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.

Effect of cryoprotectants on the viability and function of unfrozen human polymorphonuclear cells.

High concentrations of membrane permeable cryoprotectants are necessary to protect human polymorphonuclear leukocytes from osmotic stress injury during freezing, but there are reports that some cryoprotectants are chemically toxic. Cells were exposed to various concentrations of glycerol, dimethyl sulfoxide, or ethylene glycol for 5 min to 2 hr at 37, 22 or 0 degree C, adding or removing the cryoprotectant either slowly or rapidly. Assays included cell number recovery, membrane integrity, phagocytosis, microbicidal ability, and chemotaxis. We conclude that (1) 1 and 2 M concentrations generally are not toxic if they are added and removed slowly at 22 degrees C; (2) addition and removal of glycerol at 0 degree C was injurious even at 1 M; (3) slow addition and removal allowed better recovery than rapid addition or removal; (4) salt concentration in cryoprotectant solutions should be adjusted to isotonic on the basis of moles per liter of solution, rather than moles per kilogram of water; (5) the toxicity reported by other investigators can be largely explained by osmotic stress or dilution shock rather than chemical toxicity; and (6) ethylene glycol is the easiest cryoprotectant to add to and remove from these cells.