Social and Economic Effects of Bariatric Surgery

One to 5 years after gastric restrictive surgery and subsequent weight loss, 79 bariatric surgery patients were compared with a similar group of 54 non-operated patients. The operated group had a significantly higher proportion of employment, more working hours, and a higher income. They were also more active in different physical and social activities and had a better sexual life. They required less medical care, had fewer days of sick leave or sick pension, and gave a much higher score in assessment of their general health. The results indicate that obesity surgery is highly cost-effective.     

Morphological changes in bone following intramedullary implantation of methyl methacrylate. A morphometrical study of calcium deficiency

Adult male Sprague-Dawley rats had a methyl methacrylate implant in their right femur. After 16 weeks a group of rats was given a calcium-deficient diet. The rats were followed for another 31 weeks. Due to calcium deficiency a loss of femoral bone mass occurred which was relatively greater in the non-operated femur, as compensatory periosteal bone apposition and remaining necrotic bone areas contributed to the bone mass in the operated femur. The calcium deficiency did not affect the interface between bone and implant, where a thin sleeve of new bone was formed. While the non-operated femur lost its bone through endosteal resorption, the loss of bone in the operated femur was due to intracortical resorption.     

Acute hemiarthroplasty after proximal humerus fracture in old patients: A retrospective evaluation of 18 patients followed for 2-7 years

We evaluated the outcome of acute shoulder hemiarthroplasty in 18 patients following displaced three-and four-part fractures of the proximal humerus. The mean age of the patients was 82 (70-92) years and the average follow-up time was 3.5 (2-7) years. No revision due to loosening was performed. All patients were evaluated concerning activities of daily living, degree of pain (VAS-scale, 0-100 mm) and range of motion. The patients had a low functional level, but were able to sleep on the operated side and keep up their hobby. 11 patients were painfree and the worst pain recorded was 28 mm. Range of motion for all movements, except extension, was statistically significant lower than for the non-operated side. We conclude that in elderly patients acute hemiarthroplasty following three- or four-part fractures of the proximal humerus results in good pain relief, but a more limited range of motion than that reported for younger patients.     

Quadriceps and hamstring strength after anterior cruciate ligament rupture treated operatively with Leeds-Keio prosthesis and without surgery]

69 patients with the ACL rupture: 40 non-operated, without functional knee instability, and 29 after the ACL reconstruction using Leeds-Keio prosthesis due to knee instability have been evaluated. Isometric dynamometric examination of the quadriceps and hamstring muscles was performed. The mean strength deficit in non-operated group was: quadriceps--18.48%, hamstring--7.19%, in operated group was: quadriceps--11.87%, hamstring--10.30%. The higher strength deficit of the quadriceps and lower of the hamstring in non-operated patients may be the sign of an adaptational mechanism to the ACL deficiency. No statistical correlation between the strength deficit and the deficit of the thigh circumference 10 cm above the patella was found.     

Morphological changes in bone following intramedullary implantation of methyl methacrylate: A morphometrical study of calcium deficiency

Adult male Sprague-Dawley rats had a methyl methacrylate implant in their right femur. After 16 weeks a group of rats was given a calcium-deficient diet. The rats were followed for another 31 weeks. Due to calcium deficiency a loss of femoral bone mass occurred which was relatively greater in the non-operated femur, as compensatory periosteal bone apposition and remaining necrotic bone areas contributed to the bone mass in the operated femur. The calcium deficiency did not affect the interface between bone and implant, where a thin sleeve of new bone was formed. While the non-operated femur lost its bone through endosteal resorption, the loss of bone in the operated femur was due to intracortical resorption.     

Minimally invasive fixation versus conservative treatment of undisplaced scaphoid fractures: a cost-effectiveness study

This study compares the direct and indirect costs of conservative and minimally invasive treatment for undisplaced scaphoid fractures. Costs data concerning groups of non-operated and operated patients were analysed. Direct costs were higher in operated patients. Although highly variable, indirect costs were significantly smaller in operated patients and the total costs were higher in non-operated patients. In conclusion, operative treatment of scaphoid fractures is initially more expensive than conservative treatment but markedly decreases the work compensation costs.     

