Temperature monitoring and perioperative heat loss

To assess the temperature fall at various stages in the perioperative period and identification of contributing factors. This observational study was carried out at Blackpool Victoria Hospital, UK from August 2005-January 2006 on 32 patients undergoing major lower limb vascular surgery. Semistructured data collection form was designed to record the time and tympanic temperature at different stages in perioperative period and the warming methods used. A median fall of 0.1°C [0-0.5°C] in core temperature was recorded in ward and theatre reception area. The median fall of temperature in the anaesthetic room was 0.3°C [0-.8°C]. Patients [n=16] spending more than 0.5 hour in the anaesthetic room had a significant [p=0.002] temperature drop recorded at 0.4°C as compared to 0.2°C for those spending less than 30 minutes. During operation, a median fall of temperature by 0.8°C [0.3-2.1°C] was recorded. Operations lasting for 2.5 hours or more [n=16] resulted 2 in a 1°C temperature fall as against 0.5°C for the rest. Seven patients, in whom a warming mat was used, had a temperature drop of 0.6°C compared to 0.35°C in patients who received warm touch. In the recovery unit, 23 patients had a further drop of 0.3°C, while 9 patients who were actively warmed gained 0.6°C. Significant heat loss occurs in the anaesthetic room relevant to the length of time consumed in anaesthetising the patient. Furthermore active warming measures in the perioperative period have a positive impact on maintaining core temperature

Is routine histopathological examination of the gall bladder a futile exercise?

This study was conducted in Surgical "B" Unit of Khyber Teaching Hospital, Peshawar from October 1998 to November 2003 to look for the incidence of malignancy in apparently benign looking gall bladders. A total of 750 patients, 126 [16.80%] males and 624 [83.20%] females, were included in the study. Cholecystectomy was performed in all these patients for non-malignant diseases, mostly gall stones, and all the specimens sent for histopathology. The biopsy reports of these specimen showed chronic cholecystitis in 512 [68.27%] patients, acute cholecystitis / empyema in 225 [30%] and normal gall bladder in 10 [13.33%] patients; in the latter it was removed as part of other procedures. Three [0.40%] gall bladders, which did not reveal any evidence of malignancy on gross peroperative examination, had primary carcinoma at an early stage i.e. confined to mucosa only. It is, therefore, concluded that early stage carcinoma [Stage I] does occur in normal / non-neoplastic looking gall bladders at operation, but in a negligible number. However, it does not alter the management of these patients, as cholecystectomy is the only treatment for early carcinoma. Hence selective histopathology of gall bladder is safe and recommended, as it will save the un-necessary expenditure on routine biposy of every case