[Laparoscopic approach of the ovarian cyst tumors]. / Abordarea laparoscopica a tumorilor chistice de ovar.

Given the continuous technical upgrade and increased surgical expertise, laparoscopy is replacing laparotomy in day-to-day gynecological surgical practice. Laparoscopic management offers many advantages for the patient: accurate diagnosis, minimal bleeding, reduced need for analgesia, less adhesion formation, fast recovery, better cosmetic results, shorter hospital stays (one day surgery in selected cases), and reduced costs for the patient and hospital.

Unexpected findings on laparoscopy for suspected acute appendicitis: a pro for laparoscopic appendectomy as the standard procedure for acute appendicitis.

PURPOSE: Evaluation of the feasibility, cost-effectiveness, time of surgery, morbidities, and other/additional findings during laparoscopy for suspected appendicitis. METHODS: Prospective evaluation of 148 laparoscopies for suspected acute appendicitis. RESULTS: Laparoscopic appendectomy was safe and cost-effective. No appendiceal stump leaks or wound infections occurred. Of the patients, 4.7% developed intra-abdominal abscesses. Mean time of all procedures was 47 min: 42 min for simple appendectomies (n = 126), 67 min for perforated appendicitis (n = 15), and 75 min for converted procedures (n = 7). Twenty-one of 148 (14.2%) patients had unexpected findings instead of appendicitis: inflamed epiploic appendices (three times), inflammatory disorders of intestine (five times), intestinal adhesions (two times), ovarian cysts (six times: one time with mesenteric lymphadenitis, one time ruptured), tubo-ovarian abscess (one time), tubal necrosis (one time), adnexitis with mesenteric lymphadenitis (one time), and acute cholecystitis (one time). These diagnoses might have been missed during conventional open appendectomy and were, if necessary, treated during laparoscopy. CONCLUSIONS: Laparoscopic appendectomy should be recommended as standard procedure for acute appendicitis.

Economic impact of extracolonic findings at computed tomographic colonography.

OBJECTIVE: To determine the prevalence of extracolonic findings at computed tomographic colonography (CTC) and estimate the cost of the workup of newly discovered potentially significant lesions. SUBJECTS AND METHODS: An electronic information system was used to review all patient data before and after the CTC in a mixed cohort of 376 patients. Extracolonic findings were categorized into the CT Colonography Reporting and Data System classification. The impact of additional diagnostic workup was estimated using Medicare reimbursement for relevant extra services. RESULTS: There were 51 patients (13.6%) with E3 and 16 (4.3%) with E4 findings. At least 1 extracolonic finding was found in 272 patients (72.3%). There were 520 extracolonic findings, of which, 447 (86.0%) were classified as low clinical significance, E2. Only 7 (12.5%) of 56 E3 lesions and 7 (41.2%) of 17 E4 lesions received additional diagnostic workup. The total additional cost of evaluating E3 and E4 lesions was $13.07 per CTC. CONCLUSIONS: A mixed (screening and nonscreening) CTC population has a low prevalence of high-risk lesions, and the additional cost of their evaluation is relatively small.

Economic comparison of timed artificial insemination and exogenous progesterone as treatments for ovarian cysts.

