Laparoscopic cholecystectomy in cirrhotic patients.

BACKGROUND: Reported mortality for open cholecystectomy in patients with cirrhosis ranges from 10% to 80%. Laparoscopic cholecystectomy has gained acceptance in the general population and has become the procedure of choice for symptomatic cholelithiasis. We reviewed our experience with the use of laparoscopic cholecystectomy in this group. STUDY DESIGN: We did a retrospective review of the records of 25 consecutive laparoscopic choleoystectomy procedures performed on cirrhotic patients from May 1992 to July 1996. RESULTS: There were no mortalities in our group. All procedures were completed laparoscopically. Mean length of stay was 1.7 days (range, 1 to 8 days). Morbidity consisted of wound hematomas, pneumonia, and ascites for a rate of 32%. Only patients with Child's Class A and Class B cirrhosis were operated on. CONCLUSIONS: Laparoscopic cholecystectomy can be performed safely in cirrhotic patients with well compensated liver function.

Antifreeze glycoproteins from Polar fish. Effects of freezing conditions on cooperative function.

Antifreeze glycoproteins and glycopeptides that function noncolligatively contribute one-third of the freezing temperature depression in the blood serum of some polar fishes and enable them to survive at low temperature (-1.9 degree C). There are at least eight closely related glycoproteins and glycopeptides ranging in molecular weight from 32,000 to 2,600 and numbered 1 to 8 in order of decreasing size. Under conditions of negligible supercooling, the glycopeptides have weaker antifreeze activity than the glycoproteins (20% on a weight basis, or 5% on a molar basis); in mixtures of both, their activities are additive. When nucleation is initiated in supercooled solutions (-4 to -5 degrees C), the glycopeptides are inactive, while the glycoproteins still show activity; when mixtures of both are nucleated in supercooled solutions, cooperative potentiation occurs, and the full activities of the glycopeptides are found. On nucleation of supercooled solutions of the glycoprotein alone or of the mixtures, the temperature rises above the freezing temperature ("overshoots") to an extent dependent upon the extent of supercooling; the temperature of the sample then decreases to form a plateau at the true freezing temperature.

Cooperative functioning between antifreeze glycoproteins.

Antifreeze glycoproteins from polar fish bloods are a mixture of closely related components which differ structurally by size and by the presence of proline in the smaller components. Although the smaller components containing proline exist in higher amounts than do the larger ones, their presence puzzled investigators because they had very weak antifreeze activity. A very important function for these smaller components has now been found. These smaller antifreeze glycoproteins (10 to 25 mg/ml) have now been tested as mixtures with the larger active antifreeze glycoproteins (2 to 4 mg/ml) and a very large (2- to 8-fold) potentiation of antifreeze activity has been observed. There appears to be a cooperative functioning between the larger and smaller components.