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Medical Sciences	85%

Selected Abstracts

Primary laparoscopic and open repair of paraesophageal hernias: a comparison of short-term outcomes

DISEASES OF THE ESOPHAGUS, Issue 1 2008
S. Karmali
SUMMARY. The choice of the optimal surgical approach for repairing paraesophaeal hernias (PEH) is debated. Our objective is to evaluate the short-term outcomes of primary laparoscopic and open repairs of PEH performed in the Calgary Health Region. A retrospective review of all patients undergoing repair of PEH between October 1999 and February 2005 was performed. The outcome measures evaluated included intra-operative parameters and post-operative variables, mortality rates, recurrence rates and patient satisfaction. A total of 93 patients underwent either a laparoscopic (n = 46) or open (n = 47) primary PEH repair. The laparoscopic approach was associated with a longer mean operative time (3.1 ± 1.2 hours vs. 2.5 ± 0.7 hours, P = 0.005) but resulted in a shorter overall hospital stay (5 days [2,16 days]vs. 10 days [5,24 days]; P < 0.001), and fewer post-operative complications (10/46 [22%]vs. 25/47 [53%]P = 0.002). Although the follow-up was short (laparoscopic 16 months; open 18 months), a 9% recurrence rate was reported with both approaches. Patient satisfaction using the Gastroesophageal Disease Health-Related Quality Of Life questionnaire was similar in both groups (P = 0.861) with most patients reporting excellent outcomes (laparoscopic: 32/36 [89%]; open 27/35 [77%]). Our review suggests that the laparoscopic approach is safe with shorter hospital stay and recovery. Although early follow-up suggests that recurrence rates and patient satisfaction are similar, long-term follow-up is required to determine whether the laparoscopic approach will become the procedure of choice. [source]

Comparative Analysis of Adult versus Adolescent Sexual Assault: Epidemiology and Patterns of Anogenital Injury

ACADEMIC EMERGENCY MEDICINE, Issue 8 2003
Jeffrey S. Jones MD
Abstract Objectives: To compare the characteristics of sexual assault in pubertal girls (<18 years old) and adults in a community-based population of women presenting to an urban sexual assault clinic. Methods: This case-series analysis evaluated consecutive female patients presenting to a sexual assault clinic during a three-year study period. The clinic is associated with a university-affiliated emergency medicine residency program and is staffed by forensic nurses trained to perform medicolegal examinations using colposcopy with nuclear staining. Patient demographics, assault characteristics, and injury patterns were recorded using a standardized classification system. Data from the two patient groups (adolescents vs. women ,18 years of age) were analyzed using chi-square test and t-test. Results: A total of 766 cases were identified: 43% of the victims were 13 to 17 years old (mean 15.0 years old), and 57% were older than 17 years old (mean 30.8 years old). Adolescents were more likely to be assaulted by an acquaintance or relative (84% vs. 50%, p < 0.001) and to delay medical evaluation (17 hours vs. 12 hours, p < 0.001) than were older women. Adolescent sexual assault was less likely to involve weapons or physical coercion (29% versus 57%, p < 0.001) and was associated with fewer nongenital injuries (33% vs. 55%, p < 0.001). Adolescents had a greater frequency of anogenital injuries (83% vs. 64%, p < 0.001), however, compared with older women. Common sites of injury in adolescents were posterior, including the fossa navicularis, hymen, fourchette, and labia minora. The injuries showed consistent topologic features, varying with the site and nature of tissue. Adult victims of sexual assault had a less consistent pattern of anogenital injuries with fewer hymenal injuries, greater injury to the perianal area, and widespread erythema. Conclusions: Of women presenting to an urban sexual assault clinic, 43% were adolescents. The epidemiology of sexual trauma and the pattern of anogenital trauma in this age group are unique and may pose special challenges to emergency health care providers. [source]

Schedule of Passive Ethanol Exposure Affects Subsequent Intragastric Ethanol Self-Infusion

