Non-elective Group Research Articles

Non-elective intra-coronary stenting: are the clinical outcomes comparable to elective stenting at 6 months?

The aim of this study was to compare prospectively the clinical outcome of patients treated with intra-coronary stents as a non-elective/bailout procedure for acute or threatened vessel closure, with those undergoing elective stenting at 6 months. Sixty-four patients (60.2±11.7 y) who underwent non-elective stenting for abrupt or threatened vessel closure and/or sub-optimal results were prospectively compared with 68 patients (62±10.0 y) who were stented electively. All patients had broadly similar pre-procedural clinical profiles. However, patients in the elective group had a higher incidence of previous PTCA (10.2% vs. 0%, P=0.01) and bypass surgery (30.9% vs. 6.3%, P=0.0003) compared with the non-elective group. A total of 158 stents (1.19 per patient) were implanted in 132 patients with a procedural success rate of 99.3%. At 6 months follow-up there was no statistical difference in the primary composite end-point of death, myocardial infarction and the need of repeat revascularisation (10.9% vs. 5.8%, P=0.35) between the two groups. However, patients in the non-elective group showed a higher incidence of unstable angina compared with the elective group (25% vs. 1.4%, P=0.0004). The findings of this study suggest that stents (single or multiple) can be effectively implanted in non-elective situations with no increase in the incidence of death, non-fatal myocardial infarction, and the need of repeat revascularisation at 6 months compared with elective stenting.

The use of radiologically placed gastrostomy tubes in head and neck cancer patients receiving radiotherapy

Purpose: Patients undergoing radiotherapy to the head and neck area frequently experience radiation reactions that can markedly restrict oral intake, require hospitalization, and occasionally cause treatment interruptions. The Vancouver Cancer Center (VCC) has recently employed radiologically placed gastrostomy tubes (G-tubes) in the management of this problem. A review of the patients on whom its procedure had been performed is the subject of this review.Methods and Materials: Thirty-four patients had gastrostomy tubes inserted under radiologic guidance. This group is compared to a control group matched for age, sex, irradiated volume, and radiation dose, who did not have gastrostomy tubes. Patients with gastrostomy tubes were divided into two categories: (a) patients who had tubes inserted in anticipation of severe reactions, and (b) patients who developed severe radiation reactions necessitating nutritional support.Results: The gastrostomy group consisted of 65% males with an average age of 59 years and stage range of II (12%), III (24%), and IV (65%). In both the elective group and the nonelective group, patients maintained their weight at 95 to 97% of the pretreatment weight, at follow-up of 6 weeks and 3 months. This compared with an average weight loss in the control group of 9% at 6 weeks and 12% at 3 months. The length of hospitalization was a mean of 4.9 days in the elective group and 19 days in the nonelective group. Complication were low compared to those documented in the literature, but included two tube migrations, two aspirations, and one gastrointestinal bleed.Conclusions: We believe that gastrostomy tubes contribute significantly to the management of patients with lead and neck cancer, particularly in maintenance of nutrition, and they may decrease the need for hospitalization.

Cesarean section with subsequent hysterectomy

We had 65 Caesarean hysterectomies from 1960-1982 at our hospital. 43 patients were elected for various reasons: contraception 26, fibromatosis 13, intraepithelial neoplasia 4. 22 had vital indications: rupture of the uterus 12, placenta increta/percreta 5, abruptio placentae 3, atony 2. The time we needed for the operation was up to 100 minutes in the elective group, 160 minutes in the non-elective group. In vital indications, postoperative morbidity was higher than when treatment was elective. In the group of vital indication, 4 patients died, whereas no patient died if operation was performed on an elective basis.