Femoral head density on CT scans of patients following hip fracture fixation by expandable proximal peg or dynamic screw

Computed tomography (CT) is currently considered to be an accurate method for evaluating bone density. We evaluated the CT measurements of bone density using the Hounsfield units (HUs) in 23 patients who had been operated in the past for an extra-capsular hip fracture. Twelve patients were treated with a dynamic hip screw and 11 with a proximal femoral expandable hip nail. All the CTs had been performed for non-orthopedic purposes. Bone density with a region of interest (ROI) could be assessed for both hips. We compared the bone density between the operated versus the non-operated sides as well as between the two surgical groups.Bone density was higher in the hip peg (the femoral component of the expandable nail) side 262.5 (range, 169-351) HU, compared to the opposite non-operated side and to the hip screw group 194 (range, 99-283) HU. The hip screw side had decreased bone density compared to the opposite non-operated side. We were able to define a density index and a difference index: both were higher in the hip peg group. These findings persisted over time. It would be interesting to speculate that increased bone density around an expandable peg provides better fracture stabilization and probably faster healing than a dynamic hip screw.     

Life expectancy following diagnosis of a vertebral compression fracture

Summary

The life expectancy of vertebral compression fracture (VCF) patients was evaluated as a function of their treatment. Compared to non-operated patients, the kyphoplasty and vertebroplasty patient cohort had 115% and 44% greater adjusted life expectancy, respectively. Kyphoplasty patients had a 34% greater adjusted life expectancy than vertebroplasty patients.

Introduction

Balloon kyphoplasty and vertebroplasty are minimally invasive procedures for the treatment of painful VCFs. This comparative effectiveness study characterized the life expectancy of VCF patients as a function of their treatment.

Methods

Life expectancy of VCF patients in the 100% U.S. Medicare dataset (2005–2008) was estimated using a parametric Weibull survival model (adjusted for comorbidities), and compared between operated and non-operated patients as well as between kyphoplasty and vertebroplasty patients. A total of 858,978 patients with a newly diagnosed VCF were identified, including 119,253 kyphoplasty patients (13.9%) and 63,693 vertebroplasty patients (7.4%).

Results

Adjusted life expectancy was 85% greater for operated than non-operated patients (p?<?0.001; 95% confidence interval: 82–89%). Compared to non-operated patients, the kyphoplasty and vertebroplasty patient cohort had 115% (p?<?0.001; 95% confidence interval: 111–119%) and 44% (p?<?0.001; 95% confidence interval: 42–47%) greater adjusted life expectancy, respectively. Kyphoplasty patients had a 34% greater adjusted life expectancy than vertebroplasty patients (p?<?0.001; 95% confidence interval: 31–36%). Across all gender–age groups, the median life expectancy predicted by the parametric Weibull model was 2.2–7.3 years greater for operated than non-operated patients.

Conclusions

Statistically significant and substantial differences in life expectancy were observed between the treated and non-treated cohorts in the Medicare population. Among the treated cohorts, patients in the vertebroplasty group experienced less of a survival benefit than those who received kyphoplasty. The results will be a useful basis for future cost effectiveness studies of VCF treatments for the Medicare population.     

Graded pressure stockings in prevention of deep vein thrombosis following total hip replacement

The occurrence and distribution of deep vein thrombosis after elective hip surgery were studied in 22 consecutive patients wearing graded pressure stockings as thromboprophylaxis. The frequency of thrombosis, as evidenced by leg-scan and phlebography, was 59%. Thirty-six per cent of the patients developed femoro-popliteal thrombosis. Thrombosis was unilateral and located in the operated limb, except for one patient who had concurrent leg-vein thrombosis in the non-operated limb. Two patients developed symptomatic lung embolism. Antithrombin III was determined pre- and postoperatively. There was no evidence of antithrombin III consumption due to postoperative thrombosis.     

Eight to ten years follow-up after carotid endarterectomy: clinical evaluation and Doppler examination of patients operated on between 1978-1980

Follow-up information was obtained on 185 patients who consecutively underwent carotid endarterectomy eight to ten years previously. Doppler ultrasound examination was performed in 59 patients who were still alive and living within 100 miles of the hospital. Using lifetable analysis, the annual rate of focal strokes was estimated to be 2% and 1.5% on the operated and the contralateral, non-operated carotid artery, respectively. Doppler examination revealed 48% re-stenoses, including 14% occlusion and 15% greater than 50% stenosis. However, there was no association between the occurrence of restenosis and the development of symptoms, perhaps with the exception of internal carotid artery occlusion, which is not an accepted indication for carotid endarterectomy. Together with recent data from the literature, these observations challenge the indication for reoperative carotid surgery.     

