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PubMedDate not supplied

Bilateral adrenalectomy for Cushing's syndrome: a comparison between laparoscopy and open surgery.

We report our experience with bilateral adrenalectomy for treatment of Cushing's syndrome and we compare the outcome of laparoscopy with open surgery in terms of effectiveness and safety. A series of 23 patients underwent bilateral adrenalectomy for treatment of Cushing's syndrome [Cushing's disease in 16, ectopic ACTH syndrome in 2, and ACTH-independent macronodular adrenal hyperplasia (AIMAH) in 5 cases]. From 1993 to 1996, all patients were treated using an open approach (Group A), while from 1997 all patients were treated using a transperitoneal laparoscopic approach (Group B). The comparison between the 2 groups was performed considering patients characteristics, operative times, blood losses, intraoperative and post-operative complications, analgesic consumption, post-operative hospital stay and recovery. Open surgery was performed in 10 patients and laparoscopy in 13 patients. No significant difference was recorded between the two groups as to patients' characteristics and complications. Mean operative time was significantly increased in Group B, while post-operative hospital stay was significantly longer in Group A. Laparoscopic bilateral adrenalectomy can be safely and effectively employed to treat Cushing's syndrome. However, long operatives times may represent a limitation especially in high risk patients.

Adrenalectomy↗

PubMed1986

The efficacy and timing of operative intervention for spontaneous pneumothorax.

To reassess the role and timing of operative intervention for spontaneous pneumothorax, 119 patients were retrospectively reviewed to compare recurrences, complications, and hospital stay between a nonoperative group (Group 1) and an operative group (Group 2). Total hospital days were greater in Group 2, but excluding the length of preoperative stay, the number of hospital days were similar in both groups. Group 1 patients more than 40 years old had a longer postoperative hospitalization, but not a higher rate of complication. Overall, morbidity was not different between the two groups, and there were no immediate or perioperative deaths in either group. There were no recurrences in Group 2. At least 11 of the 49 patients in Group 1 had a recurrence (p = .012). Considering the excellent results achieved with operative pleurodesis and the total hospital days accrued with nonoperative therapy, operative pleurodesis should be considered if an active leak persists more than three days after the initial episode of spontaneous pneumothorax or at the time of the first recurrence in the hospitalized patient.

Adolescent↗

PubMed2003

Vaginal and laparoscopic myomectomy for large posterior myomas: results of a pilot study.

OBJECTIVE: To evaluate the feasibility and complications of vaginal and laparoscopic myomectomy, and analgesic drug consumption. METHODS: We conducted a pilot study involving 24 women with single, large (>5cm) symptomatic posterior uterine leiomyomas. Twelve women underwent vaginal myomectomy and 12 laparoscopic myomectomy. The main outcome measures were the operating time, peri- and post-operative complications, and analgesic drug consumption. RESULTS: There was no difference in mean age, the rate of nulliparity, and the mean size of myomas between the two groups. The mean operating time was shorter in the vaginal group (96+/-38min versus 166+/-78min; P<0.01). There was no difference in mean blood loss or fibroid weight between the two groups. One of the 12 patients in the vaginal myomectomy group required laparoscopic conversion for an inaccessible fundal myoma. Post-operative morphine consumption was lower in the vaginal group (37.2+/-64mg versus 150.8+/-42mg; P<0.003). No post-operative complications occurred in either group. Gas and stool recovery, the length of hospital stay, and the time required to return to normal activity were similar in the two groups. CONCLUSION: Vaginal myomectomy is feasible and safe, and was associated with a shorter operating time and lower morphine consumption than laparoscopic myomectomy.

Adolescent↗

PubMed2005

[Analysis of operative patterns of 2272 laparoscopic hysterectomies].

