and the absolute quantity of each: assay activity/known activity was 1.03 for each subform at a total MB subform activity of 5.0 U/L (r = 0.98). Assay time is 25 min, and there is no loss of CK during electrophoresis. Thus, this system can be used to rapidly, sensitively, and precisely quantify the two CK-MB subforms at activities well within the normal reference interval.

Radial manometric study of the anal canal: preliminary results.

The pressure profile of the anal canal results from the effects of several muscles mainly the internal and external anal sphincter and the puborectalis. The preliminary results of radial manometric study of the anal canal carried out in 36 healthy volunteers, are reported. Based on the obtained results it is concluded that the anal canal shows a statistically significant difference in the radial distribution of pressure. The anatomo-physiologic mechanisms underlying this phenomenon, are discussed.