Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “HOSPITALS, CONVALESCENT”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,477 records · Page 82Linked to original sources
PubMed1984

Early rehabilitation at home of elderly patients with hip fractures and consumption of resources in primary care.

From 1976 onwards an active rehabilitation programme has been applied to elderly patients with fresh hip fractures at the Department of Orthopaedics in Lund in Southern Sweden. This involves early mobilisation in the hospital (internal fixation and immediate weight-bearing) and at home, rehabilitation in cooperation with primary health care personnel from the time of the patient's admission. The purposes of this investigation were to evaluate the effect of this programme in primary care and to assess the consumption of resources for rehabilitation at home of patients with cervical or trochanteric hip fractures. One hundred of 161 consecutive patients returned home directly on discharge from the hospital and were followed up until four months after the fracture by the home care unit (a primary health care centre). Most patients regained their previous functions within four months of their fractures. Patients with cervical fractures consumed less resources for rehabilitation than patients with trochanteric fractures. The total cost per patient was ten times higher for care at a convalescent-home than for rehabilitation at home through primary care. Early at home rehabilitation of elderly patients with hip fractures gives good results at a minimal cost and is thus of advantage both to the patient and to the community.

Activities of Daily Living↗
PubMedDate not supplied

[Miliary tuberculosis in 27 children].

In the course of 3 1/2 years, 27 children with miliary tuberculosis were seen at the Hospital Infantil Lorencita Villegas de Santos in Bogotá, Columbia. Twenty-six percent of cases were infants under 12 months of age. Typical clinical cases were malnourished patients with impairment of their general condition, light respiratory stress or neurologic meningoencephalic involvement and febrile syndrome having a high contact index with tuberculous relatives. Some of them were undergoing measles or whooping cough convalescence. The chest X-ray showed micronodular infiltration and some cases, with hiliar adenomegaly, effusion or caverns. The liver percutaneous biopsy was of great help. The isolation of the bacillus from exudates was difficult to achieve. Tuberculin test was positive only in 30%. Cause of death: infiltration of central nervous system.

Adolescent↗
PubMed1997

Rapid recovery after coronary artery bypass grafting: is the elderly patient eligible?

BACKGROUND: Rapid recovery protocols after coronary artery bypass grafting have been applied successfully to young patients with normal ventricular function. However, the success of such protocols when applied to the elderly population has not been thoroughly validated, and at some centers there is still reluctance in allowing elderly patients to be discharged early from the hospital. METHODS: One hundred fifty-two consecutive younger patients (< 70 years) were compared retrospectively with 167 consecutive elderly patients (> or = 70 years) who underwent isolated coronary artery bypass grafting using cardiopulmonary bypass. A rapid recovery protocol emphasizing an anesthetic protocol for early extubation, reduced cardiopulmonary bypass time, and perioperative administration of corticosteroids and thyroid hormone was applied to all patients. The protocol also emphasized early identification and management of postoperative atrial fibrillation, a proactive negative fluid balance, rapid return of bowel function, mobilization of the patient, and aggressive use of the intraaortic balloon pump preoperatively. RESULTS: The 30-day mortality rate for the younger group of patients was 3.3% (Parsonnet risk 7.2 +/- 6.2), compared with 4.2% (Parsonnet risk, 17.7 +/- 6.8) for the elderly group of patients. There were no statistically significant differences in the 30-day mortality rates or postoperative complications between the elderly and younger patient groups. Rapid recovery with discharge before the fifth postoperative day was achieved in 19% of the elderly, in comparison with 48% of the younger patients (p < 0.001). The younger patients were discharged earlier after operation than the older patients (5.7 +/- 5.2 versus 8.0 +/- 8.5 days; p < 0.01). CONCLUSIONS: Application of the rapid recovery protocol helped expedite recovery for all patients regardless of age, acuity of illness, or associated conditions. Although younger patients had a significantly shorter postoperative length of hospital stay, older patients performed well and are suitable candidates for rapid recovery protocols.

Aged↗
PubMed1999

Risk factors for lack of recovery of ADL independence after hospital discharge.

