Emergent laparoscopic sigmoid resection for perforated diverticulitis: can it be safely performed by residents?

AIM: Outcomes after resident involvement in emergent colectomies have rarely been studied. The aim of this study was to analyse the outcomes of laparoscopic sigmoidectomy for Hinchey III diverticulitis performed by residents. METHOD: This study was a retrospective analysis of patients undergoing laparoscopic sigmoidectomy for diverticulitis. The sample was divided into two groups: patients operated on by a supervised resident (SR) or a senior surgeon (SS). Supervising surgeons and SSs could be general surgeons (GSs) or colorectal surgeons (CSs). A SR was considered the first surgeon if he/she completed at least three of five defined steps of the procedure. The primary end-points included length of hospital stay (LOS), morbidity and 30-day mortality. A sub-analysis of patients operated on by a SR assisted by either a CS or GS was performed. RESULTS: Supervised residents and SSs operated on 59 and 42 patients, respectively. The presence of a CS was more frequent in the SS group (SR 41% vs SS 81%, P < 0.001). LOS (SR 9.4 days vs SS 6.4 days, P = 0.04) was higher in the SR group. Overall morbidity (SR 39% vs SS 43%, P = 0.69) and 30-day mortality (SR 5% vs SS 5%, P = 0.94) were also comparable among the groups. Procedures performed by SRs and supervised by a CS were associated with lower morbidity (GS 48% vs CS 25%, P = 0.06) and mortality (GS 8% vs CS 0%, P = 0.26). CONCLUSION: Laparoscopic sigmoidectomy for Hinchey III diverticulitis has comparable outcomes when performed by a supervised SR or a SS. Procedures performed by residents assisted by a CS seem to have better outcomes than those assisted by a GS.

[Comparative morphological characteristics of changes in the liver in case of poisoning with alcohol-containing liquids in human and following subacute treatment of animals with ethyl and propyl alcohols, ethylene glycol and their mixtures].

The authors present results of comparative morphological studies of changes in the liver after intoxication with alcohol-containing liquids in human and following subacute treatment of animals with ethyl and propyl alcohols, ethylene glycol and their mixtures. It was shown that poisoning caused by individual chemical substances and their mixtures induced significantly different changes in the liver of animals. The mixtures produced much more serious toxic lesions in the parenchymal tissue than individual spirits (including development of necrotization foci) and contributed to enhanced mortality of experimental animals. The morphological picture of the liver in human subjects poisoned by a mixture of alcohols resembled that after intoxication with carbon tetrachloride and was consistent with the changes in people who had died during episodes of mass poisoning with surrogate alcoholic beverages and alcohol-containing liquids.

Coordinación asistencial entre atención primaria y especializada. Satisfacción con el proyecto especialista consultor / Coordination between primary and specialist care. Satisfaction with the consulting specialist project

Conocer la satisfacción de los médicos con el proyecto especialista consultor en el Área 7, y su opinión respecto a éste. Explorar la opinión de estos médicos sobre los problemas y soluciones en la relación entre atención primaria (AP) y atención especializada (AE). Material y métodos: Estudio descriptivo transversal mediante cuestionario autoadministrado. Población de estudio: Médicos de AP del Área 7 de Madrid (n=304). Variables Demográficas y profesionales, relacionadas con la satisfacción con el desarrollo del proyecto, relacionadas con la percepción general del proyecto, el beneficio potencial para los pacientes y con la opinión acerca de las dificultades en la relación AP-AE y las posibles soluciones. Resultados: La tasa de respuesta fue del 56% (contestaron el cuestionario 170 médicos). Respecto a la satisfacción con el proyecto, la puntuación global fue de 8,9 sobre 10. Al 83% de los médicos de AP les resultó fácil el contacto con el especialista de referencia, y el 90% refirió que las cuestiones planteadas se habían resuelto de forma satisfactoria. La herramienta peor valorada para establecer comunicación fue el teléfono. El 27% de los médicos de AP refirió registrar las actividades del proyecto siempre y el 39%, casi siempre. Resultados: En cuanto a la opinión sobre el proyecto, los encuestados reconocieron el mayor beneficio potencial para el proceso diagnóstico y valoraron la necesidad del proyecto en el área con un 9, su utilidad con 9,1 y la prioridad con un 8,7. El 74% de los médicos opinó que sería de interés incorporar un consultor de otra especialidad. Resultados: Los problemas de coordinación AP-AE priorizados fueron la falta de comunicación y diálogo y la masificación de la asistencia. La solución más valorada fue la historia única informatizada (AU)

