Laparoscopic-assisted sigmoid colectomy for sigmoid volvulus.

A 75-year-old black man came to the emergency room because of nausea, vomiting, abdominal pain, and distension and obstipation. An abdominal radiograph revealed a sigmoid volvulus. This was nonoperatively reduced in the emergency room. Following a mechanical and antibiotic bowel preparation, the patient underwent elective exploration. We report, for the first time, operative treatment of sigmoid volvulus with a laparoscopic-assisted sigmoid colectomy and primary anastomosis. Because of dense fibrous scarring of the sigmoid mesentery produced by chronic mesosigmoiditis, the redundant sigmoid was exteriorized and resected extracorporeally. A stapled, side-to-side, functional end-to-end anastomosis was constructed. The patient experienced little postoperative pain and virtually no postoperative ileus. We believe that laparoscopic-assisted sigmoid resection may offer distinct advantages for the treatment of the typically elderly, debilitated patient in whom sigmoid volvulus develops. Furthermore, because of the characteristic mesosigmoiditis associated with sigmoid volvulus, we suspect that exteriorization and extracorporeal resection may prove the easiest and most rapid laparoscopic approach to this disease.

Representativeness of the surveillance, epidemiology, and end results program data: recent trends in cancer mortality rates.

BACKGROUND: Mortality, incidence, and survival rates are the primary measures used by the National Cancer Institute (NCI) to monitor cancer in the United States. The Surveillance, Epidemiology, and End Results (SEER) data system collects data on all cancers diagnosed among residents in geographically defined populations, which comprise about 10% of the U.S. population. This data system is the major component of the NCI system for tracking these rates. Thus, it is important to assess the degree to which SEER data are representative of the entire U.S. population. PURPOSE: National data on mortality, but not on incidence or survival, are available from the National Center for Health Statistics. These data provide a census against which mortality data from the subset of the SEER regions may be compared. METHODS: Multivariate regression analyses of age-adjusted mortality rates from 1975 to 1988, computed for the SEER areas and for the entire United States, were performed for race- and sex-specific data from 15 cancer sites. Representativeness was evaluated by testing for differences in trends and levels between the data from the U.S. population and those from the SEER Program. RESULTS: Data from the SEER regions reflected the correct direction of trend for all sites, although some race-, sex-, and site-specific differences existed for the magnitude of the trends and levels of mortality when compared with data from the U.S. population. CONCLUSIONS: The demonstration that data from the SEER population do occasionally yield mortality rates that differ from those for the entire U.S. population suggests that data from the SEER coverage population are, in some cases, not representative of the greater U.S. population. IMPLICATIONS: This issue is of particular relevance to the interpretation of incidence measures, computed from the SEER data, for which there is no national database. Future efforts should be directed at a better understanding of how the SEER population differs from the U.S. population so that SEER rates can be adjusted to be more nationally representative.

The increasing prevalence of acalculous cholecystitis in outpatients. Results of a 7-year study.

Acute acalculous cholecystitis (AAC) is a disease that causes high rates of morbidity such as those traditionally observed in the critically ill. Recently we noted an increase in the de novo presentation of outpatients with this disease. Our aim was to characterize this disease in outpatients, identify risk factors, and assess clinical outcome. Therefore a 7-year review of the Yale experience with AAC was undertaken. Forty-seven patients were identified. Seventy-seven per cent (36 of 47 patients) developed AAC at home without evidence of acute illness or trauma, while 23% (11 of 47 patients) developed the disease while hospitalized. Significant vascular disease was observed in 72% of outpatients. A 38% morbidity rate and 6% mortality rate were observed. We conclude that AAC occurs commonly in elderly male outpatients with vascular disease and that these patients incur significant morbidity in association with this condition. AAC should be suspected and prompt surgical management instituted when these patients present with an acute right upper quadrant inflammatory process.

Self-reported diabetes in Mexican Americans: HHANES 1982-84.

In the Hispanic Health and Nutrition Examination Survey (HHANES) of 3,928 Mexican Americans ages 20-74 years, the age-adjusted prevalence of self-reported diabetes was 6.8 percent among men and 7.6 percent among women. Comparable age-adjusted rates for the US population in a national survey were 2.9 percent in men and 3.8 percent in women. The prevalence of diabetes in Mexican Americans is greater in older age groups, was similar in men and women, and among women only was inversely associated with education.

Sex-specific equivalent retirement ages: 1940-2050.

This article presents four measures of equivalent retirement ages to be considered when analyzing retirement age issues. Insofar as previous research reveals significant sex differences in life expectancy at the older ages, the analysis here extends the question of equity when increased retirement age is considered by examining each measure separately for men and for women. The measures are applied to data from 1940 to 2050. In the first two measures, all improvements in life expectancy at retirement are assigned to the labor force ages; in the second two measures, increases in life expectancy are shared between expected time in the labor force and expected time in retirement. In each case, the increase in life expectancy at retirement was measured both as the expected years in retirement among those surviving to retirement and as the expected years in retirement among all persons entering the labor force. The findings have different implications in terms of equity when an increased retirement age is considered. The article concludes that although it may not be appropriate to establish separate retirement age schedules for men and women, an awareness of existing life expectancy differences between the sexes should help in selecting a middle-range choice.

Differential mortality by sex in fetal and neonatal deaths.

Vital statistics data for the United States from 1922 to 1936 and from 1950 to 1972 were used to analyze fetal and early neonatal mortality. This analysis corroborates the previously established pattern of the sex ratio of fetal deaths--highest from months 3 to 5, lower from months 6 to 7 or 8, and increasing at term. It also indicates a postponement of late fetal deaths into the early infant period. Whereas earlier research reports have described the pattern of the sex ratio of fetal deaths, this report repeats this analysis for a recent national data base. This line of analysis is extended by using the patterns observed in the data to produce an empirical estimate of the primary sex ratio. For 1950 to 1972, this ratio (male to female) is conservatively estimated to be 120:100.