OBJECTIVE: To evaluate the clinical efficacy of four different operative patterns of laparoscopic hysterectomy: laparoscopically assisted vaginal hysterectomy (LAVH), laparoscopically introfasial subtotal hysterectomy (LISH), laparoscopically subtotal hysterectomy (LSH) and laparoscopically total hysterectomy (LTH). METHODS: A retrospective analysis on 2272 cases of laparoscopic hysterectomy was carried out, including operating time, blood loss, complication and postoperative recovery. RESULTS: For the two groups which preserved cervix, LISH was performed in 1323 cases. The operating time was (91 +/- 21) min, blood loss (93 +/- 23) ml, complication rate 4.1%. LSH was conducted in 229 cases, with an operating time (70 +/- 18) min, blood loss (69 +/- 17) ml, complication rate 0. The difference between the two groups was significant (all P < 0.01). For the two groups which excised cervix, LAVH was performed in 588 cases, with an operating time (119 +/- 28) min, blood loss (156 +/- 23) ml, complication rate 1.5%; while LTH was carried out in 132 cases, with an operating time (121 +/- 30) min, blood loss (193 +/- 38) ml, complication rate 1.2%. There were no significant differences between the two groups (all P > 0.05). All patients recovered well postoperatively. CONCLUSIONS: The four operative patterns are ideal for hysterectomy. Young patients should be operated with laparoscopic hysterectomy with preservation of cervix, old patients or patients with CIN should be operated with excision of cervix.

Adult↗

PubMed2006

[Endoscopic thyroid surgery: a comparison of the trans-subclavian and the trans-areolar approach].

OBJECTIVE: To compare the advantages and shortcomings of the endoscopic thyroid surgery by trans-subclavian approach and trans-areolar approach. METHODS: Twelve patients received the trans-areolar approach and 10 patients were given the trans-subclavian approach procedure. RESULTS: With the trans-areolar approach: the mean size of tumor was 1.8 cm, the mean operating time was 115 min, the mean blood loss during operation was 63 ml. Two patients converted to the conventional operation. With the trans-subclavian procedure: the mean size of tumor was 4.2 cm, the mean operating time was 85 min, the mean blood loss during operation was 66 ml. No complications were found in all of the patients and they were satisfied with the cosmetic effects of the procedures. There were significant differences in tumor size and operating time between the two operation types. CONCLUSIONS: Compared with the trans-areolar approach, the trans-subclavian approach comes with less trauma, higher success rate and it fits for bigger tumor.

Adult↗

PubMed2005

Bipolar radiofrequency dissection tonsillectomy: a prospective randomized trial.

OBJECTIVES: To conduct a prospective randomized controlled study presenting and comparing bipolar radiofrequency dissection tonsillectomy (BRDT) to cold dissection tonsillectomy (CDT) regarding intra-operative blood loss, operative time, postoperative pain, and postoperative complications including hemorrhage. MATERIALS AND METHODS: From January 2004 to March 2005, 200 children planned to undergo tonsillectomy were included in this study. Children were prospectively randomized into two equal groups: bipolar radiofrequency dissection tonsillectomy and cold dissection tonsillectomy. The operative time and intra-operative blood loss were recorded. Children were asked to record their pain on a standardized visual analog scale on days 1, 4, 7, and 14. All children were reviewed on the 4th, 7th, and 14th day after surgery. Postoperative complications were recorded and dealt with. RESULTS: There was a shorter operative time (mean 8.5 minutes, P < 0.001) in the radiofrequency group. BRDT showed a decrease of 7 minutes in the mean when compared to the CDT group. The amount of blood lost during BRDT was minimal (mean 13 cc), with a mean difference of 69 cc when compared to CDT (P < 0.001). There was no statistical significant difference in pain score between the two groups except in the first postoperative day where the BRDT demonstrated a statistically significant lower parameters (P < 0.05). No evidence for statistically significant difference between the two groups regarding postoperative complications. CONCLUSION: BRDT is a new, easy, and safe technique that offers a complete eradication of the tonsillar disease, short operating time, minimal intra-operative blood loss, and a suitable cost with no additional increase in postoperative pain and hemorrhage when compared to the conventional CDT. Our experience promotes BRDT as the preferred method of tonsillectomy.

