'Gear up and get ready': Collaborative curriculum for radiographers supporting percutaneous nephrolithotomy in the operating theatre.

INTRODUCTION: Newly qualified radiographers often find working in the operating theatre (OT) challenging and intimidating. These perceptions, which inhibit confidence, may hinder their effectiveness in interprofessional teamwork, which may in turn adversely affect patient outcomes. A collaborative education programme was designed, building upon the foundations of competency-based education (CBE) and simulation-based mastery learning (SBML) to examine its potential in mitigating these perceptions. The objective of this research was to assess participants' experience and level of competency after attending the curated collaborative educational programme. METHODS: The programme was developed based on the Analysis, Design, Development, Implementation, and Evaluation (ADDIE) model and comprises two teaching and learning phases: educational session and simulation. A collaborative approach was undertaken to develop an assessment checklist for the interprofessional simulation. Requirements for the simulation, such as scenario design, information and storyboard, task trainer, logistics, and learners' briefing, debrief, and feedback, were identified and assembled. The radiographers' performance was recorded using a practical skills assessment checklist and a theory assessment. RESULTS: Twelve radiographers participated and showed improvement in their self-rating of learning objectives before and after the programme. The median (interquartile range) score achieved in the theory assessment, out of a possible of 11, was 9.00 (7.75-9.50). The median (interquartile range) score achieved in the simulation component, out of a possible of 16, was 15.00 (14.00-15.00). There was statistically significant difference in self-perceived performance in all learning objective domains. CONCLUSION: The findings from the programme were promising. The use of simulation and an assessment checklist proved to be useful learning tools in preparing newly qualified radiographers for work in the OT. IMPLICATIONS FOR PRACTICE: Assessment checklists are valuable tools that should be considered to facilitate teaching and learning. The use of interprofessional simulation activities can support radiographers in developing knowledge, professional skills, and clinical competency. It should be conducted in a timely manner to facilitate the introduction to role understanding and effective communication.

Helicobacter pylori infection and the risk of colorectal cancer: a nationwide population-based cohort study.

BACKGROUND: The role of Helicobacter pylori (H. pylori) infection in the development of colorectal neoplasia has been a matter of scientific debate with controversial findings. AIMS: This study examined the association between H. pylori infection and colorectal cancer (CRC) in a nationwide population-based Chinese cohort study. METHODS: A total of approximately 3936 individuals with newly diagnosed H. pylori infection (the H. pylori-infected cohort) and 15 744 age- and sex-matched patients with diagnoses absence of H. pylori infection (the comparison cohort) from 2000 to 2005 were identified from Taiwan's National Health Insurance Research Database. The Kaplan-Meier method was used for measuring the cumulative incidence of CRC in each cohort. Cox proportional hazards models were used to compute hazard ratios (HRs) and accompanying 95% confidence intervals (CIs) for the estimation of the association between H. pylori infection and CRC. RESULTS: The cumulative incidence of CRC was higher in H. pylori-infected cohort than that in the comparison cohort (log-rank test, P < 0.001). After adjustment for potential confounders, H. pylori infection was associated with a significantly increased risk of CRC (adjusted HR 1.87; 95% CI 1.37-2.57). In addition, the HR of CRC appeared to increase with increasing frequency of clinical visits for H. pylori infection. CONCLUSIONS: Our study demonstrated that H. pylori infection was associated with an increased risk of CRC, which warrants confirmation and exploration of the underlying biologic mechanisms by future studies.

Concurrent carpal tunnel syndrome and pronator syndrome: A retrospective study of 21 cases.

