Severe Surgical Complications Research Articles

Pelvic exenteration: Factors associated with major surgical morbidity

Sixty-nine women underwent pelvic exenteration at Duke University Medical Center from 1970 through 1987. The operative mortality rate was 7.2% with a trend toward a reduction during the course of the study. One or more serious gastrointestinal or genitourinary surgical complication occurred in 26 (38%) patients and 20 (29%) required reoperation for these complications. There was a trend ( P < 0.1) toward an increase in surgical complications among patients who received prior radiation therapy and those requiring urinary diversion, with a decrease among those who underwent gracilis flap pelvic reconstruction. Patients with sigmoid or ileal conduits had a significantly higher incidence of severe surgical complications than those with transverse colon conduits or posterior exenteration alone ( P < 0.05). Those in whom an ileal conduit was constructed without gracilis flap pelvic reconstruction had signficantly more surgical morbidity compared to those who underwent pelvic reconstruction or received a transverse colon conduit ( P < 0.05). Multiple changes in technique since 1978 including (1) the routine use of surgical staplers for bowel resection and anastomosis, (2) the introduction of the transverse colon conduit, and (3) the use of gracilis flap for pelvic reconstruction have combined to produce a significant ( P < 0.05) decrease in life-threatening surgical complications.

The urinary excretion of ten plasma proteins in long-term renal transplant patients.

Using an automated immunoprecipitin reaction, the urinary excretion of albumin, transferrin, haptoglobin, IgM, IgG, IgA, free lambda and kappa light chains from immunoglobulin, lysozyme and beta2-microglobulin has been investigated in 40 long-term bilaterally nephrectomized renal transplant patients. The excretion of the proteins, except lysozyme, was significantly increased in 21 of the paitents with Albustix-negative urine. In patients with glomerulonephritis prior to the transplantation, the excretion of albumin, transferrin, and IgG was significantly increased compared with the other patients. The IgM excretion was significantly increased in patients who had received C and D matches compared with those with A and B matches. Patients with severe surgical complications in the postoperative period had a tubular proteinuria, and in patients surviving more than 60 months after transplantation the excretion of several proteins was significantly increased compared with patients surviving less than 60 months.

APPENDICES EPIPLOICAE: CLINICAL AND PATHOLOGICAL CONSIDERATIONS

APPENDICITIS epiploica should no longer be regarded as a surgical or pathological oddity. Owing to improved methods of diagnosis and to more painstaking and searching scrutiny of the viscera, as displayed at laparotomy, it can be demonstrated that appendicitis epiploica occurs more frequently than was commonly supposed. After reviewing 105 cases from the literature, with 3 additional cases,1a comprehensive study of clinical entities related to appendices epiploicae has been made. Only those cases with symptoms primarily leading to surgical intervention are included in this series. Cases in which loose calcified bodies were fortuitously found in the abdominal cavity are deliberately eliminated because it is difficult to correlate the clinical findings, if any, with the pathological findings in these instances. Although it cannot be classified with acute appendicitis as a highly treacherous disease, appendicitis epiploica has been directly responsible for fatalities and has caused severe surgical complications. In this