Endoscopic para-thyroidectomy: a new approach.

Two patients (one male and one female) underwent endoscopic para-thyroidectomy for parathyroid adenoma at the Department of Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. Three ports (one mid line and two laterals) were employed, a 10 mm telescope was used for the visualization and a harmonic scalpel was used for the dissection. To the best of our knowledge, there was no report of endoscopic para-thyroidectomy from Bangladesh. Both patients were fed on the first post operative day and discharged from the 4th and 8th operative day. Both patient's parathyroid hormone (PTH) level dropped to about one fourth the level in 12 to 20 minutes after enucleation (as compared to the immediate pre operative level). Endoscopic para-thyroidectomy appears to be a technically feasible patient friendly modality of treatment for the selected cases of para-thyroid pathology in experienced hand with excellent cosmetic outcome.

Laparoscopic highly selective vagotomy using CO2 laser: experimental study in dogs.

We attempted to establish a modified laparoscopic highly selective vagotomy using CO2 laser in dogs and evaluated its effectiveness and feasibility. After the laser dose based on gross and histologic measurements was determined, five dogs underwent anterior CO2 laser vagotomy with posterior truncal vagotomy under laparoscopy (lap-laser vagotomy) and five others underwent anterior selective vagotomy with posterior truncal vagotomy in the standard fashion via laparotomy (open surgical vagotomy). No complications such as gastric perforation were observed in any of the dogs subjected to lap-laser vagotomy, and the operating time was approximately half of that required for open surgical vagotomy. After surgery, acid secretion significantly decreased versus preoperative values in both groups of animals and remained stable for 6 months. We conclude that anterior CO2 laser vagotomy with posterior truncal vagotomy is as effective as conventional vagotomy and easier to perform; thus, we recommend it as a method of laparoscopic highly selective vagotomy.

Plasma serotonin and platelet aggregation during ischemia-reperfusion in dogs: effect of dipyridamole and coenzyme Q10.

Platelet aggregation and plasma serotonin were studied during ischemia-reperfusion of the small intestine in dogs. Blood was withdrawn from the superior mesenteric vein before and 1 h after ischemia, then 5, 30 and 60 min after reperfusion. Dipyridamole (5 mg/kg body weight) and coenzyme Q10 (CoQ10; 10 mg/kg body weight) were administered intravenously 5 min before reperfusion, following 1 h ischemia, in order to investigate their effects on platelet function and free serotonin. Ischemia-reperfusion resulted in an increased local free serotonin concentration together with an enhanced platelet response to ADP, collagen and arachidonic acid. Administration of dipyridamole and CoQ10 prior to reperfusion prevented, at least in part, augmented platelet activation and serotonin release. It appeared that dipyridamole was more potent than CoQ10. Our results may indicate a possible protective effect of dipyridamole on enhanced platelet activation during ischemia-reperfusion in dogs.

Serotonin as a factor involved in pathophysiology of thromboangiitis obliterans.

Whole blood and plasma levels of serotonin (5-hydroxy-tryptamine, 5-HT) as well as its uptake and spontaneous release from blood platelets were studied in 20 patients suffering from thromboangiitis obliterans (TAO, Buerger's disease) and 20 healthy subjects matched in pairs for age. Results of patients suffering from thromboangiitis obliterans differed in several ways from those of controls. Whole blood 5-HT content was significantly lower in the group of patients compared to that of the control group. It was established that patients with Buerger's disease have significantly greater plasma concentrations of free serotonin. In Buerger's disease patients, maximal platelet serotonin uptake velocity (Vmax) was significantly decreased. It was associated with the enhanced spontaneous release of 5-HT from blood platelets. We conclude that impaired platelet serotonin uptake and increased local concentration of serotonin in the vicinity of platelets in Buerger's disease may lead to platelet activation via 5-HT2 receptors, and it could be involved in the pathogenesis of thromboembolic complications.

Plasminogen activators and plasminogen activator inhibitor 1 before and after venous occlusion of the upper limb in thromboangiitis obliterans (Buerger's disease).

