Laparoscopy and acalculous cholecystitis.

Acalculous cholecystitis is probably more common than the medical literature would suggest. This paper reviews a series of 13 patients who presented with symptoms of cholecystitis and who had normal ultrasound or cholecystogram examinations. Eleven patients underwent cholecystectomy and all had their symptoms ameliorated or cured. Laparoscopy is suggested as an early diagnostic procedure in these patients, followed by cholecystectomy if there is objective laparoscopic evidence of cholecystitis.

Flexible fibre-endoscopy of the ileal loop.

Three cases are described in which conventional radiology had suggested that recurrent tumour was present at a ureteroileal anastomosis. Fibre-endoscopy of the ileal conduits was performed with the Olympus short colonoscope. In each case the anastomosis was seen to be normal and no complications ensued. It is suggested that fibre-endoscopy of the urinary conduit is a safe and simple adjunct to conventional radiology.

Acid secretion in the bile duct-ligated pig.

Bile duct ligation is associated with severe gastric ulceration in the pig, but the pathogenesis is unknown. Gastric acid secretion was therefore studied before and after bile duct ligation in pigs with Heidenhain pouches. Basal pouch secretion and the response to submaximal pentagastrin stimulation incresed significantly 6--14 days after ligation of the common bile duct (P < 0,05). Bile duct ligation was not followed by gastric ulceration in the pigs in this study which had had, in effect, a 50--70% gastric resection in the course of fashioning the Heidenhain pouch. These observations suggest that oesophagogastric junction ulceration in pigs is associated with gastric acid hypersecretion.

The role of antibacterial preparation of the intestine in the reduction of primary wound sepsis after operations on the colon and rectum.

A consecutive series of 320 patients undergoing operations on the colon and rectum, under the care of one surgeon, was studied to determine the influence of oral antibacterial preparation of the intestine on the incidence of postoperative wound sepsis. Thirty patients were excluded from the analysis, and the rates of major wound sepsis in the remaining 290 patients were 21.7 per cent when no antibacterial preparation was used; 18.6 per cent when the intestine was prepared with phthalylsulfathiazole and neomycin, and 1.6 per cent when the intestine was prepared with phthalysulfathiazole, neomycin and tetracycline. Other important determinants of the rate of wound sepsis were obesity and the use of cephaloridine prophylaxis. Results of bacteriologic studies showed the effectiveness of triple antimicrobial preparation of intestine against gram-negative aerobes and Bacteriodes species.

Pathophysiology of capillary circulation: Raynaud's disease.

Despite the frequency of Raynaud's disease in cold climates, the etiology of the condition remains uncertain. This report reviews the literature since Raynaud's original description and Lewis and Pickering's addition to the concept, and several recent observations which add to our understanding of the disease are discussed. We investigated the effect of posture and a vasodilator drug on the digital capillary circulation; digital blood flow increases as the body moves from a recumbent, through a sitting, ti an upright position. Bradilan, a vasodilator drug, increases the circulation in the recumbent and sitting positions, but has no effect in standing patients, despite symptomatic relief.