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Objective: The key step during laparoscopic appendectomy and cholecystectomy is the occlusion of vascular structures, cystic duct and appendiceal stump. It may be performed using different techniques that affect the outcome and cost of the surgery. The objective here is to analyze outcomes and costeffectiveness of nonabsorbable polymer clips in laparoscopic appendectomy and cholecystectomy. Methods: We evaluated data of 85 patients who underwent laparoscopic appendectomy and 136 who underwent laparoscopic cholecystectomy. The patients who underwent laparoscopic appendectomy were divided in groups where the appendiceal stump occlusion was performed using an endocutter (n=17 ; Ethicon Endo-Surgery, USA), endoloops (n=38 ; Covidien, USA), and nonabsorbable polymer clips (n=30 ; Grena, UK), respectively. In laparoscopic cholecystectomy group titanium clips (Ethicon Endo- Surgery, USA) were used in one group (n=83) while in other (n=53) we used polymer clips (Grena, UK). The data on patients demographics, intra- and postoperative complications, hospital stay and costs were analyzed. Results: The baseline clinical and demographic characteristics were similar among the groups. All costs used in this study reflect the direct costs of key steps of each procedure. The cost of two types of clips slightly varied for both procedures (titanium clips cartridge €10.99, nonabsorbable polymeric clips cartridge €16.48). The effectiveness of nonabsorbable polymer clips seem to be comparable to that of titanium clips. Treatment of the appendiceal stump by nonabsorbable polymeric clips decreases the expense associated with the use of a endostapler and endoloop. The cost of the 45 mm endocutter and cartridge is €371.45, for one endoloop is €30.66, and for nonabsorbable polymeric clips cartridge €16.48. The type of device applied had no influence on early postoperative complications. Conclusion: Nonabsorbable polymer ligating clips may provide safe and effective alternative for endostaplers, endoloops and titanium clips during laparoscopic cholecystectomy and appendectomy. They provide some technical advantages, including feature of low interference with CT, MRI and X- ray, while in the same time ensure substantial cost saving.

Cilj: Istražiti dovodi li operacija preponske kile ugradnjom mrežice do promjene u testikularnoj cirikulaciji te dolazi li do imunološke senzibilizacije na spermije. Ispitanici: Prospektivna nerandomizirana studija od 82 operirana muškarca s preponskom kilom u dobi od 61 (33-81) godine, koji su operirani na Kliničkom odjelu digestivne kirurgije. Isključujući čimbenici su bili da ranije nije bilo operacija kila, traume testisa, autoimune bolesti, imunodeficijencija, upalne bolesti prostate, epididimisa i varikocela. Metode: Bolesnici su bili podijeljeni u dvije grupe, Grupa A 53 pacijenta koji su operirani otvorenim pristupom po Lichensteinu i Grupa B 29 pacijenata laparoskopski TAPP pristupom. Kod svih je primijenjena polipropilenska mrežica. Krv za analizu ELISA testom kod svih bolesnika je vađena prije i najmanje 120 dana nakon operacije. Mjerenje doplerskih protoka testikularne cirkulacije od strane jednog radiologa prije operacije, 48 sati nakon i 120 dana nakon operacije, korištenjem sonde visoke rezolucije od 10 MHz. U statističkoj analizi koristio se Wilcoxonov i Friedmanov test. Rezultati: Našli smo prolaznu statistički značajnu razliku u protoku aa. intratestikularis, u ranom razdoblju. Zaključak: Operacija preponske kile uz uporabu mrežice ne dovodi do trajne promjene u testikularnoj cirkulaciji niti do imunološke senzibilizacije na spermije.

Spermatozoa, essential for human reproduction, were investigated by FTIR spectroscopy in an attempt to establish connection between spectral features and essential spermatozoa parameters to determine whether that method can be employed as diagnostic tool.

In significant number of cases, male infertility is caused by the structural abnormalities of sperms [1]. These abnormalities could be detected at the light microscopy level and using computer-aided systems for the sperm morphological and kinetic analysis. However, in selected cases, an ultrastructural analysis should be performed in order to establish a correct diagnosis [2]. The aim of our study was to detect ultrastructural sperm abnormalities in patients with the male factor infertility and to compare the electron microscopy data with the results of computer-aided ejaculate analysis. Using a CASA HAMILTON THORNE /IVOS HTM 10/ system, ejaculates from 14 selected patients with severe oligoasthenospermia were analysed at the light microscopy level. For the ultrastructural analysis, a transmission electron microscope Carl Zeiss 902A has been employed. A Fourier transform infrared spectrometry was performed by a Pectin Elmer GX spectrometer. 5 ejaculate samples form men with normospermia served as controls. Sperms form infertile group of patients displayed low concentrations, poor or no kinetics and a significant polymorphism (assessed by Tygerberg strict criteria). In 8 cases electron microscopy analysis showed combined anomalies of the sperm head and the tail. The chromatin of the sperm nucleus was not condensed whereas the head often displayed membranous inclusions. In one patient all sperms had globular shape (total globozoospermia), whereas in another two samples there was a mixed sperm population bearing globular or enlarged nucleus with a variety of shapes. The acrosome in the above-mentioned cases was frequently abnormal. In some sperms acrosome was included in the residual body or formed prominent inclusions within the nucleus. In 6 cases the sperm abnormalities were located in the tail. Mitochondria in the proximal part of the tail were in some cases uncoiled or poorly developed. In one case, the tail had abnormal arrangement of microtubules (additional microtubule attached to one peripheral microtubule pair). Preliminary infrared spectrometry data indicated significant difference between normal and abnormal sperms. It is concluded that the ultrastructural analysis could provide valuable data for the correct diagnosis of male infertility. A good correlation could be established between computer-aided ejaculate analysis and electron microscopy. Gopalkrishnan K. et al., Arch Androl 45 (2000), 111-7. Grab D. et al., Arch Gynecol Obstet 252 (1993), 137-41.