[Endoscopic Ultrasound Drainage of the Gallbladder in Acute Cholecystitis in Patients at High Surgical Risk]

BACKGROUND

The standard treatment for acute cholecystitis is laparoscopic cholecystectomy. Alternative procedures are used for patients at high surgical risk. Percutaneous drainage is widely available. The alternative of transpapillary drainage of the gallbladder via the ductus cysticus has only limited prospects of success. With the widespread use of interventional endoscopic ultrasound and the development of new stent systems, endoscopic ultrasound gallbladder drainage has proven to be a safe and reliable procedure.

MATERIAL AND METHOD

We retrospectively report on our experiences in 11 consecutive patients with endoscopic ultrasound gallbladder drainage in acute cholecystitis between December 2018 and January 2021.

RESULTS

11 patients with acute cholecystitis with a mean age of 84.5 years (70-95 years) are reported. All patients had severe general comorbidities or advanced abdominal tumours or a combination of these conditions. After interdisciplinary debate, the indication for interventional therapy was made. This was carried out in 9 cases by means of endosonographic drainage alone and in 2 cases by means of percutaneous and two-stage endosonographic drainage. Technical success was achieved in 10 cases (91%), clinical success in 9 cases (82%). In 2 cases there were procedural complications that led to the operation.

CONCLUSION

In the case of high surgical risks, endosonographic drainage of the gall bladder is a safe and definitive therapy. This can be performed alone or in combination with percutaneous drainage. Endoscopic ultrasound drainage is superior to percutaneous drainage alone, due to its lower complication rates and lower rates of necessary follow-up interventions. Therefore, in cases of relatively high surgical risk, endoscopic ultrasound drainage of the gall bladder should be preferred to percutaneous drainage, especially when definitive therapy is required.

The effect of GABA and the GABA-uptake-blocker NO-711 on the b-wave of the ERG and the responses of horizontal cells to light

BACKGROUND

The effects of GABA in the retina have now become of special interest because the anti-epileptic drug vigabatrin, a GABA analogue, can cause visual field loss in humans. Vigabatrin inhibits the GABA-aminotransferase, which finally results in GABA accumulation in the extracellular space. The b-wave of the electroretinogram (ERG), which originates partly in on-bipolar cells, is influenced by both GABAergic horizontal cells (HCs) and GABAergic amacrine cells (ACs). Their influences, however, are difficult to separate. In an attempt to isolate the effect of GABAergic ACs, use has been made of the specific effect of the GABA-uptake-blocker NO-711, which blocks only the GABA transporter GAT1 of GABAergic ACs.

METHODS

The ERG and the intracellular responses of HCs to light were recorded in the isolated rabbit retina, and the effects of GABA and NO-711, when added separately to the superfusate, were determined.

RESULTS

GABA reduced significantly both the light responses of HCs and the b-wave. NO-711 enlarged the b-wave drastically, but did not affect the responses of HCs to light.

CONCLUSIONS

An increase in the extracellular GABA concentration decreases the b-wave; an impairment of the function of ACs increases the b-wave. These conditions are discussed in the context of the lack of consistent changes to the b-wave during therapy with vigabatrin.

Low b-wave amplitudes in a strain of rabbits with a pigment epithelium defect

When preparing isolated rabbit retinas we found in some animals fundi which were not uniformly dark but had abnormal areas of red coloration. The in situ electroretinograms (ERG) of 82 rabbits recorded after 1 h of dark adaptation were checked for abnormalities indicative of a degenerative disorder. The ERGs of eight rabbits with small dark adapted b-waves (< or = 250 microV) were re-recorded and their b-waves found to decline with time. The greatest reduction, in three rabbits, was > or = 150 microV over 2.5 years. After 1 year, however, the light adapted b-waves were similar to those of rabbits with normal dark adapted b-waves. The majority of the progeny of these rabbits also had small b-waves, which became still smaller in 2 years. Ultrastructural studies of two rabbit retinas of the first generation showed pathological changes of the pigment epithelium (Wrigstad, Hanitzsch & Nilsson, Ultrastructural and electrophysiological studies of the retina and the retinal pigment epithelium in rabbits with low b-wave amplitudes, in preparation). Evidently there is an inheritable defect in the pigment epithelium which first impairs the rod pathway.