ABSTRACT
BACKGROUND: Laparoscopic colorectal surgery (LCS) performed in tertiary care centers has been well studied. It has been shown to provide improved short-term outcomes and comparable long-term outcomes to the conventional open approach. However, LCS performed in a community hospital setting has not been well studied. In a previous paper, we presented the short-term outcomes of 100 LCS performed by two community surgeons with no formal training in LCS. In this follow-up study, we present both short- and longer-term outcomes for 250 patients who underwent LCS. METHODS: This is a prospective study of 250 consecutive patients who underwent LCS at the North Bay District Hospital (a 200-bed community hospital located 350 km away from the nearest tertiary care center). RESULTS: Between October 2000 and October 2006, 250 consecutive patients (130 women and 120 men, mean age of 64.4 +/- 13.7 years) underwent LCS for benign (N = 129) and malignant (N = 121) disease. Median operating time was 215.0 min (58.0-475.0 min) and the conversion rate was 7.2%. The intraoperative complication rate was 2.8%. There were 20 (8.0%) major postoperative complications and 42 (16.8%) minor postoperative complications. There was no intraoperative mortality. There were six 30-day mortalities due to ischemic bowel (1), stroke (1), myocardial infarction (3), and pneumonia (1). The median length of stay was 4.0 days (2.0-55.0 days). Disease-free survival for stages I-IV colorectal cancer (CRC) was 100, 97.2, 71.4, and 10% for a mean follow-up time of 36.9, 29.3, 27.9, and 21.1 months, respectively. The mean number of resected lymph nodes was 11.5 +/- 8.6. CONCLUSION: We note that both our short and longer-term outcomes are similar to tertiary care centers. We therefore conclude that LCS can be performed in a community hospital setting with both short- and longer-term outcomes similar to tertiary care centers.
Subject(s)
Colonic Diseases/surgery , Community Health Services , Hospitals, Community , Hospitals, District , Laparoscopy , Rectal Diseases/surgery , Aged , Clinical Competence , Cohort Studies , Colectomy , Colonic Diseases/pathology , Female , Humans , Male , Middle Aged , Rectal Diseases/pathology , Retrospective Studies , Treatment OutcomeABSTRACT
Real-time ultrasound and portable bladder scanners are commonly used instead of catheterisation to determine bladder volumes in postnatal women but it is not known whether these are accurate. Change in bladder volumes measured by ultrasound and portable scanners were compared with actual voided volume (VV) in 100 postnatal women. The VV was on average 41 ml (CI 29 - 54 ml) higher than that measured by ultrasound, and 33 ml (CI 17 - 48 ml) higher than that measured by portable scanners. Portable scanner volumes were 9 ml (CI -8 - 26 ml) higher than those measured by ultrasound. Neither method is an accurate tool for detecting bladder volume in postnatal women.
Subject(s)
Urinary Bladder/diagnostic imaging , Urodynamics , Adolescent , Adult , Female , Humans , Sensitivity and Specificity , Ultrasonography/methods , Urinary Catheterization , UrineABSTRACT
Given the large number of cholecystectomies performed annually, a nonsurgical approach to gallstone therapy is of great interest. A laboratory ultrasound system has been developed to study enhancement of methyl-tert-butyl ether (MTBE) dissolution of human gallstones in vitro. A mathematical model that quantitatively characterizes the dissolution process via a rate constant has been developed. Using this model, the kinetics of 15 gallstones from a single patient were evaluated for three dissolution methods: 1) unstirred MTBE, 2) aspirated MTBE, and 3) ultrasonically enhanced MTBE. The results showed excellent fits between the model and measured dissolution rates. 195 kHz continuous-wave (CW) ultrasonically enhanced dissolution rates exhibited a 6.2 fold gain over the manually aspirated MTBE and a 49.5 fold gain over static MTBE dissolution. Investigation of 50% duty cycle pulsed mode ultrasound revealed that total power appears to be the determinant of the observed dissolution rates. Gallstone calcification showed a strong correlation with dissolution rates measured by the model.
Subject(s)
Cholelithiasis/therapy , Ethers/therapeutic use , Methyl Ethers , Ultrasonic Therapy , Cholelithiasis/drug therapy , Combined Modality Therapy , Evaluation Studies as Topic , Humans , In Vitro Techniques , Solvents/therapeutic useABSTRACT
Evoked potentials (EP) contain information about various physiological parameters and the estimation and detection of these signals can aid in the diagnosis of many pathological conditions. However, the signal-to-noise ratio (SNR) for EP measurement is often very low, and thus signal processing techniques must be employed to enhance the SNR. A delay and sum beamformer acquisition system has the potential for significant SNR improvement in EP measurements. In this communication it is shown that an electrode array acquisition system implements a uniform coherent delay and sum beamformer. The performance of the beamformer is characterized in terms of the number of electrodes, and cross-channel correlation. When compared to conventional ensemble averaging, the beamformer reduces the number of response repetitions required to achieve a given SNR by a factor which approaches the number of channels in the acquisition system.