OBJECTIVE: To determine risk factors for lack of recovery of independent functioning after hospitalization for acute medical illness. DESIGN: Secondary analysis of cohort study of patients receiving home nursing after discharge. SETTING: Evaluations performed in the home after discharge and 1 month later. PARTICIPANTS: A total of 73 adults aged 65 years and older who were independent in activities of daily living (ADLs) before hospitalization and dependent at discharge. MEASUREMENTS: Self-report and objective measures of function, mobility, and cognition. OUTCOME: Return to independence in ADLs 1 month after discharge. RESULTS: Fifty-nine percent of patients did not return to previous ADL independence by 1 month postdischarge. The likelihood for not recovering was 87% (95% CI, 70-100%) if a patient had a Mini-Mental State Examination score (MMSE) < 24 at discharge (P = .015). Among patients with good cognition, 85% (95% CI, 66-100%) of those who used an assistive device indoors before hospitalization did not recover (P = .007). Among patients with good cognition and no previous assistive device use, 73% (95% CI, 47-99%) of those with a Timed "Up and Go" of > or = 40 seconds did not recover (P = .012). The likelihood of recovery was high (76%, 95% CI 56-96%) if a patient had no assistive device prehospital, a good MMSE, and a Timed "Up and Go" of < 20 seconds. CONCLUSION: We hypothesize that a classification strategy using cognition, prehospital mobility, and discharge physical performance will predict patients who are less likely to recover functional independence after hospitalization. If this is validated in future study, it may help clinicians identify patients who are more likely to benefit from additional intervention.

Activities of Daily Living↗
PubMedDate not supplied

[Rehabilitation of patients with coronary cardiopathy. Early mobilization after acute myocardial infarction].

The early mobilization of selected patients with uncomplicated myocardial infarction is not any longer a controversial subject. The benefits are the prevention of decreasing physical capacity and other complications due to physical immobilization. Anxiety and depressive states are prevented or improved, physical capacity is maintained; there is a well being sensation upon discharge and there are economical advantages due to shortening of the hospitalization period. The latter favors an early return to work and a rapid turnover of hospital beds. From different points of view, early discharge of these patients is desirable, safe, possible, decreases expenses, and favors recovery.

Activities of Daily Living↗
PubMed2001

[Hysterectomy for benign lesions in the north of France: epidemiology and postoperative events].

OBJECTIVE: We conducted an inquiry on hysterectomy practices in gynecology and obstetric units of general hospitals in the north of France (North and Picardy regions) focusing on procedures made for benign lesions of non-prolapsed uteri. MATERIAL: and methods: Two studies supported this inquiry. The first was a retrospective study in 1997 concerning 21 gynecology and obstetric units in general hospitals among the 24 units belonging to the general hospital network in the North and Picardy regions. The series included 1293 hysterectomies for benign lesions on non-prolapsed uteri, accounting for 68.6% of all hysterectomies performed during the study period. Surgical route, indications and duration of hospital stay were recorded. The second study was a prospective study conducted in 1998 in 9 voluntary units among the 24 units in the hospital network. This study included 423 hysterectomies and recorded techniques, indications, and complications as well as late complications and social and psycho-sexual impact assessed during a telephone interview at 3 months. The 5 University Hospitals in the North, Picardy and Champagne regions also participated in the inquiry and provided data on 191 hysterectomies performed during a three-month period. RESULTS: Twenty-seven hysterectomies were performed per year and per operator. The main indications for hysterectomy were, for the two studies respectively: fibroid uterus 66.7% and 60%, menstrual disorders 13.8% and 27.2%, endometriosis 10.6% and 5%, and hyperplasia of the endometrium 3.9% and 5%. Surgical routes recorded in the second study were: vaginal 64.8%, abdominal 30.5%, vaginal laparoscopy 4.7%. Reductions were performed to facilitate vaginal hysterectomy in 25% of the cases. The vaginal route was used for adnexectomy in 30% of the cases. The rate of peroperative complications were observed in 3 - 4.8% of the vaginal, 4.8 - 10.7% of the abdominal and 15% of the laparoscopic vaginal hysterectomies. Bleeding was reported in 0.4% and 9.3% of the vaginal and abdominal hysterectomies respectively (p<0.001). The rate of postoperative complications was 0.8 - 4.9%, 1.6 - 19.4%, and 5% for vaginal, abdominal and vaginal laparoscopic hysterectomies respectively. Duration of convalescence was 4.4 weeks for vaginal and 6.1 weeks for abdominal (p<0.00001) and 5.3 weeks for vaginal laparoscopic procedures. The quality of sexual intercourse was improved in 30% of the patients irrespective of the surgical rout but was found to be deteriorated in 20% of those who had laparoscopic vaginal hysterectomy. DISCUSSION: It is difficult to ascertain the exact number of hysterectomies performed in France. The computerized information system currently in use in France (PMSI) should provide interesting data. Reports from North America, Great Britain and the Scandinavian countries have found comparable data. Complication rate, duration of hospitalization and social impact are in favor of vaginal hysterectomy.

