"Overtime Hours Effect" on emergency surgery of acute type A aortic dissection

Abstract Objective: Treatment of acute diseases of the aorta is still associated with high mortality and morbidity. It is believed that interventions for these diseases on overtime hours (night shifts or weekend shifts) may increase mortality. In this study, we investigated the effect of performing acute type A aortic dissection surgery on overtime hours in terms of postoperative outcomes. Methods: 206 patients who underwent emergency surgery for acute type A aortic dissection were retrospectively evaluated. Two groups were constituted: patients operated on daytime working hours (n=61), and patients operated on overtime hours (n=145), respectively. Results: Chronic obstructive pulmonary disease and repeat surgery were higher in group 1. There was no statistically significant difference between the two groups in terms of operative and postoperative results. Mortality rates and postoperative neurological complications in group 1 were 9.8% and 13.1%, respectively. In group 2, these rates were 13.8% and 12.4%, respectively (P=0.485 - P=0.890). Multivariate analysis identified that cross-clamp time, amount of postoperative drainage, preoperative loss of consciousness and postoperative neurological complications are the independent predictors of mortality. Conclusions: As the surgical experience of the clinics improves, treatment of acute type A aortic dissections can be successfully performed both overtime and daytime working hours.

Factors of Academic Success Among Undergraduate Medical Students in Taif University, Saudi Arabia: A Cross-Sectional Study

This cross-sectional research was carried out in the College of Medicine at the University of Taif, Kingdom of Saudi Arabia.It included a random sample of medical students in 4th, 5th and 6th years (males and females). Data were collected using asemi-structured, self-administered questionnaire, including comprehensive, anonymous demographic and socioeconomicdata, lifestyle factors, health related quality of life, social support, student’s academic motivation, the past year grade pointaverage (GPA). The study included 261 students. The age ranged between 21 and 27 years (22.8±1.1 years). Malesrepresented 55.9% of the participants. Moreover, non-smokers, membership in charity association, having higher score ofpsychological domain of quality of life, and higher learning strategies score were significantly associated with grade pointaverage (GPA) score and they are responsible for 21.5% variability of the score. From the results it could be concluded thatAcademic performance of senior medical students in Taif University, manifested by GPA score is influenced by many factors(multi-factorial) that are responsible for only 21.5% of variability in grade point average (GPA).

Microbiological Characteristics of Acute Prostatitis After Transrectal Prostate Biopsy

PURPOSE: We aimed to identify microbiological characteristics in patients with acute prostatitis after transrectal prostate biopsy to provide guidance in the review of prevention and treatment protocols. MATERIALS AND METHODS: A retrospective analysis of medical records was performed in 1,814 cases who underwent prostate biopsy at Seoul St. Mary's Hospital and St. Vincent's Hospital over a 5 year period from 2006 to 2011. Cases in which acute prostatitis occurred within 7 days after the biopsy were investigated. Before starting treatment with antibiotics, sample collections were done for culture of urine and blood. Culture and drug susceptibility was identified by use of a method established by the Clinical and Laboratory Standards Institute. RESULTS: A total of 1,814 biopsy procedures were performed in 1,541 patients. For 1,246 patients, the procedure was the first biopsy, whereas for 295 patients it was a repeat biopsy. Twenty-one patients (1.36%) were identified as having acute bacterial prostatitis after the biopsy. Fifteen patients (1.2%) had acute prostatitis after the first biopsy, and 6 patients (2.03%) experienced acute prostatitis after a repeat biopsy. Even though the incidence of acute bacterial prostatitis was higher after repeat biopsy than that after the first biopsy, there was no statistically significant intergroup difference in terms of incidence (chi2=1.223, p=0.269). When the collected urine and blood samples were cultured, Escherichia coli was found in samples from 15 patients (71.4%), Klebsiella pneumoniae in 3 patients (14.3%), Enterobacter intermedius in 1 patient (4.8%), E. aerogenes in 1 patient (4.8%), and Pseudomonas aeruginosa in 1 patient (4.8%). A fluoroquinolone-resistant strain was confirmed in 5 cases (23.8%) in total. Three cases of E. coli and 1 case of Klebsiella had extended-spectrum beta-lactamase activity. CONCLUSIONS: Empirical treatment of acute prostatitis should be done with consideration of geographical prevalence and drug resistance. This study will provide meaningful information for the management of acute prostatitis after transrectal prostate biopsy.

Hérnia de Amyand / Amyand's hernia

We present vermiform appendix finding within an inguinal hernia sac, rare pathology, well-known as Amyand's hernia. We relate the incidence in the literature and the recommended conducts.

