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M P Bannon

Publications and source records attributed to M P Bannon.

15 recordsLinked to original sources
PubMed2001

A prospective randomized comparison of laparoscopic appendectomy with open appendectomy: Clinical and economic analyses.

BACKGROUND: Previous randomized studies of laparoscopic appendectomy produced conflicting recommendations, and the adequacy of sample sizes is generally unknown. We compared clinical and economic outcomes after laparoscopic and open appendectomy in a sample of predetermined statistical power. METHODS: A pre-study power analysis suggested that 200 randomized patients would yield 80% power to show a mean decrease of 1.3 days' hospitalization. One hundred ninety-eight patients with a preoperative diagnosis of acute appendicitis were randomized prospectively to laparoscopic or open appendectomy. Economic analysis included billed charges, total costs, direct costs, and indirect costs associated with treatment. RESULTS: Laparoscopic appendectomy took longer to perform than open appendectomy (median, 107 vs 91 minutes; P <.01) and was associated with fewer days to return to a general diet (mean, 1.6 versus 2.3 days; P <.01), a shorter duration of parenteral analgesia (mean, 1.6 versus 2.2 days; P <.01), fewer morphine-equivalent milligrams of parenteral narcotic (median, 14 mg versus 34 mg; P =.001), a shorter postoperative hospital stay (mean, 2.6 versus 3.4 days; P <.01), and earlier return to full activity (median, 14 versus 21 days; P <.02). However, operative morbidity and time to return to work were comparable. Billed charges and direct costs were not significantly different in the 2 groups ($7711 versus $7146 and $5357 versus $4945, respectively), but total costs (including indirect costs) of laparoscopic appendectomy were, on average, nearly $2400 less, given the shorter length of stay and abbreviated recuperative period ($11,577 versus $13,965). Subgroup analyses suggested the benefit of a laparoscopic approach for uncomplicated appendicitis and for patients with active lifestyles. CONCLUSIONS: While laparoscopic appendectomy is associated with statistically significant but clinically questionable advantages over open appendectomy, a laparoscopic approach is relatively less expensive. The estimated difference in total costs of treatment (direct and indirect costs) was at least $2000 in more than 60% of the bootstrapped iterations. The economic significance and implications favoring a laparoscopic approach cannot be ignored.

Appendectomy↗
PubMed2001

Meckel's diverticulum causing intestinal obstruction.

Meckel's diverticulum is an uncommon cause of acute abdominal pain and small bowel obstruction in adults. We present a case of a 31-yr-old man with recurrent vomiting and abdominal pain in whom the diagnosis of Meckel's diverticulum was not suspected until CT of the abdomen revealed multiple fluid-filled, dilated loops of ileum with distal collapse after normal abdominal radiographs. We suggest that CT may be helpful when the diagnosis of Meckel's diverticulum is suspected.

Adult↗
PubMed2000

Trauma in pregnancy.

OBJECTIVE: To determine whether the severity of maternal injury or other maternal and fetal variables will predict the outcome of pregnancy in the injured pregnant patient. PATIENTS AND METHODS: In this retrospective review of pregnant patients hospitalized at a level 1 trauma center from 1986 to 1996, we analyzed the maternal Injury Severity Score, maternal mortality, fetal-neonatal mortality, maternal hypotension, and fetal heart rate. RESULTS: Sixty-one pregnant women were identified who were hospitalized after trauma. The mean +/- SD maternal age was 26.6 +/- 6.6 years. The distribution of trauma per gestational age was 21%, 20%, and 59% for the first, second, and third trimester, respectively. The most common mechanism of injury was motor vehicle crashes. Long-term pregnancy outcome was available in 53 patients (87%). There was 1 maternal death. Fetal-neonatal death occurred in 8 (15%) of 53 pregnancies. Most maternal physiologic variables were not predictors of pregnancy outcome. We were unable to detect a difference in the distribution of Injury Severity Scores between viable and nonviable pregnancies. However, maternal hypotension and low fetal heart rate were common in nonviable pregnancies (P = .02). CONCLUSIONS: Maternal hypotension and fetal heart rate are potential predictors of pregnancy outcome after trauma. Other maternal and fetal physiologic variables are poor measures of fetal well-being and are unable to predict fetal outcome. Fetal-neonatal death does not necessarily correlate with severity of maternal injury.

