Shorter Hospitalization Period Research Articles

A review of sternal closure techniques

Sternotomy and sternal closure occur prior to and post cardiac surgery, respectively. Although post-operative complications associated with poor sternal fixation can result in morbidity, mortality, and considerable resource utilization, sternotomy is preferred over other methods such as lateral thoracotomy. Rigid sternal fixation is associated with stability and reduced incidence of post-operative complications. This is a comprehensive review of the literature evaluating in vivo, in vitro, and clinical responses to applying commercial and experimental surgical tools for sternal fixation after median sternotomy. Wiring, interlocking, plate-screw, and cementation techniques have been examined for closure, but none have experienced widespread adoption. Although all techniques have their advantages, serious post-operative complications were associated with the use of wiring and/or plating techniques in high-risk patients. A fraction of studies have analyzed the use of sternal interlocking systems and only a single study analyzed the effect of using kryptonite cement with wires. Plating and interlocking techniques are superior to wiring in terms of stability and reduced rate of post-operative complications; however, further clinical studies and long-term follow-up are required. The ideal sternal closure should ensure stability, reduced rate of post-operative complications, and a short hospitalization period, alongside cost-effectiveness.

Efficacy of stapler pharyngeal closure after total laryngectomy: A systematic review

Some primary studies compare manual and mechanical pharyngeal closures after total laryngectomy. The purpose of this study was to evaluate the advantages of the mechanical suture in pharyngeal closure. The literature survey included research in MEDLINE, EMBASE, and LILACS. The intervention analyzed was stapler-assisted pharyngeal closure, whereas the control group was manual suture pharyngeal closure. The survey resulted in 319 studies. However, 4 studies were selected (417 patients). In the group of patients in whom the stapler was used, the incidence of pharyngocutaneous fistula was 8.7%, whereas in the other, it was 22.9%, with an absolute risk reduction of 15% (95% confidence interval [CI], 0.02-0.28; p = .02; I(2) = 66%). Regarding the surgical time, the average difference was 80 minutes in favor of the stapler group (95% CI, 23.16-136.58 minutes; p < .006). The difference for starting oral feeding was 8 days in favor of the mechanical suture (95% CI, 4.01-11.73 days; p < .001). Patients who underwent mechanical suture had a shorter hospitalization period.

A Hospital‐Based, Healthy Pregnancy Promotion Program to Empower the Socially at Risk: The Healthy Beginnings Program

Paper Presentation Purpose for the Program The Healthy Beginnings Program provides education, support, counseling, and a link to community resources to socially high‐risk pregnant women who will give birth at Saint Joseph Medical Center. The purpose is to encourage a healthy lifestyle for every mother, so she will give birth to a full‐term, healthy newborn. Eligibility includes the following: Medicaid patient; limited finances; uninsured; single or without social support; teen; domestic violence; and drug/alcohol use. Proposed Change A registered nurse meets privately with the patient (four 1‐hour visits) and encourages her to write goals and attend childbirth and breastfeeding classes. Participants also are offered incentives, such as free books, maternity clothes, infant clothes, a breast pump, food vouchers, and a car seat. The following are topics covered in the program: Maternal/fetal growth and development, preterm labor, urinary tract infection prevention, nutrition, benefits of breastfeeding, seat belt use, smoking and secondhand smoke, healthy relationships, sudden infant death prevention, shaken baby syndrome awareness, and infant care and car seat usage. Implementation, Outcomes, and Evaluation The Healthy Beginnings Program was established in 1996 and has enrolled between 100 patients and 172 patients annually. The annual operating budget for the Healthy Beginnings Program is approximately $35,000 per year. The average cost per participant in 2012 was $203. Statistics, such as birth weight, birth length, number of neonatal intensive care days, gestational age, and hospital costs, are compiled and compared with those of infants whose mothers are not in the program, but who are similar demographically. The comparative outcomes show that enrolled women tend to have infants that are slightly larger and slightly longer than nonparticipants who come from a similar client base. The most remarkable facts are the number of days spent in the neonatal intensive care unit and the gestational age. Year after year, program participants have healthier infants that are closer to term than nonparticipants. In 2009, 8.8% of program participants gave birth to infants at 37 weeks of gestation or less. Comparatively, out of the women who qualified for the program but did not partake 15.2% gave birth to infants at 37 weeks of gestation or less. Implications for Nursing Practice Caring for the socially high‐risk pregnant patient and her infant is an ongoing nursing challenge because of the short hospitalization period at delivery. By establishing a rapport with families prenatally, the transition of a healthy mother and newborn from the hospital to the home is much easier and often times seamless, which saves both nursing time and energy.

