Experimental comparison of mesenteric vessel sealing and thermal damage between one bipolar and two ultrasonic shears devices.

BACKGROUND: Several instruments are available for open and laparoscopic dissection, including electrothermal bipolar vessel sealers and ultrasonically coagulating shears. The vessel sealing ability of three devices in colorectal specimens was compared in an experimental study. METHODS: Surgical specimens from patients scheduled for elective open or laparoscopic colorectal resection were allocated to one of the three devices. After removal of the surgical specimen, up to eight mesenteric vessels were dissected ex vivo and sealed using the allocated instrument. The vessel seal was tested for the maximum pressure at which it leaked and then assessed by a pathologist for depth of thermal tissue damage. RESULTS: A total of 93 vessels from 18 patients were assessed ex vivo (LOTUS™ n = 33; Harmonic Ace® n = 30; LigaSure™ n = 30), a median of 6 (range 1-8) vessels per surgical specimen with a mean(s.d.) diameter of 1·06(0·70) mm and wall thickness of 0·29(0·19) mm. Mean(s.d.) bursting pressures were 1170(440), 1470(670) and 1510(740) mmHg with LOTUS(™) , Harmonic Ace® and LigaSure™ respectively. ANCOVA showed no difference in bursting pressure between the instruments (P = 0·058). The depth of thermal damage was significantly greater with LigaSure™ (3·37(1·44) mm) than with LOTUS(™) (2·18(0·99) mm; P < 0·001) or Harmonic Ace® (1·95(0·92) mm; P < 0·001). CONCLUSION: All three instruments were equally good at sealing blood vessels, with bursting pressures well above physiological blood pressure levels. REGISTRATION NUMBER: NCT01121614 (http://www.clinicaltrials.gov).

Randomized clinical trial of preoperative intravenous iron sucrose to reduce blood transfusion in anaemic patients after colorectal cancer surgery.

BACKGROUND: The transfusion rate following colorectal cancer resection is between 10 and 30 per cent. Receipt of allogeneic blood is not without risk or cost. A preoperative adjunct that reduced the need for transfusion would mitigate these risks. This study was designed to determine whether iron sucrose reduces the likelihood of postoperative blood transfusion in patients undergoing elective colorectal cancer resection. METHODS: In this randomized prospective blinded placebo-controlled trial of patients undergoing resectional surgery with a preoperative diagnosis of colorectal cancer, 600 mg iron sucrose or placebo was given intravenously in two divided doses, at least 24 h apart, 14 days before surgery. The primary outcome measures were serum haemoglobin concentration, recorded at recruitment, immediately before surgery and at discharge, and perioperative blood transfusions. RESULTS: No difference was demonstrated between treatment groups (iron sucrose, 34 patients; placebo, 26) for any of the primary outcome measures, for either the whole study population or a subgroup of anaemic patients. CONCLUSION: This pilot study provided no support for the use of intravenous iron sucrose as a preoperative adjunct to increase preoperative haemoglobin levels and thereby reduce the likelihood of allogeneic blood transfusion for patients undergoing resectional surgery for colorectal cancer. REGISTRATION NUMBER: 2005-003608-13UK (Medicines and Healthcare products Regulatory Agency).

Computer-assisted reporting system for the follow-up patients with cardiac pacemakers.

The implantation of large numbers of permanent cardiac pacemakers carries with it the responsibility for continual reassessment of all aspects of patient management. Experience with more than 4,000 pacemaker implants and replacements since 1963 has led to the development of a comprehensive computer-assisted data collection, management, and reporting system for the follow-up of patients with cardiac pacemakers. Over a seven-year period, data forms have been developed for the detailed documentation of pre-operative, intraoperative and follow-up information. These were designed in the form of checklists suitable for direct computer entry using mark-sense document readers. Special emphasis has been placed on pre-operative indications, selection of appropriate pacing systems, reliable follow-up methodology, and monitoring the performance of various pulse-generators. This system makes possible the rapid computer production of hospital records and reports to involved physicians and can be used to schedule follow-up assessments as required. The information also can be used for hospital statistics, billing, research, and pacemaker registration at the provincial, state of federal level. Experience has shown that a computer-assisted methodology is the only practical means of providing adequate follow-up for a large group of patients. In addition, direct access to relevant information helps to create an environment in which essential research can be carried out in the face of demanding clinical practice.

Initial experience with universal pacemakers.

Thirty-five patients were implanted with the Sequicor DDD pacemaker between September 1, 1981 and March 1, 1982. The mean age was 61.7 years (range, 17-88). According to their ECGs, the patients fell into two distinct groups--those with A-V block and those with sick sinus syndrome. Our initial experience has indicated an excellent electronic component function (except for 1 discrepant reed switch); high battery drain of the Sequicor; complications similar to those seen with DVI or VVI pacing; and an increase in the hemodynamic benefits resulting from DDD as compared to DVI or VVI pacing in 70% of patients.