Urgent cholecystectomy

A retrospective review of cholecystectomy at the Naval Regional Medical Center, Portsmouth, Virginia revealed 92 patients (22%) who had urgent or early operation for acute cholecystitis. There were no infections or deaths in this group and the complication rate was similar to that of patients who had elective cholecystectomy. We advocate liberal use of intraoperative cholangiography in these patients. Interestingly, a high number of positive common duct explorations were found in those patients with a bilirubin level of over 4.0 mg/dl.     

Urgent lung transplantation in Spain

BACKGROUND: Lung donors are scarce and lung transplantation resources are limited. Because urgent lung transplantation (ULT) is assumed to yield poor results, its use is controversial. We assessed the outcome of patients who received ULT seeking to determine effectiveness and risk factors. PATIENTS AND METHOD: We collected data from every ULT performed in Spain during 5 years (1998-2002). The survival of patients was studied using Kaplan-Meier, Cox regression, and chi-square statistical analyses. We compared outcomes and perioperative mortality (over 30 days) for ULT procedures, analyzing the influence of certain variables (age, type of transplant, diagnosis, indication, and time on waiting list). RESULTS: Among 109 patients proposed for the procedure, 73 ULT were performed during the period. The most frequent indications were pulmonary fibrosis (19 cases) and cystic fibrosis (19 cases), showing the worst and the better survival rates, respectively. The bad prognosis, determined mainly by per operative mortality rate (35.62%), was significantly affected by age (worse for patients older than 40 years) and type of LT (single worse than double; P < .05). A longer time waiting for ULT also showed a worse prognosis (P < .005). CONCLUSIONS: Long-term survival after ULT shows that the procedure is effective and efficient for a select group of patients, despite the high per operative risk. ULT should be reserved for younger patients. It also requires performance in a short period (just a few days), initially rejecting a single lung transplant, provided that the patient is adequately monitored.     

Urgent and emergency carotid TEA

Restoration of blood flow to reperfuse ischemic but not infarcted areas of the brain (ischemic penumbra) and the removal of an ongoing embolic source are the therapeutic aims of emergency and urgent carotid endarterectomy (CEA), both in patients with an acute or progressive ischemic stroke and in patients in the early period after a carotid-related stroke. Based on poor results in the 60ies and 70ies, many centers traditionally perform CEA four to six weeks after a carotid-related stroke at the earliest interval. Since natural history is associated with a high risk of an disabling and/or recurrent stroke in several subgroups of patients, some reports were able to show that urgent and emergency CEA could be worthwhile in well-selected patients.     

Urgent surgery in colon carcinoma

INTRODUCTION: About 10% of all operations in colon carcinoma are performed in emergency situations because of severe preoperative complications. PATIENTS AND METHOD: The prospectively collected data of 1496 patients with colon carcinoma treated from 1987 to 2002 at the Department of Surgery of the University of Erlangen were analysed with special interest on postoperative morbidity and long-term prognosis after elective and urgent surgery. RESULTS: The rate of urgent surgery was 11%. The most frequent complication was bowel obstruction (73%) followed by perforation (20%). Emergency patients were significantly older (p<0.001) and in worse general condition (p<0.001). The rates of surgical and nonsurgical postoperative complications were higher in urgent surgery than in elective surgery (28.8% vs. 19.8%, p=0.015) and also postoperative mortality was significantly higher (10.1% vs. 4.0%, p<0.001). The rates of locoregioanal recurrences and distant metastases were significantly higher. Urgent surgery was found to be an independent prognostic factor for distant metastasis (relative risk 1.8) and cancer-related survival (relative risk 1.6). DISCUSSION: Urgent surgery in colon carcinoma is usually performed in advanced tumours of elderly patients. This operation can be a challenge for the treating surgeon. Adequate medical emergency supply needs to provide an experienced surgeon for those interventions.     

开放性骨盆骨折的急救处理

开放性骨盆骨折合并大出血是骨盆骨折最紧急、最严重的并发症,也是造成病人死亡的主要原因。1998.1～2000．6我们共抢救开放性骨盆骨折伴大出血休克病人14例,其中13例病人有完整的抢救记录,现报道如下,