Laparoscopic vs open appendectomy. A randomized clinical trial.

BACKGROUND: A randomized clinical trial was performed to compare open appendectomy (OA) and laparoscopic appendectomy (LA). METHODS: 201 patients with similar characteristics of appendicitis were randomized to either OA or LA. Operative time and technique, reintroduction of diet, postoperative pain, use of analgesia, hospital stay, and complications were documented. RESULTS: 104 patients were allocated to the OA group and 97 to the LA group. Postoperative pain was significantly less in the LA group on the 1st (p < 0.001) and 2nd (p < 0.001) postoperative day, resulting in less use of analgesics on both days (p < 0.001). Restoration of diet was similar in both groups. Mean operative time was longer in the LA group: 61 vs 41 min (p < 0.001). Postoperative complications did not differ in either group, except for wound infections (six OA group vs zero LA group, p < 0.05). Mean hospital stay was similar in both groups. CONCLUSIONS: LA results in less postoperative pain and fewer wound infections. The laparoscopic procedure is technically more demanding to perform, resulting in longer operative time.

Comparative cell culture effects of shape memory metal (Nitinol), nickel and titanium: a biocompatibility estimation.

Nitinol is an equiatomic alloy of nickel and titanium which has been attracting increasing interest in the field of biomedical engineering. To quantify toxicity as a preliminary evaluation of biocompatibility, inhibition of mitosis in human fibroblasts in tissue cultures exposed to test materials is an accepted screening method, although a dose-effect relationship had never been investigated. In this experiment, the effect of an increasing dose exposure to Nitinol, nickel or titanium on human fibroblasts in cell cultures was tested in subgroups in comparison with a control group. The results showed that nickel induces a significant (p < or = 0.05) inhibition of mitosis in human fibroblasts, whereas no significant effects of this kind were found for titanium or Nitinol. According to the results of these studies, Nitinol is to be considered in this respect biocompatible and comparable to titanium, which would seem to justify application as a surgical implant.

Sharp thoracic injury.

In an effort to develop effective rules for the management of penetrating thoracic injuries, all records of 515 patients treated for sharp chest injuries between 1961 and 1985 at the University Hospitals of Amsterdam (Binnengasthuis, Wilhelmina Gasthuis and Academic Medical Centre), were reviewed. The analysis reveals that of these patients 321 (62 per cent) could be treated conservatively, because of a non-penetrating injury, while 140 had a penetrating injury, of whom 77 had to be operated on. Eleven patients died (2.1 per cent). Data concerning these patients are discussed separately. Based on our analysis, and supported by recent literature, an aggressive approach towards penetrating thoracic injury in haemodynamically unstable patients is justified.