The objective of this study was to compare the economic benefits of timed artificial insemination (AI) and a progesterone insert as therapeutic treatments for cows diagnosed with cystic ovarian disease (COD). A secondary objective was to illustrate the use of a stochastic dynamic simulation model to fully account for all changes in revenues and costs affected by differences in treatments. First, 4 herds of 1,000 cows each were simulated until steady state. These cows were free from COD and inseminated based on estrus only. Herds differed by probability of estrus detection (46 or 70%) and days in milk (DIM) when nonpregnant cows were culled (330 or 400 d). Second, 3 herds were created with 1,000 nonpregnant cows at 90, 170, or 250 DIM. These cows were considered diagnosed with COD at the start of the simulation (d 0); no new cases of COD developed after d 0. Cows spontaneously recovered or were treated. Treatments were either timed AI or intravaginal device containing progesterone followed by PGF(2alpha) and then AI if estrus was detected. Effects of treatments were evaluated in 48 scenarios based on compliance of timed AI (82 or 100%), probability of estrus detection (46 or 70%), and DIM when nonpregnant cows were culled (330 or 400 d). As cows became pregnant or were replaced, the herd evolved into the associated steady-state herd. Seven scenarios resulted in less than 50% of cows conceiving before they were culled. The percentage of cows diagnosed with COD that calved again ranged from 14.0 to 74.4% and was significantly reduced when COD was diagnosed later in lactation. Treatments in all cases were more valuable than waiting for spontaneous recovery. The average values of timed AI (82 or 100% compliance) and the progesterone insert were 83.29 dollars, 86.83 dollars, and 71.89 dollars, respectively, compared with waiting for spontaneous recovery. Treatments were least beneficial at 90 DIM. The benefits of timed AI (82 or 100% compliance) compared with the progesterone insert, adjusted for DIM and days to culling, were 14.98 dollars and 21.53 dollars when the probability of estrus detection was 46%. At 70% probability of estrus detection, the benefits were 7.81 dollars and 8.34 dollars, respectively. Overall benefit of treatment by timed AI was 11.39 dollars greater than by progesterone insert.

Risk factors and the economic impact of ovarian cysts on reproductive performance of dairy cows in Korea.

The objectives of this study were to determine the risk factors for development of postpartum ovarian cysts by evaluating several reproductive factors in individual cows, and to determine the economic impact of ovarian cysts on subsequent reproductive performance in dairy herds in Korea. The data, including cow parity, abnormal puerperium, endometritis, body condition score (BCS), and breeding status were collected from 634 cows in 9 dairy herds. We used logistic regression to evaluate the effects of these factors on ovarian cysts. A stepwise procedure, used to obtain the appropriate model with alpha=0.05, revealed that cow parity was the most important risk factor for ovarian cyst development within 8 weeks postpartum, while development of endometritis and BCS loss>or=1 from the dry period to 8 weeks postpartum were the most important risk factors for ovarian cyst development beyond 8 weeks postpartum. The occurrence of ovarian cysts beyond 8 weeks postpartum prolonged (P<0.01) the mean intervals from calving to first service (27 days) and conception (77 days), and increased (P<0.05) the culling rate (7.8%), while ovarian cyst development within 8 weeks postpartum did not affect (P>0.05) the mean intervals from calving to first service and conception or the culling rate. The economic loss resulting from the occurrence of ovarian cysts was estimated at approximately 823,996 won ($687) due to effects on the cost of nutrition, average growth of calves, labor and medical costs, and culling. These results suggest that cow parity is correlated with the development of ovarian cysts within 8 weeks postpartum, and endometritis and BCS loss>or=1 from the dry period to 8 weeks postpartum are correlated with the development of ovarian cysts after 8 weeks postpartum, which decreases reproductive performance and results in economic loss in dairy herds in Korea.

[Surgical treatment of ovarian cysts: economic analysis as a means for the evaluation of alternative technics. Results of a biennial study]. / Trattamento chirurgico di cisti ovariche: analisi economica come strumento di programmazione e di valutazione di tecniche. Risultati di un'indagine su un biennio.

The large use of new gynaecological technologies such as the operative laparoscopy, requires both efficacy and efficiency evaluation. The aim of this work is to compare costs of the surgical treatment of ovarian cysts between two groups of patients--35 patients undergone to laparotomic cystectomy (age: mean 27.5) and 34 operated by laparoscopic technique (age: mean 27). The analysis of the costs, related to three steps of health care (pre-operative, operative, post-operative) shows that the laparoscopic cystectomy results the more efficient intervention (L. 6,244,808 vs L. 8,310,002). This economic analysis may offer a planning tool for health care to hospital managers and represent an efficiency evaluation criterion of surgical techniques employed by the gynaecologists.

Treatment of ovarian cysts in dairy cattle. A decision analysis.

A formal decision analysis was done to answer the question: At what day post partum does it become cheaper to treat ovarian cysts with gonadotropin-releasing hormone than to wait for spontaneous recovery?