Technique of intraluminal biliary ultrasonography during laparoscopic cholecystectomy.

Intraluminal ultrasonography of the common duct was performed in nine patients undergoing laparoscopic cholecystectomy, using a system comprising a 20-MHz crystal in a 95-cm, blunt-tipped 6F sheath, mechanically rotated at 1,800 rpm. The probe was introduced through an incision in the cystic duct and passed into the duodenum. When the catheter was withdrawn, excellent visualization of the common and cystic ducts and lower end of the common hepatic duct was achieved. In seven patients, the biliary tree was normal. A small calculus was discovered in the common duct in one patient. This stone was not seen on a subsequent cholangiogram and was subsequently retrieved. An additional patient had mucus or sludge noted in the duct, which cast no acoustic shadow and thus was distinguished from calculi. The technique was fast, efficient, and easy to perform in this small group of patients and holds promise for screening the common duct pathology during laparoscopic cholecystectomy.

An evaluation of a program to prevent the sexual victimization of young children.

Young children (ages 4 and 5) and school-aged children (6 to 10) from a day-care center were randomly assigned to a sexual abuse prevention training group and a wait-list control group. Children in the prevention training group were exposed to a three-hour program teaching common sexual abuse prevention concepts (e.g., the difference between OK and not-OK touches). Children in both groups were given a structured interview before and after the prevention group received training. Results of a repeated measures multivariate analysis of variance indicate that children in the prevention training group significantly increased their knowledge of prevention concepts while children in the control group did not. Older children learned more than younger children. Both younger and older children had greater difficulty learning prevention concepts of an abstract nature than concepts of a specific nature.

An analysis of programs to prevent the sexual victimization of children.

This paper provides a review and analysis of current programs to prevent sexual abuse of children. Seven aspects of prevention programming are discussed: prevention content, the length of the program, occupation of the trainer, prevention materials, training formats, types of abuse covered, and assertiveness and self-defense skills. Three potential problem areas prevention should address are also discussed. These include: the cognitive orientation of much prevention training, uncertainty surrounding what prevention content should actually be taught, and the need for quality assurance procedures.

Hepatic laceration from wedged venography performed before transjugular intrahepatic portosystemic shunt placement.

Transjugular intrahepatic portosystemic shunt (TIPS) placement is an increasingly used, nonoperative technique for treating variceal bleeding and refractory ascites secondary to portal hypertension. Since the first clinical TIPS case in 1989, the procedure has undergone significant technical refinement to improve the safety and efficacy of shunt placement. A major technical challenge of TIPS creation is passage of the transjugular needle from the hepatic vein into the portal vein. Perforation of the liver capsule from an errant needle pass can lead to massive intraperitoneal bleeding. To minimize the number of needle passes required to enter the portal vein, investigators have devised a variety of techniques to visualize the portal vein anatomy including direct transhepatic catheterization of the portal vein, superior mesenteric artery (SMA) angiography, real-time ultrasound (US) guidance and refluxing contrast medium into the portal vein with wedged hepatic venography. While these technical improvements have made TIPS a safe and attractive alternative to conventional surgical shunts, the procedure remains technically challenging and lethal hemorrhagic complications can occur when the liver capsule is perforated during the course of the procedure. To our knowledge, there are no reported major complications directly related to the wedged hepatic venogram prior to TIPS. We describe an unusual series of severe liver injuries from wedged hepatic venography during attempts to localize the portal vein.

Transforming growth factor-beta 1 and mannose 6-phosphate/insulin-like growth factor-II receptor expression during intrahepatic bile duct hyperplasia and biliary fibrosis in the rat.

These studies investigate the role of transforming growth factor-beta 1, a potent inhibitor of epithelial cell proliferation and stimulator of extracellular matrix biosynthesis, during intrahepatic bile duct hyperplasia and biliary fibrosis. These pathogenic responses were induced in rats by common bile duct ligation. Bile duct cell replication, measured by the bromodeoxyuridine labeling index, was significantly increased 24 hr after common bile duct ligation. This response diminished to baseline by 1 wk. Liver collagen content, determined by quantification of hydroxyproline, was increased significantly after 1 wk of common bile duct ligation, and by 4 wk was increased by a factor of 4. Immunohistochemistry revealed low levels of TGF-beta 1 in normal intrahepatic bile duct epithelium. In contrast, the bile duct epithelium in bile duct-ligated rats stained strongly positive for transforming growth factor-beta 1 at 1 and 4 wk after ligation. These results suggest that transforming growth factor-beta 1 may play a role in both the termination of the bile duct epithelial cell proliferative response and the induction of fibrogenesis after common bile duct ligation. In addition, the mannose 6-phosphate/insulin-like growth factor II receptor was up-regulated in hyperplastic bile duct epithelium 1 and 4 wk after ligation. Because the mannose 6-phosphate/insulin-like growth factor-II receptor has been shown to facilitate the proteolytic activation of transforming growth factor-beta 1, these results suggest that the bile duct epithelium may also be involved in the activation of transforming growth factor-beta 1.

Exogenous neuropeptide Y blocks myoelectric activity in the upper gastrointestinal tract of starved dogs. Brain neuropeptide Y converts a fasting pattern of myoelectric activity to a fed pattern.

The effect of intracerebroventricular (ICV) neuropeptide Y (NPY) on the migrating motor complex (MMC) was examined in five starved dogs. Myoelectric activity was recorded using gastric, duodenal, and jejunal electrodes. Intragastric pressure was monitored via a gastric fistula, and ICV injections were given through a cerebroventricular guide. Recordings were made with no ICV injection and before and after 250-microliters bolus injections of vehicle as control (0.1% dog serum albumin in saline) or 500 pmol/kg NPY. The mean interval between MMCs was 98 +/- 10 min without ICV injection and 96 +/- 7 min after control solution. After ICV injection of NPY no further MMCs were recorded in any dog, even though the study was continued for a minimum of 3.5 h. Instead, the myoelectric pattern became indistinguishable from that in fed dogs. We conclude that central NPY plays a role in modulation of upper gastrointestinal myoelectric activity. This may reflect a central regulatory role for NPY in the coordination of feeding.