Risk associated with diabetes mellitus in patients undergoing gallbladder surgery.

Diabetes mellitus has been suggested as a risk factor in patients undergoing gallbladder surgery. To assess the validity of this observation, a study of 175 diabetic and nondiabetic patients who underwent cholecystectomy of cholecystostomy was undertaken. Eighty patients (40%) were diabetic, and 95 (54%) were nondiabetic. The rates of death and complications were nearly identical in both diabetic and nondiabetic populations. In this selected population renal disease and vascular occlusive disease (with or without diabetes mellitus) resulted in a significant (P less than 0.01) increase in morbidity and mortality rates. Therefore, we conclude that diabetes mellitus alone does not appear to adversely affect the prognosis of patients who require gallbladder surgery.

Selective management of penetrating neck trauma. Cost implications.

Many authors advocate mandatory surgical exploration for all patients with penetrating neck trauma, while other maintain that with careful diagnostic evaluation some patients safely can be spared an operation. From our hospitals, 65 cases of penetrating neck trauma were reviewed, 27 of which showed no mortality without operation. Surgical exploration of the neck showing no injury added $1,930 to the cost of hospitalization. Review of the surgical literature discloses that mortalities reported by authors advocating selective and mandatory exploration are similar. The incidence of missed significant injury is low among patients observed selectively. A management algorithm for the diagnostic evaluation and treatment of patients with penetrating neck trauma is advocated. All stable patients should undergo four-vessel angiography. Studies of the cervical esophagus may be performed. Patients with entirely normal diagnostic evaluations may be observed safely, sparing unnecesary operation.

Femoropopliteal bypass for limb salvage.

A total of 148 femoropopliteal bypass procedures followed for a minimum of 2 years yielded a patency rate of 61.9 percent among survivors. Diabetes mellitus, cigarette smoking, quality of the outflow, or prior inflow procedures did not influence patency rate. Results were less satisfactory in women and when cloth grafts were used. The indications for femoropopliteal bypass require continuing careful assessment.

The use of velour as a vascular prosthesis.

Knitted Dacron cloth fabricated into tubes has gained widespread acceptance as an arterial prosthesis. Continued research and development in the field of vascular prostheses is required because existing materials are not ideal. This paper relates general developments in vascular prosthesis research and focuses on specific results with Dacron velour materials. The nature of the velour surface offers several advantages that are important in designing a more satisfactory prosthesis.

Flexible fiberoscopy of urinary conduits.

During the last 2 years 7 patients with intestinal urinary conduits, exhibiting symptoms of gross hematuria and ureteral stricture or other difficulty with the conduit, were examined with flexible fiberoptic endoscopes. The entire lumen of the intestinal conduit, all urinary-intestinal anastomoses and the bladder of 1 patient were visualized successfully. Retrograde pyelography was performed on 2 patients. In 4 of 7 patients we were able to demonstrate abnormalities that were not demonstrable by any other method.