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BACKGROUND: The aim of this experimental study is to assess the consequences of biliary stones placed in the abdominal cavity of rabbits. METHODS: The animals were allocated to five groups. In group A a nonsterile gallstone was used. In group B animals with a nonsterile gallstone received preoperative chemoprophylaxis. In group C a sterile stone was placed in the abdomen. Group D served as control. In group E were animals with a nonsterile stone who had a prolonged follow-up period. Parameters studied postoperatively were temperature, white blood cell count, abscess formation, sepsis, peritonitis, adhesion formation, intestinal obstruction, and histological changes of the omentum enveloping the gallstones. RESULTS: There was no statistically significant difference among the five groups concerning morbidity, mortality, or histological findings. CONCLUSIONS: The prevalence of septic complications was higher among the four groups that received gallstones compared to the control group and thus an adverse effect of gallstone implantation can be suggested.

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An awareness of the surgical anatomy and the possible dispositions of the recurrent laryngeal nerve (RLN) is very helpful in avoiding its injury during thyroidectomy. The relationship of the RLN to the inferior thyroid artery (ITA) and the suspensory ligament of Berry were studied in 172 patients undergoing thyroidectomy. One hundred and ninety one nerves were identified, 109 on the right and 82 on the left. Most nerves, both on the right (82.6%) as well as on the left (85.4%) ran either posterior or between the branches of the inferior thyroid artery. The majority of nerves were found within 3 mm from Berry's ligament. The relationship of the recurrent laryngeal nerve to the inferior artery and to the ligament of Berry does not follow a constant anatomical pattern. Nevertheless these structures have a quite close relationship to the nerve in the majority of cases.

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In an effort to establish diagnostic criteria for rejection and recurrent disease in transplanted pancreas, a comparative study was performed based on clinical diagnosis. Clinical rejection was diagnosed in patients who had decreased urinary amylase or increased blood glucose; they were treated for rejection and improved. A clinical diagnosis of recurrent diabetes was made in syngeneic transplant recipients with islet dysfunction. In addition, two control groups were used--nontransplant, nondiabetic pancreatitis patients and pretransplant normal biopsies from patients in the study. Morphologically, tissues were assessed for acinar inflammation, ductal changes, islet and nerve inflammation, and vascular changes. Immunohistochemical staining for insulin and glucagon was also performed to quantitate differences between the groups. Vascular changes (endothelialitis, vasculitis, obliterative endarteritis) were specific for rejection. Also, rejection was characterized by a lymphocytic or mixed infiltrate that involved the ducts. Recurrent diabetes was characterized by selective loss of beta cells with isletitis. Leukocyte common antigen and UCHL1 staining was helpful in identifying islet inflammation. An insulin/glucagon ratio of less than 1.0 appears to be specific for recurrent disease and in the absence of isletitis is a reasonable method for detecting recurrent disease at an early stage.

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The pig is a large animal suitable for experimental pancreas transplantation due to its anatomy and transplant immunology, both of which are similar to humans. We established a model of en bloc simultaneous pancreas and kidney transplantation that decreases preservation time, operation time, and clamp time. The donor aorta--with celiac axis, superior mesenteric artery, and left renal artery--is anastomosed en bloc to the recipient's aorta in a side-to-oblique fashion. The portal vein is anastomosed end-to-side to the distal vena cava, and the left renal vein end-to-side to the left common iliac vein. The donor duodenum is anastomosed to the bladder to allow monitoring of the urinary amylase for rejection. En bloc transplantation is preferable for separating pancreas and kidney anastomoses in pigs. This technique could be used in humans, especially in adult uremic diabetic patients who receive a combined pancreas/kidney transplant from a pediatric cadaver donor.

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Eight patients with end-stage renal failure due to Wegener's granulomatosis underwent renal transplantation at the University of Minnesota. Seven patients were alive with a functioning graft 40 to 128 months posttransplant (mean follow-up: 91 months). One patient died 126 months posttransplant with a well-functioning graft. Posttransplant immunosuppression controlled primary disease in all but 1 patient, who presented with perisinusitis. Recurrent disease was not noted in any of the transplanted organs. We conclude that transplantation is an excellent treatment for renal failure secondary to Wegener's disease.

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Two unusual cases of primary hydatid disease are described. In one of them a retroperitoneal cyst, presenting as a palpable abdominal mass, was strongly adherent to the inferior vena cava and dislocated the right kidney. Partial cystectomy and drainage were performed. The other cyst, of the right ischiorectal fossa, was initially misinterpreted as a perineal of sciatic hernia. It was completely removed. No other site of hydatid disease was found and the patients remain well 3 and 4 years postoperatively.

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The site distribution of large-bowel adenocarcinomas was studied in a retrospective study compromising 600 patients. These patients were divided into two groups according to the year of their operation; group A included patients operated upon between 1978 and 1982, and group B patients were operated upon between 1983 and 1987. Comparing these two five-year periods, a statistically significant increase in the incidence of right colon tumors was noted (P less than 0.05). There was no difference in the distribution pattern of the carcinomas according to sex or age between the two groups (P less than 0.1). The shift to the right of large-bowel neoplasms may indicate the need for an alteration of the diagnostic procedures concerning this disease, with more emphasis given to total colonoscopy and or double-contrast barium enema.

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Fifteen per cent of patients with end stage renal insufficiency are being treated in Greece with continuous ambulatory peritoneal dialysis (CAPD). Postoperative hernia, which is mostly incisional, is a complication which may compromise the efficacy of the method. We present our experience on patients undergoing CAPD, concerning this complication.

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In a clinical prospective study, three cases of superior laryngeal nerve injury were detected after 54 classical high ligations of the superior thyroid artery. On the contrary no injury of the nerve was noted in 227 cases in which the technique of separate ligation of the superior thyroid artery's branches was used. Voice changes secondary to thyroid gland operations, without injury to the recurrent laryngeal nerve, are commonly attributed to laryngeal trauma or tracheitis. This view does not seem to be entirely true, because voice changes can follow injury to the external branch of the superior laryngeal nerve. The current study was undertaken to give a better insight to the problem on injury to the external branch of the superior laryngeal nerve during superior thyroid artery ligation and to evaluate for this purpose a technique of separate ligation of the superior thyroid artery's branches during thyroidectomy.

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