The adverse hemodynamic effects of laparoscopic cholecystectomy

Recent studies suggest that significant physiologic derangements can occur during laparoscopic surgery. Eighteen patients admitted for laparoscopic cholecystectomy were studied. The mean age was 46.7 (range 19-78). A standard anesthetic technique, reverse Trendelenburg positioning, and an abdominal insufflation pressure of 15 mmHg with CO2 were used with all subjects. Central venous pressure (CVP) and arterial pressures were measured invasively. Stroke volume and cardiac index were calculated using quantitative transesophageal echocardiography. Baseline measurements were taken after induction. Additional measurements were taken at 15-min intervals throughout the procedure. There was a statistically significant increase in mean arterial pressure (15.9%), systolic blood pressure (11.3%), diastolic blood pressure (19.7%), and CVP (30.0%) from control baseline values. Significant decreases in stroke volume (29.5%) and cardiac index (29.5%) occurred within 30 min of the induction of pneumoperitoneum and positioning (P < 0.05, ANOVA). Laparoscopic cholecystectomy significantly and reversibly decreases cardiac performance. Compromised patients may be at increased risk for complications not previously recognized with this procedure.

Hospitalization and injury influence on the prosecution of drunk drivers

The influence that injury and hospitalization from alcohol-related motor vehicle crashes may have on subsequent prosecution for drunk driving was studied utilizing concurrent controls consisting of three cohorts of drivers. The cohorts were drunk and injured drivers, drunk and not injured drivers, and sober and injured drivers. Even though the majority of intoxicated drivers were identified by police as having been drinking, evidentiary testing was not uniform. Culpability for the crash was high in the drunk cohorts compared with the sober drivers, and yet there was a statistically significant difference in the conviction rate of injured drunk drivers (59%) compared with uninjured drunk drivers (100%). Injury and hospitalization for drunk drivers after motor vehicle crashes affords protection from prosecution, and may enable ongoing risk-taking behavior by the drunk driver.

Accidental carbadox overdosage in pigs in an Irish weaner-producing herd

A weaner ration containing carbadox at concentrations of 331 to 363 mg/kg was accidentally fed to suckling and weaned pigs in an 84 sow herd. Discarded ration was fed to 36 sows. One hundred and sixty five weaner pigs died in a 10 week period with clinical signs including refusal to eat, ill thrift, the passing of hard pelleted faeces, posterior paresis and death in seven to nine days. The surviving weaners did not thrive and some males showed poor testicular development. Sows and suckling pigs that consumed the ration also failed to thrive as did the progeny of affected sows. The main pathological finding was obliteration of the zona glomerulosa of the adrenal cortex. Increased potassium and decreased sodium concentrations in serum were the most notable and consistent biochemical findings.