ALCOHOLISM, Issue 11 2009
Tara L. Fidler
Background:, Many studies have shown that chronic ethanol exposure can enhance later self-administration of ethanol, but only a few studies have identified critical parameters for such exposure. The present studies examined temporal and other parameters of chronic ethanol exposure on subsequent intragastric (IG) self-infusion of ethanol. Methods:, Sprague,Dawley rats implanted with IG catheters were passively infused with ethanol for 5 to 6 days and then allowed to self-infuse ethanol or water using a procedure in which infusions were contingent upon licking fruit-flavored solutions. Experiment 1 examined the time interval between consecutive periods of passive infusion (Massed Group: 12 hours vs. Spaced Group: 36 hours). Experiment 2 studied the interval between the final passive infusion and onset of self-infusion (12 vs. 36 hours). Finally, Experiment 3 tested the effect of inserting self-infusion days within the passive infusion phase. Results:, Passive ethanol exposure on consecutive days induced relatively large amounts of ethanol self-infusion (4.1 to 7.9 g/kg/d). Increasing the duration of the ethanol-free interval between periods of passive exposure to 36 hours significantly reduced ethanol self-infusion (2.2 g/kg/d; Exp. 1). The time delay between the last passive ethanol exposure and onset of self-infusion had no effect on self-infusion (Exp. 2). Moreover, inserting no-choice self-infusion days between the last few passive exposure days did not increase self-infusion (Exp. 3). Conclusions:, Measurement of withdrawal signs indicated that Massed passive exposure produced stronger dependence than Spaced passive exposure, suggesting that enhanced ethanol self-infusion in Massed Groups might be explained by the opportunity for greater negative reinforcement by ethanol. Although enhanced negative reinforcement might also explain why the Massed Group showed a weaker aversion for the ethanol-paired flavor than the Spaced Group, this observation could also be explained by the development of greater tolerance to ethanol's aversive pharmacological effects in the Massed Group. [source]

Ascites after liver transplantation,A mystery

LIVER TRANSPLANTATION, Issue 5 2004
Charmaine A. Stewart
Ascites after liver transplantation, although uncommon, presents a serious clinical dilemma. The hemodynamic changes that support the development of ascites before liver transplantation are resolved after transplant; therefore, persistent ascites (PA) after liver transplantation is unexpected and poorly characterized. The aim of this study was to define the clinical factors associated with PA after liver transplantation. This was a retrospective case,control analysis of patients who underwent liver transplantation at the University of Pennsylvania. PA occurring for more than 3 months after liver transplantation was confirmed by imaging studies. PA was correlated with multiple recipient and donor variables, including etiology of liver disease, preoperative ascites, prior portosystemic shunt (PS), donor age, and cold ischemic (CI) time. There were 2 groups: group 1, cases with PA transplanted from November 1990 to July 2001, and group 2, consecutive, control subjects who underwent liver transplantation between September 1999 and December 2001. Both groups were followed to censoring, May 2002, or death. Twenty-five from group 1 had ascites after liver transplantation after a median follow-up of 2.6 years. In group 1 vs group 2 (n = 106), there was a male predominance 80% vs 61% (P = .10) with similar age 52 years; chronic hepatitis C virus (HCV) was diagnosed in 88% vs 44% (P < .0001); preoperative ascites and ascites refractory to treatment were more prevalent in group 1 (P = .0004 and P =.02, respectively), and CI was higher in group 1, (8.5 hours vs 6.3 hours, P = .002). Eight of the 25 (group 1) had portal hypertension with median portosystemic gradient 16.5 mm Hg (range, 16,24). PS was performed in 7 of 25 cases, which resulted in partial resolution of ascites. The development of PA after liver transplantation is multifactorial; HCV, refractory ascites before liver transplantation, and prolonged CI contribute to PA after liver transplantation. (Liver Transpl 2004;10:654,660.) [source]

Factors influencing self-report of mobile phone use: the role of response prompt, time reference and mobile phone use in recall

APPLIED COGNITIVE PSYCHOLOGY, Issue 5 2009
Lada Timotijevic
The current study (n,=,180) assesses factors affecting the recall of past mobile phone behaviour. It manipulates two factors hypothesised as influencing recall of duration and number of calls made: time reference (24,hours vs. 3 days) and context prompt (temporal, person called, reason for call) and also considers their impact in relation to levels of mobile phone use. A measure of recall error was constructed by matching self-reported calls to actual calls and weighting for actual usage. The results indicate that most people tend to overestimate duration and underestimate number of phone calls, although these discrepancies are related to actual amount of mobile phone use. The manipulations of time reference and context prompt have some effect on the patterns of recall in relation to number, rather than duration, of calls. The implications of these results for the development of reliable and valid self-report measures of mobile phone use are discussed. Copyright © 2008 John Wiley & Sons, Ltd. [source]

