Batmanacarus robini, n. gen., n. sp. (Trombidiformes: Trombiculidae) collected parasitizing a ghost-faced bat (Chiroptera: Mormoopidae) from a cave in Trinidad and Tobago.

Trinidad and Tobago, a neotropical country, has 38 reported chigger species. Of these species, 18 were parasitizing bats. Here, we describe a new genus and species parasitizing a ghost-faced bat in this country.

Batmanacarus robini, n. gen., n. sp. (Trombidiformes: Trombiculidae) collected parasitizing a ghost-faced bat (Chiroptera: Mormoopidae) from a cave in Trinidad and Tobago

Trinidad and Tobago, a neotropical country, has 38 reported chigger species. Of these species, 18 were parasitizing bats. Here, we describe a new genus and species parasitizing a ghost-faced bat in this country.

Selective preoperative endoscopic retrograde cholangiography with sphincterotomy avoids bile duct exploration during laparoscopic cholecystectomy.

A policy of preoperative endoscopic retrograde cholangiography (ERC) for suspected bile duct stones was used in 1507 patients considered for laparoscopic cholecystectomy in three district general hospitals. Altogether 306 patients underwent ERC, and bile duct cannulation was achieved in 276 (90%). Bile ducts were cleared by endoscopic sphincterotomy in 128 of 161 patients (79%) with proven duct stones. Laparoscopic cholecystectomy was completed in 1396 patients. Ten laparotomies were necessary for complications of laparoscopic cholecystectomy. The complication rate for endoscopic sphincterotomy/laparoscopic cholecystectomy was 2.7%, with no mortality. Overall, a combined endoscopic/laparoscopic approach succeeded in 1386 patients (92%). Fourteen patients (1%) had retained stones during a median of 14 months (range 1-42) follow up, all of which were removed by ERC/endoscopic sphincterotomy. If a policy of selective ERC before laparoscopic cholecystectomy is used for all patients with symptomatic gall stones, most will avoid an open operation and laparoscopic exploration of the bile duct is not necessary.

Prospective evaluation of ultrasonography and liver function tests for preoperative assessment of the bile duct.

Current means of predicting the presence of bile duct stones are sensitive but produce a large number of false-positive results, potentially leading to added morbidity from unnecessary invasive investigation. This study prospectively assessed 545 patients with gallbladder stones, including 55 patients with bile duct stones, to refine criteria for further investigation of the bile duct. The sensitivity, specificity, and positive and negative predictive values were calculated for bile duct dilatation (diameter abnormal if larger than 5 mm below age 50 years, normal value increasing by 1 mm per decade) and elevation of three liver function tests, singly or in combination. Depending on the number of abnormalities used the sensitivity ranged from 46 to 96 per cent and the positive predictive value from 35 to 77 per cent. All groupings gave at least 96 per cent negative predictive value for the absence of stones but none combined both high sensitivity and positive predictive value. The specificity was improved if the tests were done on the working day before operation. Refining criteria for predicting bile duct stones allows the selective use of cholangiography and may reduce the number of negative cholangiograms.

Endoscopic sphincterotomy without cholecystectomy for gall stone pancreatitis.

Fifty one patients (median age 78, range 54-92) who had endoscopic sphincterotomy for gall stone pancreatitis without planned cholecystectomy were followed up to assess the effectiveness of this treatment in preventing further acute pancreatitis. In 48 patients sphincterotomy was technically successful and none had further acute pancreatitis after a mean follow up of 26.9 months. In three patients sphincterotomy was incomplete and two developed recurrent pancreatitis. These results suggest that endoscopic sphincterotomy alone is an acceptable alternative to cholecystectomy in the prevention of further attacks of acute pancreatitis in the elderly.

Endotoxin, septic shock and acute lung injury: neutrophils, macrophages and inflammatory mediators.

The treatment of septic shock remains a major problem in surgical practice. Current research on the pathogenesis of the sepsis syndrome focuses on the effects of the lipopolysaccharide constituents of bacterial endotoxin. Evidence suggests that endotoxin induces a whole-body inflammatory response that in turn mediates organ damage, eventually leading to multiorgan failure. The first organ in which failure is usually apparent is the lung, with the appearance of non-cardiogenic pulmonary oedema as part of the adult respiratory distress syndrome. Inflammatory cells involved in lung injury include neutrophils and macrophages, which release mediators such as elastase, oxygen radicals and cytokines. This review summarizes current experimental work on how endotoxin leads to lung injury, based on its effects in animals and patients. Present knowledge suggests that future treatment of septic shock might involve inhibiting the body's inflammatory response to endotoxin. Possible ways of doing this are discussed.

