Sigmoid colonic fistula secondary to Perfix-plug, left inguinal hernia repair.

The "plug and patch" mesh herniorrhaphy has become a popular option for inguinal hernia repair. Previous reports have documented several complications with some regularity. This case presents an additional complication and offers suggestions as to why this complication and others might occur.

Protective effects of enalaprilat against postischemic renal failure.

Prolonged intraoperative renal ischemia requires modalities to reduce the incidence of acute tubular necrosis, but there exists no definitive prophylactic regimen. We studied the effects of enalaprilat, an angiotensin-converting enzyme inhibitor, in an attempt to identify such a protective drug. Thirty-four mongrel dogs underwent 90 min of bilateral renal pedicle clamping. Group I was a control of 6 animals. Group II comprised 10 animals who received 12.5 g iv mannitol 15 min prior to clamping and 1 mg/kg iv furosemide immediately after clamp removal. Group III also comprised 10 animals who received enalaprilat 1 mg/kg iv enalaprilat each 15 min prior to clamp placement. Group IV consisted of 8 dogs, each of which received 12.5 g mannitol and 1 mg/kg iv enalaprilat 15 min prior to clamping and 1 mg/kg iv furosemide immediately upon removal of the clamps. Serum blood urea nitrogen (BUN) and creatinine levels were drawn preoperatively and at 12, 24, 48, and 72 hr postoperatively in each animal. The serum BUN levels in group III were significantly lower than those in group I at all times postoperatively (P < 0.05) and were not significantly different from those of group II at any time postoperatively. Similarly, the serum creatinine levels in group III were significantly lower than those of group I (P < 0.05) and were not significantly different from those in group II at any time postoperatively. Neither the serum BUN nor the serum creatinine levels in group IV were different from those of group I at any time postoperatively.(ABSTRACT TRUNCATED AT 250 WORDS)

Results of surgical therapy for biliary dyskinesia.

One hundred eighty-seven patients who presented with symptoms consistent with biliary colic but had no ultrasonic evidence of cholelithiasis were observed in an effort to identify those with a functional gallbladder disorder that might benefit from surgical intervention. All patients underwent quantitative evaluation of gallbladder emptying using cholecystokinin biliary scanning, and ejection fractions less than 35% were considered abnormal. One hundred twenty-nine patients (69%) had abnormal ejection fractions, and 88 (68%) of these subsequently underwent cholecystectomy. Sixty of the surgical specimens revealed pathologic changes. Eighty-four percent of patients successfully contacted for follow-up experienced complete relief, and another 13% had partial relief of preoperative symptoms. Only two patients reported no change in symptom complex. Twenty-nine patients with abnormal ejection fractions elected not to undergo surgery. Fifty-nine percent of these patients continued to experience symptoms of biliary colic at a mean follow-up of 22 months. Of the 44 patients with normal ejection fractions, 35 (80%) reported resolution of symptoms during follow-up of medical treatment. Cholecystokinin biliary scanning can help identify patients with acalculous, functional gallbladder disease who may benefit from cholecystectomy.

Determination of interactive thiol ionizations in bovine serum albumin, glutathione, and other thiols by potentiometric difference titration.

A potentiometric difference titration (PDT) method is used to study the ionization behavior of the thiol group in bovine serum albumin and in the following less complex compounds: glutathione, cysteine, 2-mercaptoethanol, 3-mercaptopropionic acid, 2-mercaptoethylamine, cis-2-mercaptocyclobutylamine, 2-aminothiophenol, and 5-mercapto-2-nitrobenzoic acid. In the PDT method the pH dependence of the amount of protons released in the reaction RSH + CH3SO2SCH3 leads to RSSCH3 + CH3SO2- + H+ is measured in order to obtain the pH dependence of the molar proton content of the thiol (hu) relative to the molar proton content of its methylthio derivative (hm). The pH dependence of hu--hm reflects the ionization behavior of the thiol group and of other groups whose ionization is thermodynamically linked to that of the thiol group. Data presented here indicate that the ionization behavior of the single thiol group in albumin is strikingly different in the native and the urea-denatured proteins. Three ionizable groups appear to affect ionization of the thiol in the native protein whereas only one group appears to affect ionization of the thiol in the urea-denatured protein. Furthermore, the measured PDT curves are consistent with an abnormally high acidity (pK less than 5) for the thiol in native albumin and a normal acidity for the thiol in the urea-denatured protein. Comparisons of microscopic ionization constants determined for cysteine by using the PDT method with those determined by other methods indicate that the PDT method should be useful in characterizing the ionization behavior of thiol groups in proteins and other polyprotic substances.