Justification for an active surgical procedure in the outcome in acute cholecystitis

Long-term results (up to 25 years) in 624 patients with acute cholecystitis discharged from the hospital without operation were found to be unsatisfactory in 68,4% of cases: 54,1% needed an operative treatment, 14,3% were operated upon. Mortality from complications after cholecystitis among non-operated patients in the remote period was 3,4%. Better results of treatment may be obtained by increased surgical activity and higher quality of prophylactic medical examination of patients with cholecystitis.     

Postoperative synovial fluid. Metabolic response to meniscectomy or synovectomy.

The metabolic response of synovial tissue to surgery was investigated by synovial fluid analysis after two types of operations, medial meniscectomy and synovectomy. Analyses of intra-articular fluid were also performed in non-operated patients with traumatic effusion or chronic synovitis in the knee. It was found that the knee joint metabolism in chronic synovitis is shifted towards anaerobic glycolysis in both operated and non-operated patients whereas meniscectomized and traumatized knees are more capable of maintaining oxidative metabolism. The data also demonstrate that one of the main reasons for decreased oxygen supply on the articular surface after meniscectomies or synovectomies is excessive intra-articular effusion which, according to earlier investigations, produces pressure in the joint cavity and inhibits local capillary circulation.     

The results of surgery for intracerebral hematomas

Our retrospective study included 104 patients (28 female and 76 male) with intracerebral bleeding, treated between 1978 and 1988 in the Neurosurgical Clinic of the Medical University in Hannover. The average age was 43 years. 53 patients presented with traumatic intracerebral bleedings, and 51 with spontaneous hematomas. 31 patients with spontaneous hematomas were operated: among these a good or satisfactory result was obtained in 19 patients, and 12 died. Of the 20 non-operated patients, a good or satisfactory result was achieved in 10. 31 patients were operated in the group with traumatic hematoma, of these 22 had a good or satisfactory outcome and 9 patients died or had an unsatisfactory result. Of the 22 non-operated patients, 13 died and 9 achieved a good or satisfactory result. In the stratified Chit-Test the effects of the operation were not found to be significant, with 0.1 < p < 0.25 for spontaneous, and 0.25 < p < 0.05 for the traumatic hematomas. There is a trend in favor of the operation in certain cases.     

Place of the surgery in the management of brainstem cavernomas. Results of a multicentric study

OBJECTIVE: To compare the outcome between operated and non-operated brainstem cavernomas. METHOD: Clinical and radiological data of 30 patients harboring 35 brainstem cavernomas were retrospectively reviewed. The mean follow-up period was 47 months. Relationship between the cavernoma and the pi maer was graded. The histology of each operative case was systematically confirmed. The Karnofsky mean score was calculated at admission and at the end of the follow-up period. Patients were classified in three groups according to their outcome grade (Group I=good; Group II=unchanged; Group III=worse). We compared the outcome between operated and non-operated patients. For operated cases, we found several factors of poor outcome. Statistical tests used to compare the groups of patients were Yates modified chi(2) with calculation of the exact probability. Chosen risk was 5%. RESULTS: Thirty-eight percent of operated patients were permanently disabled after surgery whereas the same proportion was improved. None of the patients in the control group worsened at the mean 47-month follow-up despite the occurrence of two hemorrhagic events. Statistical study showed that treatment modality affected clinical outcome in these patients. Only patients presenting with multiple deficits and progressive neurological deterioration were improved with surgery. Surgical access through the floor of the fourth ventricle was correlated with a poor outcome. Partial removal of the cavernoma increased the risk of future hemorrhage. CONCLUSION: Surgery showed no proof of its efficiency in the management of brainstem cavernomas at the end of the follow-up period. Indications of surgical treatment must be restricted to cases with a severe and progressive neurological deterioration.     