The Efficacy of Unenhanced MR Imaging for the Diagnosis of Acute Appendicitis: A Performance Comparison Versus Abdominal Ultrasonography

PURPOSE: To evaluate the efficacy of unenhanced MR imaging compared to the diagnostic accuracy, advantage, and limitations of abdominal ultrasonography in the diagnosis of acute appendicitis. MATERIALS AND METHODS: The study included 40 patients suspected of having acute appendicitis and who were subjected to an unenhanced MR image, as well as an abdominal ultrasonography. A T1 FLASH in an axial image, a chemical shift-selective fat suppressed T2 HASTE in an axial image, as well as a T2 HASTE in an axial and coronal image were obtained as unenhanced MR images. The diagnosis was established based on a surgical or clinical follow-up of the unenhanced MR results, which were then statistically compared to the ultrasonographic results. RESULTS: The surgical or clinical follow-up results revealed that 25 patients were positively diagnosed with appendicitis. Of these, 7 patients had symptoms of acute appendicitis with no pathologic diagnoses, whereas the 8 remaining patients were diagnosed with another condition. The sensitivity and accuracy of the unenhanced MR imaging was 92% and 90%, compared to ultrasonography which was 68% and 72.5% accurate, respectively. The differences in sensitivity and accuracy between the two methods were found to be statistically significant (p < .05, chi-square test). Based on these results, unenhanced MR imaging was superior to sonography for the diagnosis of appendicitis. CONCLUSION: Unenhanced MR imaging may be a useful modality for the diagnosis of acute appendicitis, especially for suboptimal or nondiagnostic sonographies, as well as patients that are particularly sensitive to radiation exposure.

Changes of serum intercellular adhesion molecules levels in acute pancreatitis / 国际检验医学杂志

Objective To investigate the function of serum soluble intercellular adhesion molecule-1(sICAM-1) in acute pancreatitis(AP).To study the significance of continuous monitoring sICAM-1 in differential diagnosis of AP.Methods A total of 60 patients were investigated;36 patients with acute edematous pancreatitis(AEP),and 24 with acute haemorragic necrotic pancreatitis(AHNP).The concentrations of sICAM-1 in the patients' serum were measured serially over a period of 7d by enzyme-linked immunosorbent assay(ELISA).Results There was significant difference between AEP group and AHNP group(P

Diagnosis and treatment of acute occlusion of abdominal aorta / 中国普通外科杂志

Objective To study the etiology, diagnosis and treatment of acute occlusion of abdominal aorta(AOAA). Methods Clinical data of 35 patients with AOAA admitted to our hospital from January 1980 to August 2001 were analyzed retrospectively. Results There were 17 patients with acute aortic embolism(AAE) and 18 patients with acute aortic thrombosis(AAT) . All cases had total occlusion of abdominal aorta,and bilateral iliac arteries were involved. All the 35 cases underwent operations, including bilateral transfemoral thromboembolectomy by Fogarty balloon catheter in 18 cases, thromboembolectomy via laparotomy aortotomy in 11 cases, aortobiiliac reconstruction in 2 cases, aortobifemoral bypass in 2 ( 1 had profundaplasty) and axillobifemoral bypass in other 2 cases. Operative mortality was 25.7%(9/35). After the operations, artery embolism recurred in 3 cases; 3 patients required amputation; renal failure occurred in 3 cases and paraplegia in 4; ischemic colitis occurred in 5, impaired sexuality in 1 and incomplete intestinal obstruction in 1. Conclusions AOAA is an urgent disease with high mortality. Fast preoperative diagnosis and prompt operation are the keys to salvage the patient. Color Doppler is the first choice of diagnosis. Fogarty balloon catheter thromboembolectomy and vascular reconstruction are effective treatments for this disease.

Acute retroperitoneal colon perforation: a report of 20 cases / 中国普通外科杂志

Objective To explore the clinical features of acute retroperitoneal colon perforation. Methods A retrospective analysis and summary were made on the clinical data of 20 cases of various retroperitoneal colon perforation. Results All of the 20 cases had been misdiagnosed preoperatively. Eighteen cases received surgical treatment, of which 5 cases underwent one-stage tumor resection, 5 cases had two-stage tumor resection and anastomosis;of 8 cases with traumatic perforation,7 were treated by simple suture, 1 case underwent two-stage colonic anastomosis; 2 cases died,all the 2 cases were treated conservatively.Conclusions There are many differences between retroperitoneal colon perforation and intra-abdominal perforation in clinical symptoms, signs and supplementary examinations. Diagnosis of retroperitoneal colon perforation is difficult and the rate of misdiagnosis is high, so this condition must be highly regarded.Surgery is the best option to treat this disease.