Type 1 Diabetes in Children and Adolescents

Type 1 Diabetes in Children and Adolescents

Extended duration of hospitalization in first episode psychosis: An evaluation of its clinical justification

Short periods of hospitalization for first episode psychosis are generally considered preferable, although research evidence is inconsistent. Clinical and social determinants of length of hospital stay (LOS) were examined in 121 admissions for first episode psychosis using standardized assessment measures, in five clinical units of a French psychiatric hospital. LOS varied from 4 to 371 days, and considerably between units. LOS was examined both as a continuous variable and dichotomized comparing short (<31 days) to long (>31 days) stays. In the multivariate analyses, change in antipsychotic medication and the unit head psychiatrist's preference for longer stays were significantly associated with both measures of LOS, indicating effects on LOS per SE and not only with respect to a threshold duration of stay. Of the clinical factors at admission, the only borderline significant association found was between the severity of negative symptoms and LOS on a continuum. Despite some justification for longer stays with respect to discharge conditions, the persisting association with the head psychiatrist's preference for long or short stays strongly suggests a need for greater evidence-based rationalization of practice.

Antibiotic Resistance Patterns of Escherichia coli Isolates from Hospitals in Kumasi, Ghana

Nosocomial infections are infections acquired by a patient as a result of treatment in a hospital or healthcare service providing center and symptoms occurs within a short period of hospitalization. The study was to determine the antibiotic resistance patterns of Escherichia coli isolated from Kumasi-South, Tafo and Suntreso Hospitals, Kumasi, Ghana. Total of 600 swabs samples from the hospitals were collected between January and June, 2010. The isolates were identified using morphological and biochemical means. A total of 97 E. coli isolates were obtained from the hospitals. Beds in hospital wards had the highest number of E. coli strains (53.6%), followed by floors (20.6%) while drainages had the least isolates (3.1%). Majority of the E. coli isolates (90.7%) exhibited resistance to ampicillin while 6.2 and 3.1% showed intermediate and sensitive respectively. Co-trimoxazole, 78.4% of the isolates were resistant while 9.3 and 12.4% exhibited intermediate and sensitive responses respectively. E. coli isolates (28.6 to 46.4%) were resistant to gentamicin, ciprofloxacin and ceftriaxone while 14.4 to 47.4% gave intermediate responses. Most isolates (80.4%) exhibited multi-drug resistance. There is a need to observe proper personal hygiene, use of effective disinfectants and proper disposal of contaminated/pathogenic materials in these hospitals to control nosocomial infections.

