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At least 289 records · Page 16Linked to original sources
PubMed2005

Laparoscopic adrenalectomy for patients who have Cushing's syndrome.

Laparoscopic adrenalectomy is one of the most significant advances in the past 20 years for treating adrenal disorders. When compared with open adrenalectomy, laparoscopic adrenalectomy is equally safe, effective, and curative; it is more successful in shortening hospitalization and convalescence and has less long-term morbidity. The laparoscopic approach is the procedure of choice for the surgical management of cortisol-producing adenomas and for patients who have corticotropin (ACTH)-dependent Cushing's syndrome for whom surgery failed to remove the source of ACTH. The keys to successful laparoscopic adrenalectomy are appropriate patient selection, knowledge of anatomy, delicate tissue handling, meticulous hemostasis, and experience with the technique of laparoscopic adrenalectomy.

Adrenalectomy↗
PubMed2006

Implementation of dietitian recommendations for enteral nutrition results in improved outcomes.

A primary role of the registered dietitian (RD) is to assess nutritional needs of patients in states of physiological stress and illness and to recommend changes to diet and tube feedings when warranted. However, implementation of changes is dependent upon the physician accepting the recommendations of the RD. This study evaluated outcomes of two groups of enterally fed patients in a long-term acute-care facility in northwest Louisiana: (a) those for whom the physician accepted RD recommendations; and (b) those for whom the physician did not accept RD recommendations. Data showed that physician-prescribed enteral formulas provided 10.0% less kilocalories and 7.8% less protein than the RD-assessed needs. t tests showed that when RD recommendations were implemented, patients had a significantly shorter length of stay (28.5+/-1.8 vs 30.5+/-4.8 days, P<0.05), as well as significantly improved albumin (0.13+/-0.17 vs -0.44+/-0.21 g/dL [1.3+/-1.7 vs -4.4+/-2.1 g/L], P<0.05) and weight gains (0.51+/-0.1 vs -0.42+/-0.2%, P<0.05) when compared to those who continued with physician's orders. These data suggest that if RDs had the authority to write nutrition orders and provide early nutrition intervention, patient care would improve.

Adolescent↗
PubMed2001

Transperitoneal laparoscopic adrenalectomy.

Laparoscopic adrenalectomy has been demonstrated by many institutions to be a safe and effective approach to benign adrenal lesions. As surgical skills improve, it will most likely be comparable with open adrenalectomy in overall cost. Although it is technically demanding and takes slightly longer than open surgery, the benefits to the patient in terms of hospital stay, convalescence, and cosmetic results have been conclusively reported. The decision to use a transperitoneal or retroperitoneal access is mostly a function of surgeon preference, with similar outcomes by either approach. It is more important that the surgeon be comfortable with the selected approach. Laparoscopic adrenalectomy has become the gold standard for benign adrenal lesions.

Adrenalectomy↗
PubMed1998

Laparoscopic retroperitoneal lymphadenectomy for cancer of the testis.

Laparoscopic retroperitoneal lymph node dissection (RPLND) is a technically advanced procedure that has been undertaken for the management of low-stage nonseminomatous germ cell testis tumor. Although it has been shown to be an effective staging technique, its role as a therapeutic operation is currently unknown. Laparoscopic RPLND requires longer operative times but offers the patient all the advantages of minimally invasive surgery, such as less postoperative pain and shorter hospitalization and convalescence. The role of laparoscopic RPLND for the evaluation of residual abdominal masses following chemotherapy is currently being examined.

Humans↗
PubMed1977

Length of stay.

Explore the source record for details and available documents.

Convalescence↗
PubMed2001

Fast track hysterectomy.

OBJECTIVE: To identify factors limiting early discharge after laparoscopically assisted vaginal hysterectomy (LAVH) and abdominal hysterectomy, in a fast track setting with emphasis on information, treatment of pain, early mobilization, and early food intake. STUDY DESIGN: A prospective, descriptive study of 32 unselected women allocated to either abdominal hysterectomy (n=16) or LAVH (n=16). The patients received the same information, care, and advice for the perioperative period except for an assumed 1-day hospital stay in the LAVH-group and 2 days in the abdominal group. RESULTS: Patients were discharged median 1 day (1-3) after LAVH and 2 days (2-4) after abdominal hysterectomy. Work was resumed median 23 days after abdominal hysterectomy and 28 days after LAVH (P > 0.05). CONCLUSIONS: The study questions the previously proposed advantages of shortened hospitalization and convalescence after LAVH compared with abdominal hysterectomy. Further studies with active rehabilitation are needed to demonstrate real differences between laparoscopic and open hysterectomy.

