ABSTRACT
Multiple endocrine neoplasia (MEN) Type I syndrome is a rare tumor of unknown etiology with a prevalence of 0.02 to 0.2 per 1000. Some of the tumors associated with MEN I include pituitary adenomas, parathyroid adenomas, hyperplastic tissue, and pancreatic B and non-B islet cell tumors. The clinical presentation is usually secondary to the specific hyperfunction characteristic of the different endocrine glands. Hyperparathyroidism and hypercalcemia precede all other manifestations in the majority of cases. Surgery plays a major role in management, and the condition should be considered when a tumor is diagnosed along the endocrine axis of glands, especially in hyperparathyroid patients.
Subject(s)
Multiple Endocrine Neoplasia Type 1/surgery , Adenoma/surgery , Adenoma, Islet Cell/surgery , Adult , Female , Follow-Up Studies , Humans , Hypercalcemia/surgery , Hyperparathyroidism/surgery , Hyperplasia , Pancreatic Neoplasms/surgery , Parathyroid Diseases/surgery , Parathyroid Neoplasms/surgery , Pituitary Neoplasms/surgeryABSTRACT
BACKGROUND: Few studies have examined the results of laparoscopic cholecystectomy (LC) in the elderly. We reviewed our experience with the procedure in 194 patients age 65 and older. METHODS: A chart review was performed on patients who underwent attempted LC over a 4-year period. Age, conversion rate to open cholecystectomy (OC), length of stay, and morbidity and mortality rates were compared between elective and inpatients as well as between patients age 65-75 and patients over age 75. RESULTS: Conversion rate to OC was 10.6%. Mean length of hospital stay was 2.7 days. Morbidity and mortality rates were 18% and 1%. Elective patients experienced significantly fewer medical complications. There were no differences in complication rates between patients age 65-75 and patients over 75 years, but younger patients had a significantly shorter mean length of hospitalization. CONCLUSIONS: Elderly patients experience more complications and longer lengths of stay than the general population. However, our results compare favorably with OC series in elderly patients.
Subject(s)
Cholecystectomy, Laparoscopic , Age Factors , Aged , Aged, 80 and over , Cholecystectomy/adverse effects , Cholecystectomy, Laparoscopic/adverse effects , Elective Surgical Procedures , Heart Diseases/complications , Hospitalization , Humans , Length of Stay , Lung Diseases/complications , Postoperative Complications , Retrospective Studies , Survival Rate , Urinary Retention/complicationsABSTRACT
Carbon dioxide pneumoperitoneum (PP) during laparoscopic cholecystectomy (LC) causes hypercapnia and acidemia. Thermocautery carbon monoxide formation during LC was studied in 15 patients. CO samples were read by electrochemical sensor as parts per million (ppm) and obtained intraperitoneally at PP, gallbladder takedown (GBTD), and exhalation. In blood, CO was measured by spectrophotometry as percentage of carboxyhemoglobin (HbCO) during anesthesia induction, at end of PP, at GBTD, and in the recovery room. Heart rate, mean arterial pressure, oxygen saturation, and end-tidal CO2 were followed prospectively. Data were analyzed by analysis of variance and Student's t test. In 35 min, thermocautery increased intraperitoneal CO from 4.7 +/- 3.8 ppm at baseline to 326 +/- 360 ppm at GBTD (p < 0.004). HbCO increased from PP to GBTD (0.7 +/- 0.6 vs. 1.2 +/- 0.7%; p < 0.01). Thermocautery produces high levels of CO intraperitoneally, which are absorbed into the circulation. Exposure time is short, which may explain the lack of hemodynamic and oxygenation changes.
