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  • 1
    ISSN: 1432-2218
    Keywords: Laparoscopic cholecystectomy ; Bile leak ; Cholelithiasis ; Complications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Laparoscopic cholecystectomy (LC) is now the treatment of choice for gallstones, but there has been concern that bile leakage with LC is more frequent than after open cholecystectomy (OC). We have analyzed our experience of this complication with regard to both its incidence and management. From a consecutive series of 500 LC, in which both operative cholangiography and drainage of the gallbladder bed were routine, bile leakage was identified in ten patients (2%). There was no bile duct injury. Nine of the ten patients presented with bile in the drain within 24 h of operation and one patient presented 1 week after operation with a subphrenic collection. Of the ten patients, five settled spontaneously. Of the five remaining patients, two needed laparotomy—one for a subphrenic collection not responding to percutaneous drainage and one for biliary peritonitis. One patient was treated by relaparoscopy and suture of a duct of Luschka and one patient had successful percutaneous drainage of an infected collection; the fifth patient who presented with a late subphrenic collection of bile was shown at endoscopic retrograde cholangiopancreatography (ERCP) to have a cystic duct stump leak and was treated with an endoscopic stent. Bile leakage is seen more frequently after LC than OC for reasons that are currently unclear. We believe that the use of routine gallbladder bed drainage is justified for this reason alone. The majority of bile leaks settle either spontaneously or with minimally invasive intervention.
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  • 2
    ISSN: 1432-2218
    Keywords: Laparoscopic cholecystectomy ; Liver retraction ; Fundus-first
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Removal of the gallbladder with commencement of dissection at the fundus is well recognized as a safe technique during difficult “open” cholecystectomy because it minimizes the risks of damage to the structures in or around Calot's triangle. We report here the routine employment of liver retractors and fundus-first dissection during laparoscopic cholecystectomy (LC) as an alternative to techniques previously described. Retraction of the liver and “fundus-first” dissection was used in 53 patients who underwent laparoscopic cholecytectomy. There were 16 male and 37 female patients. Seven were operations performed during an acute admission and 20 had moderate or severe adhesions involving the gallbladder. Thirteen patients had a preexisting abdominal incision. The procedure was successful in 52 patients (98%), but in one patient it was converted to open operation because of dense adhesions. Median duration of operation was 90 min (range 35–240 min). There was no mortality and two complications (persistent right upper quadrant pain for 2 weeks after operation and bile leakage from the gallbladder bed). The facility to retract the liver and carry out a fundus-first dissection extends techniques developed for “open” surgery into the laparoscopic arena. It offers the surgeon the safety and versatility during laparoscopic cholecystectomy that it confers during conventional open surgery.
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  • 3
    ISSN: 0951-4198
    Keywords: Chemistry ; Analytical Chemistry and Spectroscopy
    Source: Wiley InterScience Backfile Collection 1832-2000
    Topics: Physics
    Additional Material: 3 Ill.
    Type of Medium: Electronic Resource
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  • 4
    ISSN: 1432-2218
    Keywords: Laparoscopic cholecystectomy ; Pregnancy ; Second-trimester pregnancy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Laparoscopic cholecystectomy is now the standard treatment for symptomatic gallstones; while symptomatic gallstones during pregnancy are not frequent they are by no means rare. The role of laparoscopic cholecystectomy during pregnancy is controversial but initial reports suggest it is both safe and feasible. Methods: During a consecutive series of 500 laparoscopic cholecystectomies, 3 patients have undergone laparoscopic cholecystectomy during pregnancy. The 3 patients were 16–27 weeks pregnant with an average age of 32 years. The indication for laparoscopic cholecystectomy was severe pain in two patients and gallstone pancreatitis in one patient. Following standard obstetric anesthesia, laparoscopic cholecystectomy was performed. Open cannulation was used to establish peritoneal access, following which “standard,” four-port laparoscopic cholecystectomy was performed without complication. The insufflation pressure used was 8–10 mmHg CO2 and a liver retractor was employed to facilitate access. Results: In each case the postoperative recovery was rapid and uneventful for both mother and fetus. The patients were discharged on the first or second postoperative day. Conclusions: Laparoscopic cholecystectomy during the second trimester of pregnancy is both safe and feasible provided both suitable surgical and anesthetic expertise are available. Even up to the end of the second trimester there is sufficient access for the technique to be employed.
