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Resume Objectifs Les objectifs principaux etaient la description des modalites de fonctionnement des revues de la mortalite morbidite (RMM), l’analyse des causes de deces evitables ou de complications graves, ainsi que l’elaboration de themes d’actions a mettre en œuvre afin d’eviter que l’evenement indesirable ne se reproduise. Methodes Nous avons mis en place un comite de coordination des RMM constitue d’un representant de chaque specialite exercee au sein de notre etablissement. Chaque representant etait charge d’organiser des reunions de service au cours desquelles le cas de patients ayant eu une complication grave ou dont le deces etait potentiellement evitable etait analyse. Resultats Le comite de coordination des RMM de l’etablissement s’est reuni 3 fois par an afin d’ameliorer la methodologie de l’analyse des dossiers patients. Au sein de chaque service, une frequence moyenne de 3 reunions par an a ete observee (1 a 12 pour les valeurs extremes), aux cours desquelles 1 a 3 dossiers ont ete analyses. Au cours d’une periode de 30 mois d’activite, parmi les 35 817 patients admis a l’institut, 341 (1%) sont decedes. Le taux de deces evitable variait selon les departements (mediane 27%, extremes de 6 a 65%). Parmi les patients analyses en RMM (n = 92, 27 % ; extremes de 6 a 70 % des deces hospitaliers selon les services), un taux important d’infections nosocomiales (30%) a ete note. La pathologie la plus frequente a l’origine des deces inattendus a ete la pathologie cardiaque. Discussion Les ameliorations principales a apporter ont concerne la strategie medicochirurgicale, la technique operatoire, le respect des indications lors des prescriptions medicamenteuses et la surveillance du patient.

Purpose: To compare the results of carotid stenting and carotid surgery in a consecutive group of 455 patients (482 lesions). Methods: Between January 1995 and July 2002, 107 patients (114 lesions) were treated with carotid stenting and 348 patients (368 lesions) with carotid surgery. A cerebral protection device was routinely used in the last 46 stent cases. All patients were followed with duplex examination at 1 and 6 months postoperatively and yearly thereafter. Results: The stent and surgery groups were similar in terms of mean age (70.5 and 71.1 years, respectively), sex distribution (men 72% versus 75%), and symptoms (transient ischemic attack [TIA] or minor stroke 32.7% versus 42.2%). Median follow-up was 15 months in stent patients and 14 months in the surgical group. At 1 month postoperatively, there were 7 minor strokes (5 temporary lasting Conclusions: This series showed encouraging and comparable major stroke and deaths rate of carotid stenting and carotid surgery. However, there was more restenosis in the stented group on midterm follow-up.

Abdominal aortic aneurysm (AAA) resection is a major surgical procedure performed frequently. As a minimal access procedure, laparoscopy has been shown in the field of general surgery to improve a patient's postoperative well-being and to shorten hospital stay. The same benefits could be expected from a laparoscopic approach for AAA repair. We report what we believe to be the first totally laparoscopic AAA repair performed according to the principles of endoaneurysmorrhaphy. (J Vasc Surg 2001;33:181-5.)

The objective of this study was to describe the steps involved in establishing a morbidity/mortality review committee (MMRC) to analyze the causes of avoidable deaths or life-threatening complications and the development of plans and protocols to avoid their recurrence.The MMRC included physicians from each hospital department. Each member was responsible for organizing departmental meetings to analyze its avoidable deaths and life-threatening complications.During its meetings three times a year, the MMRC developed a method for analysis of these serious events. Each department organized 3 (range: 1-12) meetings a year and analyzed 1-3 cases at each. Over 30 months, 35,817 patients were admitted to the hospital and 341 (1%) died. The unexpected mortality rate varied by department and specialty (median: 27%, range: 6-65%). In all, 92 cases were referred to MMRC meetings (27%; range: 6-70% of hospital deaths), and 30% of them involvement nosocomial diseases. Heart disease was the primary cause of unexpected deaths.The principal improvements involved medical and surgical strategies, surgical techniques, drug prescriptions, and patient monitoring.

Since its introduction to the United States in 1991, laparoscopic antireflux surgery (LARS) has created renewed interest in the surgical treatment of gastroesophageal reflux disease (GERD). Acceptance of the reliability of the laparoscopic procedure combined with the attraction to both patients and physicians of shorter recovery and hospital stay and decreased pain has led to a dramatic increase in the numbers of these procedures being performed. We will discuss controversies in indications for surgery, necessary preoperative work-up and technical aspects of antireflux surgery.

Purpose: The purpose of this study was to assess the feasibility of insertion of endovascular stents and the precision of an open-field interventional magnetic resonance imaging (iMRI) system in an in vivo model. Methods: A feasibility study was undertaken at a university-affiliated hospital. Three male piglets with an average age of 6 months and a weight between 70 and 77 kg and two 3-month-old male piglets that weighed 40 to 44 kg were anesthetized. The five piglets underwent placement of nitinol stents inserted through the right femoral artery, under the guidance of a SIGNA-SP 0.5T open-configuration iMRI unit. With a dedicated high-resolution near–real-time MRI sequence, the stent was guided and deployed onto a predefined target. Results: The main outcome measures were the duration of the procedure from the beginning of positioning to the end of deployment of the stent, the final position of the stent in relation to the target on the iMRI screen, and comparison with autopsy findings. Three stents were deployed within the aorta at the level of the renal arteries, and two were deployed within the right iliac artery just below the aortic trifurcation. The average duration of the endovascular deployment was 13 minutes. There was an agreement of 0.6 mm in the position of the stent as observed on iMR images and found at autopsy. When the piglets were sacrificed, the average distance between the stents and the predefined target was 7.8 mm, mostly because of the migration of one stent. Axial views allowed for accurate determination of stent impaction on the vascular wall. Conclusions: This study confirms the feasibility of stent deployment under near–real-time MRI guidance. It also emphasizes some inherent characteristics that hold promise with regard to other conventional techniques: stents and vascular structures are visualized in near–real-time in any desired plane, and the technique is performed without the potential adverse effects of ionizing radiations and iodinated contrast agents. (J Vasc Surg 2000;32:1006-14.)