Endometrial Hyperplasia↗
PubMed2001

[Tularemia outbreak in the province of Cuenca associated with crab handling].

OBJECTIVE: To report the clinical and epidemiologic characteristics of 19 patients diagnosed of tularemia at our hospital following an epidemic outbreak occurred in our health area. METHODS: Retrospective analysis of clinical records of patients admitted to our hospital who were examined at the Infectious Diseases Clinic and had clinical findings and epidemiologic data consistent with tularemia during the period from June 1998 to March 1999. CASE DEFINITION: A patient was considered to fulfill the case definition when clinical symptoms, epidemiologic data and the following laboratory criteria were met: antibody titer to Francisella tularensis (tube agglutination test) > or = 1/128 in the convalescence serum specimen, seroconversion or recovery of the microorganism from biological material. RESULTS: Nineteen patients with a median age of 60 years. Males predominated (63.1% male patients); all of them had handled red crayfish from the same source (río Mayor). The incubation period ranged from 0 to 15 days (mean 4.88 days). All patients presented with the ulceroglandular form. Seventy-three percent of patients received doxycycline. Only one patient relapsed. Water samples from the reservoir of the depuration plant of the river were positive to F. tularensis by PCR. This same result was confirmed in stomach and hepatopancreas of crayfish fished in río Mayor in the second half of July. CONCLUSIONS: The most likely hypothesis of this outbreak was the contamination of the river water with animals dead from tularemia which, together with the characteristics of the transmission mechanism (wounds caused by crabs) had contributed to the acquisition of this disease in humans. Interestingly too, red crayfish as the source of infection.

Animals↗
PubMedDate not supplied

Diarrhea in medical care workers with severe acute respiratory syndrome.

BACKGROUND AND GOAL: Several known coronavirus species cause a variety of diseases, including respiratory or enteric diseases. The purpose of this study was to investigate the interesting enteric symptoms of the medical care workers who were evidently infected with SARS by means of respiratory transmission. STUDY: Between May 1 and June 16, 2003, we enrolled 16 medical care workers who fulfilled the definition of probable SARS. Samples used for the detection of coronavirus RNA by RT-PCR were collected from throat and rectal swabs during acute phase. Serum anti-SARS IgG was checked by enzyme-linked immunosorbent assays at the convalescent phase. RESULTS: The incidence of watery diarrhea was 18.8% (3 of 16). The RT-PCR of coronavirus was positive in three (18.8%) of 16 throat swabs and in none (0%) of seven rectal swabs. Serum anti-coronavirus IgG was positive in 13 of the 15 patients (86.7%). The mortality rate was 6.25% (1 of 16). The diarrhea rate in our hospital was significantly lower in comparison with the 73% (55 of 75) of the Amoy Gardens outbreak in Hong Kong (P = 0.000073), and similar to the 19.6% (27 of 138) of the hospital-acquired outbreak in the Prince of Wales Hospital in Hong Kong (P = 0.798). In contrast to the high positive rate of feces RT-PCR (97%) in Amoy Gardens, our positive rate in rectal swab RT-PCT (0%) was significantly lower (P = 0.00000002). CONCLUSIONS: Hospital-acquired SARS cases infected mainly by respiratory route less commonly presented with diarrhea. Lower intestinal viral load, when the virus spread by respiratory route, may be contributive to lower diarrhea rate and lower positive rate in rectal swab RT-PCR.

Adult↗
PubMed1985

[Assessment of the pulmonary blood flow changes in thromboembolism of small branches of the pulmonary artery].

Patients with thromboembolism of small branches of the pulmonary artery (TESPA) were examined by rheopulmonography (RPG) for the pulmonary blood flow over the zones of thromboembolism and uninvolved parts of the lungs. The study was performed at the initial disease stage, on days 3-7 of the disease and before the patient's discharge from hospital. It was shown that pulmonary circulation undergoes some successive changes. During the first phase, the total vascular hypertension and arterial hypertension of the pulmonary circulation together with occlusion are noted. During the second phase, dilatation of the arterial bed in the healthy zones and normalization of arterial hypertension together with the reduced blood flow in the area of thromboembolism are observed. The convalescence phase is characterized by the recovery of the blood flow in the area of thromboembolism and return of the arterial tone in the pulmonary circulation to normal. RPG permits one to have an objective evaluation of the clinical picture of TESPA and therapy received by the patients.

