Prophylactic cholecystectomy during abdominal surgery.

The presence of asymptomatic gallstones is no longer an indication for elective prophylactic cholecystectomy (PC) according to the recommendations of the 1991 French Consensus Conference on cholelithiasis. However, there may be potential benefits of performing prophylactic cholecystectomy during certain abdominal procedures for non-biliary disease; this remains a subject of debate. This debate has become livelier with the recent increase in bariatric surgery. Gastrectomy for cancer, small bowel resection, colonic resection, and splenectomy for hereditary spherocytosis as well as all bariatric surgical interventions can all alter the physiology of gallstone disease raising the question of the value of PC, but the specific morbidity of cholecystectomy must be kept in mind. The purpose of this study was to report epidemiological and pathophysiological data and the results from literature reports in order to assess the value of concomitant prophylactic cholecystectomy during various common surgical situations.

Gas phase formation and Doppler monitoring during decompression with elevated oxygen.

Subjects in 150 man-dives were precordially monitored with a 5-MHz Doppler ultrasound bubble detector. These measurements were made during a series of dives conducted to test decompression tables that utilize changes of breathing mixtures and a time-average PIO2 of 1.9 b during the entire decompression period. Precordially detected bubbles at depth were predictive for limb pain in divers approximately 50% of the time; however, 70% of the divers encountered bends problems in the absence of precordially detectable bubbles. Thus, while the presence of venous return bubbles can be associated with a risk factor for bends, the Doppler method appears to lack the specificity needed for personal dive monitoring. During the oxygen-breathing portions of the decompression individual bubbles could not be detected precordially. The amplitude of the Doppler-detected pulmonary artery flow sound increased, however, and possibly indicated the presence of numerous microbubbles.