Lactic acidosis is a severe metabolic disorder with multiple pathogenesis; biguanides increase serum lactate. The authors describe a case of phenformin-associated acidosis enhanced by predisposing conditions (dilated cardiomyopathy, renal failure, hypothyroidism). Causative mechanisms and consequences on production/clearance lactic acid cycle are discussed. The benefits of hemodialysis and inotropic therapy (dobutamine) are emphasized. Treatment of critically ill patients must be designed to avoid increase in serum lactate.

Acidosis, Lactic↗

PubMedDate not supplied

[Costs of cholecystectomy after the arrival of video-laparoscopic surgery].

The authors proceeded to point out the hospital stay costs and the operating-room costs of the cholecystectomy after the introduction of the laparoscopic technique, underlining the higher economic advantages. The total unit cost for laparoscopic cholecystectomy, even if there are higher costs due to the surgical equipment, thanks to the mini-invasive approach and to the reduced hospital stay, results lower (17%) then the total unit cost for laparotomic cholecystectomy (L. 3.982.489 vs. L. 4.825.300). Let us suppose that in the Emilia Romagna Region an 80% of patients underwent to laparoscopic cholecystectomy and only a 20% underwent to laparotomic cholecystectomy: in this case there could be the economic savings of L. 3.777.478.902 and concerning the hospital stay there could be the savings of 17.928 days too. This cost estimation is important if we consider that the rate of cholecystectomy procedures, in our local area, per 1000 inhabitants, increased from 2.29 in 1990 to 3.99 in 1992 (rate of increase: 74%).

Adult↗

PubMedDate not supplied

[Costs of video-laparoscopic surgery in the treatment of ovarian cysts].

The authors proceeded to point out the hospital stay costs and the operating-room costs of the operations for benign adnexal pathologies, especially concerning the ovarian cysts, after having introduced the laparoscopic technique. The highly costs, due to the laparoscopic surgical equipment, are compensated by the reduced hospital stay. The total unit cost for laparoscopic approach results lower then the total unit cost for laparotomic approach (L. 3.253.923 versus L. 4.662.892). If we consider that, in our local area, in 1993, 1212 operations were performed, with 5454 days of postoperative hospital stay, we could suppose that the laparoscopic approach affords higher savings. This cost estimation is important if we consider the diffusion of the mini-invasive procedures.

Adolescent↗

PubMedDate not supplied

[Evaluation of costs in surgery of inguinal hernia. Day surgery and one day surgery versus ordinary admission].

The authors have completed an analytic research about costs of hospitalization and treatment for inguinal hernioplasty and costs of anesthesiologic and surgical techniques and hospitalization regimen. The authors consider possible in about 50% of cases the tension-free hernioplasty carried out with local anesthesia and day or one day surgery regimen and they have estimated that it is very less costly then traditional herniorraphy carried out with general anesthesia and hospitalization: L. 1.056.075 versus L. 2.252.650. In Emilia-Romagna we could have a considerable cost-saving, even if only the 50% of patients treated for uncomplicated inguinal hernia every year (7.133 patients with mean hospital stay = 5,8 days and total hospitalization = 41.731 days during 1993) could benefit by treatment in one day surgery regimen. In fact, leaving out of account the advantage of the rapid return the patient to work, the costs of hospital stay, esteemed in L. 25.038.600.000, would be L. 8.558.700.000. A considerable increase of one day surgery hernioplasties should be expected by the hospital administration in budget planning.

Adolescent↗

PubMedDate not supplied

[Video laparoscopy in patients with pain in the right iliac region].

The authors report on their experience of 235 laparotomy operations and 125 laparoscopic operations performed on patients with right lower abdominal pain. Concerning each of these different approaches, the authors analyzed and compared preoperative diagnosis, anatomo-pathological findings, intraoperative and early post operative morbidity and hospital stay. The ratio of negative open-appendectomies was 24.1% (56 cases out of 233). The laparoscopic approach, performed on 88 cases of suspected appendicitis, allowed to document and to treat other pathologies, real causes of the lower right abdominal pain, in 42 cases (47.7%). The rate of conversion from laparoscopic appendectomy to open appendectomy was only 2.19% (2 cases out of 91). The morbidity rate of laparoscopic appendectomy was estimated at 6.5% (4.4% major complications, 2.2% minor complications). The morbidity rate of open appendectomy was estimated at 8.9% (0.4% major complications, 8.5% minor complications). Though the median postoperative stay, after laparotomy approach, was slightly longer (2.6 days versus 2.4 days), the difference was not statistically significant. Based on these results, the authors conclude that the laparoscopic approach should be reserved for fertile female patients, especially when the diagnosis of appendicitis is uncertain.

Abdominal Pain↗