The effect and the indications of intermittent short veno-venuous hemofiltration in severe acute pancreatitis / 中国普通外科杂志

Objective Observe the effect and the indications of intermittent short veno-venuous hemofiltration(ISVVH) in severe acute pancreatitis(SAP). Methods APACHE II scores≥14 and fluids imbalance were respectively used to define as the indication of starting hemofiltration and ending hemofiltration. In 39 patients with SAP,19 underwent ISVVH(IS group),and the other 20 patients were not accepted hemofiltration (N group). APACHE II scores, Balthazar CT grades and the plasma levels of procalitonin(PCT), TNF-?, IL-6, IL-8, IL-1ra, IL-2 and IL-10 were observed. Results At admission and 2d after admission, APACHE II scores in IS group and N group were (13.8?3.1)and (17.8?3.2) ( P

The operation timing and operative procedure for sevese acute pancreatitis / 中国普通外科杂志

Objective To investigate the operation timing and operative procedure for serious acute pancreatitis(SAP).Method To analyze retrospectively the clinic data of 56 cases treated by operation.Result 54 cases were cured,who treated by operation within 48h after SAP onset. All the 2 cases dead of multiple organs failure who underwent operation 5-6d after SAP onset.Conclusions When SAP advanced to have indications of operative treatment,an-operation should be done as early as possible, no metter the time from the onset of SAP is long or short.

Study of the effect of early using selective digestive decontamination in treating acute necrotizing pancreatitis in rats / 中国普通外科杂志

Objective To investigate the protevtive effect and mechanism of early using selective digestive decontamination (SDD) on severe acute pancreatitis(SAP) in rats.Methods Sixty rats were randomly assigned into SAP group and SAP+SDD group after SAP model was set up.Rats in the SAP+SDD group underwent SDD immediately after the model was established and last for 3 days. The peripheral and portal vein serum endotoxin, tumor necrosis factor -a (TNF-a) and interleukin -1 (IL-1) at 24 hours, 48 hours, and 72 hours and the mortality, average living time and the degree of pancreatic necrosis were observed and compared in the 2 groups. Results The levels of peripheral and portal vein serum endotoxin, TNF-? , IL-1,and the mortalities in SAP+SDD group were significantly lower than those in SAP group(all P

The value of ultrasound examination in the diagnosis of acute appendicitis in children / 中国普通外科杂志

Objective To investigate the value of ultrasound examination in the diagnosis of acute appendicitis. Methods Emergency abdominal ultrasound examination was performed on 152 children who had clinically suspected acute appendicitis. Results Sixty-three children were diagnosed as acute appendicitis by ultrasound . Among them, fifty-nine children had emergency appendectomy; the other 4 had delayed appendectomy six months after conservative therapy for appendiceal mass. All of the diagnoses were confirmed to be correct by pathologis examination . Among the other 89 children, the diagnosis was luteinic rupture in 4, choledochal cyst in 2, omental cyst in 1, hydronephrosis in 1, and nephrolithiasis in 1. Eighty of them were diagnosed as mesenteric lymphadenitis and treated conservatively. Seventy-six of these eighty children recovered , and appendectomy was performed on four patients. In two of them the diagnosis was suppurative appendicitis, and in two, the diagnosis was simple appendicitis. Conclusions Combined with consideration of the symptoms and signs, ultrasound is valuable in the diagnosis of appendicitis.

Clinical study on the treatment of severe acute pancreatitis with combination of sandostatin and growth hormone / 中国普通外科杂志

Objective To evaluate the therapeutic effect of combination of sandostatin and growth hormone (GH) in the treatment of severe acute pancreatitis (SAP ). Methods Sixty patients with SAP were divided randomly into 3 groups:(1)Sandostatin treatment(ST) group (n=15);(2)combination of sandostatin with GH treatment(CT) group (n=30) ;(3)control group (n=15). The changes in serum IL-1, IL-6,TNF-? and albumin levels after treatment, and the incidence of complications, the duration of hospital stay and cost were compared among the 3 groups. Results The complications, mortality, duration of hospital stay in the CT group were significantly shorter than those in ST group and control group (all P

Surgical management of acute colon obstruction caused by carcinoma in elder patients:a report of 98 cases / 中国普通外科杂志

ObjectiveTo determine the principle and method of surgical management of acute colon obstruction caused by carcinoma in the elder patients. MethodsClinical data of 98 patients with acute colon obstruction caused by carcinoma were analyzed retrospectively. ResultsOf 98 patients undergoing operation,complications occurred in 8 cases,and 3 ( 3.1%)died postoperatively.The other patients were healed. ConclusionsThe management of acute colon obstruction caused by carcinoma in the elder patients depends on the patients,general condition and local condition of the carcinoma.If it is an indication, one-stage resection of the cancer and anastomosis of the colon may be safe and suitable .

