Laser use in laparoscopic surgery.

Gynecologists have found the argon and CO2 lasers very valuable for performance of pelviscopic surgery. Their interest was born from the complications initially seen with electrosurgical pelviscopic procedures and from the unique features of the laser for treatment of endometriosis. Laser technology was applied to laparoscopic cholecystectomy from its inception. This article reviews the arguments for laser and electrosurgical use in the many laparoscopic procedures--established and in evolution.     

Comparison of abdominopelvic computed tomography results and findings at second-look laparotomy in ovarian carcinoma patients

In 35 women with epithelial carcinoma of the ovary, the results of restaging laparotomy were compared with the preoperative abdominopelvic computed tomography (CT) findings to evaluate the accuracy of CT for determining tumor status. In the 36 studies performed, enhanced CT scans at 10-mm to 15-mm intervals had a sensitivity of 84% and a specificity of 88%; in addition, there was 86% agreement between the CT and surgical findings. These results suggest that although CT is not accurate enough to completely replace the restaging laparotomy, its high accuracy in determining residual disease after treatment is helpful for patient management.     

Lipid and insulin concentrations in obese postmenopausal women: separate effects of energy restriction and weight loss.

The separate effects of energy restriction and weight loss on serum lipids were studied in 24 postmenopausal moderately obese women before and after weight loss of greater than 10 kg to normal weight. Fasting serum triglycerides (TGs), total cholesterol (TC), high-density-lipoprotein (HDL) and low-density-lipoprotein (LDL) cholesterol, and insulin were measured at the end of four 10-d in-hospital phases, two before and two after weight loss: phase I, stable weight; phase II, 3350 kJ/d(800 kcal/d), followed by outpatient weight loss; phase III, 3350 kJ/d (800 kcal/d); and phase IV, stable weight. Diet composition and exercise were constant the entire study. Energy-restriction effect was determined by comparing average values in stable-weight phases (I and IV) with low-energy phases (II and III); weight-loss effect was determined by comparing values in obese phases (I and II) with reduced-weight phases (III and IV). Energy restriction lowered TG, TC, LDL cholesterol, the LDL-HDL cholesterol ratio, and insulin and raised HDL cholesterol (all P less than 0.05). Weight loss lowered TG, TC, LDL cholesterol, and insulin (all P less than 0.01) but did not change HDL cholesterol or the LDL-HDL cholesterol ratio. The results suggest that reduction to a weight-steady nonobese state significantly lowers TG, TC, and LDL cholesterol but does not improve HDL cholesterol or the LDL-HDL cholesterol ratio.     

Development of a revised version of the Women's Health Questionnaire.

OBJECTIVES: The Women's Health Questionnaire (WHQ) includes 36 items assessing nine domains of physical and emotional experiences of mid-aged women. The primary aim of the current research was to examine the psychometric properties of the WHQ across linguistic versions in view of the increased need for reliable health-related quality of life (HRQL) measures in multinational studies. METHODS: In this paper, we examine the hypothesized structure of the questionnaire in a UK sample, to develop and verify a revised model to be used in multicenter, international studies. RESULTS AND CONCLUSIONS: Content analysis and evaluation of missing data led to exclusion of 'Menstrual symptoms' and 'Sexual behavior' domains, retaining these as optional modules of the core questionnaire. Additionally, item 13 was excluded because it does not investigate the same concepts as other domains and the deletion of five additional items appeared to improve the questionnaire's factor structure. The revised WHQ comprises 23 items, investigating six domains. The cross-sectional psychometric properties of the 23-item WHQ were good and better than those of the 36-item version. The 23-item WHQ was assessed with multinational data, to evaluate cross-cultural equivalence of linguistically adapted versions. In addition, its reproducibility and responsiveness need to be documented.     

A midface swelling in a child – A possible diagnostic dilemma

A lump on the midface of a child can pose as a diagnostic dilemma. There is a wide variety of possible differential diagnoses, ranging from simple benign conditions such as a sebaceous cyst, dermoid cyst, lipoma, neuroma and neurofibroma, to potentially devastating conditions such as odontogenic myxoma.A case of a child in which the formulation of a definite diagnosis was clinically and histologically challenging is presented.     

Lower urinary tract symptoms in older adults undergoing hip arthroplasty: a feasibility study.

PURPOSE: We undertook a feasibility study to explore the prevalence of preoperative and postoperative lower urinary tract symptoms (LUTS) in older adults undergoing elective hip arthroplasty and to determine whether a larger prospective study was warranted. METHOD: Subjects awaiting elective hip arthroplasty were recruited preoperatively from an orthopedic office and preadmission clinic at 1 university-affiliated hospital. LUTS and related quality of life were measured prehospitalization and 6 weeks postoperatively using the American Urological Association Symptom Index and quality-of-life score. Postvoid residual urine and the 24-hour pad test were used to assess bladder emptying and continence status. RESULTS: Sixteen participants (9 males, 7 females, mean age 74 years) completed the study. Preoperatively, 15 participants reported at least 1 symptom and none had discussed these with a healthcare professional. The most common LUTS were nocturia, frequency, and urgency. Postoperatively, all reported symptoms, with 8 (53%) experiencing increased symptoms with a negative impact on quality of life for 3. Recruitment was a major barrier in conducting the study and would need to be taken into account in further studies of the topic. CONCLUSION: Despite recruitment issues, we suggest larger studies of LUTS in older adults undergoing surgery are warranted to further understand potential problems and risks in transition from hospital to home. Future studies should include identification of potential reasons for increased LUTS, including urinary tract infection.     

The management of adult respiratory distress syndrome: 2

In the second article in this series we describe some of the newer options in respiratory support and pharmacological intervention which, although largely experimental at present, may prove to be of benefit in the future.     

The community perinatal health care system of urban Cape Town, South Africa--I. Characteristics of mothers and birth outcomes

Greater Cape Town has developed a geographical network of perinatal health care services for low-income mothers using community-based clinics with hospital referrals. This study analyzes 25,409 births recorded in 162 different urban residential areas during 1987. The data apply to two populations--black and mixed. Information on the mother, such as height, weight, education, parity, and prenatal visits is indicated by suburb, as well as birth outcomes such as gestational age, birthweight, and method of obstetrical delivery. Comparisons are drawn between black and mixed populations and among suburbs. High utilization rates and successful maternity and infant outcomes suggest that the outreach clinics of Cape Town could provide a model for urban agglomerations in other African countries.