Gallstone cholangitis: a 10-year experience of combined endoscopic and laparoscopic treatment

BACKGROUND: To date, no procedure has yet been identified as the gold standard for the treatment of gallstone cholangitis in the laparoscopic era. METHODS: The data of 109 consecutive patients with acute cholangitis were prospectively entered into a computerized database. All patients were managed according to a standard protocol. The main treatments were endoscopic retrograde cholangiography (ERC) combined with endoscopic sphincterotomy (ES), followed by interval laparoscopic cholecystectomy (LC). Patients in whom ERC or endoscopic stone clearance failed were managed by emergency open common bile duct exploration. LC was performed with a standardized four-cannula technique. The mean duration of surgery, conversion rate, and postoperative outcome of these patients were evaluated. RESULTS: ERC was successful in 103 patients (94.5%). In five of these patients (4.8%), no bile duct stones were found. The 98 patients (95.2%) with common bile duct stones were referred for ES. The bile duct stones were successfully removed after ES in 93 cases (94.9%). The overall failure rate of ERC and ES for choledocholithiasis was 10.1%. Self-limiting pancreatitis occurred in four patients (4.3%). Overall, two of the 109 patients died (1.8%). After ES, 81 patients underwent LC. LC was performed successfully in 74 patients (91.3%). Conversion to open surgery was required in seven patients (8.7%). The morbidity rate after cholecystectomy was 7.4%; the morbidity rate after open bile duct exploration was 36.4% (p<0.05). Fifteen patients were managed conservatively after initial endoscopic management of their cholangitis. The overall incidence of recurrent biliary symptoms was significantly higher among patients with gallbladder in place than for patients who underwent cholecystectomy (38.5% vs 1.5%, p<0.001). CONCLUSIONS: ES followed by LC is a safe and effective approach for the management of gallstone cholangitis; cholecystectomy should be performed in patients with gallstone cholangitis unless the operative risk is extremely high. These high operative risk patients and those who refuse surgery after ES should be warned that they are at high risk for recurrent biliary symptoms

[Treatment of supra-aortic trunk aneurysms: report on 16 cases]. FT Il trattamento degli aneurismi dei tronchi sovraaortici: esperienza su 16 casi.

The Authors report their own experience in treating 16 patients suffering from aneurysms of the supra-aortic trunks, 6 of the innominate artery, 4 of the common carotid artery, 3 of the intrathoracic subclavian artery and 3 of the extrathoracic subclavian artery. Eleven cases were of atherosclerotic nature, 3 from Takayasu's, 1 dysplasic and 1 mycotic. To aneurysms of the innominate artery with diameter less than 2 cm and one of the subclavian artery, in a patient with on carcinoma of the lung, was treated non surgically; all other patients were operated. The mortality was 0, and morbidity rate very low. With a mean follow-up of three years, only a patient, with Takayasu's disease, developed a recurrence and one, with mycotic aneurysm, died from persistence of the sepsis

Synthesis and antileukemic activity of 1-[(quinolizidinylalkyl)amino]4/7-R-thioxanthen-9-ones

Fifteen 1-(quinolizidinylalkyl)amino derivatives of thioxanthenone bearing different substituents on position 4 and 7 were prepared and tested in mice against lymphocytic leukemia P 388. These compounds were inactive or displayed only borderline activity (compounds 1, 10, 15)

New benzamide-derived 5-HT3 receptor antagonists which prevent the effects of ethanol on extracellular dopamine, and fail to reduce voluntary alcohol intake in rats

A set of substituted benzamides, characterized by the presence of a bulky quinolizidine moiety, were subjected to binding assays for 5-HT3 and D2 receptors on membranes obtained from the bovine area postrema ([3H]-GR65630) and the rat striatum ([3H]-spiperone) respectively. These benzamides resulted unsuitable for the recognition of D2 receptors, while a few of them, devoid of 5-HT4 receptor activity, had consistent affinity for central 5-HT3 receptors, inhibiting also potently the ethanol-induced dopamine efflux from the mesolimbic dopamine terminal region. However they failed in attenuating voluntary alcohol consumption in rats, as observed with several other chemically unrelated 5-HT3 antagonists. Thus the 5-HT3-mediated inhibition of alcohol-induced striatal release of dopamine by substituted benzamides is not a requisite for affecting ethanol intake

[Association of deep venous thrombosis and popliteal pseudoaneurysm after arthroscopic meniscectomy]. FT Associazione di TVP e pseudoaneurisma popliteo dopo meniscectomia artroscopica.

Popliteal pseudoaneurysm is an infrequent outcome of closed or penetrating injuries to the popliteal artery. An unusual case of iatrogenic right popliteal pseudoaneurysm in a female patient referred to our attention 20 days after arthroscopic meniscectomy is described