Ergebnisse der Kniescheibenzügelung nach Slocum und Larson

The Slocum and Larson's surgical repair of the laterally dislocating patella is described. The results of 32 operations are discussed, follow-up-time was one to four years. 25 patients have no problems and have full activity in sports. Two patients have femoropatellar pain in the operated and two in the non-operated knee joint; so they had no normal athletic activity but they had no subluxation pain. One patient had a recent traumatic dislocation of the patella in landing a backward salto. We have obtained good results by the method of Slocum and Larson compared with various techniques of transfering tibial tubercle. This operation can be used also in young patients without disadvantages being a mere soft tissue procedure. The importance of lateral release and VMO-plastik is emphasized.     

Treatment policy of surgery in small cell carcinoma of the lung: retrospective analysis of a series of 874 consecutive patients.

A therapeutic policy of surgery in the treatment of small cell carcinoma of the lung was evaluated in a retrospective series of 874 consecutive patients. All patients were included in one of six clinical trials of intensive combination chemotherapy and radiotherapy, carried out during 1973-81. General criteria of resectability, including normal appearances at mediastinoscopy, were fulfilled in 33 electively operated patients and in 46 non-operated patients. An elective operation was defined as a thoracotomy performed with the intention of pulmonary resection in a patient known to have small cell carcinoma. Pneumonectomy or lobectomy was performed in 73% of the electively operated patients. Residual macroscopic or microscopic tumour tissue was left after half of these resections. Both operated patients and non-operated patients with operable tumours survived significantly longer than 696 patients deemed to have been inoperable. There was no significant difference, however, in the duration of survival between the two subsets of operable patients. According to this analysis, a treatment policy of surgery for resectable small cell carcinoma does not lead to better overall results than treatment with chemotherapy and radiotherapy alone.     

Subcutaneous rupture of the tibialis anterior-tendon. (Report of 3 cases) (author's transl)]

In 1966 we saw 1, in 1973 2 cases of spontaneous rupture of the tibialis anterior-tendon. 2 patients were treated by operation, 1 declined it. A follow-up the operated patients had no symptoms and normal function. The non-operated patient also had no symptoms, but slight limitation of dorsiflexion and uncertain gait. One female and one male had been treated with local injections of cortisone before rupture. One can neither prove nor disprove a connection.     

Ultrasonic endoscopic examination in pancreatic diseases

Under analysis were 76 patients with diseases of the pancreas. The data of the ultrasonic endoscopic method were compared with operative findings in 49 patients and with the final clinical diagnosis in 27 non-operated patients. The correctness of the method in the group of operated patients was 80%, in non-operated patients 96.3%.     

Quality of life in bariatric surgery

Background: Bariatric surgery is the treatment of choice for morbid obesity.Since bariatric operations alter gastrointestinal anatomy, they may induce symptoms that have a negative impact on quality of life (QOL).The aim of this study was to prospectively analyze QOL after bariatric surgery. Methods: The QOL index questionnaire (GIQLI) was applied to 45 surgically treated morbidly obese patients (15 vertical banded gastroplasty, 15 Roux-en-Y gastric bypass (RYGBP), and 15 distal RYGBP) and to 15 non-operated morbidly obese controls. Follow-up was of 1-year minimum. The GIQLI evaluates physical and mental well-being, digestion and bowel habits. Results: Physical and mental well-being as well as the overall QOL were significantly higher in the operated patients. There were no significant differences in digestion and bowel habits between the groups. Differences in QOL were not related to the type of surgical procedure. Conclusion. Overall QOL was significantly better in operated than in non-operated patients. There is no negative impact of bariatric surgery on QOL related to GI symptoms.     

The local hemodynamic effects of operation in a bloodless field

Skeletal muscle blood flow and transport function were investigated in 25 patients operated on for a knee injury in a bloodless field. With a double-isotope-clearance technique, measurements were carried out in the operated leg immediately after re-establishment of blood flow, and 1-2 days postoperatively in both the operated and the non-operated leg. A significant increase in blood flow and transport function was registered immediately after release of the tourniquet. The initial maximal hyperemic flow and transport responses were inversely related to the duration of the occlusion. The peak of the blood flow response was more marked and somewhat earlier in the patients with a short duration of occlusion (less than or equal to 60 min) than in those with longer occlusions. 9 of 16 operated legs showed a maximal transport function 1-2 days postoperatively. Peripheral vascular resistance decreased after re-establishment of blood flow. The blood flow in the non-operated leg showed no changes after release of the tourniquet in the operated leg.