PURPOSE: Concurrent carpal tunnel syndrome and pronator syndrome are rarely considered and the proximal compression sites are easily overlooked. We retrospectively studied 21 concurrent cases in our series from 2009 to 2015 and report the results. PATIENTS AND METHODS: The typical symptoms were pain, tingling, and numbness of the radial 3½ digits. If paresthesia involved the thenar eminence and proximal forearm pain was noted in cases of carpal tunnel syndrome, carpal tunnel syndrome combined with pronator syndrome was considered. Additionally, nocturnal paresthesia symptoms are absent in pronator syndrome. Therefore, if nocturnal symptoms occurred in pronator syndrome, carpal tunnel syndrome was considered. We included concurrent carpal tunnel syndrome and pronator syndrome. We used arthroscopic release of the transverse carpal ligament and open decompression for the pronator teres in cases that underwent surgery for the first time. However, recurrent carpal tunnel cases were treated with the open carpal tunnel release and open pronator decompression procedure in our hospital. The two-point discrimination was used for evaluation of sensory deficit. The grip and pinch (thumb tip to index) strength were measured by dynamometry and pinch gauge respectively. RESULTS: We retrospectively reviewed 344 cases of sustained carpal tunnel syndrome or pronator syndrome from the medical records of our institution. Of the 344 cases, 322 involved carpal tunnel syndrome alone, 1 involved pronator syndrome alone, and 21 involved carpal tunnel syndrome combined with pronator syndrome. The 21 cases of carpal tunnel syndrome combined with pronator syndrome were included in our study. Among the total cases of carpal tunnel syndrome, 6% (21/343) had pronator syndrome. The patients included 3 men and 18 women with a mean age of 52 years (range: 42-69 years). Electromyography (EMG) and nerve conduction studies were routinely performed. Postoperative evaluation showed that 15 out of 21 patients (71%) were completely relieved of pain and paresthesia and had no sensory deficit, satisfied strength improved (>85% of the opposite hand). Six patients (29%) had occasional paresthesia and pain, but no sensory deficit; grip and pinch strength deficit were recorded (<50% of the opposite hand). Six cases of these partially relieved patients had recurrent carpal tunnel syndrome but no one needed to perform tendon transfer for thenar muscle atrophy. CONCLUSION: It is important to consider the diagnosis of double crush syndrome of the median nerve, as carpal tunnel syndrome combined with pronator syndrome may impede treatment of the carpal tunnel syndrome.

African Americans and Caucasian Americans: differences in glucocorticoid-induced insulin resistance.

African Americans are more insulin resistant than Caucasian Americans and this discrepancy cannot be explained by measures of body weight or body composition. The aim of the study was to compare the sensitivity of African Americans and Caucasian Americans to glucocorticoids by measuring glucose and insulin responses to a meal challenge under conditions of placebo and glucocorticoid. A total of 160 healthy or overweight/obese African American and Caucasian American participants completed exercise testing and a liquid meal challenge during separate laboratory visits. Participants were evaluated following treatments with placebo and dexamethasone (4 mg). Main outcome measures were correlation between body composition measures (body mass index, percent body fat, waist circumference) and insulin responses; insulin and glucose responses after a liquid meal challenge; and calculated HOMA. After dexamethasone treatment African Americans were significantly more hyperinsulinemic after a meal as indicated by higher peak insulin (p=0.02) and postprandial insulin areas under the curve (p=0.006) than Caucasians. Additionally, African Americans were more insulin resistant than Caucasian Americans under both placebo and dexamethasone as determined by fasting insulin and HOMA (p=0.05). Waist circumference correlated with post-dexamethasone insulin AUC and HOMA in Caucasian Americans (p<0.05), but none of the body composition measures were predictive of IR for African Americans. African Americans are more sensitive to glucocorticoids (dexamethasone) than Caucasian Americans, as indicated by significantly greater peak insulin and postprandial insulin areas under the curve. The glucocorticoid receptor and its potential interactions with stress may contribute to this ethnic disparity.

Surgical management and clinical outcome of gastrointestinal stromal tumor of the colon and rectum.

