Biomedical subjects

A K Saba

Publications and source records attributed to A K Saba.

5 recordsLinked to original sources

PubMed1999

Efficacy of routine preoperative computed tomography scans in colon cancer.

A retrospective review of 180 patients who underwent surgery for primary colon carcinoma from August 1989 to August 1994 was performed to evaluate the necessity of preoperative CT scans in patients with known colon cancer. Sixty-seven patients had preoperative CT scans. Data were collected to evaluate the ability of the scan to detect hepatic metastases, lymph node involvement, and incidental findings that would possibly alter the planned surgical approach. In this study, CT had a sensitivity and specificity of 75 per cent and 88 per cent, respectively, in detecting hepatic metastases. Only 19 per cent of patients with lymph node involvement were correctly staged with CT scans as having lymphadenopathy. Only 3 of 67 patients had incidental findings on CT scans that ultimately changed the surgical approach. It is apparent that because CT scans detect only 75 per cent of hepatic and 19 per cent of hepatic and lymph node involvement and does not seem to alter the planned approach, it is not justified for routine preoperative evaluation of all patients. We, therefore, recommend a more selective approach to patients suspected of having advanced disease if the surgeon suspects that the information may alter the surgical approach.

Adult↗

PubMed1997

Outpatient laparoscopic cholecystectomy: safe and cost effective?

Among the many advantages of laparoscopic cholecystectomy (LC), which has become the standard of care for symptomatic gallbladder disease, is the decrease in hospital stay. Although some studies of outpatient LC are starting to appear, few compare return visits to the hospital up to 30 days after surgery as well as cost of hospitalization between a group of outpatients and overnight admission patients. From January through December 1994, 415 LCs were attempted at Good Samaritan Hospital. Total hospitalization charges were obtained for a comparable subset of the outpatient and 24-h observation patients. There were 229 LCs performed without difficulty on an outpatient basis and 90 performed with a 24-h hold. Of the 229 outpatient LCs, only 1.3% had minor problems related to LC. Of the 90 LCs performed with 24-h hold, only 2.2% had problems related to the LC. The average charge for LC with overnight admission $4,890.37; the average charge for outpatient surgery was $3,669.54 (p < 0.0001). There was no increase in patient morbidity or mortality associated with outpatient LC. The cost savings for outpatient surgery compared with surgery with 24-h admission was 25%.

Adolescent↗

PubMed1995

Laparoscopic assisted colectomies versus open colectomy.

Minimally invasive techniques are having an impact on a variety of surgical procedures. Before their widespread acceptance as the standard of care, studies need to document their efficacy in comparison to open techniques. This study compared 25 laparoscopic-assisted colectomies to 25 open colectomies all performed within the last five years by the same surgeon. In terms of adequacy of resection, laparoscopic assisted colectomy compared favorably with open colectomy in both length of resection (15.7 cm vs 19.3 cm) and average number of nodes (6 vs 10). In addition to lessening patient discomfort, the other advantages were earlier return of bowel function (regular diet postoperative day 2 vs postoperative day 5) and shorter length of stay (4 vs 8 days). Operating costs were significantly greater, but this was offset by the shorter length of stay. This study supports laparoscopic assisted colectomy as a technically safe procedure with substantial patient benefits.

Adenocarcinoma↗

PubMed1994

Clinical comparison of three methods to determine resting energy expenditure.

An accurate and reliable method of determining resting energy expenditure in the critical care setting is crucial because inadequate caloric intake and excessive caloric intake are both associated with a number of complications. Energy requirements were determined by three different methods in a group of 25 post-cardiac surgery patients in the intensive care unit. Patients were intubated and had a thermodilution pulmonary artery catheter in place. The first method measured resting energy expenditure by indirect calorimetry. For the second method, the results of blood gases drawn at the same time that indirect calorimetry was measured were used in the Fick equation. In the third method, a registered dietitian assessed each patient by using the Harris-Benedict equation with stress factor modification. Indirect calorimetry was considered the standard with which the other two methods were compared. The results showed that, compared with calorimetry, both the Fick equation and the Harris-Benedict equation underestimated resting energy needs. Statistically, only the difference between the Fick equation method and indirect calorimetry was significant. Clinically, however, both methods seem to have applicability.

Adult↗

PubMedDate not supplied

Abscess formation following spilled gallstones during laparoscopic cholecystectomy.

OBJECTIVE: Our purpose was to report the occurrence of abscess following spilled gallstones during laparoscopic cholecystectomy as experienced at Good Samaritan Hospital, and to compare it to the experience of other institutions in order to identify the incidence, characteristics and possible risk factors for the development of this complication. METHODS: Four case reports of abscess following spilled gallstones during laparoscopic cholecystectomy are presented. The English literature was reviewed, and characteristics of the case reports found in the literature were compared. RESULTS: In four years at this institution, four reports of abscess formation following laparoscopic cholecystectomy have been identified. Two occurred in elderly females and were located in the right flank in both. Two were in middle-aged men, both diabetic. One abscess was in the right flank and one in the right pleural space. Twenty-three cases were found in the literature. The average age was 65 years; there were 12 men and 11 women. The locations of abscess formation were trocar sites (most common), right subphrenic space, right flank or retroperitoneum, and pelvis. The average time to presentation was 4-5 months (range 4 days-12 months). CONCLUSIONS: Abscess formation following spilled gallstones during laparoscopic cholecystectomy occurs infrequently, but can be debilitating and require more than one procedure. The older population appears to be at greater risk. Future prospective studies of patients who undergo laparoscopic cholecystectomy are needed to more accurately determine the incidence of this complication and to identify the population at risk.

Abdominal Abscess↗