Objective: To find out the level of satisfaction and opinions of doctors on the specialist consultant project (SCP) in Area 7. To report on these opinions on the difficulties and possible solutions in inter-relationships between of primary health care and specialised care. Material and Methods: Transversal descriptive study using a self-administered questionnaire. Study population: Doctors working in a primary health care district of Madrid (Area 7). Variables: Demographic and professional variables, including their satisfaction after the implementation of the SCP, their general opinion of SCP, potential benefits and their opinions on the difficulties and possible solutions in interrelationships between primary health care and specialised care. Results: A total of 170 (56%) doctors working in primary health care responded. As regards satisfaction with the SCP, the overall score in the evaluation was 8.9, (0 to 10). The majority of primary health care doctors (83%) found it easy to contact the specialist and 90% said that problems were solved satisfactorily. The telephone was the worst communication tool. Only 27% of primary health care doctors said they always register SCP activities, and 39% register them almost always. Results: They thought that the most useful part of this project was the potential benefit on diagnosis. The SCP need score was 9, SCP usefulness 9.1 and priority 8.7. A large majority (74%) of primary health care doctors thought it would be of great interest to incorporate consultants from other specialisations. Results: The main coordination problems found where the lack of communication, and overcrowding. The most valued solution to these problems is the computerised clinical history (AU)

[Coordination between primary and specialist care. Satisfaction with the consulting specialist project]. / Coordinación asistencial entre atención primaria y especializada. Satisfacción con el proyecto especialista consultor.

OBJECTIVE: To find out the level of satisfaction and opinions of doctors on the specialist consultant project (SCP) in Area 7. To report on these opinions on the difficulties and possible solutions in inter-relationships between of primary health care and specialised care. MATERIAL AND METHODS: Transversal descriptive study using a self-administered questionnaire. STUDY POPULATION: Doctors working in a primary health care district of Madrid (Area 7). VARIABLES: Demographic and professional variables, including their satisfaction after the implementation of the SCP, their general opinion of SCP, potential benefits and their opinions on the difficulties and possible solutions in interrelationships between primary health care and specialised care. RESULTS: A total of 170 (56%) doctors working in primary health care responded. As regards satisfaction with the SCP, the overall score in the evaluation was 8.9, (0 to 10). The majority of primary health care doctors (83%) found it easy to contact the specialist and 90% said that problems were solved satisfactorily. The telephone was the worst communication tool. Only 27% of primary health care doctors said they always register SCP activities, and 39% register them almost always. They thought that the most useful part of this project was the potential benefit on diagnosis. The SCP need score was 9, SCP usefulness 9.1 and priority 8.7. A large majority (74%) of primary health care doctors thought it would be of great interest to incorporate consultants from other specialisations. The main coordination problems found where the lack of communication, and overcrowding. The most valued solution to these problems is the computerised clinical history. CONCLUSIONS: Doctors are very satisfied with this project. They considered the project to be very useful, necessary and a priority, with high potential benefit in several areas of patient care. As quality improvement areas we stress the importance of continuing to promote SCP, of adequate telephone communications and to assess a new easy to fill-in register system.

[Hygienic standardization of fluogermanate in the air of a working area].

The paper presents the data on the impact of the most possible concentrations of fluogermanate (GeF4) in the air of a working area with a pencil-beam irritant acting the respiratory organs and those obtained from chronic experiments. The most possible concentration is 0.2 mg/m3 (Class II hazard).