BACKGROUND: A standardized treatment for gastrointestinal stromal tumors (GIST) of the colon and rectum has not been clearly established. The objective of this study is to examine our experience in patients with colorectal GISTs and review the appropriate surgical management. METHODS: The medical records of patients with colorectal GIST treated in our institution between 1995 and 2005 were reviewed. The malignant potential of the GIST was assessed with the current consensus criteria defined by the National Institutes of Health. Clinical parameters were also evaluated to determine prognostic factors. RESULTS: There were 10 male and 7 female patients, with a median age of 64 years (range: 19 - 84). Bloody stool and abdominal pain were the most commonly reported symptoms in colorectal GISTs. There were 7 colonic GISTs and 10 rectal GISTs. Sixteen patients underwent surgery with a margin of negative resection including 12 radical surgical resections, 3 transanal wide excisions, and one colonoscopic excision. Pathological results revealed a high risk in 8 patients (47.1 %), an intermediate risk in 4 (23.5 %), a low risk in 3 (17.6 %), and a very low risk in 2 (11.8 %). Three patients (3 / 16, 18.6 %) developed disease relapse after primary radical resection. All the three patients were high-risk rectal GISTs, accounting for 42.9 % (3 / 7) in the high-risk group. The median time to disease relapse was 15.7 months (range: 6 - 24). Cox regression analysis showed that variables including age, gender, and tumor size were not presenting statistically significant differences between groups of relapse and non-relapse patients. CONCLUSION: Non-high-risk colorectal GISTs bear a good prognosis after margin-negative surgery. Transanal wide excision for non-high-risk GISTs is mandatory if a complete resection can be performed. Abdominoperineal resection would be preserved only in patients with high risk or large non-high-risk lower rectal GISTs. The high-risk group has high incidence of relapse even though a complete resection was achieved. Adjuvant therapy with a tyrosine kinase inhibitor would be beneficial to these patients.

Rectal prolapse as initial clinical manifestation of colon cancer.

Rectal prolapse as the initial clinical manifestation of colorectal cancer is uncommon. We describe the case of a 75-year-old woman who was diagnosed as having adenocarcinoma of the sigmoid colon after presenting with complete rectal prolapse. The tumor caused rectosigmoid intussusception and then it prolapsed out through the anus. She underwent rectosigmoidectomy and rectopexy. The postoperative course was uneventful. The relationship between colorectal cancer and rectal prolapse has not been clearly established. This case report describes an unusual presentation of colorectal cancer. It suggests that rectal prolapse can present as the initial symptom of colorectal cancer and may also be a presenting feature of the occult intra-abdominal pathology. The importance of adequate investigation such as colonoscopy should be emphasized in patients who develop a new onset of rectal prolapse.

Hand-assisted laparoscopic colectomy vs open colectomy: a prospective randomized study.

BACKGROUND: We compared the perioperative parameters and outcomes achieved with hand-assisted laparoscopic colectomy (HALC) vs open colectomy (OC) for the management of benign and malignant colorectal disease, including cancer patients treated with curative intent. METHODS: Sixty eligible patients were randomized to either HALC (n = 30) or OC (n = 30) treatment groups. We used Pearson's chi-square and two-sample t-tests to compare the differences in demographics and perioperative parameters. RESULTS: There were no significant differences in age, gender distribution, disease pattern, operative procedure, comorbidity, or history of abdominal surgery. The HALC patients had significantly shorter hospital stays and incision lengths, faster recovery of gastrointestinal function, less analgesic use and blood loss, and lower pain scores on postoperative days 1, 3, and 14. There were no significant differences in operative time, complications, or time to return to normal activity. CONCLUSION: Hand-assisted laparoscopic colectomy (HALC) is safe and produces better therapeutic results in terms of perioperative parameters than OC.

Minithoracotomy with simultaneous video-assisted thoracoscopic surgery vs. video-assisted thoracoscopic surgery for spontaneous hemopneumothorax.