Adult↗
PubMed1993

Practice patterns and the adequacy of residency training in consultation medicine.

OBJECTIVE: To describe consultation practice patterns of graduates of an internal medicine residency program and to determine whether they consider themselves to be adequately trained to practice in the area of internal medicine consultations. DESIGN: The authors surveyed graduates of the internal medicine residency program at the University of California, San Diego, School of Medicine from 1980 to 1989. Respondents described their practice types and the mechanics of consultations they currently perform, as well as the adequacy of their training in and frequency of encountering 74 clinical problems in the area of internal medicine consultation. Topics were categorized as Group I: excessive training; Group II: adequate training, frequently encountered; Group III: adequate training, infrequently encountered; Group IV: inadequate training, frequently encountered; and Group V: inadequate training, infrequently encountered. SETTING: University teaching hospital. PARTICIPANTS: Of 214 graduates, 91 returned surveys adequate for analysis. RESULTS: Internists prefer verbal communication with their colleagues and seeing surgical patients in the office prior to admission. Residents perceive that they have been excessively trained in preoperative evaluations of the asymptomatic and chronically ill adult and in several postoperative complications. Topics seen frequently in clinical practice but inadequately taught include: issues in convalescence and rehabilitation from surgical procedures, use of psychotropic medications, and management of eating disorders. CONCLUSIONS: To prepare residents for practice, program directors in consultation medicine might consider incorporating outpatient preoperative evaluation assessments, encouraging a liaison between surgeons and internists, and modeling verbal communication among colleagues. Consideration should be given for more didactic training for Group IV topics.

Adult↗
PubMed1990

Pulmonary complications following myocardial revascularization with the internal mammary artery graft.

A total of 106 patients participated in a clinical investigation to determine the incidence and etiology of pulmonary complications following myocardial revascularization with the internal mammary artery graft; 39 patients (group I), undergoing valve replacement or myocardial revascularization with vein grafts, served as control. The mammary artery was used for revascularization in the remaining patients. The pleura was opened during the dissection of the mammary graft in 34 patients (group II), but was left intact during harvesting of the internal mammary artery in 33 patients (group III). Inspiration and expiration chest X-rays were obtained during the first 3 months of convalescence to determine the presence of pleural fluid, the position of the left hemidiaphragm, and to asses diaphragmatic movement. Pleural effusions, left lower-lobe atelectasis, and elevation of the left hemidiaphragm were observed in all groups after operation, but were more commonly observed in those patients undergoing revascularization with the mammary artery graft. Postoperative chest X-rays just prior to discharge from hospital were normal in 69% of the control group, only 9% of patients in group II who had pleurotomy during mammary artery dissection, and 42% of group III. By 3 months, however, 95% of patients in groups I and II had normal chest X-rays, whereas 53% of patients in group II had persistent loss of left-lung volume related to the presence of left-lower-lobe atelectasis, left pleural effusions and organization of the postoperative hemothorax.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗
PubMed1998

Laparoscopic cholecystectomy: day-care versus clinical observation.

