Evaluation of early versus delayed laparoscopic cholecystectomy in the treatment of acute cholecystitis.

BACKGROUND/AIMS: The optimal timing of laparoscopic cholecystectomy (LC) in the treatment of acute cholecystitis remains controversial. This retrospective study was undertaken to assess the clinical outcomes, possible advantages and disadvantages of early versus delayed LC for acute cholecystitis. MATERIALS AND METHODS: Records of all patients admitted for acute cholecystitis in whom laparoscopic cholecystectomy was attempted between January 2004 and January 2006, at National Taiwan University Hospital were reviewed. RESULTS: A total of 89 patients were recruited to the study. Of these, 56 patients received early laparoscopic cholecystectomy (ELC), and 33 patients received delayed laparoscopic cholecystectomy (DLC) following conservative therapy. There were no intergroup differences in age, gender, or days of symptoms prior to presentation. Patients undergoing ELC experienced a significantly longer operation time (109 +/- 37.59 minutes versus 77 +/- 25.65 minutes, p < 0.001), more blood loss (76ml versus 28ml, p = 0.006) and a longer post-operation hospital stay (4.5 days versus 2.6 days, p < 0.001). The conversion rate to open cholecystectomy was not significantly different (4/56 versus 2/33, p = 0.84), and there were no biliary tract injury or other major complications in either group. However, patients with ELC had a shorter total hospital stay (4.53 days versus 7.79 days, p < 0.001) and fewer admission times (1 time in ELC versus 2.4 times in DLC, p < 0.001). CONCLUSIONS: Both early and delayed LC appears to be effective and safe in the treatment of acute cholecystitis. Early LC may be more technically demanding and time-consuming, and may be associated with a higher rate of wound infections; however, it also tends to shorten the total length of hospital stay and reduce the risk of repeat cholecystitis. We recommend early LC for acute cholecystitis comparison with delayed LC.

Effects of Astragalus Membranaceus Injection on TNF-alpha-induced release of inflammatory factors from HUVECs and the molecular mechanisms / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the protective effect of Astragalus Membranaceus Injection on human umbilical vein endothelial cells (HUVECs) against tumor necrosis factor alpha (TNF-alpha).</p><p><b>METHODS</b>Cultured passage 2 HUVECs were stimulated with TNF-alpha with or without a 2-h Astragalus Membranaceus Injection treatment. The expression of nuclear factor-kappaB (NF-kappaB) subunit p65 were evaluated by immuncytochemistical method, and the levels of p65 in the nuclei and the protein Ikappabetaalpha in the cytoplasm were evaluated by Western blotting. The levels of interleukin-6 (IL-6) and soluble intracellular adhesion molecule-1 (sICAM-1) in the cell culture were determined with ELISA.</p><p><b>RESULTS</b>TNF-alpha induced the activation of NF-kappaB and increased the expressions of IL-6 and sICAM-1 in HUVECs. The activation of NF-kappabeta by TNF-alpha was suppressed by Astragalus Membranaceus Injection in a dose-dependent manner.</p><p><b>CONCLUSION</b>Astragalus Membranaceus Injection can inhibit the TNF-alpha-induced expression of IL-6 and sICAM-1 by suppressing NF-kappabeta activation, suggesting its protective effect on the endothelial function.</p>