Laparoscopic Cholecystectomy in a Patient on Continuous Ambulatory Peritoneal Dialysis

The patient was a 72-year-old man who was receiving continuous ambulatory peritoneal dialysis (CAPD) with a diagnosis of chronic renal failure. Although his response to dialysis therapy was favorable, right hypochondralgia and fever occurred, and gallstones were detected by abdominal ultrasonography and computed tomography. Drip-infusion cholangiography (DIC) revealed neither dilation nor calculus in the common bile duct. The patient was diagnosed as having acute cholecystitis and cholecystolithiasis and, in consideration of his general condition, laparoscopic cholecystectomy was carried out. Pneumoperitoneum was performed through a CAPD tube, and a 10 mm-trocar was carefully introduced through a supraumbilical incision so as not to injure the CAPD tube. Since intraoperative cholangiography showed a condition similar to preoperative DIC, only cholecystectomy was undertaken. The postoperative course was uneventful, with neither postoperative hemorrhage nor leakage of dialysate from the wound

Topical nipradilol: effects on optic nerve head circulation in humans and periocular distribution in monkeys,”

PURPOSE. To investigate the effects of topical nipradilol on blood velocity in the optic nerve head (ONH) in normal humans and the ocular and periocular distribution of topically instilled nipradilol in monkeys. METHODS. In normal humans, 0.25% nipradilol was instilled in one eye and vehicle in the other twice daily for 7 days, and blood velocity in the ONH was measured by the laser speckle method. In monkeys, after a single instillation of 1% [ 14 C]nipradilol in one eye, distribution of radioactivity was evaluated by whole-head autoradiography. RESULTS. Twice-daily 7-day instillation of nipradilol temporarily but significantly increased human ONH blood velocity, in the ipsilateral eye only (P ϭ 0.005), independent of a reduction in the intraocular pressure. In monkeys, equivalent nipradilol concentration in the periocular tissue around the optic nerve insertion was higher on the ipsilateral side than on the contralateral side (140 Ϯ 25 ng/g and 42 Ϯ 10 ng/g, P ϭ 0.022, n ϭ 5). Radioactivity was higher in the periocular tissue behind the equator than around the optic nerve insertion on the ipsilateral side (P ϭ 0.004), but not on the contralateral side. The equivalent nipradilol concentration in the ipsilateral posterior retina-choroid was 636 Ϯ 92 ng/g, which was significantly higher than that on the contralateral control side (521 Ϯ 92 ng/g, P Ͻ 0.001). CONCLUSIONS. The ipsilateral increase in ONH blood velocity induced by topical nipradilol in humans was attributed to drug that penetrated locally. Whole-head autoradiographic study suggests that topically instilled nipradilol can rapidly reach the posterior periocular tissue at pharmacologic concentrations. (Invest Ophthalmol Vis Sci. 2002;43:3243-3250) G laucoma is a disease that primarily damages the optic nerve head (ONH). One of the major risk factors in glaucoma is chronically elevated intraocular pressure (IOP). 1 However, reports of the relation between a subtype of glaucoma and low blood pressure, 2 migraine, 3 and optic disc hemorrhage 4 or findings on the favorable effect of a Ca 2ϩ channel blocker on the visual field 5-8 suggest that not only an increase in IOP but disorders of the systemic and/or local circulation are involved in the development of glaucomatous ONH damage. 9 -11 There are two ways for antiglaucoma agents to modify circulation in the ONH. One is to increase ocular perfusion pressure (OPP) while decreasing IOP. It is not known, however, whether a chronic increase in OPP in fact causes a chronic change in blood flow in the ONH. 12-14 The other way is to effect direct, drug-mediated vascular dilatation. Several in vitro studies are available on the vasodilatory effects of antiglaucoma agents. The ophthalmic artery branches into the central retinal artery, posterior ciliary arteries, and anterior ciliary arteries. Short posterior ciliary arteries, separate from the posterior ciliary artery, penetrate the eye wall around the insertion of the optic nerve and are essential in supplying blood to the ONH. Nipradilol (3,4-dihydro-8-(2-hydroxy-3-isopropylamino)propoxy-3-nitroxy-2H-1-benzopyran, molecular weight: 326.35) is a newly developed antiglaucoma ophthalmic agent that has nonselective ␤-receptor and selective ␣ 1 -receptor blocking properties 22,23 with a nitric oxide (NO) donative action. 24 Topical instillation of 0.25% nipradilol lowers IOP as effectively as 0.5% timolol with a less systemic ␤-blocking effect. 25 In this study, we examined whether topically instilled nipradilol also influences blood velocity in the ONH in eight normal humans as a pilot study. Because the result suggested that the effect was attributable to local penetration of the drug, we examined the ocular and periocular distribution pattern of nipradilol after topical instillation, by analysis of whole-head autoradiographs in monkeys. METHODS The study of human ONH blood velocity was approved by the Ethics Review Committee of the University of Tokyo School of Medicine and the tenets of the Declaration of Helsinki were observed. Before admission into the study, each subject signed a written consent form after the nature of the study had been fully explained and routine eye examinations had been performed. Animal experiments were performed in accordance with the ARVO Statement for the Use of Animals in Ophthalmic Vision Research. Effects on ONH Circulation in Humans Eight young volunteers (20 -24 years of age) with no history of smoking, who had neither systemic nor ocular disease and only mild refractive errors, participated in the study. On the day on which measureFrom th