Predictive factors for conversion in laparoscopic colorectal surgery.

BACKGROUND: Although laparoscopic colon and rectal surgery can be safely performed in the hands of well-trained surgeons, criteria for patient selection should be further developed in order to decrease the conversion rate. The main objective of this study was to identify predictive factors for conversion of laparoscopic colorectal surgery to an open procedure based on statistical analysis. METHODS: A retrospective survey was performed using data collected from 400 patients who underwent laparoscopic colorectal surgery between March 2000 and December 2006. As potential predictive factors for conversion, we considered demographic characteristics, surgery-related variables and disease-related variables. Univariable analysis was performed to identify individual predictive risk factors for conversion. Factors with p values below 0.05 were included in a regression model. RESULTS: Conversion to open surgery was required in 51 patients (12.7%). Age (>65 years) was the only independent predictive demographic factor (OR=2.3; 95% CI, 1.25-4.46). Low anterior resection (OR=3.9; 95% CI, 1.64-9-18) and complicated diverticulitis (OR=3.9; 95% CI, 1.64-9.18) were also predictive factors. The only predictive factor evidenced in the multivariate analysis was complicated diverticulitis (OR=159.99; 95% CI, 41.02-624.02). Indications for conversion were: adhesions in 53% of the patients, technical problems in 18%, bleeding in 1%, and other indications for the remaining 28%. CONCLUSION: Complicated diverticulitis or cancer of the rectum treated by low anterior resection have higher probabilities of conversion.

Long-term assessment of fecal incontinence after lateral internal sphincterotomy.

BACKGROUND: Lateral internal sphincterotomy (LIS) can cause fecal incontinence. The aim of this study was to evaluate this sequelae after long-term follow-up of patients treated by LIS and to identify possible associated factors. METHODS: Data were retrospectively collected for patients with chronic anal fissure who had LIS between 1994 and 1997. Continence was assessed according to the incontinence score (IS) obtained by medical record review and telephone questionnaire. Statistical analysis was performed using by Student's t test for qualitative variables and chi-square test for qualitative variables. RESULTS: All 68 patients evaluated had healed after fissure surgery. None of these patients had preoperative fecal incontinence neither recurrence at the time of follow-up. At a mean follow-up of 66.6 months (range, 30-84 months), 7 patients (10.2%) were incontinent (mean IS=8.2; range, 5-16) and none had recovered continence at the time of follow-up. There was no significant difference between patients with and without fecal incontinence relative to gender age, hemorrhoidectomy combined with LIS, or vaginal delivery. CONCLUSIONS: Incontinence due to LIS does not recover after long-term follow-up and appears to be an independent cause of fecal incontinence.

[Hygienic standardization of the levels of selenium hexafluoride in the air of a working area]. / Gigienicheskoe normirovanie geksaftorida selena v vozdukhe rabochei zony.

The paper presents the results of investigations on the hygienic standardization of the levels of selenium hexafluoride (SeF6) in the air of a working area. It also analyzes the data on the effects of SeF6 inhalation on laboratory animals, by applying morphological, physiological, hematological, and biochemical studies. The studies have yielded the basic parameters of inhalation toxicity and established the threshold of the irritant action of the substance, developed and approved its maximally acceptable concentration (0.2 mg/m3, gas + vapors) and a procedure for photometric determination of SeF6 in the air of a working area.

[A state of confusion following cerebral angiography with iopamidol: a case report].

A 59-year-old male in a state of confusion following cerebral angiography with iopamidol was reported. He was admitted to our hospital for right upper monoparesis. MRI demonstrated multiple cerebral infarction. The patient had undergone angiographies with iopamidol, of which a total of 100 ml had been used. After the examination, the patient showed perseveration, continuing to say the same sentence and 30 minutes later he entered a state of confusion. He recovered completely from this consciousness disturbance after 30 hours. No lesion except for the old infarction was demonstrated on CT and MRI. Confusion in this case was assumed to be a toxic reaction caused by the contrast agent.