Laparoscopic laser cholecystectomy. Results of 100 successful operations.

It would seem that laparoscopic laser cholecystectomy is a safe and reasonable procedure. We feel that it will be indicated for most patients with symptomatic gallbladder disease. The only distinct contraindications which we have noted are multiple prior upper abdominal procedures, common bile duct obstruction, or intense acute inflammation. However, as experience has widened, even some of the above problems may be manageable with laparoscopic technique. We would expect that the technique can be attempted on at least 90% of patients with proven gallbladder disease and that this percentage may increase with further experience. Our experience suggests that there is probably no increased operative risk with this operation. Any potential risks associated with pneumoperitoneum and introduction of laparoscopic instruments is more than offset by higher morbidity associated with open techniques. Besides the obvious economic benefits of shorter hospital stay and recovery time and rapid return to self-care and employment, this operation is quite rewarding for both surgeon and patient due to the decrease in post-operative pain and discomfort and a striking decrease in pulmonary problems, phlebitis and other complications of more invasive procedures. We expect this to become the standard procedure for gallbladder disease as experienced is widened.

Primary teratocarcinoma of the lung.

Presented is the ninth reported case of teratocarcinoma arising from the parenchyma of the lung. Treatment should include wide surgical resection and adjuvant chemotherapy. Postoperative radiation therapy should be utilized if there is residual disease or nodal metastasis. Preoperative radiation therapy should be considered if there is evidence of chest wall involvement.

Duodenal villous adenomas.

Two cases of villous adenoma of the duodenum are presented. These rare tumors are best diagnosed with upper gastrointestinal radiographs and endoscopic biopsy. Malignant degeneration is more common in the second portion of the duodenum which makes excision more difficult. If no malignancy is found, sleeve resection is preferred. Tumors in the second portion of the duodenum should be treated with wide mucosal excision if carcinoma in situ is found and with pancreaticoduodenectomy if invasive cancer is present.

Cystic islet cell tumor of the pancreas.

Presented is the fifth case of a cystic islet cell tumor of the pancreas. The diagnosis is usually made postoperatively but should be considered in a patient with "recurrent pseudocyst" or a history incompatible with pseudocyst in combination with a cystic area in the pancreas. Computed tomography is preferred for diagnosis, and resection is the preferred therapy.

Segmental pulmonary resection for cancer.

Segmental pulmonary resection was employed in 61 patients with cancer whose ages ranged from 44 to 82 years (average 62 years). There were 39 patients in the curative group with disease staged T1N0M0, 9 patients in the limited group with residual thoracic disease, 8 patients in the palliative group with severe chronic obstructive pulmonary disease, and 5 patients in the metastatic group. Two patients died within 30 days after operation. Significant palliation was obtained in the limited and metastatic groups. Most patients in the palliative group died from emphysema within 1 to 2 years after resection. Early survival rates (64 percent after an average of 16 months) in the curative group were not as good as had been anticipated because small peripheral, asymptomatic, and predominantly scar adenocarcinoma spread systemically more than similar bronchogenic cancer. Furthermore, about half the deaths were related to the many other diseases of smoking. However, the local recurrence rate of 5 percent was low. Segmentectomy was well tolerated, even in patients with compromised pulmonary function.

Noncolonic diverticular disease.

Diverticula occur throughout the gastrointestinal tract. A high index of suspicion is necessary to diagnose and treat complications arising from diverticula. Presented is a review of gastrointestinal diverticular disease exclusive from the more common diverticular disease of the colon.

Melanoma today does not require radical surgery.

From this study we conclude that melanoma has a more favorable outcome today than 20 years ago, 2 cm margins around the tumor achieve acceptable survival and local recurrence rates, primary closure is preferred when possible, elective regional node dissection is of questionable value, and further trials are warranted to determine optimal therapy for intermediate thickness melanoma.

Bile drainage through lymphatic collaterals.

Bile drainage through normal lymphatic pathways has been described, but bile drainage from the liver to the duodenum via lymphatic collaterals has not. We have described a patient with a common bile duct stricture and lymphatic drainage of bile into the duodenum.

Fifteen years surgical experience with carcinoma of the lung.

This review has emphasized the need to manage carcinoma of the lung with a systematic approach. Diagnostic and staging procedures should be performed to prevent unnecessary thoracotomy. In patients with limited pulmonary reserve, segmentectomy or wedge resection is an acceptable procedure. A staging mediastinal node dissection should be included in every resection for lung cancer. Those patients with positive mediastinal nodes found in this manner should receive postoperative mediastinal irradiation.

Leiomyosarcoma of the rectum: report of three cases.

Leiomyosarcoma is a malignant tumor which rarely occurs in the rectum. Three patients with leiomyosarcoma of the rectum are presented. Treatment should include wide surgical excision followed by adjuvant chemotherapy. Emphasis is placed upon computerized tomography as the method of choice for the diagnosis of recurrent disease. Recurrent tumor should be resected whenever possible.

The effects of sodium nitroprusside on the hemodynamics of burn shock: results of an experimental sheep model.

A low cardiac output state is observed following major thermal injury in both experimental and clinical settings. The major determinants of cardiac output are preload, afterload, and the contractile state of the myocardium. The effects of afterload reduction in acute thermal injury are the focus of this experiment. Pure-bred young nonpregnant ewes of the Suffolk strain were utilized to determine the effect of afterload reduction on the cardiac index in experimental burn shock. Four groups of animals were studied; Group 1: unburned control (n = 5); Group 2: unburned-treated with sodium nitroprusside (n = 5); Group 3: 40% burned (n = 9); and Group 4: 40% burned-treated with sodium nitroprusside (n = 9). Pulmonary arterial, intravenous, and bladder catheters were placed in all animals. Following anesthesia with or without a burn, the animals were monitored for 24 hours. Measured and calculated parameters included cardiac index, pulmonary arterial and arterial pressures, pulmonary and systemic vascular resistance indices, shunt, arterial and mixed venous blood gases and pH, and hematocrit. When burned animals with and without nitroprusside were compared, significantly higher cardiac indices, expressed as per cent of baseline, were noted for the sodium nitroprusside-treated group at 8 and 12 hours postburn. The burned-treated animals' cardiac index was not significantly different from control animals' at 8 hours postburn. However, the burned-untreated animals had significantly depressed cardiac indices until 18 hours postburn.(ABSTRACT TRUNCATED AT 250 WORDS)