Oleg Kleiner

A comparative study of gallstones from children and adults using FTIR spectroscopy and fluorescence microscopy

BackgroundCholelithiasis is the gallstone disease (GSD) where stones are formed in the gallbladder. The main function of the gallbladder is to concentrate bile by the absorption of water and sodium. GSD has high prevalence among elderly adults. There are three major types of gallstones found in patients, White, Black and Brown. The major chemical component of white stones is cholesterol. Black and brown stones contain different proportions of cholesterol and bilirubin. The pathogenesis of gallstones is not clearly understood. Analysis of the chemical composition of gallstones using various spectroscopic techniques offers clues to the pathogenesis of gallstones. Recent years has seen an increasing trend in the number of cases involving children. The focus of this study is on the analysis of the chemical composition of gallstones from child and adult patients using spectroscopic methods.MethodsIn this report, we present FTIR spectroscopic studies and fluorescence microscopic analysis of gallstones obtained from 67 adult and 21 child patients. The gallstones were removed during surgical operations at Soroka University Medical Center.ResultsOur results show that black stones from adults and children are rich in bilirubin. Brown stones are composed of varying amounts of bilirubin and cholesterol. Green stones removed from an adult, which is rare, was found to be composed mainly of cholesterol. Our results also indicated that cholesterol and bilirubin could be the risk factors for gallstone formation in adults and children respectively. Fluorescence micrographs showed that the Ca-bilirubinate was present in all stones in different quantities and however, Cu-bilirubinate was present only in the mixed and black stones.ConclusionsAnalysis based on FTIR suggest that the composition of black and brown stones from both children and adults are similar. Various layers of the brown stone from adults differ by having varying quantities of cholesterol and calcium carbonate. Ring patterns observed mainly in the green stone using fluorescence microscopy have relevance to the mechanism of the stone formation. Our preliminary study suggests that bilirubin and cholesterol are the main risk factors of gallstone disease.

Management of Blunt Pancreatic Injuries in Children

AbstractBackground: Most blunt abdominal injuries of solid organs in children can be managed nonoperatively. To date, however, there has been no general agreement regarding the application of nonoperative management to pancreatic injuries. Objective: We evaluated the course of patients who underwent blunt pancreatic trauma and were managed nonoperatively, in order to determine the efficacy and safety of this strategy. Patients and Methods: A retrospective study of 26 patients with blunt pancreatic injury admitted to the Department of Pediatric Surgery at the Soroka Medical Center between 1983 and 2002 was conducted. The data was collected from the Trauma Registry and the medical records. The results were analyzed using Fishers exact test for comparison of proportions and Students t-test for comparison of means. Level of confidence was defined at p < 0.05. Results: We identified 26 children with blunt panc reatic injuries. 19 patients sustained a minor injury, and seven had a major injury with transection of the main pancreatic duct. All 19 patients considered to have a minor injury, including three in whom pseudocysts were formed, responded well to nonoperative management. Five of the seven patients who sustained a major injury required an interventional procedure. Conclusion: Most pediatric patients with blunt pancreatic trauma, including those with pseudocyst formation, respond well to supportive nonoperative management. Symptomatic patients due to a large pseudocyst or a pancreatic abscess can be managed successfully by percutaneous computerized tomographic scan-guided drainage; however, some of these patients may require operative intervention.

Thoracoscopic Upper Thoracic Sympathectomy for Primary Palmar Hyperhidrosis in Children and Adolescents: A Ten-Year Experience

We report our initial experience, over the past 3 years, with thoracoscopic sympathectomy for severe, primary, palmar hyperhidrosis in children and adolescents. From 1992-1995, 179 thoracoscopic sympathectomies were performed in 61 girls and 35 boys, 5.5 to 18 years old (mean 14.8). During the first 2 years the procedures were performed bilaterally but not simultaneously. During the past years, 65 underwent bilateral, simultaneous sympathectomy, using a single 10 mm subaxillary port of entry. 94 (98%) had immediate and permanent relief of palmar sweating. The immediate postoperative course was uneventful in all except 2 who had residual pneumothorax that required 24-hour intercostal drainage. These results compare favorably with the open method and are actually better in terms of less pain, early discharge, quicker return to normal activity and a smaller and less conspicuous scar. We emphasize the benefits of early surgery in children with severe, palmer hyperhidrosis, to avoid the many years of psychological, social and physical discomfort during adolescent growth and development.