Abortion, Spontaneous↗
PubMed1998

Management of necrotizing pancreatitis by repeated operative necrosectomy using a zipper technique.

METHODS: From 1983 to 1995, 72 patients with necrotizing pancreatitis were treated with a general approach involving planned reoperative necrosectomies and interval abdominal wound closure using a zipper. RESULTS: Hospital mortality was 25%. Multiple organ failure without sepsis caused early mortality in 3 of 4 patients and sepsis caused late mortality in 11 of the remaining 14. The mean number of reoperative necrosectomies/debridements was 2 (0 to 7). Fistulae developed in 25 patients (35%); 64% were treated conservatively. Recurrent intraabdominal abscesses developed in 9 patients (13%) but were drained percutaneously in 5. Hemorrhage required intervention in 13 patients (18%). Prognostic factors included APACHE-II score on admission < 13 (P = 0.005), absence of postoperative hemorrhage (P = 0.01), and peripancreatic tissue necrosis alone (P < 0.05). CONCLUSIONS: The zipper approach effectively maximizes the necrosectomy and decreases the incidence of recurrent intraabdominal infection requiring reoperation. APACHE-II score > or = 13, extensive parenchymal necrosis, and postoperative hemorrhage signify worse outcome.

APACHE↗
PubMed1997

Management of colonoscopic perforations.

OBJECTIVE: To document our evolving surgical management of colonoscopic perforation and examine factors crucial to the improvement of patient care. DESIGN: We conducted a computer-based retrospective analysis of medical records (1980 through 1995). MATERIAL AND METHODS: Among 57,028 colonoscopic procedures performed, 43 patients (0.075%, or 1 perforation in 1,333 procedures) had a colonic perforation. Two additional patients were treated after colonoscopy performed elsewhere. The outcomes analyzed included surgical morbidity and mortality. RESULTS: Twenty-six women and 19 men who ranged in age from 28 to 85 years (median, 69) were treated for colonic perforation. More than 80% of perforations occurred during the latter half of the study period because of the increased volume of colonoscopic procedures (8 perforations among 12,581 examinations from 1980 through 1987 versus 35 perforations among 44,447 colonoscopies from 1988 through 1995). Emergency laparotomy was performed in 42 patients (93%). Perforations occurred throughout the colon: right side = 10; transverse = 9; and left side = 23. Three patients without evidence of peritoneal irritation fared well with nonoperative management. Most patients underwent primary repair or limited resection in conjunction with end-to-end anastomosis. In 14 patients (33%), an ostomy was created. One patient underwent laparotomy without further treatment. Intra-abdominal contamination ranged from none (31%) to local soiling (48%) to diffusely feculent (21%). Postoperative complications occurred in 12 patients and were associated with older age (P = 0.01), large perforations (P = 0.03), and prior hospitalization (P = 0.04). No postoperative deaths occurred. CONCLUSION: Despite a consistently low risk of colonic perforation, the increasing use of colonoscopy in our practice has resulted in an increased number of iatrogenic colonic perforations. In order to minimize morbidity and mortality, prompt operative intervention is the best strategy in most patients. Non-operative management is warranted in carefully selected patients without peritoneal irritation.

Adult↗
PubMed1996

Mitral valve injury after blunt chest trauma.

Isolated mitral valve injury after blunt chest trauma is a very rare event. This disruption, causing sudden and severe mitral regurgitation, will rapidly lead to congestive heart failure and death unless operatively corrected. A high index of suspicion coupled with appropriate diagnostic tests will provide the diagnosis and allow operative correction. We report a patient who survived this injury and review all previous reports of blunt traumatic disruption of the mitral valve.

