Hypothesis: Patients with mild gallstone pancreatitis may undergo an early laparoscopic cholecystectomy (LC) within 48 hours of hospital admission without awaiting the normalization of pancreatic and liver enzyme levels. This may decrease the hospital stay without increasing morbidity or mortality and may minimize the unnecessary use of endoscopic retrograde cholangiopancreatography. Design: A retrospective review. Setting: Two university-affiliated urban medical centers. Patients: A total of 303 patients with mild gallstone pancreatitis, of whom 117 underwent an early LC and 186 underwent a delayed LC. Main Outcome Measures: Hospital length of stay, morbidity and mortality rates, and the use of endoscopic retrograde cholangiopancreatography. Results: Similar hospital admission variables were observed in the early and delayed LC groups, although the delayed group was older (P =.006). The median hospital length of stay was significantly less for the early group than for the delayed group (3 vs 6 days; PϽ .001). There were no patients who died, and the complication rates were similar for both groups. However, the patients who underwent an early LC were less likely than patients who underwent a delayed LC to undergo endoscopic retrograde cholangiopancreatography (P =.02). Conclusions: An early LC may be safely performed for patients with mild gallstone pancreatitis, without concern for increased morbidity and mortality, resulting in shortened hospital stays and a decrease in the use of endoscopic retrograde cholangiopancreatography. The practice of delaying an LC until normalization of laboratory values appears to be unnecessary.

No abstract

Background Prompt diagnosis and treatment of acute mesenteric ischemia (AMI) requires a high index of suspicion for timely management. Poor clinical outcomes and delays in surgical treatment are demonstrated even in modern clinical series. Recognition of exhaled volatile organic compounds (VOC’s) specific to AMI may facilitate early detection and diagnosis and improve patient outcomes. Study Design Adult Wistar Rats (n=5) were intubated and anesthetized and control tracheostomy breath samples were collected using Tedlar gas sample bags. Intestinal ischemia was induced by placing an occlusive clip across the superior mesenteric artery and breath samples were collected following one hour of intestinal ischemia and following 15 minutes of intestinal reperfusion. Gas chromatography was used to identify and measure levels the VOC’s obtained and measured retention indices were compared with known values in the Kovats Retention Index. Results Multiple retention indices (n=41)) were noted on gas chromatography representing a variety of VOC’s detected. Z,Z,-farnesol (C15H26O), an isoprenoid, was the only compound detected which was undetectable during the control phase (median=0 Cts/sec, range=0) but significantly elevated during the ischemic and reperfusion phases(median=34 Cts/sec, range=25–37) and (median=148 Cts/sec. range=42–246), respectively. Three other isoprenoid compounds: E,E-alpha-farnesene, germacrene-A, and Z,Z-4,6,8-megastigmatriene were also detected in all five animals, but their levels did not differ significantly between control, ischemic and reperfusion phases. Conclusions This pilot study demonstrates the feasibility of analyzing exhaled VOC’s using a novel rat model for acute mesenteric ischemia. These findings may be useful for the development and identification of similar assays for the rapid diagnosis of acute mesenteric ischemia.

Microscale systems that enable measurements of oncological phenomena at the single-cell level have a great capacity to improve therapeutic strategies and diagnostics. Such measurements can reveal unprecedented insights into cellular heterogeneity and its implications into the progression and treatment of complicated cellular disease processes such as those found in cancer. We describe a novel fluid-delivery platform to interface with low-cost microfluidic chips containing arrays of microchambers. Using multiple pairs of needles to aspirate and dispense reagents, the platform enables automated coating of chambers, loading of cells, and treatment with growth media or other agents (e.g., drugs, fixatives, membrane permeabilizers, washes, stains, etc.). The chips can be quantitatively assayed using standard fluorescence-based immunocytochemistry, microscopy, and image analysis tools, to determine, for example, drug response based on differences in protein expression and/or activation of cellular targets on an individual-cell level. In general, automation of fluid and cell handling increases repeatability, eliminates human error, and enables increased throughput, especially for sophisticated, multistep assays such as multiparameter quantitative immunocytochemistry. We report the design of the automated platform and compare several aspects of its performance to manually-loaded microfluidic chips.

Human small intestinal crypts are the source of intestinal stem cells (ISCs) that are capable of undergoing self-renewal and differentiation to an epithelial layer. The development of methods to expand the ISCs has provided opportunities to model human intestinal epithelial disorders. Human crypt samples are usually obtained from either endoscopic or discarded surgical samples, and are thereby exposed to warm ischemia, which may impair their in vitro growth as three-dimensional culture as spheroids or enteroids. In this study we compared duodenal samples obtained from discarded surgical samples to those isolated from whole-body preserved cadaveric donors to generate in vitro cultures. We also examined the effect of storage solution (phosphate-buffered saline or University of Wisconsin [UW] solution) as well as multiple storage times on crypt isolation and growth in culture. We found that intestinal crypts were successfully isolated from cadaveric tissue stored for up to 144 h post-procurement and also were able to generate enteroids and spheroids in certain media conditions. Surgical samples stored in UW after procurement were sufficiently viable up to 24 h and also allowed the generation of enteroids and spheroids. We conclude that surgical samples stored for up to 24 h post-procurement in UW solution allowed for delayed crypt isolation and viable in vitro cultures. Furthermore, in situ, hypothermic preservation in cadaveric duodenal samples permitted crypt/ISC isolation, and successful culture of spheroids and enteroids from tissues held for up to 6 days post-procurement.

No abstract