Hinged distraction of the hip joint in the treatment of Perthes disease

The aim of this work is to determine the effect of this type of treatment on the shape of the femoral head, the range of motion (ROM), radiological changes in the femoral head, and the prognosis of Perthes disease at skeletal maturity. From 1998 to 2007, 53 patients with Perthes disease were treated with a combination of soft tissue release and joint distraction with a hinged monolateral external fixator in 32 patients and by Ilizarov external fixator in 21 patients. Nineteen of our 53 patients attained skeletal maturity and were evaluated in our study. This study included 15 boys and four girls, mean age at surgery 9.3 years (range 7.2-13.1), and mean age at the last follow-up 17.4 years (range 14.9-21.3). The duration of symptoms varied from a period of 6 to 60 months before the operation. Radiographs taken during the fragmentation stage of the disease were classified by the lateral pillar classification of Herring; 19 of our patients attained skeletal maturity and were evaluated. Clinical assessment included the Harris hip score, hip ROM, and limb length discrepancy. Radiographic assessment included sharp transverse acetabular inclination, the uncoverage percentage, the epiphyseal index before surgery (modified Eyre-Brook), at frame removal, and at the last follow-up, the epiphyseal quotient (of Sjovall), and the Stulberg classification. The mean follow-up was 7.2 years (range 4.1-11.3). The mean Harris hip score was 87.1/100 (range 49.2-94.8). An improvement in hip (ROM) of 83.3% of the normal range was restored. There was a marked improvement in the degree of pain and limp postoperatively. The hip ROM was slightly limited in most patients, and seven patients had limb shortening of between 1 and 3 cm. The mean sharp transverse acetabular inclination of the affected side was 44° (range 35-51) compared with 37° for the unaffected side (P=0.042). The mean uncoverage percentage was 36% (range 24-45) compared with 21% for the unaffected side (P=0.027). The mean epiphyseal index was 0.74 (range 0.36-0.94) before surgery, 0.78 (range 0.49-0.89) at frame removal (P=0.017), and 0.80 (range 0.54-0.91) at the last follow-up (P=0.701). The epiphyseal quotient was 0.74 (range 0.51-0.94) and the Stulberg classifications were type II in eight patients, type III in seven patients, type IV in three patients, and type V in one patient. Arthrodiastasis of the hip joint with soft tissue release may represent a good contribution toward the treatment of Legg-Calvé-Perthes disease. This method of treatment has many advantages such as easy technique, minimal rate of complications, a short hospitalization period, correction of shortening because it adds to the length of the limb, and a higher rate of acceptable results than would be expected compared with other methods. It also improves the ROM, reduces superior and lateral subluxation, and provides better radiographic sphericity of the femoral head. In addition, it does not distort the anatomy of the pelvis or the proximal femur; it can be used with equal success in older children who are typically expected to have a poor prognosis. Distraction treatment is not limited by hip stiffness, degree of femoral head deformity, or subluxation, and can be used when other methods of treatment are contraindicated.

Laparoscopic adhesiolysis and marsupialization of a rapidly progressing pelvic pseudocyst

Pelvic inflammatory cyst, also known as pelvic inclusion cyst, is usually caused by postsurgical pelvic adhesions [1]. Peritoneal fluid and adnexa are entrapped in adhesions and form a pseudocyst, without true cystic walls, with complex appearance. A large, complex pelvic inflammatory cyst can simulate ovarian malignancy and requires laparotomy for maximal debulking surgery. Ultrasound-guided aspiration is the treatment of choice for minimally invasive management of benign cysts; however, recurrence is quite common and repeated aspirations are inevitable, causing considerable morbidity. Laparotomy can definitively resolve the problem of recurrence, but surgeons tend to avoid this procedure because of additional problems such as the need for a wide abdominal incision, wound infection, postoperative pain, postoperative ileus, and adhesion reformation [2]. Laparoscopic surgery is rapidly replacing laparotomy for many gynecologic surgical conditions because of less tissue reaction, better cosmetic results, and shorter hospitalization period. This approach reportedly yields good results for peritoneal and intra-abdominal adhesions [3]. Some authors have indicated a reduction in adhesion formation after laparoscopic surgery compared with open surgery [2]. Here, we present a case of a rapidly progressing pelvic pseudocystmimicking ovarian malignancy in a 41-year-old nulligravida woman who was successfully managed by laparoscopic adhesiolysis and marsupialization. We specifically described our surgical procedures to offer a manner in laparoscopic approach to extensive pelvic cyst.

THE METHOD OF PNEUMATIC IMITATION OF WEIGHT-BEARING IN CHILDREN WITH SHIN FRACTURES

The article contains a comparative analysis of shin fracture treatment in 102 children at the age of 4–18 years old. The main group consisted of 51 (50%) children, who received postoperative treatment according to the method of pneumatic imitation of weightbearing both on health and injured limbs with «Korvit» apparatus. The control group consisted of 51 (50%) patients who did not received the afore-mentioned method of postoperative treatment. The groups were comparable on age, trauma mechanism and localization, surgical operation and complex postoperative therapy. Children of the first group were found to have shorter period of time needed to achievement of pain relief, soft tissue swelling decrease, restoration of the movements in adjacent joints and somatometry values normalization, which allowed earlier verticalization and shorter period of hospitalization.