BACKGROUND: Spontaneous hemopneumothorax, a life-threatening and rare disorder and complication of primary spontaneous pneumothorax, is regarded as a surgical emergency. We have prospectively investigated the differences in safety and utility between minithoracotomy with simultaneous video-assisted thoracoscopic surgery (MT + VATS) and the video-assisted thoracoscopic surgery approach (VATS) in the treatment of spontaneous hemopneumothorax. METHODS: From Jan 1998 to May 2002, 248 patients with primary spontaneous pneumothorax were treated in our hospital. Among these patients, 12 (4.8 %) spontaneous hemopneumothorax occurred, all in the first episode of spontaneous pneumothorax. After tube thoracostomy, the amount of blood drainage ranged from 500 to 1,500 ml. 8 patients were treated by MT + VATS and 4 by VATS. RESULTS: During surgery, the sources of hemorrhage were all from the torn aberrant vessels between the apical blebs and the parietal pleura. The duration of main surgical procedure (including removal of blood clot in pleural cavity, control of bleeding and blebectomy) was significantly shorter in MT + VATS than in VATS (p < 0.01, Mann-Whitney U). There were no differences between these two groups in postoperative chest tube drainage duration, average postoperative pain score or hospital stay. No relapses occurred in the succeeding 6 months to 4 years. CONCLUSIONS: Spontaneous hemopneumothorax is usually treated as an urgent surgical condition. MT + VATS is an easy accessible and safe procedure that could be applied as an initial treatment method in the patient with spontaneous hemopneumothorax, especially in the treatment of the patients with active hemorrhage and massive blood clot in the thorax.

Tracheoinnominate artery fistula: successful surgical management of one case.

Fistula formation between the trachea and the innominate artery following tracheostomy is a rare, but life-threatening complication. Because of its clinical presentation with acute, massive, intractable bleeding, the mortality is nearly 100% without operation. To the best of our knowledge, the autologous pericardium flap for coverage of the tracheal defect has not been discussed in the English-language literature. We successfully treated one case of tracheoinnominate artery fistula following tracheostomy by using autologous pericardium flap.

Carcinoid tumor of the spleen: report of a case.

Carcinoid tumors are uncommon tumors of the neuroendocrine system. They grow slowly and may remain silent for years before presenting with carcinoid syndrome. A diagnosis of asymptomatic carcinoid tumor is difficult. Wide resection of the primary tumor and metastatic lesions is the first choice of treatment. Primary carcinoid is sometimes distributed throughout the entire body, but it is rare in the spleen. We herein present a rare case of a symptomless carcinoid tumor that predominantly invaded the spleen with liver metastasis.

Accurate assessment of tissue expansion in the lower face and anterior neck by a simple measurement technique.

A simple, precise method of clinical estimation for the accurate assessment of tissue expansion in the lower face and anterior neck is described using fixed anatomical reference points. The method makes it possible to select the most suitable size of tissue expander and to decide the optimal timing of operation. By recording the baseline data before expansion and repeating measurements as expansion proceeds, the discrepancy of the expectation between the surgeon and patient concerning the postoperative result can also be minimised.

Use of the scalp as a donor site for large burn wound coverage: review of 150 patients.

The characteristics of rapid wound healing and multiple harvest capacity make the scalp an important donor site when dealing with large and deep burn wounds. This paper reports the results of a retrospective analysis of 150 patients treated for large burn wounds. The findings indicated that bleeding during graft skin harvest could be limited to 50 ml by intradermal injection of epinephrine (1:2,000,000), high-concentration epinephrine-soaked gauze compression (1:20,000), and temporary porcine skin coverage. Use of a scalp graft also carried a low risk of complications, with only four (2.7%) major complications including three cases (2.0%) of visible alopecia and one case (0.7%) of hair transplantation. There were no hypertrophic scars, even in the patient who had the largest number (11) of repeat harvests.

Necrotizing soft tissue infections. Surgical or conservative treatment?

