Laparoscopically assisted vaginal hysterectomy at a health maintenance organization. Cost-effectiveness and comparison with total abdominal hysterectomy.

Fifty laparoscopically assisted vaginal hysterectomies (LAVHs) were compared with 46 total abdominal hysterectomies (TAHs) at a health maintenance organization for operating time, preoperative and postoperative hematocrit, estimated blood loss, major and minor complications, length of hospital stay and disability until return to normal work duties. Indications for surgery, parity and weight were similar for both groups. Although operating time and blood loss were greater for LAVH, hospital stay was statistically significantly shorter, disability time was shorter, and return to normal activity was sooner. The cost of nonreusable instruments was $1,250 per case, far lower than in other settings. The potential for a shorter recovery time and real cost savings would be considerable if LAVH could convert an abdominal to a vaginal approach.

Laparoscopic removal of ovarian lesions. A report of two cases.

Removing dermoid cysts laparoscopically can be time-consuming and tedious, and adhesions may develop after surgery. We describe the use of an endoscopic pouch to remove apparently benign ovarian cysts in two cases. This method permits removal of ovarian lesions with little or no risk of intraperitoneal spillage. We believe that its use in laparoscopic removal of tumors or cysts is a reasonable alternative to more traditional approaches and should be considered if laparoscopic treatment is planned.

Laparoscopic management of bile peritonitis after liver biopsy.

Bile peritonitis is an infrequent complication of liver biopsy and is usually treated by supportive care or laparotomy. Fever, peritoneal signs, and hemoconcentration developed in a 56-year-old man 7 hr after biopsy. At laparoscopy, a large amount of cloudy, bilious fluid was aspirated using a suction-irrigation device. No liver injury or bile leak was seen. The patient gradually improved and, although he required percutaneous drainage of the subhepatic bile collection, did well. This case illustrates the new use of laparoscopy to manage bile peritonitis after liver biopsy. Compared with conventional laparotomy, this procedure has the advantages of lower intraoperative risk, shorter recovery time, and superior visualization of peritoneal contents.

[The simulation of mental disorders. 2. Other psychopathological and psychosociodynamic aspects]. / La simulation des troubles psychiques. 2. Les autres aspects psychopathologiques et psychosociodynamiques.

The output and presentation of unauthentic symptoms, or more or less roughly exaggerated, effected intentionally, can only create conceptual and semantic difficulties to the observer when, well informed by the context, he suspects a utilitarian objective from the individual person. The problem of malingering, seed of pathology, refers to questions on the expert's role and his way of collaboration with the petitioning authority.