High-frequency external muscle stimulation in acute kidney injury (AKI): potential shortening of its clinical course

The prognosis of acute kidney injury (AKI) is markedly influenced by the degree of muscle protein catabolism. Since the current therapeutic strategies are rather limited, for the first time, we attempted to attenuate the hypercatabolism by high tone electrical muscle stimulation (HTEMS) in AKI patients. This kind of therapy may lower protein degradation via its effect on muscle activity as well as improving insulin resistance. Moreover, electrotherapy may improve renal function due to circulatory effects as well as lowering the sympathetic tone. 34 patients with AKI Stage 3 were included; all required daily hemodialysis with a dose of Kt/V urea > 1. The patients were randomized into two groups of 17 patients each with and without HTEMS. The groups were comparable with regard to age, gender, underlying diseases, causes of AKI and the baseline biochemistry. HTEMS was performed intradialytically for 1 h. This new electromedical device is characterized by changes in the frequency between 4,100 and 33,000 Hz in short intervals (3 s) and also the amplitude and frequency are modulated simultaneously. The treatment was well tolerated and associated with an improved clinical outcome. As compared to the untreated patients the HTEMS group showed a significant shorter duration of oliguria, a faster decline of serum creatinine and urea levels, less need of dialysis treatment and a shorter period of hospitalization. The decline of urea was more marked than that of serum creatinine resulting in a significant lowering of the urea/creatinine ratio. This finding suggests a reduced catabolism of muscle proteins which - via a lower release of amino acids into the circulation - results in a decline of hepatic ureapoiesis. We hypothesize that in our AKI patients the improved protein catabolism contributed to the shortening of the clinical course of acute renal failure. This study suggests for the first time that HTEMS treatment of patients with AKI during hemodialysis is associated with an improved clinical outcome. To support this novel observation, a randomized controlled trial with a greater number of homogenous AKI patients should be performed.

Functional Recovery of Patients After Stroke

Introduction: Rehabilitation of patients after the stroke is very demanding and complex process, because in addition to damage of motor functions, the patients suffer from the range of other dysfunctions and complications. Timely and early initiation of rehabilitation treatment can reduce the degree of disability; it can result in increased mobility, independent functioning and shorter period of hospitalization. Aim: of this study was to determine the outcome of early rehabilitation treatment of patients suffering from ischemic and hemorrhagic stroke, in relation to their age, sex, degree of disability, and activities of daily living. Subjects and methods: This was a prospective study, which included 50 patients suffering from ischemic stroke and 50 patients suffering from hemorrhagic stroke. All patients were tested on admission and discharge from the hospital. Age and sex of the patients was analyzed, in addition to Rankin scale, used for evaluation of functional disability, and Barthel index used for evaluation of activities of daily living. Results and discussion: The outcome of early rehabilitation treatment was negatively influenced by the older age of patients (p=0.03). Males showed significantly better functional recovery from females (p=0.03). The values of Rankin scale and Barthel index showed significant recovery in all patients on discharge ((p< 0.001), however, these values were statistically more significant in patients with hemorrhagic stroke (Rankin scale p=0.03; Barthel index p=0.04). Conclusion: Older age of patients negatively affects the outcome of early rehabilitation treatment. Male stroke patients showed better results of early rehabilitation treatment. The degree of disability is significantly reduced, while the degree of activity of daily living is significantly improved with the early rehabilitation treatment. However, this was more prominent in patients suffering from hemorrhagic stroke.

GreenLight HPS™ 120‐W laser vaporization vs transurethral resection of the prostate (&lt;60 mL): a 2‐year randomized double‐blind prospective urodynamic investigation

