Mortality risks of mentally retarded and mentally ill patients after a feeding gastrostomy.

Feeding gastrostomy procedures were performed on 9 mentally ill and 30 mentally retarded, institutionalized patients. The postoperative mortality was 0 percent (0/9) for the mentally ill and 13 percent (4/30) for the mentally retarded patients. Mortality within 1 year after the operation was 11 percent (1/9) for the mentally ill and 33 percent (10/30) for the retarded patients. This study revealed three important factors that affect mortality risks: the identification and elimination of a gastroesophageal reflux before surgery, the monitoring and improvement of the nutritional status both before and after surgery, and the evaluation and treatment of respiratory problems both before and after surgery. If care in these areas is improved, then the mortality risks for retarded patients will decrease.

Surgical management of acute diverticulitis in women.

The incidence of diverticular disease of the colon has increased during the course of this century. The management of diverticulitis has changed in many centers from a conservative medical approach to a more aggressive surgical one. The surgical technique has also evolved; primary resection and anastomosis is currently preferred after a standard bowel preparation. The authors reviewed the medical histories of 387 women who had undergone abdominal operation for acute diverticulitis at the Mayo Clinic during a recent 8-year period. Of the 387 patients, 71 (18.3%) had presented with a pelvic mass and 84 (21.7%) had the operation performed by a gynecologic surgeon. The preoperative evaluation, type of operation, morbidity, and mortality in the entire group and in the group managed by a gynecologic surgeon were studied and compared.