Assessment of bed-days utilization in general surgical wards of ismailia hospitals, Egypt

there is widespread recognition that some part of the utilization of hospital resources is inappropriate. The Appropriateness Evaluation Protocol [AEP] was developed to provide an objective criterion-based assessment of medical appropriateness of admissions and subsequent days of care. to quality the inappropriate utilization of surgical beds in terms of inappropriate days, to identify predictors of inappropriateness, and to determine reasons for inappropriate utilization of surgical beds. the appropriateness of 2406 hospital days contributed by 370 patients admitted to general surgical departments in two hospitals in Ismailia, was assessed by means of the Adult Medical-Surgical version of the AEP. If the day was inappropriate, reasons for inappropriateness were searched. Patients were followed-up daily till discharge using a questionnaire containing the predictor variables [patient and hospitalization characteristics]. AEP identified 45% [University Hospital] and 57.5% [General Hospital] of hospital days as inappropriate. Inappropriate days were higher among elderly, singles, and illiterate patients, operated cases, and those with long stay. Multivariate analysis showed that gender, education, admission channel, admission at holidays, source of payment, and length of stay were significant predictors predictors for inappropriate days. The commonest reason for inappropriate days was "Diagnostic procedure or treatment can be done on an outpatient basis". based on the AEP criteria, it was found that about half of hospital days were considered inappropriate in the two hospitals

results of oesophageal transaction and reanastamosis by stapling in patients with bleeding oesophageal varices

One hundred patients with acute bleeding esophageal varices underwent early surgical intervention by esophageal transection and reanastomosis by stapling combined with gastroesophageal devascularization together with splenectomy in 56 patients [56%] and splenic artery ligation in 44 patients [44%]. The overall mortality was 7 patients [7%] and all of them were due to liver cell failure during a mean follow up period of 49.5 months. Two patients [2%] died before discharge from the hospital and 5 patients [5%] died 13 to 20 months after operation. One patient lost the follow up. Bleeding was controlled postoperatively in all patients but during follow up, it recurred in a mild form in 14 patients [14%]. Late dysphagia was absent in all patients although 17 patients [17%] gave history of dysphagia in the early postoperative period. Hb% and platelet count showed significant increase in splenectomized patients. The mean serum albumin was improved significantly at the end of follow up period [P <0.05]. Endoscopically, varices disappeared completely in 75 patients [75%] and regressed to grade I in 15 patients [15%]

Electrolytes and pH of mammary cyst fluid and their relation to cyst pathology

The relation between intracystic levels of Na+, K+, Na+/K+ ratio, pH and the cytologic appearance of fluid contents and the histopathology of gross mammary cysts was studied in 182 gross mammary cysts. Na+ level was inversely correlated to K+ level [P <0.001]. Two types of cysts were identified: The first group [105 cysts] with Na+/K+ ratio <3 and the lining was mainly metaplastic apocrine epithelium, the second group [77 cysts] Na+/K+ ratio was >3 and the lining was flattened ductal epithelium. Na+K+ was also found to be inversely correlated with the degree of epithelial hyperplasia of the cyst wall [P <0.005]. Poor correlation, however, was found between cytologic appearance of cyst fluid contents and the degree of hyperplasia

Late results of splenic devascularization in treatment of bleeding oesophageal varices

Portal hypertension and bleeding oesophageal varices is considered to one of the urgent problems in the management of liver diseases. A ten years follow up [40 to 121 month] of 52 patients with endoscopically proven varices and who suffered at least one attack of haematemesis and underwent splenic artery ligation and vasoligation was done. Recurrent varicael bleeding occurred in 50% of patients. It was mild or moderate in 25%, severe in 9.5% and it was fatal in only 11.5% of cases. Most rebleeding occurred during the 1st year. Endoscopy for 28 patients showed reduction in the size of varices. Modified child's risk grading showed improvement. Post operative ascites recurred in 20 patients compared to 24 patients preoperatively. The splenic size diminished post-operatively to mean of 4.5cm below costal peripheral blood picture improved in most of the cases. Hypersplenism was controlled in 12 patients out of 16 [75%]. There was no operative mortality but during the 10 years follow up period the mortality rate was 36.5% [25%were due to liver cell failure 11.5% were due to bleeding varies]. This study showed that procedure still has a role in the mangement of bleeding oesophageal varices

Morphological and histological study of the internal anal sphincter in newborns

Eight post mortem specimens were obtained by dissecting the anal canal and the lower rectum together with the surrounding musculature out of newborns dying in the first day after birth. Examination of the specimens by the naked eye, by the hand lens and histologically, using both longitudinal and transverse sections taken at different levels and stained by haematoxylin and Eosin Masson's Trichrome Stain and modified silver technique enabled us to study the nature, location and extent of the internal anal sphincter IAS and to measure its dimensions

Changes in the blood coagulability and fibrinolytic activity induced by muscular exercise and their relation to the low incidence of atherosclerosis in athletes

The effect of exercise on both the blood coagulability and fibrinolytic activity, and the relation between the changes observed and the low incidence of atherosclerosis in atheletes, were investigated in 24 young male athletes. Blood coagulability and fibrinolytic activity were estimated by determination of the venous coagulation time and the euglobulin lysis time respectively, which were measured at rest and following an exhausting muscular exercise. After work performance, both the venous coagulation time and the euglobulin time were decreased. The decrease in the coagulation time was slight [5.13%] and of no statistical significance. On the other hand, the decrease which occurred in the euglobulin lysis time was much more marked [41.6%] and of a highly statistical significance. These changes suggest that physical activity alters the coagulation fibrinolytic equilibrium, favouring the blood fibrinolytic activity. According to the fibrin-deposit theory of atherosclerosis, this effect may be the possible mechanism by which work performance lowers the incidence of atherosclerosis and occlusive vascular diseases in atheletes. Since the exercise-induced fibrinolytic activity is transient and proportional to the intensity of work performance, it can be concluded that the greatest benefit would be obtained by daily strenuous exercise performance

