Endoscopic management of postoperative biliary fistula

Endoscopic retrograde cholangiography (ERC) was performed in two patients with persistent bile fistulae after cholecystectomy. Contrast leakage was demonstrated in a leaking cystic duct stump and an aberrant intrahepatic duct. Endoscopic insertion of nasobiliary catheters led to rapid drainage and healing of the biliary fistulae.

Endoscopic management of biliary ascariasis

Cholangitis and pancreatitis have resulted from migration of Ascaris lumbricoides up the biliary tree. We report our experience with the endoscopic management of 11 patients who presented with cholangitis and pancreatitis. Successful endoscopic worm extraction with or without sphincterotomy was achieved for worms located in the biliary tree but endoscopic worm extraction from the pancreas was technically difficult. Anthelminthic therapy is indicated to eradicate the gut infestation and prevent recurrent disease.

Endoscopic injection of adrenaline for actively bleeding ulcers: a randomised trial

A prospective randomised trial was performed to assess the efficacy of endoscopic injection of adrenaline for actively bleeding ulcers. Emergency endoscopy in 961 patients admitted for upper gastrointestinal haemorrhage identified 68 patients with actively bleeding ulcers. These 68 patients were randomised to receive either endoscopic injection of adrenaline or no endoscopic treatment. After endoscopy both groups were managed in an identical manner, and strict criteria for emergency operation were adhered to in both groups. Bleeding was initially controlled in all 34 patients assigned to the treatment group. Significantly fewer patients in the treatment group than in the control group needed emergency operations (five v 14, respectively). In addition, in the treatment group the median transfusion requirement was significantly less (three v five units of blood) and the median hospital stay shorter (six v eight days). No complications were observed with the injection of adrenaline, and the rate of healing of ulcers in those attending for endoscopy six weeks after discharge was similar in both groups (81% (17 out of 21 patients) in the treatment group v 79% (11 out of 14) in the control group). Injection of adrenaline is effective in stopping bleeding from actively bleeding ulcers.

Endoscopic removal of large common bile duct stones in recurrent pyogenic cholangitis

It is not uncommon to find large stones obstructing the bile duct in patients with recurrent pyogenic cholangitis. In a series of 291 patients with cholangitis, 32 patients had stones more than 2 cm in diameter. Endoscopic extraction using a combination of large baskets, 1% EDTA flushing, and manual or mechanical lithotripsy allowed the common bile duct to be cleared in 50% of patients. Lack of space in the common bile duct to open the retrieval basket because of stone impaction was the major reason for failure.

Heater-probe treatment of bleeding peptic ulcers

Fifty-six patients with actively bleeding peptic ulcers were treated with the heater-probe unit. Initial haemostasis was achieved in 48 patients (85.7%). The mean number of heater-probe applications was 6.7 pulses at a setting of 25-30 J. Rebleeding occurred in 11 patients (19.6%). Five were successfully treated with repeat heater-probe treatment, 5 required emergency surgery, and 1 rebleeding was stopped by adrenaline injection. The complications included one perforation in a patient with duodenal ulcer. The overall mortality was 2/56 (3.6%). Heater-probe treatment is an effective and safe haemostatic method for controlling actively bleeding ulcers.

An unusual case of oesophageal rupture treated by transhiatal oesophagectomy

Spontaneous rupture of the oesophagus is an uncommon surgical emergency. A case is presented in which the extensive nature of the rupture precluded standard methods of treatment and was treated by transhiatal oesophagectomy.

Endoscopic injection of adrenalin in bleeding peptic ulcers

Endoscopic injection of actively bleeding peptic ulcers with adrenalin was performed in 37 patients. Initial hemostasis was achieved in all. Five patients rebled and three required emergency surgery. Definitive hemostasis was achieved in 34 (92%). No significant local or systemic complication was observed. The technique in our patients was safe and deserves further comparative study with other methods of endoscopic hemostasis.

Hepatic metastases in Hong Kong Chinese: evidence for an East-West difference in gastric cancer

The incidence of hepatic metastases found at laparotomy for colorectal and gastric cancer amongst Hong Kong Chinese was found to be 16% and 5% respectively. These figures were compared to similar Western series, and the incidence of metastases from gastric cancer was significantly lower in the Chinese population. This geographical variation may have important implications for the interpretation of treatment results for gastric cancer in different parts of the world.

