Identifying patients at risk for urinary retention following inguinal herniorrhaphy: a single institution study.

PURPOSE: We aim to identify patients at risk for post-operative urinary retention (POUR) and factors associated with POUR. METHODS: Males who underwent inguinal hernia repair (IHR) from June 2010 to September 2014 at a single institution were grouped according to the presence (symptomatic) or absence (asymptomatic) of preoperative urogenital symptoms (UGS). Patients ≤ 18 years of age were excluded. POUR was defined as the need to catheterize a patient who had not voided 6 h after surgery. Data were examined using IBM SPSS v23.0. RESULTS: Of the 60 asymptomatic and 30 symptomatic patients identified, no differences were seen in age (55 vs. 65, p = 0.13), length of stay > 1 day (3% vs. 13%, p = 0.09), bilateral inguinal herniation (23% vs. 23%, p = 1.00), or laparoscopic approach (70% vs. 69%, p = 1.00); however, significant differences were seen in POUR (5% vs. 27%, p = 0.01) and α-blocker utilization (50% vs. 80%, p = 0.01). When age-matched, neither POUR (10% vs. 27%, p = 0.10) or α-blocker utilization (57% vs. 80%, p = 0.05) significantly differed between asymptomatic and symptomatic patients, respectively. Logistic regression analysis demonstrated that only bilateral inguinal herniation (OR 6.55, p = 0.03) and symptoms (OR 6.78, p = 0.02) were associated with POUR. Asymptomatic patients with a unilateral hernia have a 4.3% risk of POUR, whereas symptomatic patients with a bilateral inguinal hernia have at 57.1% risk. CONCLUSIONS: We demonstrate that bilateral inguinal herniation and UGS independently increase the risk of POUR, whereas α-blockers do not. For the general surgical population, α-blockers should not be routinely prescribed to all patients and instead should be limited to high-risk patients.

Open surgical biopsy for nonpalpable mammographic abnormalities: still an option compared with core needle biopsy.

OBJECTIVE: Our purpose was to present information about open surgical biopsy. It is hoped that this will be helpful when reviewing information about core needle biopsy STUDY DESIGN: Review of 461 open surgical biopsies for nonpalpable mammographic abnormalities was performed. All patients were managed by the Women's Health Center of Logansport. Core needle biopsy data came from the literature. RESULTS: Open surgical biopsy compared favorably to core needle biopsy with regard to accuracy, cost, patient convenience, recovery, adequacy of specimen, identification of primary site, and cosmetics. CONCLUSION: Despite core needle biopsy marketing, open surgical biopsy has its advantages and should not be relegated to the museum.

An improved technique to enable 2-dimensional shoe sole impression evidence to be photographically recorded "to scale".

An improved technique to photographically record 2-Dimensional shoe sole impressions "to scale" is described. This technique was developed as a result of continual attacks in court in relation to the question of precise SCALE. Staff at our laboratory are routinely required to examine shoe sole impressions evidence that has been collected by our Scenes of Crime Officers. The Scenes of Crime Officers have been instructed in the appropriate photographic techniques which should be used to record 2-Dimensional shoe sole impressions, however, for one reason or another, including inexperience, this technique is not rigidly adhered to. We have seventy-five (75) Scenes of Crime Officers throughout Queensland, and nearly all of the shoe sole interpretation work is done in the Brisbane Headquarters. It is the case that the Scenes of Crime Officers record the scene and other photographers record the Test Impression. There are three problems that affect the quality of the scale photographs submitted. 1. The camera is not directly over the center of the subject. 2. The camera is not exactly parallel to the subject. 3. The designs of the camera lens. These problems are highlighted when barristers compare the scale photos of the test impressions made in the laboratory, with the scale photos of the scene impressions. Barristers actually measure the distance between features and usually a discrepancy (albeit slight) is found. The GRID allows us to demonstrate to Lay persons and Lawyers the interrelationship of identification features, by reference to a particular GRID.

Mammographic abnormalities and the detection of carcinoma of the breast.

OBJECTIVE: In an attempt to reduce the number of unnecessary breast biopsies, the yield rate of cancer relative to specific types of mammographically detected abnormality was investigated. STUDY DESIGN: Between 1989 and 1991, 169 patients with an abnormality as detected by mammogram but with no palpable mass were reviewed. Abnormalities detected by mammogram were divided into four types. The rate of biopsy-confirmed cancer per type of abnormality was calculated. RESULTS: The incidence of cancer per type of mammographically detected abnormality was as follows: mass 11%, mass with abnormal calcification 21%, abnormal calcification 22%, and asymmetric density 2%. CONCLUSION: Biopsy is recommended for mammographically detected abnormalities of a mass, a mass with abnormal calcification, and abnormal calcification without mass. Consideration should be given to deferring biopsy in favor of a follow-up study for asymmetric densities.

Surgical management of breast disease in an obstetrics and gynecology group.

The surgical management of breast disease from 1978 through 1988 by the Women's Health Center of Logansport is reviewed. Three hundred twelve biopsy procedures resulted in the diagnosis of 59 cancers. Biopsy and mastectomy procedures were performed by the authors (obstetrician-gynecologists). There were no significant complications and all patients had an adequate surgical result. Preoperative needle localization techniques proved to be a safe and effective method to identify and remove nonpalpable mammographic abnormalities. Because women depend on their gynecologist for advice regarding reproductive organs including the breasts, it is logical for the gynecologic surgeon to become involved in the surgical management of breast disease.

Irving tubal sterilization: report of 634 procedures.

PIP: Experience with the use of the Irving tubal sterilization technique in 634 patients from 1969 through 1983 during postpartum, interval, and cesarean section tubal sterilizations is reported. The average time to perform interval Irving sterilization was 30 minutes. The postpartum (n=362) and cesarean section (n=100) were easily done in a length of time not significantly different from a Pomeroy procedure. All interval patients (n=171) were released by the 4th postoperative day. All postpartum patients were released by the 2nd postoperative day. The Irving tubal ligation did not lengthen the hospital stay for any of the cesarean section patients. Of 634 patients, only 5 had early morbidity, i.e., that which occurred while in the hospital. 1 postpartum patient and 1 interval patient developed urinary tract infections, and another postpartum patient had a wound cellulitis. 2 patients had temperatures of 100.8 degrees on the 2nd postoperative day that resolved spontaneously without treatment or sequelae. There were no surgical complications or operative accidents. There was no indication in any patient of postoperative hemorrhage. There were no bladder, bowel, or uterine lacerations or perforations. 1 patient developed late morbidity. She had an interval ligation and developed a wound seroma that spontaneously resolved. There have been no known intrauterine or extrauterine pregnancies in any of the 634 patients following Irving tubal sterilization.^ieng

A versatile computing system for sampling, manipulation and display of biological signals using high-level language.

A medium sized minicomputer system is presented as an attractive way of balancing the cost of computing equipment with that of programme development. A versatile circuit has been coupled to a computer system and programmes have been developed to control the functions of this circuit. With such a system it is possible for relatively untrained biological workers to use FORTRAN programming language to control sampling of analogue signals, manipulation of data and finally graphical presentation of results. The system is proposed for use both in anaesthetic research and in on-line monitoring of critically ill patients.