BACKGROUND: Both surgeons and dermatologists are increasingly challenged with the prompt diagnosis and management of severe soft tissue infections. Although early surgical intervention appears to be for life-saving in many patients, especially those diagnosed as necrotizing fasciitis, some patients recover well with only conservative treatment. Because most of these infections have similar initial clinical presentations, there remains a need to find reliable clinical and/or laboratory parameters that can predict the prognosis and to accordingly judge the necessity and timing of operation. METHODS: We conducted a retrospective study of case records of patients with necrotizing soft tissue infections. The clinical presentation, laboratory findings, management, and therapeutic outcome of 34 cases with necrotizing soft tissue infections were reviewed. RESULTS: These infections were potentially life-threatening, with an overall mortality of 26.5%. Shock on admission was an extremely grave sign associated with a poor prognosis (P < 0.05). In this grave condition, most (80%) patients died regardless of the choice of treatment. Coagulation parameters, including platelet counts, prothrombin time (PT), and partial thromboplastin time (PTT), were available in 21 patients, of whom 16 had at least one abnormality at their initial presentation. In these 16 patients, those who underwent surgery had a significantly higher survival rate than those who were treated conservatively (P < 0.05). Prolonged PT was significantly associated with a higher mortality (P < 0.05). Surgery did seem to correct coagulopathies. However, in patients presenting with substantial alteration of all three coagulation parameters, there was no significant difference between medical treatment and surgical intervention in terms of mortality. In such cases, mortality was high (75%). On the other hand, the prognoses of patients who presented with normal coagulation profiles were rather good. Most of them recovered well despite the therapeutic option. Surgical treatment did not seem to increase additional benefits on chances of survival. Extent of tissue plane involvement, bacteriology, and site of infection had no significant influence on patients' survival. CONCLUSIONS: A comprehensive, well-organized, universal approach, regardless of classification, is essential for all suspected cases of necrotizing soft tissue infections. Prompt diagnostic studies are needed, and platelet counts, PT, and PTT are readily available parameters that provide substantial information on diagnosis and treatment, thus avoiding an unwarranted loss of life or unnecessary operative sequelae. Early diagnosis and, in most cases, prompt radical surgical, intervention remain the cornerstone of successful management in these infections.

Continuous antegrade warm blood cardioplegia attenuates augmented coronary endothelium-dependent contraction after cardiac global ischemia and reperfusion.

BACKGROUND: Experiments were designed to evaluate the effect of warm blood cardioplegia on endothelium-dependent contraction of the coronary endothelium after cardiac global ischemia and reperfusion. METHOD: Dogs (n = 12 in each group) were exposed to extracorporeal circulation with the body temperature at 37 degrees C (group 1) or 28 degrees C (groups 2 and 3). The ascending aorta was crossclamped for 120 minutes while continuous infusion of warm blood cardioplegec solution (group 1) or intermittent infusion of cold (4 degrees C) crystalloid cardioplegic solution (group 2) was performed via the coronary arteries through the aortic root. Cardioplegic solution was not used in group 3 animals. The heart was then allowed to function for 60 minutes of reperfusion. Reperfused (groups 1, 2, and 3) and control (group 4) coronary arteries were then harvested for study. RESULTS: Perfusate hypoxia caused endothelium-dependent contraction in the arteries of all four groups that could be attenuated by NG-monomethyl-L-arginine (L-NMMA) or L-NMMA plus D-arginine, but not by L-NMMA plus L-arginine or endothelin receptor A and B antagonist PD 145065. The endothelium-dependent contraction results in groups 2 and 3 (75% +/- 4% and 80% +/- 5%, respectively) were significantly greater than those in groups 1 and 4 (15% +/- 3% and 18% +/- 5%, respectively). Scanning electron microscope studies showed that platelet adhesion and aggregation, areas of microthrombi, disruption of endothelial cells, and separation of the intercellular junction could be found in coronary segments from groups 2 and 3, but not in vessels from groups 1 and 4. CONCLUSION: These experiments suggest that global ischemia and reperfusion enhances hypoxia-mediated endothelium-dependent contraction of the coronary endothelium and damages the ultrastructure. These kinds of changes can be prevented by continuous antegrade infusion of warm blood cardioplegic solution during global ischemia.