Plasma levels of plasminogen activators (t-PA, u-PA) and their inhibitor (PAI-1) were studied in patients suffering from Buerger's disease and healthy volunteers before and after 15 minutes of venous occlusion test. The baseline levels of t-PA in group of patients did not differ from those of controls. On the contrary patients with Burger's disease showed a marked increase in u-PA antigen concentrations with concomitant decrease in PAI-1 antigen levels. During venous stasis t-PA antigen concentrations increased in all subjects, however it was much pronounced in controls. Venous occlusion resulted in significant decrease in free PAI-1 levels in the group of patients only. In conclusion, Buerger's disease is associated with the endothelial derangement with increased u-PA release and decreased PAI-1 release, which does not influence the function of fibrinolytic system. The fact that the reduced response of the endothelium to release t-PA after venous stasis goes in parallel with marked decrease in PAI-1 antigen levels seems to suggest that patients suffering from Buerger's disease are not at high risk of intravascular fibrin deposition.

Experimental studies on the prediction and prevention of stress ulcers using tonometry, reflectance spectrophotometry and oxygenated perfluorochemicals.

The present study investigates whether oxygenated perfluorochemicals protect the gastric mucosa against hemorrhage-induced stress ulceration. The influence of oxygenated perfluorochemicals on both macroscopic and microscopic lesion formation, gastric intramural pH, index of oxygen saturation and index of hemoglobin saturation of the gastric mucosa was studied. To assess the severity of gastric mucosal ischemia, intramural pH was directly measured using a pH sensitive microelectrode and indirectly by utilizing hollow viscus tonometry, and the indices of oxygen saturation and hemoglobin saturation were measured by reflectance spectrophotometry. Oxygenated perfluorochemicals (30 ml/kg/h) significantly protected the gastric mucosa against both gross (lesion index 0.85 +/- 0.2 vs 2.23 +/- 0.31) and microscopic (lesion index 0.52 +/- 0.02 vs 2.04 +/- 0.03) injuries. This protection was associated with a significantly decreased acidification of the mucosa during shock (intramural pH 7.24 +/- 0.02 vs 6.97 +/- 0.02) and significantly increased oxygen saturation of the gastric mucosa (30 +/- 6 vs 5 +/- 2). These data indicate that topical oxygenated perfluorochemicals protect the gastric mucosa against mucosal damage provoked by hemorrhagic shock, and this protection seems to be mediated by an increased oxygen saturation of the gastric mucosa. Tonometry and reflectance spectrophotometry thus are able to predict the critical level of gastric mucosal ischemia.

Free radical injury in skeletal muscle ischemia and reperfusion.

This study was made in a canine isolated gracilis muscle model to measure directly the free radicals, to predict the severity of ischemia and reperfusion injury of the skeletal muscle by measuring its surface pH (mspH), and to determine the effect of Coenzyme Q10 (CoQ10) in reducing the extent of muscle injury. Animals were divided into three groups: group A (control, n = 10), group B (untreated, n = 10), and group C (CoQ10 treated, n = 10). In both groups B and C, 5 hr ischemia followed by 40 min of reperfusion was made. Free radicals were measured directly by electron spin resonance spectrometer (ESR) and mspH was measured using a pH microprobe. Serum creatine phosphokinase (CPK) was estimated before ischemia, 5 and 30 min after reperfusion. The extent of muscle injury was evaluated morphologically by Evan's blue dye exclusion test. ESR intensity in group B was 0.55 +/- 0.19 and decreased to 0.30 +/- 0.04 in group C (P less than 0.01). Rate of recovery of mspH was higher in group C (7.16 +/- 0.06) compared to group B (6.88 +/- 0.11, P less than 0.01) and CPK in group C was less (847 +/- 381 IU/liter) than in group B (1356 +/- 519 IU/liter, P less than 0.05) after 30 min of reperfusion. In group C the morphological muscle injury was less (37.8 +/- 5%) compared to group B (56.7 +/- 3.6%, P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)