OBJECTIVE: To determine the feasibility and desirability of laparoscopic cholecystectomy (LC) in day-care versus LC with clinical observation. SUMMARY BACKGROUND DATA: Laparoscopic cholecystectomy has been performed regularly as outpatient surgery in patients with uncomplicated gallstone disease in the United States, but this has not been generally accepted in Europe. The main objections are the risk of early severe complications (bleeding) or other reasons for readmission, and the argument that patients might feel safer when observed for one night. Quality-of-life differences hitherto have not been investigated. METHODS: Eighty patients (American Society of Anesthesiology [ASA] I/II) with symptomatic gallstones were randomized to receive LC either in day-care or with clinical observation. Complications, (re)admissions, consultations of general practitioners or the day-care center within 4 days after surgery, use of pain medication, quality of life, convalescence period, time off from professional activities, and treatment preference were assessed. The respective costs of day-care and clinical observation were determined. RESULTS: Of the 37 patients assigned to the day-care group who underwent elective surgery, 92% were discharged successfully after an observation period of 5.7+/-0.2 hours. The remainder of the patients in this group were admitted to the hospital and clinically observed for 24 hours. For the 37 patients in the clinical observation group who underwent elective surgery, the observation time after surgery was 31+/-3 hours. Three patients in the day-care group and one patient in the clinical observation group had complications after surgery. None of the patients in either group consulted a general practitioner or the hospital during the first week after surgery. Use of pain medication was comparable in both groups over the first 48 hours after surgery. There were no differences in pain and other quality-of-life indicators between the groups during the 6 weeks of follow-up. Of the patients in the day-care group, 92% preferred day-care to clinical observation. The same percentage of patients in the clinical observation group preferred at least 24 hours of observation to day-care. Costs for the day-care patients were substantially lower (approximately $750/patient) than for the clinical observation patients. CONCLUSION: Effectiveness was equal in both patient groups, and both groups appeared to be satisfied with their treatment. Because no differences were found with respect to the other outcomes, day-care is the preferred treatment in most ASA I and II patients because it is less expensive.

Adult↗
PubMed2004

Outcome of enterovirus 71 infections with or without stage-based management: 1998 to 2002.

BACKGROUND: Enterovirus 71 (EV71) infection may progress through four stages, one of which is cardiopulmonary failure. In Taiwan in 1998 almost all the EV71 patients with cardiopulmonary failure died. To improve clinical outcome of EV71 patients, we developed a stage-based management program in 2000. METHODS: The medical records of 196 EV71 patients who did not have stage-based management (1998 to 1999) and of 331 EV71 patients who did (2000 to 2002) at Chang Gung Children's Hospital were reviewed for demographic characteristics, clinical syndromes, case-fatality rates and sequelae. We compared and analyzed the results for the 2 groups. RESULTS: Of the patients who did not receive stage-based management, 83% (15 of 18) of cases with both central nervous system (CNS) involvement and cardiopulmonary failure died during the acute stage of the infection. Two patients died at convalescence, and 1 had sequelae of dysphagia and limb weakness. By contrast of the patients who received stage-based management, 33% (12 of 36) of patients with CNS and cardiopulmonary failure died during the acute stage, 8% (3 of 36) died at convalescence, 14% (5 of 36) recovered and 43% (16 of 36) had severe sequelae of central hypoventilation, dysphagia and limb weakness (P < 0.001). For cases with CNS and cardiopulmonary failure, multivariate analysis showed that age older than 2 years and cerebro-spinal fluid white blood cell count >100/microl were associated with a increase in acute mortality [95% confidence interval (CI) 1.9 to 105.3, P = 0.001; 95% CI 1.1 to 66.6, P = 0.04, respectively], but stage-based management was significantly associated with a reduction in acute mortality (95% CI 0.007 to 0.24; P = 0.0004). Stage-based management did not affect the outcome of cases with CNS involvement alone. CONCLUSIONS: Stage-based management reduced the case fatality rate of EV71-related cardiopulmonary failure, but two-thirds of the survivors had severe sequelae.

Case-Control Studies↗
PubMed1978

Randomised controlled trial of early discharge for inguinal hernia and varicose veins.

A randomised controlled trial has been conducted into the effects of discharging patients from hospital either 48 hours or six to seven days after operations for inguinal hernia and varicose veins. There was no statistically significant difference in major postoperative complications between the two lengths of stay for either of the two conditions. Similarly there was no difference between the two groups of hernia patients in relation to eventual recurrences. There was no significant difference in length of convalescence between long-stay and short-stay patients in full-time occupations. The savings to the statutory services of discharging patients early were estimated at 25.72 pounds per patient. Patients appeared to approve of the type of care they experienced, regardless of length of stay. However, the families of short-stay patients were significantly less enthusiastic in their attitudes towards the policy of early discharge than the families of long-stay patients.

Adolescent↗
PubMed1989

A decision scheme for coronary angiography after acute myocardial infarction.