Adolescent↗

PubMed2002

Endoscopic stapling technique for the treatment of Zenker diverticulum vs standard open-neck technique: a direct comparison and charge analysis.

BACKGROUND: Presently, the 2 most widely used methods for the treatment of Zenker diverticulum are endoscopic stapling of the common party wall between the diverticulum sac and the esophagus and the standard open-neck technique involving diverticulectomy and cricopharyngeal myotomy. OBJECTIVE: To perform an analysis of the hospital charges to determine the economic efficiency of each technique based on our experience at the Mt Sinai Medical Center, New York, NY. METHODS: A retrospective analysis of 16 patients diagnosed as having Zenker diverticulum was conducted. Eight randomly chosen patients underwent endoscopic stapling with an EndoGIA 35-mm endoscopic stapler (Ethicon Inc, Somerville, NJ), and 8 randomly chosen patients underwent a standard open approach with diverticulectomy. Medical records were reviewed to determine operative time, length of hospital stay, time to oral intake, and postoperative complications. A charge analysis of the operative and postoperative fees was also performed. Statistical analysis between the 2 groups was conducted using analysis of variance and the paired t test. RESULTS: The mean +/- SD operative time for the endoscopic stapling technique was 25.5 +/- 15.78 minutes, which was significantly less (P<.001) than that for the open procedure, 87.6 +/- 35.10 minutes. The mean operative charges were roughly equivalent at US$ 5178 for the endoscopic procedure and US$ 5113 for the open procedure. The endoscopic procedure, while shorter in operative time, had the added expense of specialized equipment, specifically the EndoGIA endoscopic stapler. The mean +/- SD length of hospital stay for the endoscopic procedure was significantly shorter (P<.001) at 1.3 +/- 0.59 days vs 5.2 +/- 1.03 days for the open procedure. The inpatient hospital charges for the endoscopic group was also significantly less (P<.001) at a mean of US$ 3589 per stay vs US$ 11,439 for the open group. The mean +/- SD time to oral intake was significantly shorter (<.001) at a mean of US$ 3589 per stay vs US$ 11,439 for the open group. The mean +/- SD time to oral intake was significantly shorter (P<.001) in the endoscopic group at 0.8 +/- 0.26 days vs 5.1 +/- 1.25 days for the open group. There were no major complications in either group, and all patients experienced resolution of preoperative symptoms. CONCLUSIONS: Compared with the standard open technique, the endoscopic stapling technique for the treatment of Zenker diverticulum results in a statistically significant shorter operative time, hospital stay, and time to resume oral feedings. While the charges of the operative procedures were roughly equivalent, the total hospital charges were significantly less for the patients treated endoscopically.

Aged↗

PubMed2000

Computed tomography image-guided surgery in complex acetabular fractures.

Eleven complex acetabular fractures in 10 patients were treated by open reduction with internal fixation incorporating computed tomography image guided software intraoperatively. Each of the implants placed under image guidance was found to be accurate and without penetration of the pelvis or joint space. The setup time for the system was minimal. Accuracy in the range of 1 mm was found when registration was precise (eight cases) and was in the range of 3.5 mm when registration was only approximate (three cases). Added benefits included reduced intraoperative fluoroscopic time, less need for more extensive dissection, and obviation of additional surgical approaches in some cases. Compared with a series of similar fractures treated before this image guided series, the reduction in operative time was significant. For patients with complex anterior and posterior combined fractures, the average operation times with and without application of three-dimensional imaging technique were, respectively, 5 hours 15 minutes and 6 hours 14 minutes, revealing 16% less operative time for those who had surgery using image guidance. In the single column fracture group, the operation time for those with three-dimensional imaging application, was 2 hours 58 minutes and for those with traditional surgery, 3 hours 42 minutes, indicating 20% less operative time for those with imaging modality. Intraoperative computed tomography guided imagery was found to be an accurate and suitable method for use in the operative treatment of complex acetabular fractures with substantial displacement.