Adult↗
PubMed2002

Total laparoscopic hysterectomy compared with abdominal hysterectomy in the presence of a large uterus.

STUDY OBJECTIVE: To evaluate in a prospective series whether, even in presence of a large uterus, total laparoscopic hysterectomy is feasible and safe, and may be substituted for abdominal hysterectomy. DESIGN: Randomized comparison (Canadian Task Force classification I). Setting. Center for Reconstructive Pelvic Endosurgery, Bologna, Italy. PATIENTS: One hundred twenty-two women with large uterus (>14 wks' gestation) caused by myomas. INTERVENTION: Total laparoscopic hysterectomy and total abdominal hysterectomy. MEASUREMENTS AND MAIN RESULTS: Sixty women underwent laparoscopic hysterectomy (group 1) and 62 abdominal hysterectomy (group 2). Mean longitudinal diameter of the uterus, mean number and diameter of myomas, operating time, and average drop in hemoglobin were similar in the groups. One conversion to laparotomy was necessary because of a bowel injury in a patient with severe pelvic adhesions. Cystotomy occurred in one woman in group 2 and was immediately repaired. Febrile morbidity was statistically more frequent in group 2 than in group 1. Postoperative hospitalization and convalescence were statistically shorter in group 1. CONCLUSION: Laparoscopic hysterectomy is safe and feasible even in the presence of large uterus, and is a valid alternative to abdominal hysterectomy when the vaginal route is contraindicated.

Adult↗
PubMed1996

Economic Evaluation of Hysteroscopic Endometrial Ablation versus Vaginal Hysterectomy for Menorrhagia

Between June 1992 and July 1993, 40 women with menorrhagia underwent vaginal hysterectomy, performed by 5 surgeons in one hospital. The patients were retrospectively compared with the first 40 women having endometrial ablation for menorrhagia performed during the same period by senior author. The age, parity, weight, and uterine size were similar in both groups. Measurable costs were surgical time, procedure time (anesthetist and resource use in operating room), length of hospital stay, convalescence (value of patient time), and indirect costs associated with subsequent surgical procedures. Measurable benefits were estimated blood loss, complications, and effectiveness of the procedure. The total cost per episode of care was estimated to be $5373 and $2279 (1995 $ Canadian) for vaginal hysterectomy and hysteroscopic endometrial ablation, respectively, for a mean saving of $3094. The benefits derived from both procedures were comparable. Vaginal hysterectomy eliminated bleeding in 100% of women and was associated with a complication rate of 41%. Endometrial ablation eliminated or improved bleeding in 90% of women (amenorrhea 46%, hypomenorrhea 35%, eumenorrhea 9%, no significant change 10%), was associated with no complications, and resulted in 82% satisfaction. Endometrial ablation is 82% effective and 58% less expensive than vaginal hysterectomy for the treatment of women with menorrhagia.

Journal Article↗
PubMed2003

The dynamics of local rules in hospital admission processes.

This paper reports on research into admission practices at a sub acute extended care hospital. A system dynamics simulation model of the patient flow from feeder hospitals to the hospital was built to show the impact of the local rules used by the medical registrar. Local rules are behaviours that are local, and often idiosyncratic, adaptations to the local environment. The model showed these adaptations had a significant impact on the acuity of patients being admitted as a result of the separation policies of the feeder hospitals. This patient mix in turn affected the hospital ability to meet its budget.

Admitting Department, Hospital↗
PubMed1999

The cost of a hysterectomy in a UK hospital.

