Evolution of laparoscopic cholecystectomy in the regional hospitals of Catalonia.

OBJECTIVE: to assess the safety and effectiveness of laparoscopic cholecystectomy in the hands of surgeons with different amounts of experience in laparoscopic surgery at 15 regional hospitals, and to analyze the evolution of the current performance in comparison with results published in 1993. METHODS: prospective study of 1168 laparoscopic cholecystectomies done in 1996 in 15 regional hospitals in Catalonia. RESULTS: in 887 cases (76%) the indication was uncomplicated cholelithiasis. Preoperative cholangiography was done selectively in 12 of the 15 hospitals. Preoperative endoscopic retrograde cholangiopancreatography was positive in only 50 cases (57.4%), with 9 complications (10.3%). In 87 patients (7.4%) conversions to open surgery occurred. Postoperative complications (6. 3%), bile duct injury (0.4%), reintervention (0.4%) and postoperative stay (2.8 days) decreased in comparison with the year 1993. CONCLUSIONS: the current results suggest an overall improvement in comparison with the 1993 findings, since the rate of complications and length of stay decreased. However, the increasing number of conversions was notable; this may be due to the increasing complexity of the indications and the rise in the number of surgeons still on the learning curve. Laparoscopic cholecystectomy is, in our setting and for many surgeons, a safe and effective procedure that yields results similar to those in other multicenter studies.

Evolución de la colecistectomía laparoscópica en los hospitales comarcales de Cataluña* / General and Digestive Surgery Department. Igualada General Hospital. Barcelona, Spain

OBJETIVO: valorar la seguridad y eficacia de la colecistectomía laparoscópica en hospitales de ámbito comarcal con un grupo amplio de cirujanos de experiencia variable en cirugía laparoscópica. Analizar la evolución de los resultados actuales comparándolos con los obtenidos y publicados por el mismo grupo en 1993. MÉTODOS: estudio prospectivo sobre 1.168 colecistectomías laparoscópicas practicadas durante 1996 en 15 hospitales comarcales de Catalunya. RESULTADOS: en 887 casos (76 por ciento) la indicación fue una colelitiasis no complicada. La colangiografía peroperatoria se realiza de forma selectiva en 12 de los 15 hospitales. La colangiopancreatografía retrógrada endoscópica preoperatoria fue positiva sólo en 50 casos (57,4 por ciento), refiriéndose nueve complicaciones (10,3 por ciento). Se han producido 87 (7 4 por ciento) conversiones a cirugía abierta. Las complicaciones postoperatorias (6,3 por ciento), lesión biliar (0,4 por ciento), reintervenciones (0,4 por ciento) y estancia postoperatoria (2,8 días) han disminuido respecto a 1993. CONCLUSIONES: los resultados actuales sugieren una mejoría global respecto a los obtenidos en 1993, ya que han disminuido las complicaciones y la estancia hospitalaria. Sin embargo, destaca el aumento de conversiones que podría atribuirse a la mayor complejidad de las indicaciones y la progresiva incorporación de cirujanos en plena curva de aprendizaje. La colecistectomía laparoscópica es, en nuestro medio y para un amplio número de cirujanos, un procedimiento seguro y eficaz, con unos resultados equiparables a los publicados por otros grupos multicéntricos similares (AU)

Synthesis and pharmacological evaluation of N'-morpholinomethylurea derivatives with platelet antiaggregant activity.

In the attempt to prolong and stabilize the known antiaggregant activity of morpholinomethylurea (MMU) derivatives were prepared with carboxylic acids possessing antiaggregant, anti-inflammatory or hypolipemic activity. The results of the experiments showed the important anti-aggregant and hypolipemic activity of N-2-(p-chlorophenoxy)-isobutyryl-N'-morpholinomethylurea (plafibride, ITA 104). The results obtained seem to indicate that the activity of these new N-acyl-N'-MMU is due initially to the molecule per se although it cannot be totally ruled out that part of the pharmacodynamic effect of the MMU may depend on a prodrug-like behaviour.

Physico-chemical and analytical studies on plafibride.

Physico-chemical and analytical studies on N-2-(p-chlorophenoxy)-isobutyryl)-N'-morpholinomethylurea (plafibride, ITA 104) are reported. Besides the usual analytical data, spectral (UV, IR, NMR, MS) and chromatographic (HPLC, TLC) properties are described. As to chemico-analytical procedures, ITA 104 is detectable by titrimetric and spectralphotometric methods and by thin-layer chromatography.

Pharmacokinetic approach of plafibride in rat.

The serum concentration of N-2-(p-chlorophenoxy)-isobutyryl-N'-morpholinomethylurea (plafibride, ITA 104) and its metabolites was measured in the rat after oral and intravenous administration of the drug. Plafibride was distributed in the rat according to an open two-compartment model. Moreover, 2-(p-chlorophenoxy)isobutyrylurea and clofibric acid were detected. In the urine, 81.7% of the administered dose was recovered in the form of free clofibric acid, 0.8% as plafibride itself and 1.1% as 2-(p-chlorophenoxy)isobutyrylurea. The amount of plafibride and its metabolites present in the feces was practically negligible. A mechanistic scheme for the degradation of plafibride is proposed, which agrees with the observed pharmacological and pharmacokinetic data.