What's known on the subject? and What does the study add? Photovaporization of the prostate (PVP) is now challenging TURP as the standard treatment for lower LUTS caused by BPH. The learning curve for PVP is short and the main advantages of this method over TURP are a shorter period of hospitalization, a shorter period of postoperative vesical catheterization, lower levels of retrograde ejaculation, rare development of dilutional hyponatraemia syndrome, the lack of a need for postoperative vesical irrigation as a result of extremely low indices of postoperative haematuria, and the lack of a need to suspend anticoagulant medication for the surgery. Traditionally, comparisons of the effectiveness of TURP vs PVP have involved parameters such as peak flow urinary rate and post-void residual urine volume measurements, and have employed questionnaires such as the IPSS and the International Index of Erectile Function instruments. However, studies evaluating detailed urodynamic parameters remain scarce and non-comparative The present study compared postoperative, medium-term urodynamic parameters among patients receiving TURP and high-power PVP. We consider the present study to be distinctive because it involved a double-blind, detailed functional analysis of the vesical emptying stage over the course of 2 years, and did not simply comprise an evaluation of clinical parameters and uroflowmetrics. We saw a reduction of infravesical obstruction, as shown by the significant reduction of ≥20 cm H(2)O in the mean micturition pressure for the groups studied, as well as a significant reduction in bladder outlet obstruction index. Thus, the present data show that high-power PVP can achieve and maintain the same results as TURP over a period of 24 months regarding an aspect that is particularly important for maintaining vesical health (i.e. detrusor pressure during the evacuation of the bladder). Such urodynamic data describing the functional outcome of PVP are currently missing from the literature. To assess the impact of GreenLight HPS™ 120-W (American Medical System Incorporation, Minnetonka, MN, USA) laser photovaporization of the prostate (PVP) compared to transurethral resection of the prostate (TURP) on urodynamic results, voiding function and sexual function. In total, 20 men with intermediate/severe lower urinary tract symptoms as a result of benign prostatic hyperplasia (BPH) were randomly selected and equally divided into two groups: TURP and PVP. Urodynamic evaluation was performed and International Prostate Symptom Score (IPSS), International Index of Erectile Function-5 and International Consultation on Incontinence Questionnaire - Short Form questionnaires were completed. The results were assessed at 2 years. Mean IPSS scores were reduced in both groups, although they did not differ between the TURP and PVP groups. There was no significant change in International Index of Erectile Function-5 scores. Half of the patients in the PVP group developed urge urinary incontinence with spontaneous resolution. The urodynamic parameters analyzed showed an improvement for both groups, although the values in the TURP group values were not significantly different from those in the PVP group. Bladder storage symptoms may represent a major concern, although they are of limited duration in patients undergoing PVP. High-power PVP can achieve and maintain the same results as TURP over a period of 24 months.

Comparison Between Local and General Anesthesia for Carotid Endarterectomy: Early and Late Results

The aim of this retrospective study was to compare the results between general and local anesthesia (LA) for carotid endarterectomy (CEA). Three hundred and twenty-nine patients in whom 365 CEA procedures were performed between January 1990 and September 2001, were included in this study. Operation time, shunt usage rates, hospitalization time (P < .0001), and permanent stroke rates (P < .05) were significantly lower in group with LA. For long-term period (121.3 ± 37.45 vs 98.6 ± 28.98 months), no significant difference was observed in these 2 group with respect to restenosis rates, neurological events, and deaths. Despite the lack of significant difference between LA and general anesthesia in terms of restenosis, neurological events, and death in the long-term period; LA is more preferable due its associated advantages including availability of testing the consciousness of the patients by direct contact, reduced use of shunts, shorter hospitalization periods, and less prevalence of permanent stroke in the short-term period.

Comparison between intravenous and thoracic epidural analgesia in single coronary artery bypass graft surgery

Aim: To compare thoracic epidural analgesia with intravenous analgesia in patients who underwent coronary artery bypass grafting surgery. Materials and methods: This retrospective study included 40 patients who had received elective single artery bypass surgery. After general anesthesia, one group was given patient-controlled thoracic epidural analgesia and the other group was given patient-controlled intravenous meperidine analgesia. Patient assessments were performed during the postoperative period and included the duration of hospital stay, pain and sedation scores, ambulation score, atrial fibrillation incidence, and organ morbidities. Results: No differences were detected between the groups in the demographic or intraoperative data. However, a statistically significant difference was detected in favor of thoracic epidural analgesia for the duration of extubation and hospital stay, pain control, sedation grade, mobilization, and quality of recovery scores. Conclusion: After single coronary artery surgery, thoracic epidural analgesia was more effective than intravenous analgesia; it also enabled earlier tracheal extubation and a shorter hospitalization period.