Vaginal hysterectomy has been demonstrated to be the cheapest route to perform a hysterectomy but no detailed costing has been performed in the United Kingdom. In this study the costs incurred by a UK teaching hospital for 30 women aged between 40 and 50 years of age undergoing either abdominal (AH), laparoscopically assisted vaginal hysterectomy (LH) were compared with vaginal hysterectomy (VH). VH was significantly the cheapest procedure (993.00 Pounds, 95th Cl 883.20 Pounds to 1124.80 Pounds) and there was a tendency for LH (1148.00 Pounds, 95th Cl 1006.80 Pounds to 1289.20 Pounds) to be less expensive than AH (1340.00 Pounds, 95th CI 1080.80 Pounds to 1595.20 Pounds); this difference may be reversed if disposable laparoscopic instruments were to be used for LH. Our study agrees with data from other countries showing that VH is the cheapest type of hysterectomy. With the added benefits of shorter hospital stay, convalescence and return to work, effort should be directed towards increasing the proportion of hysterectomies performed vaginally in the UK.

Journal Article↗
PubMed2006

Is antibiotic cycling the answer to preventing the emergence of bacterial resistance in the intensive care unit?

Antibiotic resistance has emerged as an important determinant of mortality for patients in the intensive care unit (ICU) setting. This is largely due to the increasing presence of pathogenic microorganisms with resistance to existing antibiotic agents, resulting in the administration of inappropriate treatment. Escalating antibiotic resistance has also been associated with greater overall health care costs, as a result of prolonged hospitalizations and convalescence associated with failure of antibiotic treatment, the need to develop new antibiotic agents, and the implementation of broader infection control and public health interventions aimed at curbing the spread of antibiotic-resistant pathogens. Antibiotic cycling has been advocated as a tool to reduce the occurrence of antibiotic resistance, especially in the ICU setting. Unfortunately, the cumulative evidence to date suggests that antibiotic cycling has limited efficacy for preventing antibiotic resistance. Nevertheless, a strategy whereby multiple or all classes of antibiotics are available for use (i.e., antibiotic heterogeneity) can be part of a broader effort aimed at curtailing antibiotic resistance within ICUs. Such efforts should be routine, given the limited availability of new antibiotic drug classes for the foreseeable future.

Anti-Bacterial Agents↗
PubMed2001

Laparoscopic radical/total nephrectomy: a decade of progress.

The first laparoscopic radical/total nephrectomy for a renal tumor was performed in June 1990. Since that time, the procedure has evolved as numerous surgeons have contributed novel strategies and technical advances. The state of the art is reviewed, including transperitoneal laparoscopic and hand-assisted techniques, as well as the retroperitoneal approach. Operative and postoperative data are reviewed with the goal of determining four factors: the efficacy, efficiency, morbidity, and cost of the procedure. Within the limits of available follow-up for this novel procedure, it appears to be as effective as open surgery in rendering the patient tumor free. Although it clearly is a less painful and less disabling procedure than open surgery, our understanding of the efficiency of the laparoscopic procedure remains in flux. The operative times for laparoscopic radical/total nephrectomy are approaching those of traditional open radical nephrectomy, although intraoperative costs remain higher and thus must be balanced against decreased hospitalization and convalescence.

Humans↗
PubMed1998

Laparoscopic nephrectomy: comparison of dialysis and non-dialysis patients.

BACKGROUND: Laparoscopy is believed to result in possible clinical benefits for the patient. We report our experience with renal laparoscopy in dialysis patients and compare the results with those from non-dialysis patients. METHODS: Between December 1994 and April 1997, 19 dialysis patients underwent laparoscopic nephrectomy or nephroureterectomy at our hospital. The group consisted of 11 female and eight male patients (mean age 45 years). In nine patients the indication for nephrectomy was chronic pyelonephritis. Nephroureterectomy for vesicoureteral reflux with recurrent episodes of pyelonephritis or analgesic nephropathy for exclusion of transitional cell carcinoma of the upper urinary tract was considered in nine other patients. Laparoscopic bilateral nephrectomy for drug-resistant hypertension was performed in one patient. In comparison, a consecutive group of non-dialysis patients who had undergone renal laparoscopy was reviewed. RESULTS: In the dialysis group, one patient had to be converted to open nephrectomy due to bleeding. Six dialysis patients required blood transfusions compared with none in the non-dialysis group. There were four complications in the dialysis group and two in the non-dialysis group. Both groups had comparable results for operative times, analgesic consumption, postoperative start of oral intake and mobilization, and duration of hospitalization and convalescence. CONCLUSIONS: Laparoscopic nephrectomy in dialysis patients has acceptable results. The higher transfusion rate is probably due to a lower preoperative haemoglobin and is not aggravated by possible affects of the clotting system in patients with chronic uraemia.

Adult↗