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  • 5
    ISSN: 1076-5174
    Keywords: Chemistry ; Analytical Chemistry and Spectroscopy
    Source: Wiley InterScience Backfile Collection 1832-2000
    Topics: Chemistry and Pharmacology , Physics
    Type of Medium: Electronic Resource
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  • 6
    ISSN: 0006-3592
    Keywords: methanogenic population dynamics ; anaerobic digesters ; solid waste ; biosolids ; Chemistry ; Biochemistry and Biotechnology
    Source: Wiley InterScience Backfile Collection 1832-2000
    Topics: Biology , Process Engineering, Biotechnology, Nutrition Technology
    Notes: An aggressive start-up strategy was used to initiate codigestion in two anaerobic, continuously mixed bench-top reactors at mesophilic (37°C) and thermophilic (55°C) conditions. The digesters were inoculated with mesophilic anaerobic sewage sludge and cattle manure and were fed a mixture of simulated municipal solid waste and biosolids in proportions that reflect U.S. production rates. The design organic loading rate was 3.1 kg volatile solids/m3/day and the retention time was 20 days. Ribosomal RNA-targeted oligonucleotide probes were used to determine the methanogenic community structure in the inocula and the digesters. Chemical analyses were performed to evaluate digester performance. The aggressive start-up strategy was successful for the thermophilic reactor, despite the use of a mesophilic inoculum. After a short start-up period (20 days), stable performance was observed with high gas production rates (1.52 m3/m3/day), high levels of methane in the biogas (59%), and substantial volatile solids (54%) and cellulose (58%) removals. In contrast, the mesophilic digester did not respond favorably to the start-up method. The concentrations of volatile fatty acids increased dramatically and pH control was difficult. After several weeks of operation, the mesophilic digester became more stable, but propionate levels remained very high. Methanogenic population dynamics correlated well with performance measures. Large fluctuations were observed in methanogenic population levels during the start-up period as volatile fatty acids accumulated and were subsequently consumed. Methanosaeta species were the most abundant methanogens in the inoculum, but their levels decreased rapidly as acetate built up. The increase in acetate levels was paralleled by an increase in Methanosarcina species abundance (up to 11.6 and 4.8% of total ribosomal RNA consisted of Methanosarcina species ribosomal RNA in mesophilic and thermophilic digesters, respectively). Methanobacteriaceae were the most abundant hydrogenotrophic methanogens in both digesters, but their levels were higher in the thermophilic digester. © 1998 John Wiley & Sons, Inc. Biotechnol Bioeng 57: 342-355 1998.
    Additional Material: 2 Ill.
    Type of Medium: Electronic Resource
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  • 7
    ISSN: 1052-9306
    Keywords: Chemistry ; Analytical Chemistry and Spectroscopy
    Source: Wiley InterScience Backfile Collection 1832-2000
    Topics: Chemistry and Pharmacology
    Notes: A quantitative mass fragmentographic method for the simultaneous determination of labeled and unlabeled propoxyphene in plasma is described. Dogs treated daily with propoxyphene-d0 were treated with a pulse dose of propoxyphene-d2 at day 20. It was found that following an initial rapid equilibrium phase levels of propoxyphene-d2 fell more rapidly than those of propoxyphene-d0. This result suggests that ‘deep’ pools of tissue bound propoxyphene exist which exchange very slowly with drug present in the central compartment. Experimental evidence is presented which demonstrates that the difference in behavior of propoxyphene-d0 and -d2 is not due to unanticipated secondary isotope effects.
    Additional Material: 5 Ill.
    Type of Medium: Electronic Resource
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  • 8
    ISSN: 1052-9306
    Keywords: Chemistry ; Analytical Chemistry and Spectroscopy
    Source: Wiley InterScience Backfile Collection 1832-2000
    Topics: Chemistry and Pharmacology
    Notes: A mass fragmentographic method for simultaneous measurement of unlabeled and deuterium labeled methadone in human plasma is described. This specific method has a lower sensitivity of about 16 pmol/ml with a coefficient of variation of less than 4%. The usefulness of the method was evaluated in studies on opiate dependent subjects undergoing methadone maintenance treatment. In one application methadone-d3 was given as a pulse dose during continuous treatment with unlabeled methadone and plasma levels of both species followed by mass fragmentography. The method will be of value in the study of methadone pharmacokinetics in the steady state and in other in vivo situations where multiple drug pools must exist.
    Additional Material: 3 Ill.
    Type of Medium: Electronic Resource
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  • 9
    ISSN: 0951-4198
    Keywords: Chemistry ; Analytical Chemistry and Spectroscopy
    Source: Wiley InterScience Backfile Collection 1832-2000
    Topics: Physics
    Notes: A focused Cs+ beam was used to obtain secondary ion mass spectra and images from samples of stearic acid on gold before and after ablation by a beam of masive cluster ions. Ablation appears to have two effects on secondary ion emission. First, the number and intensity of peaks reflecting contamination are substantially reduced. Secondly, the absolute intensity of secondary ion current characteristic of the analyte increases. These features simplify mass spectra and improve contrast in the images obtained.
    Additional Material: 4 Ill.
    Type of Medium: Electronic Resource
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  • 10
    Electronic Resource
    Electronic Resource
    Chichester : Wiley-Blackwell
    Biological Mass Spectrometry 3 (1976), S. 217-225 
    ISSN: 1052-9306
    Keywords: Chemistry ; Analytical Chemistry and Spectroscopy
    Source: Wiley InterScience Backfile Collection 1832-2000
    Topics: Chemistry and Pharmacology
    Notes: Through the combined use of stable isotope labeling and gas chromatographic mass spectrometric analysis, the metabolic patterns for propoxyphene have been determined in laboratory animals and man. The rat and dog eliminated propoxyphene and its metabolites principally via the bile, while the rabbit more closely resembled man in excreting the metabolic products into urine. Metabolites in rat and rabbit existed as conjugates, whereas in dog and man the metabolites were excreted as a mixture of the free and unconjugated forms. The primary route of metabolism in all species studied was N-demethylation. However, the rat and rabbit extensively hydroxylated propoxyphene and its metabolltes prior to elimination. Metabolites arising from ester hydrolysis were found in rat and man. N-acetylated products were identified in all four species. A metabolite formed from cyclization and dehydration of dinorpropoxyphene was isolated in urine and was further identified as a circulating metabolite in dog plasma.
    Additional Material: 5 Ill.
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