Adult↗
PubMed1996

The care and cost of snowmobile-related injuries.

From January 1, 1991, through May 1, 1993, we identified 42 patients from our prospective computer-based trauma registry (38 males, four females; mean age, 25 years) who were hospitalized after snowmobile accidents. The primary reason for hospitalization varied: bone fracture (n = 18), blunt abdominal trauma (n = nine), closed head injury (n = five), and miscellaneous injuries (n = 10). The mean injury Severity Score was 9.3 (range, one to 43; median, nine). Twenty-six patients (62%) required emergent operation. Mean hospital stay was six days (range, one to 16 days). Thirteen patients had complications: seven had wound infection; three, ileus; and three, miscellaneous. One severely injured hypothermic patient died. Medical charges totaled $569,566 (mean, $16,227; range, $1,003 to $51,642). Snowmobiling causes significant accidental injury in young persons. The physical and financial costs of such injuries are high.

Accidents, Traffic↗
PubMed1995

Tension pneumopericardium following blunt injury.

Pneumopericardium caused cardiac tamponade in a patient who was struck in the chest by a motor vehicle. Subxiphoid pericardial window and pericardial drainage successfully treated this condition. Diagnosis of this rare form of tamponade depends on clinical examination supported by chest radiographic findings.

Accidents, Traffic↗
PubMed1995

Central venous oxygen saturation, arterial base deficit, and lactate concentration in trauma patients.

Our object was to explore the usefulness of central venous oxygen saturation, arterial base deficit, and lactate concentration in the evaluation of trauma patients. In busy urban trauma centers, limited operating room availability may necessitate that certain hemodynamically stable patients experience some delay between diagnosis of injury and surgery. Because hemodynamic compromise may occur before operation is undertaken, some means of identifying those patients who have the most severe injuries or who are at greatest risk for hemodynamic instability would be useful. We prospectively studied 40 patients with operative truncal injuries admitted to the Cook County Trauma Unit, Chicago, to examine the usefulness of postresuscitation central venous oxygen saturation (ScvO2), arterial lactate concentration, and arterial base deficit in this regard. Preoperative hypotension occurred in 12.5 per cent of these initially stable patients. ScvO2 did not significantly correlate with any of the parameters of blood loss and severity of injury examined. However, both base deficit and lactate concentration correlated with transfusion requirements; in addition, base deficit correlated with trauma score, and lactate correlated with peritoneal shed blood volume. Our data suggest that, after resuscitation, arterial base deficit and lactate concentration may be better indicators of blood loss than is ScvO2.

Abdominal Injuries↗
PubMed1994

Multisystem geriatric trauma.

PURPOSE: To analyze the demographics, hospital course, functional outcome, and reimbursement for elderly patients sustaining multisystem trauma. METHODS: The Trauma Registry was searched for patients > or = 65 years old with an Injury Severity Score (ISS) > or = 10 admitted with multisystem trauma from January 1991 through December 1991. Hospital data were obtained from the Trauma Registry; reimbursement data from the business office; and complete follow-up (mean, 12 months) data by telephone survey for all patients. RESULTS: Of the 1931 trauma patients admitted during the study period, 601 (31%) were > or = 65 years old and 94 (5%) met the study criteria. Of these 94 patients, 52 were women and 42 were men; their mean age was 79 years (range, 65-100). Falls (59%) and motor vehicle crashes (36%) were the predominant causes of injury; closed head injury (CHI) and fractures were the most frequent injuries. The mean ISS was 18 (range, 10-57), and hospital stay averaged 10 days. Intensive care unit admission was necessary for 37%, and 38% required surgical intervention. Factors associated with mortality included previous myocardial infarction, chronic renal insufficiency, ventilatory or inotropic support (or both), shock (systolic BP < or = 90 mm Hg) at admission, bradycardia (HR < or = 60 bpm) at admission, and severe CHI (Glasgow Coma Scale score < or = 8). Mortality was 23% (22 of the 94 patients); three quarters of the deaths occurred in the first 24 hours--most from severe CHI. At discharge, 53% of patients (38 of 72) went home and 36% (26 of 72) went to nursing homes. At a mean follow-up of 12 months, an additional seven patients had died, and three quarters of the patients were at home with an independent functional status. The percentage of reimbursement for care was two thirds of cost. CONCLUSIONS: Mortality rates are high for elderly patients who sustain multisystem trauma. Most deaths occur within the first 24 hours, and most injuries are severe CHIs. More than half of survivors are discharged home, and most are independent at long-term follow-up. Reimbursement is not commensurate with the functional outcome achieved and the care provided.

