Laparoscopic posterior mesh rectopexy for rectal prolapse is a safe procedure in older patients: A prospective follow-up study.

BACKGROUND AND AIMS: The aim of this study is to examine the clinical and functional outcome of laparoscopic posterior rectopexy in a consecutive series of adult patients with full-thickness rectal prolapse. MATERIAL AND METHODS: Preoperative data on demography, life-style practices, medication, comorbidity, and previous surgery for rectal prolapse were ascertained from patient charts. Information on operative procedure, and pre- and postoperative complications were recorded. Short- and long-term follow-up were done after a median of 60 days and 2 years after surgery. RESULTS: Between 1 February 2009 to 1 June 2012, 81 laparoscopic posterior rectopexies were done. Male-to-female ratio was 4:77, median age 73 [57-80.5] years and median ASA Grade 2. Conversion to open surgery was done in 6.2%, the median operating time was 82 min [66 - 102] and median length of hospital stay was 2 days [2-5.7]. Minor and major complications were seen in 5.3% and 14.8%, respectively. The 30-day mortality rate was 1.2%. Constipation or incontinence improved or disappeared in 65.2% and 74.4%, respectively. The cumulated recurrence rate was 11.1% after a median observation time of 2 years. CONCLUSION: Laparoscopic posterior rectopexy is a safe and well-tolerated procedure in older patients and can be done with acceptable complications and recurrence rates and short hospital stays. Laparoscopic posterior rectopexy seems to improve bowel function in many patients.

Effect of laparoscopy on bacteremia in acute appendicitis: a randomized controlled study.

Laparoscopic appendectomy is increasingly used in treating acute appendicitis. Several controlled series have demonstrated the clinical benefit of the procedure. However, some basal pathophysiologic changes caused by the laparoscopy still need clarification, i.e., whether laparoscopy can give rise to bacteremia. The purpose of this randomized controlled study in 30 patients undergoing surgery due to suspected acute appendicitis, either by an open classic technique or by a laparoscopic technique, was (by collecting samples for blood culturing pre-, peri-, and postoperatively) to evaluate whether laparoscopy during carbon dioxide pneumoperitoneum could induce bacteremia. Six patients of 12 in the group treated by laparoscopy presented positive blood cultures peri- and postoperatively. No positive blood cultures were demonstrated in the open operated group. The difference was significant (P = 0.0183). The clinical significance of these findings should be clarified in further clinical investigations.

Changes in sexual behavior after orthopedic replacement of hip or knee in elderly males--a prospective study.

The aim of this study was to investigate two questions: Does arthroplastic surgery affect the patient's status as being sexually active; and if patients are sexually active, does surgery affect their erectile function? The study was designed prospectively and the patients filled in a questionnaire concerning sexuality and erectile function before and 6 months after alloplastic hip-or knee surgery. Ninety-nine males were included, mean age 70.6 y. The results demonstrate that 17% of patients lost a sexual activity that they had preoperatively, and no one regained sexual activity after surgery. A correlation between increasing age and risk of losing sexual activity was demonstrated. 26.1% lost a normal erectile function they had preoperatively, while 6.7% regained normal erections. A similar correlation between increasing age and increased risk was demonstrated. From this study of elderly males undergoing orthopaedic alloplastic surgery it is concluded that the risk of losing sexual activity and erectile capability is increased after surgery, and especially in the group where sexual functions are already impaired.

Fat and mesenteric blood flow.

BACKGROUND: The introduction of fat to the duodenum leads to an increase in mesenteric blood flow. The exact mechanism, however, is unknown. In this study we investigate the influence of the terminal carboxy group of the oleic acid molecule on superior mesenteric artery blood flow. METHODS: In six healthy male volunteers duplex ultrasound was used to evaluate the effects of duodenal perfusion of 48 mmol oleic acid and 48 mmol oleyl alcohol on superior mesenteric artery blood flow variables and diameter. RESULTS: The blood flow variables time-average velocity and maximal diastolic velocity increased significantly, and the resistance index decreased significantly during perfusion with oleic acid, but during oleyl alcohol perfusion no changes were found. No significant changes in vessel diameter were observed at any time. CONCLUSION: The carboxy group of the oleic acid molecule has an important role in the duodenum in mediating the postprandial increase in superior mesenteric artery blood flow.

Initial sensorimotor and delayed autonomic neuropathy in acute thallium poisoning.

In a 27-year old male with acute thallium poisoning, signs of initially severe sensorimotor neuropathy with complete remission after two weeks were demonstrated. Signs of cardiovascular autonomic neuropathy were initially absent, but developed after a latency period of one week with marked improvement after seven months. Delayed autonomic neuropathy may be caused by a late affection of small unmyelinated autonomic nerve fibers.

Intertrochanteric femoral fractures: a new method for predicting the risk of failure.

A consecutive series of intertrochanteric fractures treated with sliding screw and plate fixation were radiographically evaluated for the optimal position of the screw. An optimal position was determined. It was characterized by four position indexes in the head-neck region.