Balloon dilation facilitates stapling in esophagojejunostomy

A technique for facilitating stapled anastomosis in end to end esophagojejunostomy is described. The jejunal loop and the esophagus are dilated with a Sengstaken-Blakemore tube and a Foley catheter respectively prior to the introduction of the stapling gun. Balloon dilation simplifies the insertion and removal of the gun. The procedure is atraumatic and allows the use of larger size stapling cartridges.

Complications of oriental augmentation rhinoplasty

Augmentation rhinoplasty has become a popular plastic operation in Asia. In Korea most surgeons prefer using silicone rubber prosthesis instead of autogenous material. The authors have used the standard shaped silicone prosthesis, boat-shaped and also L-shaped prostheses. The standard shape prosthesis has less extrusion and fixation problems. In over 1,500 cases, there were 357 complications (20.8%). All the complications were due to the silicone prosthesis acting as a foreign body or failure in design of implant or unskillful operative technique. In order to minimise complications, care should be taken to use the proper size of prosthesis, the correct shape of implant and to ensure that there is adequate undermining and meticulous closure technique. To minimise the overlying skin tension at the tip and on the dorsum of the nose, the cutting of the depressor septi nasi muscle and transverse part of the nasalis muscle are recommended. In this review, we report the types and incidence of complications by analysing the cases seen during the past 10 years in our Unit and offer a few solutions to overcome these complications.

Carbohydrate modifications of the high mobility group proteins

This paper reports the results of numerous biochemical analyses which indicate that the "high mobility group" proteins (HMGs) of mouse and bovine cells are bona fide glycoproteins and can, in addition, be modified by poly(ADP-ribose) addition in vitro. The sugars N-acetylglucosamine, mannose, galactose, glucose, fucose, and one unknown sugar (possibly xylose) have been identified in purified preparations of HMGs 14 and 17. Furthermore, the fucose-specific lectin Ulex europeus agglutinin I bound both to the isolated HMGs and to monomer nucleosomes containing HMGs released from "active chromatin" by micrococcal nuclease digestion. Selective alkaline borohydride reductive cleavages of the HMGs suggested that the oligosaccharide prosthetic groups are primarily bound to these proteins by N-glycosidic linkages. The unexpected finding that the HMGs contain covalently bound complex carbohydrate moieties allows for a potentially great amount of variability and specificity in these proteins that may have important biological implications.

Comparative surfact structure of 16S ribosomal ribonucleic acid of 30S ribosomes of procaryotic cells

Ribonuclease T(1) treatment of 30S ribosomes of Escherichia coli converts a large region at the 3' OH end of 16S ribosomal ribonucleic acid (rRNA) to low-molecular-weight RNA. The final 25 nucleotides at the 3' terminus of the molecule emerge relatively intact, whereas most of the region "upstream," for about 150 nucleotides, is converted to oligonucleotides. Identical enzyme treatment generates a fragment of about 60 nucleotides from the middle of 16S rRNA (section D'). To determine whether there are similar sequences in other bacteria, which occupy similar accessible surface locations, we treated 30S ribosomes from Azotobacter vinelandii and Bacillus stearothermophilus with RNase T(1). In each case, a fragment of RNA about 25 nucleotides in length containing the 3' OH end of 16S rRNA and a fragment of about 60 nucleotides in length similar, but not identical, in oligonucleotide composition to section D' of E. coli 16S rRNA were obtained from nuclease-treated 30S ribosomes. These data indicate that, although the primary structure at the 3' end and the middle (section D') of the various 16S rRNA's is not completely conserved, their respective conformations are conserved. A number of identical oligonucleotides were found in the low-molecular-weight fraction obtained from RNase T(1)-treated E. coli, A. vinelandii, and B. stearothermophilus 30S ribosomes. These results show that identical RNase T(1)-sensitive sequences are present in all three bacteria. Hydrolysis of these regions leads to the production of the fragments 25 and 60 nucleotides in length.