Intra-abdominal foreign body as unexpected discovery mimicking suspicious malignancy.

Although rare, postoperatively retained foreign bodies in the abdominal cavity still represent a serious issue for the surgical team as for the patients. Its clinical manifestation is often unspecific and the cases are therefore only irregularly registered. There are several known factors that increase the risk of retention of a foreign body, for example emergency surgeries, unplanned changes in procedure or a high body mass index. In this article, we would like to report the case of a male patient with a foreign body in the right lower quadrant after open appendectomy mimicking a tumor.

Impact of intraoperative noise measurement on the surgeon stress and patient outcomes. A prospective, controlled, single-center clinical trial with 664 patients.

BACKGROUND: The impact of sound-activated noise meters to decrease the noise level in the operating room is not clear. The aim of this study was to determine whether a sound-activated, visual noise meter would decrease noise levels, decrease postoperative morbidity, and improve surgeons' feelings of well-being. METHODS: This prospective, single-center study proceeded in 2 phases. First, sound levels were compared during a 6-month period with noise measurement only and without a visual feedback function. Second, we conducted a subsequent 6-month phase with noise meters providing direct feedback. Surgeon disturbance during the operation was assessed by a questionnaire after each procedure. RESULTS: Of the 664 procedures included in this analysis, 447 (67.3%) were in phase 1 and 217 (32.7%) in phase 2. The noise levels in the operating room were decreased by 3.8 dB(A) from 54.6 ± 4.5 dB(A) in phase 1 to 50.8 ± 2.8 dB(A) in phase 2 after intervention with the feedback device (P < .001). During the procedures, there was an increase of 0.7 dB(A) (P < .001), with mean noise levels of 53.5 dB(A) at the beginning of the procedures and 54.2 dB(A) at the end. There was a correlation between the disturbance of the surgeon and the noise level (P < .001). CONCLUSION: The application of a visual noise warning device in an operating room decreased both the noise levels and surgeon stress and may offer sustained decreases in ambient and peak sound levels, potentially leading to improved quality outcomes in visceral surgery.

Field testing of ICHD-3 beta criteria of periictal headaches in patients with focal epilepsy - a prospective diary study.

Background To date we are lacking prospective data for field testing of ICHD-3 beta criteria for periictal headache (PIH). Methods Patients with focal epilepsy diagnosed by means of prolonged video-EEG monitoring completed a paper-pencil diary for three months and recorded seizures and headaches on a daily basis. According to ICHD-3 beta, we classified PIH, defined as headache present on a day with at least one seizure, as "7.6 headache related to epileptic seizure", "7.6.1 hemicrania epileptica" or "7.6.2 postictal headache". In addition, we compared the ICHD-3 beta diagnoses to the diagnoses according to ICHD-2. Results Thirty two patients completed the diary. Data analysis included 2,668 patient days, 300 seizures and 37 episodes of PIH. Two of these episodes (5.4%) were classified as headache related to seizure, three (8.1%) fulfilled both the criteria of headache related to seizure and hemicrania epileptica and four (10.8%) were postictal headaches. Twenty eight episodes (75.7%) did not fulfil any of the ICHD-3 beta criteria of seizure-related headaches, mostly because headache onset was before seizure onset. Applying ICHD-2 criteria allowed only one single episode of PIH to be classified as postictal headache. Discussion Our study is the first to present prospective field testing data of the ICHD-3 beta criteria for three types of seizure-related headaches. The majority of PIH episodes do not fulfil any of these criteria. One quarter can be classified according to ICHD-3 beta, whereas purely clinical diagnosis of PIH is markedly restricted in ICHD-2 because of mandatory electroencephalographic evidence.