Concomitant laparoscopic cholecystectomy and splenectomy for surgical management of hereditary spherocytosis.

Laparoscopic splenectomy is rapidly becoming a common treatment modality in the surgical management of hematological processes involving the spleen. Hereditary spherocytosis is the most common red blood cell membrane disorder, and its diagnosis is often associated with hemolytic crisis and premature cholelithiasis. This condition has not been successfully treated laparoscopically until recently, and to our knowledge, the technique of concomitant laparoscopic splenectomy and cholecystectomy described here is the first reported in U.S. literature. Our patients, a 16-year-old 5-foot 3-inch-tall 90 pound emaciated albino, presented with cholelithiasis, splenomegaly, and anemia. Because of persistent anemia and gastrointestinal symptoms, the patient underwent laparoscopic cholecystectomy and splenectomy. The cholecystectomy was performed in a standard laparoscopic fashion. An additional 12-mm trocar was utilized for takedown of the spleen. The umbilical incision was extended to 4.5 cm, and the spleen was extracted manually. Total operative time was 12 hours. Examination demonstrated a 15 x 10 x 5-cm spleen, which weighed 350 grams. The gallbladder microscopically showed cholecystitis and had several stones. In conclusion, we present a combined laparoscopic cholecystectomy and splenectomy for hereditary spherocytosis associated with splenomegaly, cholelithiasis, and cholecystitis.

Underutilization of breast-conservation surgery with radiation therapy for women with stage Tis, I or II breast cancer.

Despite clinical evidence from the National Institutes of Health consensus panel in 1991 that breast-conservation surgery (BCS) with radiation therapy (RT) is appropriate treatment in early-stage breast cancer, the overall rate of acceptance and actual practice of BCS with RT has remained low. We retrospectively reviewed 228 cases of breast cancer in female patients with stage Tis, I or II breast cancer treated between 1987 and 1995. Thirty-five cases (15.4%) were stage Tis, 70 cases (30.7%) were stage I, and 123 cases (53.9%) were stage II, Overall, 57% of Tis, I or II breast cancers received conservative treatment; 57% of stage Tis, 79% of stage I, and 44% of stage II tumors. These rates of conservative therapy are higher than in other reported series in the literature. BCS with RT produces equivalent rates of morbidity and survival as MRM, and, because it preserves the breast, is preferable for the majority of women who present with stage Tis, I, or II breast cancer.

Obturator hernia: laparoscopic diagnosis and repair.

OBJECTIVE: Review of international literature reveals eight reported cases of laparoscopic obturator hernia repair. Non-specific signs and symptoms make the diagnosis of an obturator hernia difficult. Laparoscopic intervention provides a minimally invasive method to simultaneously diagnose and repair these hernias. METHODS AND PROCEDURES: A 35 year old woman presented with lower abdominal pain, vaginal bleeding, and dyspareunia. During gynecological diagnostic laparoscopy, a pelvic floor hernia was suspected, and a general surgical evaluation was sought. At a subsequent laparoscopy, the diagnosis of a left direct inguinal and a right obturator hernia was made. Both were repaired laparoscopically with polypropylene mesh. RESULTS: At follow-up at one and six weeks postoperatively, the patient's complaints of pain had completely resolved. CONCLUSION: The diagnosis of obturator hernia is problematic. The usual presenting signs and symptoms are non-specific. Without conclusive historical or physical findings, laparoscopy is an excellent method for diagnosing obturator hernia. This entity, once diagnosed laparoscopically, can be repaired simultaneously via laparoscopic mesh technique.

Calcium-transport function of the chick embryonic chorioallantoic membrane. II. Functional involvement of calcium-binding protein, Ca2+-ATPase and carbonic anhydrase.

This study aimed to investigate the mechanism of active calcium transport in the chick embryonic chorioallantoic membrane (CAM) by assessing the functional involvement of three previously identified, putative components of the transport pathway. These components are a calcium-binding protein (CaBP), Ca2+-activated ATPase and carbonic anhydrase. Using specific reagents, including antibodies and enzyme inhibitors in vivo and in vitro in CAM calcium uptake assays, it was shown that these biochemically identified components were all functionally involved. The results of these studies also indicate that active calcium uptake by the CAM requires the presence of the CaBP on the cell surface in a laterally mobile manner, while carbonic anhydrase appeared to be a cytosolic component. We further analysed the subcellular location of the calcium-uptake activity by gel filtration and density-gradient fractionation of cell-free microsomes of the CAM and the results suggest that this activity is associated with the plasma membrane.

Calcium-transport function of the chick embryonic chorioallantoic membrane. I. In vivo and in vitro characterization.

During chick embryonic development, the chorioallantoic membrane (CAM) is responsible for the mobilization of shell calcium into the embryonic circulation. The calcium-transport function of the CAM was studied here by measuring CAM calcium uptake in vivo and in vitro. The in vivo technique involved the use of an uptake chamber constructed on top of the CAM in situ. The in vitro methods included two systems: CAM tissue disks and cell-free microsomal membranes isolated from the CAM. Analyses using these three assays show that calcium uptake by the CAM exhibited characteristics indicative of active transport, such as temperature dependence, saturability, energetic requirement and ion specificity. The data also show that calcium-uptake activities of the CAM increase as a function of embryonic age in a manner coincident with the increased accumulation of calcium by the developing embryo in ovo.