ABSTRACT
OBJECTIVE: To assess whether sound economic reasons exist for the wider introduction of laparoscopic cholecystectomy in Australia. DESIGN: A retrospective survey of patients who underwent laparoscopic cholecystectomy. We compared time of hospital stay and time off work after laparoscopic cholecystectomy with data for open cholecystectomy. PATIENTS AND SETTING: Seventeen participating surgeons in four Australian States allowed access to patients treated between May 1990 and November 1991 (1254 patients in all). MAIN OUTCOME MEASURES: Patient acceptability of the procedure, average length of postoperative in-hospital stay, and the savings associated with earlier return to work compared with open cholecystectomy. RESULTS: Almost 90% of patients (1127) replied and 1088 responses were considered appropriate for analysis. Serious complications were rare; 96% of patients thought the technique was successful. The mean length of in-hospital stay was 2.6 days (range, 1-120), compared with a mean of 8.7 days for open cholecystectomy. Among working patients, the mean time to return to work was 11.6 days (range, 10.7-13.1), an estimated 27 days sooner than after open cholecystectomy. Extrapolating from these results, replacing 95% of open cholecystectomies with laparoscopic procedures would have 133,285 hospital bed-days and 500,000 work-days each year. CONCLUSION: Laparoscopic cholecystectomy is safe and effective. Its wider use in Australia would result in savings to both the individual and the national economy.
Subject(s)
Cholecystectomy, Laparoscopic/economics , Absenteeism , Adult , Aged , Aged, 80 and over , Australia , Cholecystectomy/adverse effects , Cholecystectomy/economics , Cholecystectomy, Laparoscopic/adverse effects , Cost Savings , Cost of Illness , Costs and Cost Analysis , Employment , Female , Hospitalization/economics , Humans , Length of Stay/economics , Male , Middle Aged , Patient Acceptance of Health Care , Patient Satisfaction , Retrospective Studies , Sex FactorsABSTRACT
Serologic studies in a male Caucasian presenting with an acute hepatitis-like illness, associated with an increase in peripheral blood large granular lymphocytes (LGLs), suggested a chronic or reactived Epstein-Barr virus (EBV) infection. The LGL were shown to have a natural killer (NK) cell, CD3- CD16- CD56+ CD57- phenotype and mediated strong nonspecific major histocompatability complex-unrestricted (NK) cytotoxic activity. A progressive increase in the peripheral blood LGL count was associated with a rapid deterioration, hepatic necrosis, and death. Widespread organ infiltration with LGLs suggested a malignant lymphoproliferative condition, but no lymphoid (T-cell receptor or IgH) gene rearrangement or cytogenetic marker was detected. However, molecular analysis identified EBV genomic DNA present in a single episomal form within the LGL, establishing the clonal nature of the LGL proliferation. Confirmation that the EBV had infected the leukemic LGL was obtained by in situ hybridization studies that showed EBV RNA within the LGLs. Immunoblotting of LGL protein extracts established that, of the EBV gene products, EBV nuclear antigen-1 (EBNA-1) was expressed but EBNA-2 and the latent membrane protein (LMP-1) were not detectable in the leukemic cells. These results suggest that EBV may be involved directly in LGL cell transformation, in a manner similar to EBV-associated B-cell lymphomas, although other molecular changes probably contribute to the evolution of a fully malignant leukemic clone.
