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To study the feasibility of gasless laparoscopy using the Laparolift device (Origin Medsystems), appropriate animal studies were carried out using a porcine model. After preliminary success in the laboratory, a petition was made to the institutional review boards of our hospitals. A laparoscopic herniorrhaphy was performed successfully in a consenting male patient with a right indirect inguinal hernia. To further delineate the role of mechanical planar lifting in surgical procedures, further investigation appears safe and is warranted.

Laparoscopic cholecystectomy (LC) was first performed at Georgia Baptist Medical Center (GBMC) in December 1989, subsequently becoming the treatment of choice for most patients with symptomatic gallbladder disease. Early in the authors' series, all patients evaluated for cholecystitis were treated laparoscopically, unless the third party refused reimbursement or the attending surgeon was not trained in LC. Indications for LC were no different than for standard open cholecystectomy (OC). Eight hundred patients from December 1989 to March 1991 had an attempted LC at GBMC. The procedure was completed in 782 patients (97.7%) and required conversion to OC in 18 patients, (2.3%) primarily because of technical difficulties such as dense adhesions or gangrenous changes. No patient sustained a trocar injury to the intra-abdominal viscera, bile ducts injury, or major vascular injury. Overall morbidity was 3.1 per cent and mortality 0.13 per cent. Selective cholangiography (SIOC) was used in 14 per cent. Endoscopic retrograde cholangiopancreatography (ERCP), choledochoscopy, and Fogarty catheter techniques were used for common bile duct stone management. Average hospitalization was 0.89 days, with 85 per cent discharged in less than 24 hours. Average operative time was 86 minutes (range: 25 to 353). Patients returned to full activities at home in 8.4 days. Savings on hospital charges to patients averaged $1,100 for inpatient LC and $2,500 for outpatient LC when compared to 1989 costs for OC. Laparoscopic cholecystectomy is the current surgical procedure of choice for most patients with cholecystitis and can be done at least as safely as standard open cholecystectomy. The morbidity appears to be significantly less with LC, but longer follow-up is needed to confirm these preliminary findings.(ABSTRACT TRUNCATED AT 250 WORDS)

The developmental mode by which oospores of Pythium aphanidermatum germinate may be controlled by the concentration of glucose present in the germination medium. When incubated in a liquid medium containing emulsified lecithin without added glucose (S + L), oospores germinated indirectly, with zoospore release occurring during the 10th to 13th h. A decrease in dry weight of the fungus took place by the 13th h of indirect germination. When 0.2 mM glucose was added to S + L, the dry weigh of germlings increased and direct germination occurred without zoospore formation. Polar lipid comprised the bulk of total acylglycerides of dormant oospores. A greater decrease in total fatty acid content took place during direct germination that during indirect germination. During both developmental modes of germination, polar lipid content decreased considerably neutral lipids, however, increased during indirect germination and decreased during direct germination. Protein content of the fungus increased in both developmental modes of germination, being initally 9.7% of the dry weight of dormant oospores. After 13 h of incubation, KOH-soluble polysaccharide decreased by 35% during direct germination and by 48% during indirect germination.

This study was done to evaluate the effect of aspirin (ASA), dipyridamole (DIP), and warfarin on 406 patients who had femoropopliteal-tibial operations with saphenous vein (SV), umbilical vein (UV), polytetrafluoroethylene (PTFE) and Dacron (DuPont, Wilmington, DE). Above-knee bypasses were performed in 181 patients: 77 were taking ASA and DIP at the time of operation, 41 were placed on postoperative "low-dose" warfarin, whereas 63 did not receive adjunctive medications. Late patency demonstrated no significant difference among the groups based on graft material used (SV 71%, UV 68%, PTFE 66%, and Dacron 65%) (P less than .25). Below-knee femoro-popliteal bypasses were performed in 183 patients: 82 were taking ASA and DIP at the time of operation, 40 were placed on warfarin postoperatively and no medications were given to 41 patients. Late patency rates (39 months) demonstrated that SV (62%) was superior to UV (51%), PTFE (30%), and Dacron (18%) (P less than .01). Femorotibial-peroneal bypasses were done in 42 patients: 13 patients were taking ASA and DIP at operation, 21 were placed on warfarin postoperatively and 8 received no medication. SV late patency (33 months) was again superior (43%) to UV (31%); no PTFE or Dacron grafts functioned after 24 months. Patients who took warfarin and ASA had the best early (16 months) patency results. Above-knee prosthetic grafts achieved late patency rates similar to SV while reducing operative time, shortening recuperation, and sparing the saphenous vein for use in the coronary or infrapopliteal vessels. In below-knee bypasses SV was superior to prosthetic grafts, with or without the use of ASA and DIP or warfarin.(ABSTRACT TRUNCATED AT 250 WORDS)