Recurrent asystolic cardiac arrest and laparoscopic cholecystectomy: a case report and review of the literature [Case Report]
Laparoscopic surgery has become a durable alternative for both gynecologic and general surgical procedures, but reported complications are increasing. We describe the case of a 70-year-old male undergoing routine laparoscopic cholecystectomy for gallstone pancreatitis who developed asystolic cardiac arrest intraoperatively. A review of the literature revealed 2 cases of asystolic cardiac arrest during laparoscopy: one was during laparoscopic cholecystectomy and one was during diagnostic laparoscopy for gynecologic evaluation.
The prognostic value of the noninvasive vascular laboratory in autologous vein bypasses of the lower extremities
A retrospective study of 34 patients with 29 autologous vein femoropopliteal and 8 femorotibial bypasses was conducted, examining the correlation of angiographic runoff and non-invasive flow determinants as prognostic indicators of early graft occlusion of lower limb bypass grafts. The followup period was 3-27 months, with a mean of 5.8 months. Graft patency and improvement in presenting symptoms were unrelated to preoperative ankle systolic pressure indices. Preoperative and postoperative flow measurements were similar in patients with patent grafts (greater than 12 months) and in those with early graft occlusion (0-6 months, p greater than .05). Preoperative pressure indices did not correlate with calf vessel runoff (p. greater than 05). The data suggest: (1) the noninvasive flow studies are not reliable predictors of future graft patency, (2) vessel runoff is not a reliable predictor of limb flow, and (3) bypass procedures in the lower extremities should not be excluded on the basis of noninvasive flow studies when indicated by other clinical parameters.
Angioplasty for femoral artery occlusion: comparison with surgery
Forty-six patients with superficial femoral artery occlusions (range, 1-20 cm) had percutaneous transluminal angioplasty. The primary success rate was 76% with a late closure in six patients. Life table analysis showed a 1 year patency of 56.8%, maintained at 2 years among the group in whom the successful was 4 cm, while in those in whom the lesion was not crossed, it was 9 cm. Over the same period, 133 femoropopliteal bypass grafts were performed. The patients were comparable as to runoff, incidence of diabetes, and distal ischemia. The 1 year patency was 60.2% and the 2 year patency, 42.1%, largely because of the poor performance of grafts other than saphenous vein. Angioplasty seems to be the treatment of choice for short segment occlusions, and should be used in longer occlusions if saphenous vein is not going to be used.
Twenty-five year experience with primary hyperparathyroidism at Columbia Presbyterian Medical Center
A retrospective review of 500 patients with primary hyperparathyroidism seen from 1951 to 1975 was conducted; the effect of routine screening of calcium and phosphate levels (initiated in 1968) on the incidence and spectrum of the disease was analyzed. The majority of the patients (77%) were diagnosed in the eight-year period after routine biochemical screening was instituted. Comparing the group of patients diagnosed before the advent of biochemical screening and those diagnosed since screening was instituted, we found: (1) a small but significant increase in the number of asymptomatic patients diagnosed (from 2% to 12%); (2) no change in the incidence of related medical disorders, i.e., nephrocalcinosis and hypertension; (3) no change in the incidence of primary hyperplasia and adenoma; and (4) no change in the mean serum calcium level, the mean age at diagnosis, or the number or location of the involved parathyroid glands. Although routine calcium screening has identified significantly more cases of primary hyperparathyroidism, screening apparently does not enable diagnosis at an earlier stage.