Decreasing Lab Turnaround Time Improves Emergency Department Throughput and Decreases Emergency Medical Services Diversion: A Simulation Model

ACADEMIC EMERGENCY MEDICINE, Issue 11 2008
Alan B. Storrow MD
Abstract Background:, The effect of decreasing lab turnaround times on emergency department (ED) efficiency can be estimated through system-level simulation models and help identify important outcome measures to study prospectively. Furthermore, such models may suggest the advantage of bedside or point-of-care testing and how they might affect efficiency measures. Objectives:, The authors used a sophisticated simulation model in place at an adult urban ED with an annual census of 55,000 patient visits. The effect of decreasing turnaround times on emergency medical services (EMS) diversion, ED patient throughput, and total ED length of stay (LOS) was determined. Methods:, Data were generated by using system dynamics analytic modeling and simulation approach on 90 separate days from December 2, 2007, through February 29, 2008. The model was a continuous simulation of ED flow, driven by real-time actual patient data, and had intrinsic error checking to assume reasonable goodness-of-fit. A return of complete laboratory results incrementally at 120, 100, 80, 60, 40, 20, and 10 minutes was compared. Diversion calculation assumed EMS closure when more than 10 patients were in the waiting room and 100% ED bed occupancy had been reached for longer than 30 minutes, as per local practice. LOS was generated from data insertion into the patient flow stream and calculation of time to specific predefined gates. The average accuracy of four separate measurement channels (waiting room volume, ED census, inpatient admit stream, and ED discharge stream), all across 24 hours, was measured by comparing the area under the simulated curve against the area under the measured curve. Each channel's accuracy was summed and averaged for an overall accuracy rating. Results:, As lab turnaround time decreased from 120 to 10 minutes, the total number of diversion days (maximum 57 at 120 minutes, minimum 29 at 10 minutes), average diversion hours per day (10.8 hours vs. 6.0 hours), percentage of days with diversion (63% vs. 32%), and average ED LOS (2.77 hours vs. 2.17 hours) incrementally decreased, while average daily throughput (104 patients vs. 120 patients) increased. All runs were at least 85% accurate. Conclusions:, This simulation model suggests compelling improvement in ED efficiency with decreasing lab turnaround time. Outcomes such as time on EMS diversion, ED LOS, and ED throughput represent important but understudied areas that should be evaluated prospectively. EDs should consider processes that will improve turnaround time, such as point-of-care testing, to obtain these goals. [source]

A randomised controlled trial of vitamin E in the treatment of primary dysmenorrhoea

BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 4 2005
S. Ziaei
Objective To study the effect of vitamin E in the treatment of primary dysmenorrhoea. Design A randomised, double-blind, placebo-controlled trial. Setting A secondary school in Tehran, Iran. Population Two hundred and seventy-eight girls aged 15,17 years who suffered from primary dysmenorrhoea. Methods Participants were given 200 units of vitamin E or placebo twice a day, beginning two days before the expected start of menstruation and continued through the first three days of bleeding. Treatment was continued over four consecutive menstrual periods. Main outcome measures The severity and duration of pain, and the amount of menstrual blood loss, at two and four months. A visual analogue scale (VAS) was used to record pain, and a validated Pictorial Blood Loss Assessment Chart (PBLAC) to measure menstrual loss. Results In the vitamin E group, pain severity was lower with vitamin E at two months (median VAS score 3 vs 5, P > 0.001) and four months (0.5 vs 6, P > 0.001), pain duration was shorter at two months (mean 4.2 [7.1] hours vs 15 [17], P > 0.001) and at four months (1.6 [4.0] hours vs 17 [18] hours, P > 0.0001), and blood loss assessed by PBLAC score was lower at two months (54 [31] vs 70 [40], P > 0.0001) and at four months (46 [28] vs 70 [37], P > 0.0001). Conclusion Vitamin E relieves the pain of primary dysmenorrhoea and reduces blood loss. [source]