Laparoscopy using carbon dioxide insufflation induces adverse effects in both the cardiovascular and the respiratory function. The use of low pressure pneumoperitoneum has been shown to reduce adverse hemodynamic effects. However, its effect on tissue trauma and postoperative pain and recovery remains controversial. The aim of this study was to compare tissue trauma, postoperative pain, and recovery in two groups of patients undergoing laparoscopic cholecystectomy, one at insufflation pressure of 8 (LC8) and the other at 15 mm Hg (LC15). Forty patients were randomized, 20 in each group. The characteristics of the patients were similar in the two groups. The procedure was completed in all patients in the LC15 group, but in 2 patients in the LC8 group the pressure was increased to 15 mm Hg to complete the operation. There were no significant differences in postoperative pain scores, analgesic consumption, and the incidence of nausea, vomiting, and shoulder pain between the two groups. C-reactive protein concentrations and white blood cell count rose significantly after surgery, but the increase was similar in the two groups. The median duration of surgery was similar, 23 minutes (range 15-65) in the LC8 group and 25 minutes (range 15-80) in the LC15 group. Using our technique of laparoscopic cholecystectomy, there were no advantages to tissue damage, postoperative pain, and recovery when a low pressure pneumoperitoneum was used.
We studied 95 patients with cancer of the gastrointestinal tract in various sites. The aim of the study was to compare the forearm dynamometry vs the prognostic nutritional index which was reported by Busby et al, 1890. We used these methods as preoperative prognostic indicators for postoperative mortality and morbidity. The forearm muscle dynamometry has greater positive predictive value (58.33 vs 32.4%), higher sensitivity (77.78 vs 66.6%), and specificity (86.11 vs 65.28%) than the prognostic nutritional index. The forearm muscle dynamometry predicted the patients mortality with a high rate of sensitivity (100%). The results suggest that dynamometry is a useful, rapid, and inexpensive test. It is more accurate than the nutritional index, and can identify cancer patients at a high risk of developing major postoperative complications, and predict the postoperative morbidity and mortality.
SH is a rare entity with a wide clinical spectrum and difficulties in preoperative diagnosis. Once the diagnosis of SH is established, a surgical treatment is indicated because of the high complication risk.
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