Comparative pulmonary function after cholecystectomy performed through Kocher's incision, a mini-incision, and laparoscopy was evaluated. Forty-five patients were randomly and prospectively divided into three groups of 15 each, depending on the surgical access employed. Forced vital capacity (FVC), forced expiratory volume at 1 second (FEV1), and forced expiratory flow at 25% to 75% (FEF25-75%) were determined 1 to 3 days before and 16 to 24 hours after cholecystectomy. The percent reduction of FVC (p = 0.0170), FEV1 (p = 0.0191), and FEF25-75% (p = 0.0045) was smaller after laparoscopic cholecystectomy than after Kocher's incision cholecystectomy. The percent reduction of FVC (p = 0.0170) was smaller after mini-incision cholecystectomy than after Kocher's incision cholecystectomy. There was no difference in the FEV1 (p = 0.0971) or FEF25-75% (p = 0.2058) between these two groups. FEF25-75% was significantly less impaired in the laparoscopic group than in the mini-incision group (p = 0.0327). No difference between these two groups was found in FVC (p = 0.5755) or FEV1 (p = 0.3952). It is concluded that postoperative pulmonary function is less impaired after laparoscopic cholecystectomy than after either mini-incision or Kocher's incision cholecystectomy.

No abstract

The diversity of clinical presentations of primary progressive tuberculosis (TB) and the difficulty in establishing the diagnosis of paucibacillary forms is the subject of painstaking research, as well as a cause of delay in therapy. We report the case of a 10-year-old black child who presented with chest pain and progressive widening of the upper mediastinum. Computerized tomography of the chest revealed multiple calcifications that were not identified with X-rays. Biopsy through mediastinoscopy was compatible with a diagnosis of tuberculosis. Despite exhaustive investigation that included direct examination, culture for mycobacteria and PCR (Polymerase Chain Reaction) of tissue samples, the etiologic agent was not revealed. Tuberculin conversion was observed during the follow-up and resolution period of the lesion, after administration of isoniazid, rifampicin and pyrazinamide. The nodal pseudotumoral form of tuberculosis is rare in immunocompetent children and it may simulate neoplastic disease; therefore, it should be included in the list of differential diagnoses of masses located in the anterosuperior mediastinum.

Seven dogs were subjected to resection of 80% of the total length of the small bowel. Seven pairs of electrodes were implanted in the seromuscular layer of the antrum and remaining small bowel. Electromyographic recordings were obtained during fasting and after milk ingestion. Slow waves were identified in all sites studied and their frequencies were 4.7 +/- 0.4/min in the antrum; 17.5 +/- 0.58/min in D1; 17.5 +/- 0.61/min in D2; 17.43 +/- 0.65/min in J1; 17.40 +/- 0.62/min in J2; 10.28 +/- 0.77/min in I1; and 9.81 +/- 0.53/min in I2. The phase III of the migrating motor complex was identified in only one recording. Ingestion of milk caused the appearance of the fed pattern in all recording sites, except the antrum. It is concluded that extensive resection of the small bowel causes reduction of the slow wave frequency in the gut distal to the resection and disappearance of phase III of the migrating motor complex.