It is important to select patients in the convalescent phase of acute myocardial infarction in whom knowledge of coronary anatomy may identify those potentially suitable for intervention aimed at improving prognosis. However, differing guidelines have been proposed, and by applying some of these guidelines to our large database of patients after acute myocardial infarction, several problem areas were identified. These include lack of considering patients with resting ischemia beyond day 5 of hospitalization, management of patients with reduced ventricular function or patients not exercise tested, and the role of coronary angiography in the elderly. Based on this experience and further analysis in 1,848 patients surviving beyond day 5 of hospitalization, a modified decision scheme for coronary angiography was developed and then tested in a second population (n = 780). In the new scheme, patients over 75 years of age are considered individually. Those under 75 years of age with severe resting ischemia in the hospital at any time beyond the first 24 hours (18% mortality between day 6 and year 1), and hospital survivors with a history of previous myocardial infarction and clinical or radiographic signs of left ventricular failure in the hospital (25% 1-year mortality after discharge), are recommended for coronary angiography. Among the remaining patients, some will perform an exercise test, and those with an ischemic response or poor workload (11% 1-year mortality) are also assigned to coronary angiography. When an exercise test is not performed, a resting radionuclide left ventricular ejection fraction is recommended, and coronary angiography is considered if the value lies between 0.20 and 0.44 (12% 1-year mortality). This relatively simple scheme does not make general recommendations in the elderly, considers patients with in-hospital left ventricular failure or reduced left ventricular function or both, and approaches the problem of patients who do not perform an exercise test. This general approach would avoid early coronary angiography in patients with an average 1-year mortality risk after discharge of 3% and recommend coronary angiography in those at increased risk (average mortality rate, 16%) who make up about 55% of this population under 75 years of age.

Aged↗
PubMed1989

[Virologic and serologic observations in an outbreak of infantile bronchopneumonitis].

From December 1985 to February 1986 in Si Hong County, Jiang Su Province an outbreak of bronchopneumonitis occurred. In December the number of admitted infant cases with bronchopneumonitis was 32% of total hospitalized cases. The youngest infant was 28 days in age and the oldest was one and half years. 71.5% percent occurred in children less than six months in age. From nasopharyngeal washing of acute cases were isolated 6 strains of viruses. The result of identification of them revealed that they were respiratory syncytial virus. 3 pairs of serum sample were collected from acute and convalescent periods for neutralizing antibody titrations. The result showed that specific neutralizing antibody titers increased 8-64 fold in comparison between the acute and the convalescent.

Antibodies, Viral↗
PubMedDate not supplied

Intraoperative femur fractures during total hip replacement.

Eleven intraoperative femur fractures occurred during 605 total hip replacements at Rancho Los Amigos Hospital, an incidence of 1.8%. Fractures occur more often in women, are usually located in the proximal femur, and mostly occur during femoral reaming. The main predisposing factors were osteoporosis and previous hip operation. The treatment may be operative or non-operative depending on the location and type of fracture. This complication is associated with a high morbidity and a significant delay in convalescence.

Adult↗
PubMed2005

Outcomes of hand-assisted laparoscopic nephroureterectomy for managing upper urinary tract transitional cell carcinoma--China Medical University Hospital experience.

OBJECTIVES: To report our experience with hand-assisted laparoscopic nephroureterectomy (HALNU) to treat upper urinary tract transitional cell carcinoma (TCC). In addition, we report the treatment of 4 patients with upper urinary tract TCC and synchronous superficial urinary bladder TCC by HALNU and simultaneous transurethral resection of bladder tumor (TURBT). METHODS: We retrospectively reviewed 33 patients who had undergone HALNU. Recovery was evaluated according to the Eastern Cooperative Oncology Group performance status. Four patients had concomitant superficial urinary bladder cancer and underwent simultaneous TURBT at the beginning of surgery. We compared our data with those of our open surgery group and previously published data. RESULTS: Partial recovery had occurred by 1 week and complete recovery by 4 weeks postoperatively. Conversion to open surgery was required in 2 (6%) of the 33 patients. The complication rate was 24% (8 of 33) without any mortality. The recurrence rate of urinary bladder TCC was 6% (2 of 33). Both patients with recurrent tumor were treated successfully by TURBT and bacille Calmette-Guérin instillation. All 4 patients with synchronous superficial urinary bladder TCC had undergone simultaneous transurethral resection of bladder tumor, and all 4 were disease free at the last follow-up visit. CONCLUSIONS: Hand-assisted procedures are appropriate for surgeons with limited experience with laparoscopic surgery. In our study, the convalescence of patients was excellent, and the postoperative results were compatible with those of previous studies. To treat upper urinary tract TCC with synchronous urinary bladder TCC, HALNU and TURBT together seems to be a safe and efficient technique.

Adult↗