The American surgeon
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The American surgeon · Aug 2006
Multicenter Study Comparative StudyEvaluation of the effect of endovascular options on infrarenal abdominal aortic aneurysm repair.
Endovascular devices designed to exclude flow to infrarenal abdominal aortic aneurysms (AAA) were approved by the Food and Drug Administration in the United States in 1999. This action allowed widespread use of this technology for AAA exclusion. The purpose of this report is to examine trends for use of these modalities, rates of rupture of AAA, and to compare results of open AAA repair with endovascular repair. ⋯ Mortality from endovascular AAA repair between 2001 and 2002 was 1.9 per cent (P = 0.003). Major morbidity was 14.5 per cent for open, elective AAA repair and 6.3 per cent for endovascular elective repair from 2001 to 2002 (P < 0.001). These data suggest that the advent of endovascular AAA repair has contributed to a reduction in the rate of ruptured AAA repairs, an increase in total procedures performed, and a significant decrease in perioperative deaths and major complications when compared with open AAA repair.
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The American surgeon · Aug 2006
Randomized Controlled TrialImpedance cardiography: can it replace thermodilution and the pulmonary artery catheter?
Clinical assessment of cardiac output (CO) is inaccurate, yet the use of the pulmonary artery catheter (PAC) for thermodilution (TD) measurement of CO (CO(TD)) has declined significantly. Can noninvasive impedance cardiography (ICG) now be used to measure CO (CO(ICG)) in place of CO(TD)? A literature review of recent CO(ICG) correlations with CO(TD) (r = 0.73-0.92) were similar to ours, r = 0.81. A search for conditions interfering with CO(ICG) revealed no serious problems with patient position, cardiac or pulmonary assist devices, "wet lungs," body mass index > or = 30, or age > or = 70 years. ⋯ Data from ICG was revealed only in the study group, resulting in a 49 per cent change in treatment compared with 29 per cent in the control group. Length of stay was shorter in the study than the control group in the intensive care unit (2.4 +/- 8.8 vs 3.3 +/- 7.3 days) and on the floor (9.8 +/- 10.6 vs 15.7 +/- 19.0 days). In conclusion, ICG is comparable with TD, is easily, accurately, and safely performed, enhances clinical assessment of CO, and improves care in hemodynamically compromised patients.
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The American surgeon · Aug 2006
Comparative StudyMinimally invasive esophagectomy: early experience and outcomes.
Minimally invasive esophageal surgery has the potential to improve mortality, hospital stay, and functional outcomes when compared with open methods. Although technically complex, combined laparoscopic and thoracoscopic esophageal resection is feasible. A case series of 20 patients who underwent minimally invasive total esophagectomy is presented. ⋯ The application of minimally invasive techniques in the arena of esophageal surgery continues to evolve. This approach has the potential to improve mortality, hospital stay, and other outcomes when compared with open methods. Although technically complex, laparoscopic total esophagectomy is feasible.
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The American surgeon · Aug 2006
Comparative StudyDoes obesity predict functional outcome in the dysvascular amputee?
Limited information is available concerning the effects of obesity on the functional outcomes of patients requiring major lower limb amputation because of peripheral arterial disease (PAD). The purpose of this study was to examine the predictive ability of body mass index (BMI) to determine functional outcome in the dysvascular amputee. To do this, 434 consecutive patients (mean age, 65.8 +/- 13.3, 59% male, 71.4% diabetic) undergoing major limb amputation (225 below-knee amputation, 27 through-knee amputation, 132 above-knee amputation, and 50 bilateral) as a complication of PAD from January 1998 through May 2004 were analyzed according to preoperative BMI. ⋯ There was no statistically significant difference in outcomes for overweight patients (59.2%, 50.7%, 52.5%, and 75%) or obese patients (51.8%, 46.2%, 49.7%, and 75%) when compared with normal patients. Although there were significantly poorer outcomes for underweight patients for the parameters of prosthetic usage when compared with the remaining cohort (25%, P = 0.001) and maintenance of ambulation when compared with overweight patients (20.8%, P = 0.026), multivariate analysis adjusting for medical comorbidities and level of amputation showed that BMI was not a significant independent predictor of failure for any outcome parameter measured. In conclusion, BMI failed to correlate with functional outcome and, specifically, obesity did not predict a poorer prognosis.