Acetabulum↗

PubMed2005

The learning curve associated with laparoscopic pyloromyotomy.

BACKGROUND: Laparoscopic pyloromyotomy (LPM) for the treatment of infantile hypertrophic pyloric stenosis (HPS) has gained popularity in recent years. This study examines the learning curve associated with LPM. METHODS: We performed a retrospective analysis of patients undergoing LPM at a children's hospital between January 1, 1997 and June 30, 2003. Data including age, weight, complications, operative time, time to feeding, and length of postoperative stay were analyzed using the Student's ttest. RESULTS: A total of 51 patients underwent LPM during the study period. Patient characteristics were similar throughout the study period. Operative time ranged from 12 to 55 minutes (mean, 25 minutes). Mean operative time decreased significantly from 31+/-11 minutes for the first 15 patients, to 25+/-6 minutes for the second 15 patients, to 20+/-7 minutes for the last 15 patients (P<0.05). Operative times were erratic for the early cases but became more consistent over time, especially after 30 cases. Conversion to an open procedure was required in two patients. Complications included an umbilical port site wound dehiscence and readmission for persistent vomiting. There were no mucosal perforations. Time to ad lib feeding and postoperative length of stay did not change over time. CONCLUSION: LPM has a steep learning curve, especially for the first 15 patients. Operative time decreases and becomes more consistent after about 30 cases. Despite the learning curve, LPM can be performed safely and effectively without an increase in complications.

Clinical Competence↗

PubMed2006

Does open surgery continue to have a role in elective splenectomy?

BACKGROUND: Since it was first reported in 1991, laparoscopic splenectomy has become the procedure of choice for elective splenectomy. However, doubts have been raised regarding the suitability of patients with splenomegaly (>1 kg) for laparoscopic resection because there have been reports of greater morbidity and higher conversion rates in this group of patients. Since 2000, patients referred to the authors' center for splenectomy with an estimated spleen weight exceeding 1 kg have undergone splenectomy by the open approach. METHODS: Between September 1995 and April 2005, 95 elective splenectomies were performed by a single surgeon. Operative data were collected prospectively. RESULTS: A comparison between the operations that took place before 2001 (n = 47) and those performed after 2000 (n = 48) for all sizes of spleen showed significant reductions in conversion rate, operative time, and hospital stay in the later group. As compared with laparoscopic splenectomy (n = 11), open splenectomy (n = 18) for cases of splenomegaly resulted in a significantly shorter operative time, less operative blood loss, and no significant difference in hospital stay. CONCLUSION: Although laparoscopic splenectomy is the treatment of choice for the majority of patients requiring elective splenectomy, the procedure for patients with significant splenomegaly requires caution and common sense. This study shows that an open splenectomy for these patients significantly reduces operative time and blood loss without increasing morbidity or hospital stay.

Adolescent↗

PubMed1999

Minimally invasive direct coronary artery bypass for redo patients.

BACKGROUND: The minimally invasive direct coronary artery bypass (MIDCAB) procedure, using a small anterolateral thoracotomy without cardiopulmonary bypass, has been recommended for high-risk patients because it is less traumatic than conventional coronary artery bypass grafting. For redo patients who have patent grafts and pericardial adhesions, the MIDCAB may be preferable to the conventional operation because manipulation of the graft and dissection of adhesions may be minimized. METHODS: Since November 1995, 120 patients underwent the MIDCAB procedure in our institution. Among these patients, there were 25 redo cases (20.8%). We reviewed these redo cases and studied their surgical results (mortality, morbidity, hospital stay, operation time, and postoperative inotropic support). To clarify the usefulness of this procedure, we compared the results of redo operations with those of the first-time operations. RESULTS: For redo MIDCAB, there was one operative death (4%) because of intestinal infarction. The mean hospital stay was 4.3 days and the number of patients who needed postoperative positive inotropic agents was 3 (12%). There was no significant differences between redo and first-time operation patients in mortality, morbidity, hospital stay, operation time, and postoperative inotropic support. CONCLUSIONS: Results of the MIDCAB procedure for redo patients were comparable to those for primary MIDCAB operations.

