Costs and Effects of Abdominal versus Laparoscopic Hysterectomy: Systematic Review of Controlled Trials

Objective: Comparative evaluation of costs and effects of laparoscopic hysterectomy (LH) and abdominal hysterectomy (AH). Data sources: Controlled trials from Cochrane Central register of controlled trials, Medline, Embase and prospective trial registers. Selection of studies: Twelve (randomized) controlled studies including the search terms costs, laparoscopy, laparotomy and hysterectomy were identified. Methods: The type of cost analysis, perspective of cost analyses and separate cost components were assessed. The direct and indirect costs were extracted from the original studies. For the cost estimation, hospital stay and procedure costs were selected as most important cost drivers. As main outcome the major complication rate was taken. Findings: Analysis was performed on 2226 patients, of which 1013 (45.5%) in the LH group and 1213 (54.5%) in the AH group. Five studies scored >= 10 points (out of 19) for methodological quality. The reported total direct costs in the LH group ($63,997) were 6.1$60,114). The reported total indirect costs of the LH group ($1,609) were half of the total indirect in the AH group ($3,139). The estimated mean major complication rate in the LH group (14.3%) was lower than in the AH group (15.9%). The estimated total costs in the LH group were $3,884 versus$3,312 in the AH group. The incremental costs for reducing one patient with major complication(s) in the LH group compared to the AH group was $35,750. Conclusions: The shorter hospital stay in the LH group compensates for the increased procedure costs, with less morbidity. LH points in the direction of cost effectiveness, however further research is warranted with a broader costs perspective including long term effects as societal benefit, quality of life and survival

Jean-Michel Basquiat- : en undersøkelse av tre arbeider på papir fra 1982-1983

Jean-Michel Basquiats (1960–1988) produksjon har vært gjenstand for et konservert forskningsparadigme hvor det biografiske materialet som ligger til grunn, har fått spille en dominerende rolle i møte med verkene. Formålet med denne oppgaven har vært å foreta en analyse av tre arbeider på papir fra perioden 1982–1983; Undiscovered Genius, Ascent og 50¢ Piece, med vekt på dekoding av tekst og tegn for å gjennomgå verkenes narrative fremstilling, ekstrahert fra alt personlig-relatert materiale som fremstår som normen. Oppgaven belyser også hvordan Basquiat har tatt i bruk kunstneriske virkemidler som tekst, tegn og symboler som fremstår som gjennomgående for hele hans produksjon, fra tiden som gatekunstner til hans død i 1988

Catamenial pneumothorax, clinical manifestations — a multidisciplinary challenge

Introduction: Pleural endometriosis is a rare condition. Spontaneous, recurring pneumothorax occurring during menstruation, referred to as catamenial pneumothorax, is associated with pleural endometriosis. A multidisciplinary approach is needed for a successful result. Material and methods: During the last five years (2005–2010), we have treated six patients with menstruation related pneumothorax at Oslo University Hospital. The surgical treatment was performed by the thoracic surgery department but the medical follow-up was carried out by the gynecological and pulmonary medicine departments. Results: We report three of the patients treated. All three patients were premenopausal, aged 19–36, and had recurring, menstruation related, spontaneous pneumothorax, predominantly on the right side. The condition was treated by various surgical approaches, including chest tube drainage, video assisted thoracic surgery, chemical pleurodeses and thoracotomy. Conclusion: Spontaneous, recurring pneumothorax in women with no previous history of endometriosis can be the first manifestation of pleural endometriosis. The disorder requires surgical intervention, but early diagnosis and postoperative hormonal therapy are just as important for a successful outcome. Pneumonol. Alergol. Pol. 2011; 79, 5: 347–350Wstęp: Endometrioza opłucnej występuje bardzo rzadko. Samoistna, nawracająca odma opłucnowa występująca podczas krwawienia miesiączkowego, znana i omawiana jako odma katamenialna, związana jest z endometriozą jamy opłucnej. Do dobrego zdiagnozowania i pomyślnego leczenia, zwykle potrzebna jest współpraca i wysiłki lekarzy różnych specjalności. Materiał i metody: W okresie ostatnich pięciu lat (2005-2010), leczyliśmy sześć pacjentek z odmą opłucnową spowodowaną krwawieniem z ognisk endometriozy umiejscowionej w jamie opłucnej. Leczenie chirurgiczne wykonano w klinice chirurgii klatki piersiowej Uniwersyteckiego Szpitala w Oslo, zaś postępowanie i leczenie pooperacyjne przeprowadzono w klinice pulmonologicznej i klinice ginekologicznej tego samego szpitala. Wyniki: Wszystkie omawiane pacjentki były w wieku przedmenopauzalnym (19 do 36 lat) z nawracajacą, samoistną odmą jamy opłucnej związaną z krwawieniem miesiączkowym. W leczeniu zastosowano różne metody postępowania chirurgicznego, np: drenaż klatki piersiowej (niekiedy z pleurodezą chemiczną), torakoskopię lub torakotomię. Wnioski: Samoistna, nawracająca odma jamy opłucnej u kobiet bez poprzednio rozpoznanej endometriozy, może być pierwszym objawem endometriozy opłucnej. Zaburzenie to wymaga najczęściej leczenia chirurgicznego, ale wczesne, prawidłowe rozpoznanie i poopercyjne leczenia hormonalne są również bardzo ważne dla pomyślnego wyleczenia. Pneumonol. Alergol. Pol. 2011; 79, 5: 347–35

The VALUE national hysterectomy study: description of the patients and their surgery.

OBJECTIVES: To describe hysterectomies practised in 1994 and 1995: the patients, their surgery and short term outcomes. DESIGN: One of two large cohorts, with prospective follow up, recruited to compare the outcomes of endometrial destruction with those of hysterectomy. SETTING: England, Wales and Northern Ireland. POPULATION: All women who had hysterectomies for non-malignant indications carried out during a 12-month period. METHODS: Gynaecologists in NHS and independent hospitals were asked to report cases. Follow up data were obtained at outpatient follow up approximately six weeks post-surgery. MAIN OUTCOME MEASURES: Indication for surgery, method of hysterectomy, ovarian status post-surgery, surgical complications. RESULTS: 37,298 cases were reported which is estimated to reflect about 45% of hysterectomies performed during the period studied. The median age was 45 years, and the most common indication for surgery was dysfunctional uterine bleeding (46%). Most hysterectomies were carried out by consultants (55%). The proportions of women having abdominal, vaginal or laparoscopically-assisted hysterectomy were 67%, 30% and 3%, respectively. Forty-three percent of women had no ovaries conserved after surgery. The median length of stay was five days. The overall operative complication rate was 3.5%, and highest for the laparoscopic techniques. The overall post-operative complication rate was 9%. One percent of these was regarded as severe, with the highest rate for severe in the laparoscopic group (2%). There were no operative deaths; 14 deaths were reported within the six-week post-operative period: a crude mortality rate soon after surgery of 0.38 per thousand (95% CI 0.25-0.64). CONCLUSIONS: This large study describes women who undergo hysterectomy in the UK, and presents results on early complications associated with the surgery. Operative complications occurred in one in 30 women, and post-operative complications in at least one in 10. Laparoscopic techniques tend to be associated with higher complication rates than other methods