Can bile duct injuries be prevented? "A new technique in laparoscopic cholecystectomy"

BACKGROUND: Over the last decade, laparoscopic cholecystectomy has gained worldwide acceptance and considered to be as "gold standard" in the surgical management of symptomatic cholecystolithiasis. However, the incidence of bile duct injury in laparoscopic cholecystectomy is still two times greater compared to classic open surgery. The development of bile duct injury may result in biliary cirrhosis and increase in mortality rates. The mostly blamed causitive factor is the misidentification of the anatomy, especially by a surgeon who is at the beginning of his learning curve. Biliary tree injuries may be decreased by direct coloration of the cystic duct, ductus choledochus and even the gall bladder. METHODS: gall bladder fundus was punctured by Veress needle and all the bile was aspirated. The same amount of fifty percent methylene blue diluted by saline solution was injected into the gall bladder for coloration of biliary tree. The dissection of Calot triangle was much more safely performed after obtention of coloration of the gall bladder, cystic duct and choledocus. RESULTS: Between October 2003 and December 2004, overall 46 patients (of which 9 males) with a mean age of 47 (between 24 and 74) underwent laparoscopic cholecystectomy with methylene blue injection technique. The diagnosis of chronic cholecystitis (the thickness of the gall bladder wall was normal) confirmed by pre-operative abdominal ultrasonography in all patients. The diameters of the stones were greater than 1 centimeter in 32 patients and calcula of various sizes being smaller than 1 cm. were documented in 13 cases. One patient was operated for gall bladder polyp (our first case). Successful coloration of the gall bladder, cystic duct and ductus choledochus was possible in 43 patients, whereas only the gall bladder and proximal cystic duct were visualised in 3 cases. In these cases, ductus choledochus visibility was not possible. None of the patients developed bile duct injury. CONCLUSION: The number of bile duct injuries related to anatomic misidentification can be decreased and even vanished by using intraoperative methylene blue injection technique into the gall bladder fundus intraoperatively

Nutrition, life-style practice, serum vitamin D concentration and bone density in Hungarian adolescents

This study investigates the nutritional status, life-style practices, serum vitamin D and bone density of adolescents. A total of 326 adolescents, aged between 11 and 14 years, were involved in the present examination: after winter 110 boys and 97 girls (March 2002 and February 2003), and after summer 66 boys and 53 girls (October 2002 and 2003) were investigated. Energy and nutrient intake and life-style practices were assessed. Body mass and height were measured, body mass index was calculated. Serum concentration of 25-hydroxyvitamin D [25(OH)D] was determined. Bone mineral density of calcaneus was measured. Protein intake was higher than the Hungarian RDA. All of the students had vitamin D intake far below the RDA, 33.3% of boys and 43.2% of girls had Ca intake below 70% of RDA, and sodium intake was more than twice higher than the RDA. After winter, 2% of boys and 8% of girls were considered vitamin D deficient and 11% and 19% vitamin D insufficient, respectively. After summer, 24% of boys and 21% of girls had 25(OH)D level over the reference range. The mineral content of bone was insufficient in 12.9% of boys and 10.4% of girls, respectively. The majority of the students had physical activity only in school, incorporated in the timetable