Current status in diagnosis and treatment of acute pancreatitis / 中国普通外科杂志

Objective To introduce the current status of the diagnosis and treatment of acute pancreatitis (AP). Methods With the reference of relevent articles issued in this periodical, the summary was mad on author's professinal knowledge and special clinical experience. Results and conclusions The pathology of AP is varied. The staging of AP is divided into mild type and severe type. 90% of patients with AP take a mild course and clinical improvement can be achieved by non operative therapy; meanwhile the other 10% of patients of AP take a severity course and operation is necessary when the patients complicated with infection. Operation principle: the timing is not to be early and the procedure is not to be large. New advance had been made in the diagnosis and treatment of AP, which has improved the curative rate and reduced the mortality. For some causes, nation standard of diagnosis and treatment of AP could not been performed in many primary hospitals. It is effective for primary hospital to treat AP with Chinese medicine. The author provides four items in experience: early diagnosis, distinguishing the staging of AP(mild or severe) and improving curative effect; reducing course of treatment; preventing complicantions; and combining Chinese medicine with west medicine for AP. This is the current status of diagnosis and treatment of AP in China.

Therapeutic effect of kansui root on patients with severe acute pancreatitis / 中国普通外科杂志

Objective To investigate the therapeutic effect of kansui root on patients with severe acute pancreatitis(SAP). Methods Clinical data of 54 cases of severe acute pancreatitis treated with kansui root(kansui root group) were analyzed and compared with 54 cases of severe acute pancreatitis treated without kansui root (control group).Results The releivng time of abdominal pain was significantly shorter than that in control group( P

The role of staging nutrition in the treatment of severe acute pancreatitis / 中国普通外科杂志

Objective To investigate the role of staging nutrition(SN) in the treatment of severe acute pancreatitis(SAP). Methods One hundred patients with SAP treated in our hospital since 1997 were randomly divided into two groups: Total parenteral nutrition group(TPN group,50 cases) and staging nutrition group (SN group,50 cases). The curative effects and complications between two groups were analyzed and compared. Results The incidences of total complications,incubation complication,double infection,hepatic function injury,abdominal cavity infection and hospital stay in SN-group were significantly lower than those in TPN-group(all P

Cyclooxygenase-2 expression of pancreatic tissues in severe acute pancreatitis in rats / 中国普通外科杂志

Objective To study the expression of cyclooxygenase-2(COX-2) in pancreatic tissues of severe acute pancreatitis(SAP) in rats,and explore the possible role of COX-2 in the pathogenesis of the SAP. Methods Forty adult male Sprague-Dawley rats were randomly divided into SAP group(n=20) and control group(n=20). At 12h after operation,acites,serum levels of amylase activity,tumor necrosis factor-?(TNF-?),TXB 2 and 6-keto-PGF 1? and the expression of COX-2 in pancreatic tissue were detected.the pathological changes of pancreatic tissues were observed and scored under microscope;the survival rate in 72h and mortality in 24h in SAP and NC group were recorded.Results At 12h after the induction of SAP,the serum amylase activity,TNF-?,TXB 2 and 6-keto-PGF 1? were significantly higher in SAP group than those in NC group(P

Combined administration of rhubarb and niatrii sulfas for severe acute pancreatitis / 中国普通外科杂志

Objective To discuss the therapeutic effects of rhubarb and natrii sulfas for severe acute(pancreatitis)(SAP).Methods Eighty-three patietns with SAP were randomly divided into treatment group(group A,n=45) and control group(group B,n=38).The 2 groups received the same therapy except that group A received rhubarb and natrii sulfas through nasogastric tube.Results In treatment group(compared) to control group,the clinical symptoms such as abdominal pain and distention were more quickly(relieved),with early return to oral food intake,lesser complications and shorter hospital stay(all with P

Effect and mechanism of kansui root on microcirculation of pancreatic tissues in rats with severe acute pancreatitis / 中国普通外科杂志

Objective To explore the effect and mechanism of kansui root on microcirculation of pancreatic tissues in severe acute pancreatitis(SAP) rats.Methods SD rats were randomly divided into sham group(S group),SAP group and kansui root therapy group(K group).40 rats in each group.Serum amylase,and thromboxame-B2(TXB_2),6-Keto-F_(1?)(6-Keto PGF_(1?))levels and expressions of cyclooxygenase-2(COX-2)mRNA and protein in pancreatic tissue,microscopy and election microscopy of pancreas,mortality within 72 hour after operation in each group were tested at 2h,6h,12h,and 24h after operation.Results (1)The TXB_2,6-keto PGF_(1?) levels and the ratio of TXB_2/6-Keto-PGF_(1?)(T/P) in SAP group were all(obviously) higher than those in S group(P