Int Surg
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Randomized Controlled Trial Comparative Study Clinical Trial
Cholecystectomy: comparison of minilaparotomy and laparoscopy.
Laparoscopic cholecystectomy (LC) has become the most popular method of removing the gallbladder. Because it is an expensive operation requiring special training for the team, LC has been challenged by other methods of minimal-access surgery, e.g. by minilaparotomy (MC). This study was planned to be a single-surgeon prospective random study to compare minilaparotomy cholecystectomy (MC) and laparoscopic cholecystectomy (LC), but was never done over the pilot phase. ⋯ In the MC group three patients (37%) had complications versus no complications in the LC group (p = 0.028). Postoperative hospital stay was longer in the MC group (median three days) than in the LC group (median one day), even when the patients with complications were excluded. Due to these discouraging experiences the extended random study was never done, and MC was abandoned.
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To evaluate the efficacy of a single application of epidural anesthesia without endotracheal intubation for elderly patients over 80 years of age, the data on 108 patients who underwent abdominal surgery were analyzed for the occurrence of postoperative complications. These patients were classified into two groups according to the type of anesthesia performed: 66 received epidural anesthesia alone (Group I) and 42, general anesthesia under endotracheal intubation (Group II). ⋯ The occurrence of pulmonary complications in Group I was not related to the operating time, while pulmonary complications frequently occurred in patients who underwent lengthy operations in Group II. These findings suggest that a single application of epidural anesthesia would improve the overall safety in performing abdominal surgery in elderly patients over 80 years of age.
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Forty-nine patients sustaining Inferior Vena Cava (IVC) injuries, during a 5 year period were retrospectively analyzed in order to assess those factors related to early deaths. Mean age was 32 and 45 were male. GSW was the most frequent mechanism of injury (59.2%), followed by SW (28.6%) and blunt trauma (12.2%). ⋯ Mortality rate was 100% in supra diaphragmatic injuries, 71.4% in retrohepatic, 68.8% in suprarenal and 33% in infrarenal injuries. There was a significant difference when comparing mortality rate in stable against shock or unstable patients on admission (p < 0.001), as well as in those with diaphragmatic IVC injuries compared with all other injury sites together (p < 0.05). Hemodynamic instability on admission was the most important cause of early deaths, and all patients with concomitant abdominal vascular injuries also died.
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The results of thoracoscopic biopsy and talc pleurodesis in the management of malignant pleural effusions, is analysed. The study population consisted of 213 patients. Pre-operative cytology was positive in only 27% of patients; the diagnostic yield using thoracoscopic biopsy was 91.5%. (Sensitivity 99%; specificity 100%; positive predicted value 100%; negative predicted value 88%). ⋯ Post-operative complications occurred in 3.7% and there was a 2.3% mortality. Recurrent effusion was not a significant clinical problem. Thoracoscopy enhances the accuracy of diagnosis of pleural effusions; simultaneous talc pleurodesis has a high therapeutic success.