Adult↗

PubMed2000

Identifying the indications for laparoscopically assisted vaginal hysterectomy: a prospective, randomised comparison with abdominal hysterectomy in patients with symptomatic uterine fibroids.

OBJECTIVE: To compare laparoscopically assisted vaginal hysterectomy (LAVH) and total abdominal hysterectomy (TAH) in patients with uterine fibroids. DESIGN: A prospective randomised study. SETTING: The San Paolo Hospital, Milan. POPULATION: Sixty-two patients, who were not suitable for a vaginal hysterectomy, requiring treatment for uterine fibroids. METHODS: Randomisation between LAVH and TAH. Comparison of outcomes on the whole series, patients with uteri < or = 500 g (Group 1) and patients with uteri > 500 g (Group 2). MAIN OUTCOME MEASURES: To establish operating time, blood loss, complications, febrile morbidity, analgesics administration and hospital stay for both treatment approaches. RESULTS: Median uterine weight was 400 g in both LAVH and TAH group. Median operating time was longer for LAVH (135 min compared with 120 min for TAH; P = 0.001), but patients undergoing LAVH had less analgesics administration (23% compared with 77%, P < 0.001) and a shorter median hospital stay (3.8 compared with 5.8 days; P < 0.001). LAVH, when compared with TAH in the two weight subgroups, required a significantly longer operating time only in Group 2, significantly reduced analgesics administration only in Group 1, and significantly reduced hospital stay in both groups. Conversions of LAVH to laparotomy were significantly more frequent in Group 2 (3/11) than in Group 1 (0/20) (P = 0.04). CONCLUSIONS: Compared with TAH, LAVH has advantages in removing uteri weighing < or = 500 g, with comparable operating time, less post-operative pain and shorter recovery. Among uteri weighing > 500 g LAVH showed a shorter recovery, but longer operating time than TAH and a 27% rate of conversion to laparotomy.

Adult↗

PubMedDate not supplied

Risk factors associated with intra-operative blood loss in hepatectomized patients with giant cavernous hemangioma of the liver.

BACKGROUND/AIMS: The aim of this study was to clarify risk factors associated with intra-operative blood loss in hepatectomized patients with giant cavernous hemangioma (GCH) of the liver. METHODOLOGY: Twenty patients with GCH of the liver were treated by hepatectomy. Eleven patients with intra-operative blood loss > 2000 ml (mean: 7145 +/- 7080 m; Group 1) were reviewed retrospectively and compared to 9 patients with intra-operative hemorrhage < 2000 ml (mean: 918 +/- 429 ml; Group 2). RESULTS: Although there were no significant differences in pre-operative AST, ALT, and ICG-15 or fibrinogen and platelets between the two groups, pre-operative total bilirubin and fibrin degradation product (FDP) in Group 1 was significantly higher than in Group 2. Mean operation time and intra-operative blood transfusion in Group 1 versus Group 2 were 433 min vs. 213 min (p < 0.0001) and 3036 ml vs. 422 ml (p = 0.0072), respectively. The weight of resected liver (r = 0.821, p < 0.0001), maximum diameter of tumor (r = 0.782, p < 0.0001) and operation time (r = 0.748, p < 0.0001) were the most highly correlated with intra-operative blood loss, followed by pre-operative total bilirubin (r = 0.605, p = 0.0038), FDP level (r = 0.576, p = 0.0068) and intra-operative blood transfusion (r = 0.561, p = 0.0089). CONCLUSIONS: These findings suggest that pre-operative management to reduce the tumor size, total bilirubin and FDP levels may be essential to minimize intra-operative hemorrhage and blood transfusion.