Diagnosis of Respiratory Syncytial Virus Infection

Respiratory syncytial virus (RSV) is one of the most important pathogen causing severe lower respiratory tract infections in all age groups often requiring hospitalization. Rapid laboratory diagnosis of RSV infection significantly decreases the use of antibiotics, additional laboratory testing and is associated with shorter hospitalization periods. The specific diagnosis of RSV infection is based on the detection of virus or viral antigens or virus specific nucleic acid sequences in respiratory secretions. The kind and quality of the clinical specimen exerts a considerable influence on the results of all currently used viral detection assays. Antigen based tests are widely available, easy to perform and the results are available in a short time but their reduced sensitivity and specificity represent a considerable shortcoming. Among the methods available isolation in cell culture was considered the gold standard for the sensitive identification of RSV but is gradually replaced by highly sensitive and specific nucleic acid amplification assays that provide more rapid results. Of these reverse transcription polymerase chain reaction (PCR) was the first and is still the most frequently used nucleic acid-based assay. New methodologies, as for example the real-time PCR methods allow the quantification of viral nucleic acids in the clinical sample. Disadvantages of the nucleic acid based assays are their high costs and their limited standardization.Future research on new methodologies for the diagnosis of viral respiratory tract infections should focus on the development of sensitive, rapid and cost effective test systems allowing the screening for all probable causative agents. In addition varying testing protocols for summer and winter months based on epidemiologic data are needed to direct their practical use.

Markedly reduced rate of diabetic ketoacidosis at onset of type 1 diabetes in relatives screened for islet autoantibodies

To determine whether screening for islet autoantibodies in children prevents ketoacidosis and other metabolic complications at diabetes onset and improves the clinical course after diagnosis. The German BABYDIAB and the Munich Family Study follow children with a first-degree family history of type 1 diabetes for the development of islet autoantibodies and type 1 diabetes. The Diabetes Prospective Documentation (DPV) Initiative registers and collects information on pediatric patients with type 1 diabetes throughout Germany. Here, clinical characteristics at diabetes onset [ketoacidosis, mean hemoglobin A1c (HbA1c), and length of hospitalization] and the 5-yr clinical course (HbA1c and insulin dose) of screened and followed islet autoantibody-positive children (n = 101) and 49 883 non-screened children within the DPV registry were compared. At diabetes onset, children who were followed after screening and were positive for islet autoantibodies had lower HbA1c (8.6 vs. 11%, p < 0.001) and a lower prevalence of diabetic ketoacidosis (3.3 vs. 29.1%, p < 0.001). Screened children also had a shorter hospitalization period at onset (11.4 vs. 14.9 d, p = 0.005). Similar results were observed when the analysis was restricted to 759 non-screened DPV children with a first-degree family history of type 1 diabetes. No differences between screened and non-screened children were observed with respect to HbA1c and insulin dose during the first 5 yr after diagnosis. Screening for islet autoantibodies in children likely leads to earlier diabetes diagnosis resulting in less complications at diagnosis. However, no substantial benefit in the clinical outcome during the first 5 yr after diagnosis was observed.

Comparação das vias radial e femoral nas intervenções coronárias percutâneas: resultados do Registro TotalCor

INTRODUCAO: A intervencao coronaria percutânea (ICP) por via radial ainda e pouco utilizada em nosso meio. O objetivo do presente estudo foi avaliar a prevalencia e os resultados da ICP por via radial, comparada a via femoral, em uma populacao do mundo real. METODOS: Registro unicentrico, com 507 pacientes consecutivos submetidos a ICP pelas vias radial (n = 121) e femoral (n = 386), de acordo com a escolha do operador. RESULTADOS: Os pacientes que utilizaram a via radial (23,9%) eram mais frequentemente do sexo masculino (78,5% vs. 69,9%; P = 0,07) e tabagistas (19,8% vs. 11,7%; P = 0,02), com maior prevalencia de lesoes uniarteriais (59,5% vs. 46,4%), tipo A/B1 (39% vs. 28,4%) e com funcao ventricular preservada (87,1% vs. 73%; P < 0,01). Nesse grupo foram utilizados stents de maior diâmetro e menor comprimento. O sucesso do procedimento foi elevado (97,3% vs. 96,3%; P = 0,56) e a incidencia de obito foi baixa, nao diferindo entre os grupos (0,8% vs. 0,8%; P = 0,96), assim como as taxas de infarto do miocardio (2,5% vs. 2,1%; P = 0,73). Nao ocorreram revascularizacoes do vaso-alvo de urgencia. Os pacientes tratados pela via radial permaneceram menos tempo internados (1 dia vs. 2 dias; P = 0,02) e nao apresentaram complicacoes vasculares (0 vs. 3,4%; P = 0,045). CONCLUSOES: A utilizacao da ICP por via radial representa o dobro da media nacional na instituicao em que o estudo foi realizado, e a escolha de pacientes para essa tecnica trouxe resultados do procedimento equivalentes aos da via femoral, nenhuma complicacao vascular, e reduziu a metade o tempo de internacao hospitalar.

