A retrospective review of medical records was performed to assess the incidence and type of significant complications encountered during laparoscopic hysterectomy Two hundred and sixty-five consecutive patients were reviewed between the years 1994 and August 2001. Two hundred and thirty-two laparoscopic vaginal hysterectomies and 33 total laparoscopic hysterectomies were performed. The operations were performed at Monash Medical Centre, a Melbourne tertiary public hospital, and two Melbourne private hospitals, by three surgeons. Ten significant complications occurred. There were two cases of ureteric fistula, two bladder injuries, two bowel obstructions, two postoperative haematomas, one case of a bladder fistula and one superficial epigastric artery injury. In-patient stay ranged from two to six days. Our complication and in-patient stay rates are consistent with previously reported rates.
Objective: ARF with fluid overload (FO) occurs often in BMT recipients. We have demonstrated increasing %FO prior to CRRT initiation is associated with mortality in children with ARF. Based on these data, we devised a protocol for FO prevention in BMT pts with ARF. BMT pts with ARF and 5% FO were started on furosemide and low‐dose dopamine. To allow for nutrition, medication and blood product administration, RRT was initiated for pts with ≥ 10% FO. We reviewed the course and outcome for pediatric BMT pts with ARF and fluid overload managed with this protocol. Subjects: Medical records of 29 BMT pts with 33 ARF episodes from Jan 99 to Jan 02 were reviewed. Mean pt age was 12.8 ± 5 yrs (2–23.5 yrs). Outcome: 14/29 (48%) pts survived an initial ARF episode. 0/4 pts survived a second ARF episode. 14/14 survivors (S) either maintained ≤10% FO during course or re‐attained ≤10%FO with RRT treatment. Max %FO for S was 17%. 7/19 non‐survivors (NS) were <10% FO at the time of death. 4/18 (22%) pts who received RRT (3 HD, 15 CRRT) survived. 2/15 (13%) CRRT pts survived. Mechanical ventilation, Pediatric Risk of Mortality score ≥10 at ICU admission and use of >1 pressors were associated with lower survival (p < 0.05). Neither GVHD nor septic shock correlated with survival.
Conclusion: Our data demonstrate that maintenance of euvolemia (%FO ≤10% is critical for S in BMT patients with ARF as all non‐euvolemic pts died. We suggest that aggressive management with diuretics and earlier RRT initiation in pts not responsive to diuretics may improve BMT pt survival.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.