Adult↗

PubMed2004

Using a risk score for conversion from laparoscopic to open cholecystectomy in resident training.

BACKGROUND: We previously developed a risk score for conversion from laparoscopic to open cholecystectomy (RSCLO). The aim of this study is to validate this scoring system in a new patient population and test its use in case selection for resident training. METHODS: The data of 1,000 laparoscopic cholecystectomies (LC) that had been performed in our clinic between 1992 and 1999 were analyzed retrospectively, and RSCLO was developed. Scores take values between -20 and 41; values below -3 represent low risk, and values over -3 represent high risk. Analyses in this group of patients showed that at least 15 cases have to be performed for adequate LC training. The current study is a clinical prospective study based on data of the previous study and evaluates RSCLO in a new patient population of 400 LCs. All patients were scored preoperatively; surgeons who had performed 15 or fewer LCs previously operated only patients with a score below -3. Patients with high scores (>values of -3) were operated only by surgeons who had performed at least 16 LCs. Results of the first 1,000 cases and later 400 cases (new patient population of the current study) were compared in terms of conversion to open cholecystectomy, complications, and operation times. RESULTS: Both in the first 1,000 patients and later in 400 patients, increasing scores resulted with higher conversion rates and complication rates and longer operation times (P<.05). In the later 400 patients, conversion rate (4.8% vs 3.0%, P=.08), complication rate (5.5% vs 3.5%, P=.07), and mean operation time (56.8 min vs 52.5 min, P=.004) were decreased when compared with the first 1,000 patients. In resident training cases, conversion and complication rates decreased to 0%, and mean operation time was shortened by nearly 10 minutes. In high-score difficult cases, conversion and complication rates decreased, and mean operation time was shortened by nearly 20 minutes. CONCLUSIONS: This risk score can predict the difficulty of LC cases reliably. Scoring patients preoperatively can decrease the problems in training cases, and management of difficult cases may be left to experienced surgeons.

Cholecystectomy↗

PubMed2005

Use of AlloDerm in type I tympanoplasty: a comparison with native tissue grafts.

OBJECTIVES: AlloDerm, an acellular human dermis allograft, has been shown to be an effective option as a tympanic membrane (TM) graft in animals and humans and has several potential advantages, including eliminating donor site morbidity, reducing operative time, and preserving native tissues for later use. We compared AlloDerm and native tissue grafts in type I tympanoplasty with regard to operative time, graft success rate, and audiologic outcome. STUDY DESIGN: A retrospective chart review of tympanoplasties performed at a major tertiary referral hospital over a 31 month period, starting with the first use of AlloDerm for TM grafting at this institution. METHODS: The medical charts of all patients undergoing tympanoplasty were reviewed. Only those patients undergoing type I tympanoplasty without mastoidectomy or ossicular chain reconstruction were included. These 114 patients (25 AlloDerm, 56 fascia reconstruction, and 33 fascia plus cartilage reconstruction) were compared for operative time, success rate of the graft, and change in audiologic outcome. RESULTS: There was a statistically significant reduction in operative time in the AlloDerm group when controlled for surgeon and choice of approach. All groups showed no statistically significant difference in the success rate of the graft and closure of audiologic air-bone gap, regardless of graft material used. CONCLUSIONS: AlloDerm is an effective TM graft when used in type I tympanoplasty. It is as effective as native tissues in closing the air-bone gap on audiogram as well as in graft success rate. AlloDerm may also significantly reduce operative time, depending on the surgeon's technique.

Audiometry↗

PubMed2002

[Uterine morcellation during vaginal hysterectomy: apropos of a series of 216 prospective cases].