Home treatment of patients with acute cholecystitis

Background Patients with acute cholecystitis are treated in Hospital. The aim of the study was to analyze the security and efficacy of treating not-operated-on patients with acute cholecystitis in Hospital in the Home (HIH). Methods Prospective study from January 2010 to May 2011 including all patients diagnosed with acute cholecystitis, not operated on and without comorbidities admitted to HIH Unit from the Emergency Department Short Stay Unit and Observation Unit. Patients were treated with ertapenem for at least one week. Intravenous treatment was followed by oral therapy to complete 14 days of antibiotic treatment. Patient characteristics, clinical course, need for return to hospital during admission to HIH, and admission to hospital in the month after discharge from HIH are analyzed. Results 25 patients were included. Mean age was 59 years (34–82). Upon arrival to the Emergency Department, all patients suffered abdominal pain, 60% had fever, and 32% vomiting. 48% of patients had a leukocyte count over 13,000 cells/μl. All patients had cholelithiasis and a distended gallbladder. 56% showed thickening of the gallbladder wall. Fluid accumulation around the gallbladder was noted in 16% of the cases. Murphy's sign proved positive in 44%. All patients showed a favorable course. No patient required hospital readmission during stay in HIH or in the month after discharge. All patients expressed their satisfaction with treatment at home. Conclusions Patients with acute cholecystitis and without comorbidities can be safely and effectively treated in HIH after a short monitoring period in hospital.

Robotische Medizin in Deutschland: quo vadis?

Today, one can hardly imagine the medical daily routine without computer-assisted systems, although their benefit usually is not investigated by prospective randomised trials. While in the industrial working environment computer-assisted systems are thoroughly accepted because of their precision and endurance, in medicine there are fierce debates about their use at considerably high costs. At least the perioperative advantages (e.g. less blood loss, shorter period of hospitalization), to a large extent, are beyond dispute. The high costs may be compensated by a higher volume of treated patients. Only the treatment of a higher volume of patients will lead to a reduction of infrastructure costs per case. On the other hand, only a large number of cases ensure the achievement of skills to handle such a complex system. This, in return, reduces the chance of the occurrence of complications and shorter operation times will lead to economic advantages.

Cost-Effectiveness Analysis of Ureteroscopic Laser Lithotripsy and Shock Wave Lithotripsy in the Management of Ureteral Calculi in Eastern China

Introduction: It was the aim of this study to compare the efficiency and safety between shock wave lithotripsy (SWL) and ureteroscopic holmium laser lithotripsy (URL) methods for ureteral calculi while also determining which option is more cost-effective. Patients and Methods: During January 2008 to September 2009, a prospective randomized study was conducted to compare both modalities for the management of solitary radiopaque ureteral stones. Patient and stone characteristics, treatment outcome and charges were documented. Both options were compared using univariate statistical tests to identify the efficiency quotient and cost-effectiveness for ureteral calculi according to the stone location. Results: A total of 257 patients were in the SWL group, while 269 were in the URL group. The efficiency quotients for SWL and URL were 0.81 and 0.88, respectively. The initial stone-free rate of URL for lower ureteral calculi was higher (p = 0.002), while the complication rate of SWL for upper ureteral calculi was lower (p = 0.027). The SWL group required lower hospitalization charges (USD 440 vs. 1,221; p < 0.001), lower total charges (USD 454 vs. 1,284; p < 0.001) and a shorter period of hospitalization (5.4 vs. 6.6 days; p < 0.001) compared with the URL group for all ureteral locations. For mid and lower ureteral calculi, the postoperative office visits of the URL group were fewer (1.03 vs. 1.1 times; p = 0.001). Conclusions: Primary in situ SWL for upper and middle ureteral calculi showed lower complication rates compared to URL and was more cost-effective in Eastern China. However, primary URL was a better option for treating lower ureteral stones with a higher stone-free rate but was more expensive.