Aged↗
PubMed1992

Spontaneous rupture of the spleen due to infectious mononucleosis.

Spontaneous splenic rupture is an extremely rare but life-threatening complication of infectious mononucleosis in young adults. Although splenectomy remains effective treatment, reports of successful nonoperative management have challenged the time-honored approach of emergent laparotomy. On retrospective analysis of our institutional experience with 8,116 patients who had this disease during a 40-year period, we found 5 substantiated cases of atraumatic splenic rupture due to infectious mononucleosis. Four additional cases of suspected splenic rupture were noted. All nine patients were hospitalized and treated (seven underwent splenectomy and two were treated with supportive measures only), and they remain alive and well. In patients with infectious mononucleosis suspected of having rupture of the spleen, a rapid but thorough assessment and prompt implementation of appropriate management should minimize the associated morbidity and mortality. On the basis of review of the medical literature and careful scrutiny of our own experience, we advocate emergent splenectomy for spontaneous splenic rupture in patients with infectious mononucleosis.

Adolescent↗
PubMed1991

Soft-tissue infections after trauma.

Soft-tissue infections are best prevented by proper initial management of the wound. When they do occur, they produce certain characteristic physical signs, the appearance of which mandates prompt operative intervention. The extent of debridement is determined by the intraoperative findings. Diagnostic categorization of the infection is performed postoperatively on the basis of the level of soft-tissue involvement and the results of bacterial cultures.

Anti-Bacterial Agents↗
PubMed1988

The relationship between primary hyperparathyroidism and diabetes mellitus.

Previous reports have suggested that control of diabetes improves after successful parathyroidectomy for primary hyperparathyroidism. To investigate this proposition further, a review was made of all insulin-requiring diabetics undergoing curative parathyroidectomy at the Mayo Clinic between 1970 and 1984 (36 patients). All contemporary insulin-requiring diabetics undergoing thyroidectomy for benign euthyroid disease served as a control group (34 patients). One patient in each group had type I diabetes mellitus, and the remainder had type II diabetes mellitus. Preoperative insulin requirements, insulin requirements at follow-up, and change in insulin requirements did not differ significantly between the two groups. This study suggests that parathyroidectomy does not lead to a statistically significant reduction in the insulin requirements of diabetic patients with primary hyperparathyroidism and that coexistent type II diabetes mellitus should not be considered a further indication for parathyroidectomy in patients with primary hyperparathyroidism.

Diabetes Mellitus, Type 1↗
PubMedDate not supplied

Do research interviews cause distress or interfere in management? Experience from a study of cancer patients.

Research interviews with seriously ill patients are now often undertaken in quality of life research. Clinicians may be approached by researchers wishing to study their patients, and may be worried at some ethical aspects of interviewing. Concerns may include potential distress which interviews may cause, that they may interfere with the doctor-patient relationship, and perhaps, a scepticism that techniques addressing psychosocial concerns produce only 'soft' data. However, interview methods are a valuable tool for medical sociologists, nurse researchers and others. We discuss here some reflections following a study that involved interviewing severely ill patients with incurable malignant cerebral glioma. We use our observations to answer concerns and to discuss problems that arose. We suggest areas researchers and clinicians might consider before embarking on such collaboration.

Adult↗