OBJECTIVE: The purpose of this study was to compare the surgical outcomes of women undergoing vaginal hysterectomy with and without morcelation. PATIENTS AND METHOD: Between December 1999 and December 2000, 216 women underwent vaginal hysterectomy without laparoscopic assistance at the Department of Gynecology of Hôtel-Dieu hospital in Paris. The patients were divided into two groups: 114 of them underwent vaginal hysterectomies with morcelation whereas 102 underwent vaginal hysterectomies without morcelation. The two groups were compared as to demographic data, total complications, operative time, hospital stay length and peri-operative hemoglobin concentration change. RESULTS: Although women undergoing morcelation were significantly younger (mean 49 versus 52, p = 0.01) and less parous (mean 1.9 versus 2.3, p = 0.03), there were no significant differences in other surgical or anesthetic risks factors, including weight, BMI, nulliparity and preexisting surgical diseases. Mean uterine weight was significantly greater in those undergoing morcelation (331 versus 110 g, p < 0.001); operative time was increased in the group which had undergone morcelation (331 versus 110 g, p < 0.001). There were no significant differences between the two groups with respect to peri-operative hemoglobin concentration change or hospital stay length. Finally, the rate of surgical complication was similar in the two groups (17.5 versus 21.5%). CONCLUSION: Although vaginal hysterectomy requires an increase in operative time, morcelation at the time of vaginal hysterectomy is safe and facilitates the vaginal removal of enlarged uteri without increasing peri-operative morbidity.

Age Factors↗

PubMed2003

Surgical treatment of severe acute pancreatitis: timing of operation is crucial for survival.

BACKGROUND: In patients operated on for severe acute pancreatitis (SAP) the impact of the timing of operation on outcome is controversial. MATERIALS AND METHODS: In a retrospective analysis of a prospectively documented database, we studied 250 patients suffering from SAP, who were in need for surgical treatment during their course of disease. RESULTS: From 1982 to 1998, 250 patients with the diagnosis of SAP who required operative treatment were admitted to the intensive care unit (ICU) of a university hospital. The mean APACHE II score on the day of admission was 16.1 (8-35). One hundred eighty-five patients (74%) required reoperation, of whom 111 patients (60%) underwent reoperation on demand and 74 (40%) patients a pre-planned reoperation. Overall mortality was 38.8% (97 patients). In patients who were operated during the first three weeks after onset of disease, mortality was significantly higher than in patients who were operated after three weeks (46% vs. 25%, p < 0.01). Besides patient age (p < 0.05), APACHE II score at admission (p < 0.01), multiple organ dysfunction (p < 0.01), infection of pancreatic necrosis (p < 0.05), surgical control of pancreatic necrosis (p < 0.0001), and the time of surgical intervention (p < 0.05) determined survival significantly. CONCLUSION: Patients who were operated later than three weeks after onset of disease had a significantly better outcome. In patients suffering from SAP who required surgical treatment, the timing of operation is crucial for survival.

Adolescent↗

PubMed2001

Patient-prosthesis mismatch can be predicted at the time of operation.

BACKGROUND: Patient-prosthesis mismatch is a frequent cause of high postoperative gradients in normally functioning prostheses. The objective of this study was to determine whether mismatch can be predicted at the time of operation. METHODS: Indices used to predict mismatch were valve size, indexed internal geometric area, and projected indexed effective orifice area (EOA) calculated at the time of operation, and results were compared with indexed EOA and mean gradients measured by Doppler echocardiography after operation in 396 patients. RESULTS: The sensitivity and specificity of these indices to detect mismatch, defined as a postoperative indexed EOA of 0.85 cm2/m2 or less, were respectively: 35% and 84% for valve size, 46% and 85% for indexed internal geometric area, and 73% and 80% for projected indexed EOA. Projected indexed EOA also correlated best with resting (r = 0.67) and exercise (r = 0.77) postoperative gradients. CONCLUSIONS: The projected indexed EOA calculated at the time of operation accurately predicts mismatch as well as resting and exercise postoperative gradients, whereas valve size and indexed internal geometric area cannot be used for this purpose.

Adult↗