Deep venous thrombosis prophylaxis is not indicated for laparoscopic cholecystectomy.

OBJECTIVES: Recent publications have discussed the risk of deep venous thrombosis during laparoscopic cholecystectomy and the need for routine deep venous thrombosis (DVT) prophylaxis. The purpose of this study was to determine the incidence of clinically detectable DVT in patients undergoing laparoscopic cholecystectomy without a standard DVT prophylaxis regimen. MATERIALS AND METHODS: We performed completed laparoscopic cholecystectomy in 587 patients over a 4-year period. Eighteen of these patients received some form of perioperative DVT prophylaxis, and 569 patients did not. Routine screening with a duplex Doppler was not used. Patients were followed postoperatively for 4 weeks after discharge from the hospital. RESULTS: In an average of 4 weeks follow-up, 31 complications and 4 deaths were reported. These complications included wound infection (16), postoperative bleeding (3), persistent pain (3), pneumonia (3), retained CBD stones (2), asthma (1), papillary stenosis (1), ileus (1), and intraoperative bowel injury (1). None of the 587 patients in this study had symptoms of DVT or pulmonary embolism. DISCUSSION: Despite the fact that DVT in this patient population is rare, many reports suggest the use of routine DVT prophylaxis with sequential compression devices (SCDs) or low-molecular-weight heparin (LMWH). Because no clinically detectable evidence was found of DVT in our study group despite the lack of any perioperative DVT prophylaxis, we question whether routine DVT prophylaxis is indicated or cost effective for routine laparoscopic cholecystectomy. A large prospective trial addressing this question is needed.

Gender differences in determinants of marital disruption.

"Because the family is a highly gendered institution, the authors anticipated that characteristics of husbands and wives would have differing influences on marital disruption. Longitudinal data from the [U.S.] National Survey of Families and Households were used to examine the influence of sociodemographic and attitudinal characteristics of each spouse on the likelihood of marital disruption. In general, wives' variables have a stronger influence than do husbands' variables, suggesting that wives play a greater role in maintenance of marital relationships and are more sensitive to problems in the relationship. The relative influence of each spouse's characteristics is more similar in egalitarian marriages, however. Findings confirm the gendered nature of marital relationships."

Referral of mothers and infants for intensive care.

During 1975-7, 96 mothers were referred to University College Hospital for delivery from 39 other hospitals because their pregnancies were considered to be at very high risk. One hundred of the 111 infants born to the 96 mothers weighed 2500 g or less and 60 weighed 1500 g or less. A high proportion of the infants developed serious illnesses necessitating intensive care. The birth-weight-specific neonatal mortality rates of the infants were much lower than those of infants born in England and Wales as a whole and were also lower than those of the 370 infants transported to this hospital for intensive care after delivery elsewhere. Whenever possible mothers with very high-risk pregnancies should be referred for delivery to centres with full facilities for the intensive care of the mother, fetus, and newborn infant.

Transport of newborn infants for intensive care.

During the three years 1972-4 222 newborn infants were transported to this hospital for intensive care. They were collected by trained staff using a specially modified transport incubator with an in-built mechanical ventilator and facilities for monitoring body temperature, heart rate, and inspired oxygen concentration. Two of the infants came from home and the rest from 41 hospitals from half a mile (0-8 km) to 50 miles (80-5 km) (median eight miles (12-9 km)) away. The mean birth weight of the infants was 1702 g (range 520-4040 g) and their mean gestational age was 32 weeks (range 24-42 weeks). The principal reasons for referral were low birth weight and severe respiratory illnesses. Altogether 109 (49%) of the infants needed mechanical ventilation in transit and another 38 (17%) needed it later. During the journey the condition of 88 (40%) of the infants was thought to improve, in 125 (56%) it was static and in nine (4%)--four of whom died--it deteriorated. A total of 142 infants (64%) survived the neonatal period. There was no correlation between the distance travelled and the survival rate. Seriously ill newborn infants may be transported safely to a referral centre within a radius of 50 miles, and the risks of the journey are negligible compared with the risks of leaving the infant in a hospital that is not staffed or equipped for neonatal intensive care.

Continuous positive airway pressure and mechanical ventilation by facemask in newborn infants.

During a nine-month period 24 newborn infants were treated with continuous positive airway pressure (CPAP) or mechanical ventilation delivered through a facemask. The mask was held in place in a way that minimised trauma and distortion of the head. The median birth weight of the infants was 1096 g and their median gestational age 29 weeks. The usual reason for treatment was hyaline membrane disease or recurrent apnoea due to inadequate control of breathing. Twenty-one of the infants survived. The technique was simple to apply and complications were minimal. We suggest that it may have advantages over other methods of applying CPAP or mechanical ventilation to infants mildly affected by respiratory illnesses and that it should be useful in avoiding endotracheal intubation or reducing the length of time that infants with more serious illnesses are intubated.