Laparoscopic upper abdominal operations and mesenteric infarction.

Mesenteric visceral infarction occurring after laparoscopic procedures in the upper abdomen may be a direct result of physiologic changes induced by carbon dioxide pneumoperitoneum and other technical elements with these procedures. The reported case is characteristic of a seemingly successful operative result interrupted by this devastating complication.

The retrograde radial fascial forearm flap: surgical rationale, technique, and clinical application.

The retrograde radial fascial forearm flap may be used to provide appropriate tissue coverage for nerve, tendon, or soft tissue defects in the forearm and hand. The procedure is differentiated from the standard radial forearm flap in that the radial artery remains intact when the retrograde radial fascial flap is designed. The rationale, technique, and clinical application of the flap are presented in order to allow surgeons to maintain the radial arterial trunk in continuity while obtaining the advantage of appropriate soft tissue cover in this critical area.

Laparoscopic cholecystectomy and pregnancy.

The risk of operation during pregnancy is a concern to both patients and surgeons. Operative treatment for gallstone disease during pregnancy is therefore performed only when the severity of symptoms exceeds the tolerance of the patient. The insufflation of the abdomen during laparoscopy and the concerns regarding adequate exposure are significant in the performance of such operations. When the indications are appropriate, laparoscopic cholecystectomy can be conducted safely during the course of an intrauterine pregnancy.

Regulatory gene INO4 of yeast phospholipid biosynthesis is positively autoregulated and functions as a transactivator of fatty acid synthase genes FAS1 and FAS2 from Saccharomyces cerevisiae.

The sequence motif 5' TYTTCACATGY 3' functions as an upstream activation site common to both yeast fatty acid synthase genes, FAS1 and FAS2. In addition, this UASFAS element is shared by all so far characterized genes of yeast phospholipid biosynthesis. We have investigated the influence of a functional INO4 gene previously described as a regulator of inositol biosynthesis on the expression of FAS1 and FAS2. In a delta ino4 null allele strain, both genes are expressed at only 50% of wild type level. Using individual UASFAS sequence motifs inserted into a heterologous test system, a drastic decrease of reporter gene expression to 2-10% of the wild type reference was observed in the delta ino4 mutant. In gel retardation assays, the protein-DNA complex involving the previously described FAS binding factor 1, Fbf1, was absent when using a protein extract from the delta ino4 mutant. On the other hand, this signal was enhanced with an extract from cells grown under conditions of inositol/choline derepression. Subsequent experiments demonstrated that INO4 expression is itself affected by phospholipid precursors, mediated by an UASFAS element in the INO4 upstream region. Thus, in addition of being an activator of phospholipid biosynthetic genes, INO4 is also subject to a positive autoregulatory loop in its own biosynthesis.

Intraoperative cardiovascular crisis caused by glucagon.

Glucagon use as a muscle relaxant is common in radiologic and endoscopic examinations in which smooth-muscle spasm has interfered. Glucagon also provokes catecholamine release from an unsuspected pheochromocytoma, as occurred in a 60-year-old patient undergoing biliary tract surgery. To prevent hypertensive crisis and ventricular tachyarrhythmia after intraoperative glucagon administration, appropriate pharmacologic catecholamine antagonists must be immediately available.

Posttraumatic tension pneumopericardium: the "small heart" sign.

Radiographic measurements of the cardiothoracic ratio in four adult victims of blunt thoracic trauma with pneumopericardium demonstrated a sudden, substantial decrease in the size of the cardiac silhouette, which was accompanied by pathophysiologic effects of cardiac tamponade. The sudden decrease in cardiac size could not be attributed to a decrease in intravascular volume or to changes in positive airway pressure. Following surgical relief of tension pneumopericardium, the cardiac size was restored to baseline dimensions and the hemodynamic effects of tamponade resolved. In the presence of pneumopericardium, the "small heart" sign may alert one to the presence of tension pneumopericardium and impending cardiac tamponade.

Early environmental influences on conditioned and unconditioned ingestional and locomotor behaviors.

For 34-44 days after weaning one group of rats was raised in a socially enriched environment, whereas another group was raised in isolated individual cages without handling. Following this differential rearing subjects were tested for ingestional neophobia and its attenuation, enhancement of ingestional neophobia by aversive drug administration, taste-aversion learning and extinction, open-field activity, and passive shock-avoidance learning. Although the differential rearing influenced open-field activity and shock-avoidance this manipulation did not have a significant effect on the various measures of conditioned and unconditioned ingestional behaviors. The results provide further evidence for the distinctiveness of gustatory-visceral and telereceptor-cutaneous sensory systems.