Pathophysiology of ischaemia reperfusion injury: central role of the neutrophil.

Ischaemia is a common clinical event leading to local and remote injury. Evidence indicates that tissue damage is largely caused by activated neutrophils which accumulate when the tissue is reperfused. If the area of ischaemic tissue is large, neutrophils also sequester in the lungs, inducing non-cardiogenic pulmonary oedema. Ischaemia reperfusion injury is initiated by production of reactive oxygen species which initially appear responsible for the generation of chemotactic activity for neutrophils. Later, once adherent to endothelium, neutrophils mediate damage by secretion of additional reactive oxygen species as well as proteolytic enzymes, in particular elastase. Therapeutic options for limiting ischaemia reperfusion injury include inhibition of oxygen radical formation, pharmacological prevention of neutrophil activation and chemotaxis, and also the use of monoclonal antibodies which prevent neutrophil-endothelial adhesion, a prerequisite for injury.

Neutrophil elastase and oxygen radicals: synergism in lung injury after hindlimb ischemia.

Hindlimb ischemia and reperfusion lead to lung injury dependent on activated polymorphonuclear neutrophils (PMN) adherence. This study tests whether elastase and oxygen radicals participate in PMN-induced injury once they have become sequestered in lungs. Anesthetized rats treated with saline (n = 9) or the specific elastase inhibitor methoxysuccinyl-L-Ala-L-Ala-L-Pro-L-Val-chloromethylketone (MAAPV, n = 6) underwent 4 h of bilateral hindlimb tourniquet ischemia followed by 4 h of reperfusion. At this time, in saline-treated rats, PMN were sequestered in lungs as assayed by myeloperoxidase activity [(MPO) 51 +/- 5 U/g tissue], higher than MPO in saline-treated sham rats (n = 9; 18 +/- 3 U/g MPO; P less than 0.01); bronchoalveolar lavage (BAL) fluid leukotriene (LT) B4 levels increased to 594 +/- 46 relative to 200 +/- 38 pg/ml in shams (P less than 0.01); increased permeability was documented by BAL fluid protein content of 599 +/- 91 compared with 214 +/- 35 micrograms/ml in sham animals (P less than 0.01); and edema was shown by increase in lung wet-to-dry weight ratio of 4.77 +/- 0.14 relative to 4.00 +/- 0.09 in sham rats (P less than 0.01). In MAAPV-treated animals, lung neutrophil sequestration (62 +/- 9 U/g MPO) and rise of LTB4 in BAL fluid (780 +/- 244 pg/ml) were not affected, but both BAL fluid protein (335 +/- 32 micrograms/ml) and lung wet-to-dry weight ratio (4.21 +/- 0.17) were reduced (both P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Biochemical studies of the isolated rat glomerulus and the effects of puromycin aminonucleoside administration.

Using analytical subcellular fractionation techniques in combination with enzymic microanalysis, studies have been performed on the enzymology and organelle pathology of isolated glomeruli from normal rats and from animals with puromycin aminonucleoside nephrosis. There was a marked decrease in 5'-nucleotidase (plasma membrane) activity 2 days after puromycin aminonucleoside administration. In contrast, catalase (peroxisomes) and N-acetyl-beta-glucosaminidase (lysosomes) showed a significant rise during the first 6 days of treatment. By 10 days most marker enzymes showed a significant decrease in activity. The glomeruli were homogenized in isotonic sucrose and extracts were fractionated by isopycnic centrifugation on linear sucrose gradients in the Beaufay automatic small-volume zonal centrifuge. The properties of the principal organelles were characterized. ed. After 10 days of puromycin aminonucleoside treatment there were no marked differences in the centrifugal properties of these organelles. Morphological correlations with the biochemical changes are discussed and it is suggested that the plasma membrane changes represent the primary site of puromycin aminonucleoside damage.