Relation between work-induced changes in some blood electrolytes and the state of physical fitness

The work induced changes in the serum level of sodium, potassium, calcium and inorganic phosphates, as well as the relation between the magnitude of such post-exercise changes that were observed in these electrolytes, and the level of physical fitness [indicated by the maximal oxygen consumption], were investigated in 15 male athletes. All changes that occured in these electrolytes after vigorous work performance, were found to be, statistically, insignificant. The serum sodium level was increased by 2.74% compared with the average resting value due to loss of water in sweat in excess than the salt loss which led to a rise in the plasma sodium concentration. The serum potassium level was almost not changed after exercise. In fact, it was very slightly decreased [0.47% compared with the average resting level]. This relative stability, in spite of the great loss in sweat is most probably due to mobilistation of potassium ions from its stores in the intracellular compartments. The serum calcium and inorganic phosphate levels were on the other hand, more markedly decreased, in spite of their poverty in sweat. This may be due to their entry into the tissue cells or deposition in bone as a result of physical stress. The serum inorganic phosphate level was more decreased than the serum calcium level [12.6% and 5.27% respectively], most probably due to additional deposition of phosphates in skeletal muscles as phosphocreatine. The study also revealed that almost no relation existed between the magnitude of the post-exercise changes that occurred in the investigated blood electrolytes and the level of physical fitness, judged by the maximal oxygen consumption. This was confirmed statistically by calculation of the correlation factor [R] which was found to be 0.15, 0.11, 0.07 and 0.09 in cases of sodium, potassium calcium and inorganic phosphate, respectively

Relation between some hematological changes induced by work performance and the state of physical fitness

The effect of exercise on 5 hematological parameters, and the relation between the changes that occurred and the level of physical fitness were investigated in 20 young male athletes. The parameters studied were the R.B.C. and W.B.C. counts, the haemoglobin content, the haematocrite value and the total plasma protein level. They were estimated at rest and immediately after an exhausting exercise on a bicycle ergometer. The physical fitness of the athletes was estimated by measuring their maximal oxygen consumption. Statistical analysis of the results revealed that the changes which occurred after exercise in the R.B.C. count, haemoglobin content, haematocrite value and the plasma protein level were insignificant, greatly variable and not related to the state of physical fitness. On the other hand, the W.B.C. count showed a significant increase after exercise in almost all cases, and it was statistically proved that the better the state of physical fitness [as indicated by a higher magnitude of maximal oxygen consumption], the lesser was the magnitude of increase in the W.B.C. count after exercise, and vice versa

Local muscle fitness as a cause of variability in the evaluation of physical fitness in athletes

The influence of local muscle fitness on the post-exercise changes in the pulse rate, blood lactic acid concentration and leucocytic count, was investigated in 12 football players and 10 gymnastic players. The former represented a sport depending on the fitness of muscles of the lower extremities, while the latter represented a sport depending on the fitness of muscles of the upper extremities. All athletes were allowed to exercise their lower extremities on a bicycle ergometer, then, on the next day, to exercise their upper extremities by repeated lifting of a 20 Kg weight. The results revealed that the post-exercise increase in the 3 parameters was significantly lesser on exercising the trained muscle groups [the muscles of the lower extremities in football players, and of the upper extremities in gymnastic players] than when the untrained muscle groups were exercised [the muscles of the upper extremities in football players, and of the lower extremities in gymnastic players]. This proves that the general reaction of the body to a working load is greatly influenced by the local fitness of the exercising muscle group. Accordingly, variability in the evaluation of the state of physical fitness may be encountered with different tests. It can be concluded, therefore, that the evaluation of the state of physical fitness of an individual necessitates the performance of more than a single test, since with numerous test items, more information about the individual's fitness can be obtained

Study of the effect of prostaglandin F2 and its synthetic methyl analomuscular transmission and reflex activity in anaesthetised dogs

The intravenous injection of prostaglandin F[2] alpha a [PGF[2] alpha in doses 1 of 10-20 ug/kg body weight into anaesthetized dogs resulted in rise of arterial blood pressure. The hypertensive effect ranged between 25-46 percent of the preinjection level. Tachyphylaxis was demonstrated in several experiments. The blood pressure records showed periods of tachycardia. Also PGF[2] alpha a in the above mentioned doses produced significant inhibition of the knee jerk which ranged between 49-84 percent of the pre-injection level [P < 0.001] The response of gastronomies muscle to sciatic nerve stimulation showed insignificant change [P > 0.05]. The intravenous administration of 15 [S]-15 methyl analogue of PGF[2] alpha a in doses of 2.5, 5.0 and 7.5 ug/kg body weight elevated the arterial blood pressure by 14-31 percent. The hypertensive effect of the drug was proportional to the dose injected. The duration of action of the methyl analogue was more long lasting than that of PGF[2] alpha. This synthetic analogue in the above mentioned doses produced significant inhibition of the knee jerk which was proportional to the dose level and ranged between 31-86 percent. The inhibitory effect of this methyl analogue in a dose of 7.5 ug/kg body weight was more prolonged than that of PGF[2] alpha a in doses of 10 or 20 ug/ kg body weight. The synthetic analogue had insignificant effect on the response of gastronomies muscle to sciatic nerve stimulation [P > 0.05]. The intravenous injection of this methyl analogue in a dose of 7.5 ug/kg body weight frequently produced initial rise in arterial blood pressure, followed by severe hypotension, apnea and loss of knee jerk