Lumbar Sympathectomy in Obliterative Arteriosclerosis. Should It Still Be Performed?

During the years 1967–1976, bilateral lumbar sympathectomy was performed in 241 patients with arteriosclerotic occlusions. A questionnaire was completed by 137 patients. Of the total, 68% seem to have improved in some way postoperatively. The material was analyzed with regard to age, sex, diabetes and regarding the effects on pregangrene, established gangrene, amputation, claudication and skin temperature. The operative mortality was 2.1% and postoperative complications were few. Bilateral operation in one stage does not give a higher postoperative mortality than unilateral procedures. Postoperative side-effects, such as neuritic pains, sexual and urological dysfunctions, are considered. Bilateral lumbar sympathectomy still seems to be an alternative procedure, which may be offered some patients with marginal peripheral circulation, when reconstructive arterial surgery is not feasible.     

When Should Complete Blood Count Tests Be Performed in Primary Total Hip Arthroplasty Patients?

Background

Routine laboratory studies are often obtained following total hip arthroplasty (THA). Moreover, laboratory studies are often continued daily until the patient is discharged regardless of medical management. The purpose of this study was to investigate the use of routine complete blood count (CBC) tests following THA. Secondarily, the purpose was to identify patient factors associated with abnormal postoperative lab values.

Distal Bypass for Limb Salvage: Should the Contralateral Great Saphenous Vein Be Harvested?

The great saphenous vein (GSV) is unusable in 20% of cases. The best alternative in these cases is the GSV of the contralateral lower limb (CLL). However, many surgeons are reluctant to harvest the contralateral GSV for fear that it might be needed for future treatment of critical ischemia in the CLL. The purpose of this retrospective study was to observe the long-term behavior of the CLL and to identify prognostic factors for the development of critical ischemia as a basis for contraindicating harvest of the contralateral GSV. The study was conducted in patients who underwent distal bypass for trophic manifestations between January 1995 and December 1997. Patients who had a history of contralateral bypass using the GSV or major amputation were not included. Eighty-one of the 86 patient records could be analyzed with a minimum follow-up of 5 years. Survival was 59% and 40% at 2 and 5 years, respectively. Statistical analysis focused on age, risk factors, trophic manifestations on the CLL, ankle-brachial index, and arteriographic findings. After 5 years of follow-up, seven of the 81 patients (8.6%) required contralateral long bypass. Presence of contralateral trophic manifestations at the time of initial bypass was the only statistically significant prognostic factor for requirement of contralateral long bypass (p < 0.01). These findings support harvesting of the contralateral GSV for lower limb salvage. The risk that long contralateral bypass will be required is low except in patients with contralateral trophic manifestations.     

Importance of Routine Preoperative Upper GI Endoscopy: Why All Patients Should Be Evaluated?

Background  Morbid obesity is associated with different gastrointestinal alterations and diseases. Surgically induced weight loss has become the best treatment for morbidly obese patients. Roux-en-Y gastric bypass is the most common procedure performed worldwide. Concerns regarding difficulties in further evaluation of stomach remnant for early detection of gastric cancer, however, have emphasized the routine use of preoperative upper endoscopy, even in asymptomatic patients, to detect upper gastrointestinal abnormalities. The main outcome of this study was to identify the most common preoperative endoscopic findings. Methods  Data was collected from a prospective database and medical records of patients with available endoscopic reports, who underwent Roux-en-Y gastric bypass from February 1999 to June 2006. Logistic regression analysis was performed to detect preoperative clinical variables that might be associated with abnormal endoscopy. Results  Six hundred twenty-six patients were identified. Four hundred fifty-two (72%) were female; age and body mass index were 38.5 ± 11.3 years and 42 ± 6.5 kg/m², respectively. Abnormalities were found in 288 (46%) patients. The age of patients with abnormal and normal endoscopy was 40 ± 11 and 36.8 ± 11 years, respectively (p < 0.001). The most common findings were gastritis 21% (n = 132), esophagitis 16% (n = 100), and hiatal hernia 10.7% (n = 67). Duodenitis has a frequency of 7.8% (n = 49), gastric ulcers of 2.7%(n = 17), duodenal ulcers of 2.6% (n = 16), gastric polyps of 1.3% (n = 8), Barrett’s esophagus of 0.16% (n = 1), and gastric cancer of 0.16% (n = 1). Age was the only clinical variable associated to abnormal endoscopy (odds ratio = 1.03; 95% confidence interval, 1.02–1.05). Conclusions  Routine preoperative endoscopy detects different abnormalities which need specific approach prior to surgery. Preoperative endoscopy should be performed to all patients prior to surgery.     

All Patients Should Be Screened for Diabetes Before Total Joint Arthroplasty

Background

Diabetes is highly prevalent in patients with osteoarthritis before total joint arthroplasty and presents a higher risk of adverse postoperative outcomes. However, the rate of diabetes in this population and optimal screening strategies remain unknown.

Retropubic and Transobturator Slings: Still Useful or Should All Patients Be Treated with Mini-slings?

Traditional retropubic and transobturator midurethral slings are reliable, safe, and effective treatments for stress urinary incontinence. Unfortunately, they also are associated with rare but severe complications, such as bladder or bowel perforation, vascular injury, nerve damage, and/or groin muscle pain that can occur with the blind passage of trocars. To maintain efficacy and patient satisfaction while avoiding such complications, minimally invasive mini-slings have been developed. These smaller mini-slings can be placed through a single vaginal incision at the level of the midurethra without trocars. Mini-slings often are performed as an outpatient surgery, with minimal morbidity, pain, and quick patient recovery. With continued refinement and surgeon experience, mini-slings potentially may be performed safely in the office setting under local anesthesia while maintaining the efficacy of traditional slings.     

When and How a Prostatic Re-Biopsy Should be Performed?

Objectives: What should be done when a first set of prostate biopsies was negative is still a matter of debate.Methods: Literature on prostate re-biopsy was reviewed and a selection of articles made. Keywords used for the Medline search included: Prostate cancer, Biopsy, Diagnosis.Results: Several studies including data from the multicenter European Prostate Cancer Detection Study (EPCDS) have shown that at least 10% of patients with negative sextant biopsies had prostate cancer found on repeat biopsy. Re-biopsy can be performed 6 weeks after an intial set of biopsies without significant increase in pain or morbidity.Conclusions: The current review critically evaluated the indications, timing, number of cores and location of repeat biopsies focussing on the available literature.