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Intraoperative serial changes in systemic hemodynamic parameters and in the results of renal function tests were studied in 7 patients who underwent laparoscopic cholecystectomy (LAP) in which intra-abdominal pressure was maintained at 12 mm Hg, and in 7 patients who underwent minilaparotomy cholecystectomy (MINI). No significant changes were observed in the parameters in the MINI group during the operation. However, urine output, effective renal plasma flow and glomerular filtration rate in the LAP group were decreased 60 min after initiation of pneumoperitoneum.

Changes in the hemodynamics and urine output were investigated in 19 patients undergoing laparoscopic cholecystectomy, five of whom had heart disease with the New York Heart Association classification I (n = 1) and II (n = 4). Systemic blood pressure, central venous pressure, pulmonary capillary wedge pressure and cardiac output did not significantly change during the procedure including the establishment of pneumoperitoneum. Urine output 30-60 min after starting the pneumoperitoneum was significantly lower in the patients with heart disease compared to the values before and in the initial phase (0-30 min), and also to the values before and during the procedure in the control group. One patient suffered temporary cardiac decompensation following laparoscopic cholecystectomy which prolonged his hospital stay to seven days. The remaining four patients with heart disease could be discharged on the third or fourth day postoperatively. It is concluded that laparoscopic cholecystectomy is feasible in patients with heart disease but attention should be paid to the possibility of oliguria during prolonged pneumoperitoneum.

An ultrastructural morphological primer of human eosinophils is presented. Mature and immature eosinophils. obtained from peripheral blood and bone marrow, as well as activated tissue eosinophils are all used to illustrate the various morphologies assumed by eosinophils in vivo. The various ultrastructural changes expressed by this cell lineage in vivo reflect the impact of differentiation, maturation, activation, secretion, and cell injury on morphology. Nearly all of the changes described in vivo are also evident in eosinophils arising in in vitro systems. We review published studies of these culture systems, which have been supplemented with various conditioned media containing naturally occurring growth factor(s) that are permissive (or not permissive) for eosinophils or with the recombinant growth factors, IL-5 or IL-3. These sti~diesw ere helpful in the recognition of eosinophil-promoting, -sustaining and -activating properties of human IL-3 and IL-5. Moreover, mature and immature eosinophils were shown to release a granule matrix protein - eosinophil peroxidase (EPO) - by its transport in small cytoplasmic vesicles, a process termed piecemeal degranulation (PMD). accounting for the gradual emptying of granule contents in the absence of granule fusions to the plasma membrane. Also presented are eosinophil morphologies that occur in vitro in suspension cultures of human cord blood supplemented with the c-kit ligand from various sources. The wide variety of eosinophil subcellular changes in the c-kit ligand-supplemented cultures, like the changes of which eosinophils are capable in vivo, reflects the processes of differentiation, maturation, activation, secretion and cell injury. Presentation of this ultrastructural morphological primer of human eosinophils in vitro should enable investigators to recognize eosinophils in all of their diverse morphologic forms i n cultures that contain differentiating and Offprint requests to: Ann M. Dvorak. M.D.. Department of Pathology. Beth lsrael Hospital. 330 Brookline Avenue. Boston. MA 02215, USA functioning rnenibers of other lineages, also present in ckit ligand-supplemented cultures. These lineages include mast cells, basophils, neutrophils. monocytes, macrophages. megakaryocytes, and endothelial cells.