Robotic techniques improve quality of life in patients undergoing atrial septal defect repair

BACKGROUND: Minimally invasive cardiac surgery has emerged as an alternative to conventional, open surgery. Although most studies of robotically assisted cardiac surgery have reported morbidity and mortality, few have addressed outcome measures, such as pain and quality of life, which was the aim of this study. METHODS: Eleven patients with atrial septal defects (ASD), and five patients with patent foramen ovale, underwent repair using the Da Vinci system (Intuitive Surgical, Mountain View, CA). The Medical Outcomes Study Short Form Survey (SF-36), along with two additional questions, were administered to these patients on postoperative day 30, along with a similar number of patients who underwent ASD repair by mini-thoracotomy or sternotomy. Quality of life endpoints included bodily pain, vitality, mental health, general health, physical function, and social function. RESULTS: Robotic patients demonstrated significantly higher scores in 6 of the eight variables (p < 0.05). There was no significant difference in intensive care unit or overall hospital stay among the groups (p = NS). Robotic patients returned to work after 40.2 +/- 30.2 days, mini-thoracotomy patients after 45.6 +/- 27.9 days, and sternotomy patients after 51.7 +/- 40.2 days (p = 0.767). There were no significant differences in SF-36 scores between patients who underwent mini-thoracotomy and sternotomy approaches. CONCLUSIONS: Closure of an ASD can be performed safely and effectively via an endoscopic approach. Robotic technology minimized the degree of invasiveness, hastened postoperative recovery, and improved quality of life, although length of hospital stay was unchanged.     

Biochemical Effects from Treatment with Bisphosphonate and Surgery in Patients with Primary Hyperparathyroidism

Patients with primary hyperparathyroidism (pHPT) are sometimes treated with bisphosphonates (BPs) as an alternative to surgery despite sparse documentation of the efficacy in this disorder. It is therefore of interest to study the biochemical effects from BPs in patients with pHPT. A series of 21 pHPT patients with serum calcium levels > 2.8 mmol/L were included. One month before surgery the patients underwent intravenous infusions of 30 to 40 mg pamidronate. Study parameters were total and ionized serum calcium, intact parathormone (PTH), alkaline phosphatase (ALP) and isoenzymes, creatinine, osteocalcin, 25-OH vitamin D₃, 1,25-OH₂ vitamin D₃, urine calcium/creatinine, and osmolality. Registration of hypercalcemia-related symptoms were done by questionnaire. After pamidronate there was a temporary reduction in serum calcium with a nadir at 6 to 10 days. Normalization of serum calcium was achieved only by surgery. Intact PTH rose after pamidronate, with a maximum on day 6. Urinary calcium excretion was reduced after both pamidronate and surgery. ALP was reduced 30 days after pamidronate and also after surgery. Serum osteocalcin was not influenced by pamidronate. No statistically significant differences in symptoms were reported after treatment. In conclusion, there was a short, limited calcium-lowering effect from pamidronate in pHPT patients and a transient increase in PTH corresponding to the reduced calcium concentration. An obvious change in bone markers was found only after surgery. Treatment with BPs should not be considered an alternative to surgery, which is still the only method to cure patients with pHPT.This article was presented at the International Association of Endocrine Surgeons meeting, Uppsala, Sweden June 14–17, 2004.     

Improved teleradiology reporting using fax software

OBJECTIVE: In an effort to expedite after-hours teleradiology reports in an efficient and accurate manner with minimal usage of manpower, we have for the past 4 years used commercially available fax software running on a laptop computer placed beside the home-based teleradiology system. The software and laptop combination allows the radiologist to make a report rapidly by typing brief sentences in a fillable field or by selecting an applicable pretyped report from a menu. The report is then electronically faxed to single or multiple sites with a single mouse click. CONCLUSION: The system has drastically reduced the number of telephone calls between technologists and teleradiologists and has been well received by both technologists and emergency department staff and referring physicians.     

Impaction allografting for femoral component revision: clinical update

The technique of cancellous impaction allografting with cement aims to reconstitute a bone-deficient proximal femur while also gaining stable fixation of the femoral prosthesis. Some reports of this technique imply it is a system, requiring not just an exacting surgical method, but also a particular implant design, the polished, double-tapered stem. Other series consider it a surgical technique, and have varied the femoral component design, the method of graft delivery, and other elements of the procedure. Our review evaluates the current literature, with the goal of beginning to ascertain whether published results suggest impaction grafting must be considered a system, requiring a particular stem design, or simply another means to achieve femoral reconstruction in the revision setting. The conclusive answer will require randomized, controlled clinical trials to evaluate particular elements of the procedure, and these studies have yet to be done. However, investigators have shown similarly good short-term to intermediate-term results with various femoral stems at numerous centers. Currently, femoral impaction allografting, whether as a system using particular implant designs or as a surgical technique, is an accepted alternative for revision of a failed femoral component, particularly when bone-stock deficiency is present.     

Lymphangioma of the falciform ligament--a case report

A rare case of a lymphangioma of the falciform ligament in a child is described. He presented with abdominal pain and was found to have an unusual intraabdominal mass. Resection was curative.     

Bridging to transplant with the HeartMate left ventricular assist device: The Columbia Presbyterian 12-year experience

OBJECTIVE: Implantation of a left ventricular assist device as a bridge to transplantation has become an acceptable approach for patients with end-stage heart failure. Our long-term results with 3 Thoratec HeartMate devices are presented to outline improvements in successful bridging to transplantation and post-transplant survival. METHODS: From August 1990 through January 2003, 243 patients underwent implantation of Thoratec HeartMate devices as a bridge to transplantation. This included 52 (21.4%) pneumatic devices, 17 (7.0%) dual-lead vented electric devices, and 174 (71.6%) single-lead vented electric devices. RESULTS: Mean age was 49.7 +/- 13.7 years. Mean support time was 78.1 +/- 82.9 days (0-541). Bridging success increased from 63.5% (n = 33) for pneumatic devices to 64.7% (n = 11) for dual-lead vented electric devices and 72.4% (n = 126) for single-lead vented electric devices (P =.005). Posttransplant 1-, 3-, and 5-year actuarial survival increased from 87.5%, 78.1%, and 71.9% in patients with pneumatic devices to 91.5%, 86.9%, and 81.3%, respectively, for patients with single-lead vented electric devices. Device infection and malfunction occurred in 17.7% (n = 43) and 12.8% (n = 31) of patients, respectively. CONCLUSIONS: Successful bridging to transplantation and posttransplant survival has improved over time. Left ventricular assist devices have become increasingly more effective in bridging patients with end-stage heart failure to transplantation. This is likely due to a combination of better patient selection, improvements in clinical practice, and evolution in device design.