Disabling injuries of the cervical spine in Argentine rugby over the last 20 years.

OBJECTIVE: To investigate the incidence and risk factors of disabling injuries to the cervical spine in rugby in Argentina. METHODS: A retrospective review of all cases reported to the Medical Committee of the Argentine Rugby Union (UAR) and Rugby Amistad Foundation was carried out including a follow up by phone. Cumulative binomial distribution, chi 2 test, Fisher test, and comparison of proportions were used to analyse relative incidence and risk of injury by position and by phase of play (Epi Info 6, Version 6.04a). RESULTS: Eighteen cases of disabling injury to the cervical spine were recorded from 1977 to 1997 (0.9 cases per year). The forwards (14 cases) were more prone to disabling injury of the cervical spine than the backs (four cases) (p = 0.03). Hookers (9/18) were at highest risk of injury (p < 0.01). The most frequent cervical injuries occurred at the 4th, 5th, and 6th vertebrae. Seventeen of the injuries occurred during match play. Set scrums were responsible for most of the injuries (11/18) but this was not statistically significant (p = 0.44). The mean age of the injured players was 22. Tetraplegia was initially found in all cases. Physical rehabilitation has been limited to the proximal muscles of the upper limbs, except for two cases of complete recovery. One death, on the seventh day after injury, was reported. CONCLUSIONS: The forwards suffered a higher number of injuries than the backs and this difference was statistically significant. The chance of injury for hookers was statistically higher than for the rest of the players and it was particularly linked to scrummaging. However, the number of injuries incurred in scrums was not statistically different from the number incurred in other phases of play.

Pancreatic serous cystadenomas. Report of 8 cases with a mean follow up of 7 years.

Serous cystadenoma of the pancreas are rare tumors and have little or no malignant potential. We report our experience in the management of eight cases of these tumors in the last 22 years. All the patients were women with a mean age of 59 years. All the cysts caused symptoms. Ultrasound and CT-scan were useful in the diagnosis of the pancreatic cystic tumor out not in determining the nature of these lesions clear. FNA-biopsy was performed in 6 cases but in only case was the diagnosis confirmed. All tumors were resected. Four radical pancreatoduodenectomies, two distal pancreatectomies and two cystectomies were performed. Mean followup was 83.5 months. All patients are alive and with no signs of recurrence. Complications include an external pancreatic fistula, an acute cholangitis and a case of delayed gastric emptying. In all cases the histological diagnosis was serous cystadenoma of the pancreas. We conclude that resection of these tumors is mandatory although they are supposed to be benign, in order to avoid complications and because malignant transformations has been related to nonresective treatment.

The impact of an ambulatory surgical service in a community hospital.

The purpose of this study was to quantify the savings accrued from shifting surgical cases from an inpatient to an outpatient setting. There was no increase in the total number of operations from 7952 in 1973 to 10,250 in 1987. The percentage of ambulatory procedures showed a continuous increase from 17.9% to 56.3%. The 15-year experience accumulated at this institution now exceeds 43,000 cases, with no mortality. The study closely examined hospital charges, not costs, for 2 months, which were then annualized. The calculated average savings per case was $2000 and 3.07 hospital days. The estimated savings for fiscal 1987 were $11.5 million and 17,726 hospital days. Based on this experience, the operation of an in-hospital ambulatory surgical unit is recommended as a cost-saving, safe, and efficient method of performing many surgical procedures.

The training and utilization of surgical physician assistants. A retrospective study.

A community hospital's search for qualified surgical house staff in 1975 led to the development of a postgraduate residency program in surgery for physician assistants. Eleven years after its inception, the program's purpose and structure were reviewed, and its alumni, goals, and contributions were evaluated. A 1987 alumni survey provided data to assess the value of residency training to current employment and job satisfaction.

Subclavian artery occlusion 42 years after mastectomy and radiotherapy.

Left subclavian artery occlusion developed in a patient 42 years after a left radical mastectomy and radiotherapy. The vascular supply was successfully reconstructed by a graft from the right subclavian artery to the left brachial artery. Clinical and experimental evidence has demonstrated that radiotherapy can damage large vessels [2,4,5]. It is our contention that radiotherapy was the causative factor in the case of subclavian artery occlusion reported herein.