Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine.
This pilot study found that a future RCT to investigate the effect of using the SAS in a decisive approach may demonstrate a difference in postoperative care. However, significant changes to the design are needed if differences in clinical outcome are to be achieved reliably. These would include a wider array of postoperative interventions implemented using a quality improvement approach in a stepped wedge cluster design with blinded collection of outcome data.
Idiopathic neck and chest wall flushing could cause disabling effects on patients' quality of life. We aimed to evaluate the effectiveness of botulinum toxin-A (BTA) in the management of idiopathic neck and chest wall flushing. This was a pilot prospective clinical study of patients with severe idiopathic neck and anterior chest wall flushing. Two mouse units of BTA were injected intracutaneously with a maximum dose of 100 units per patient per session. The dermatology life quality index is used as the primary outcome measure. Twenty-two patients were included in the study (18 women, four men) with an average age of 26 years (range 18-48). Twenty patients (90.9%) had immediate improvement with almost complete resolution of their flushing. At four weeks follow-up, 18 of 22 patients were included in the final analysis, significant improvement in quality of life was achieved, and mean baseline dermatology life quality index score 7.78 (SD 3.25) improved significantly to 4.23 (SD 3.44) with a mean difference of 3.56 (SD 4.6; 95%, confidence interval 1.27, 5.84) with paired samples t-test 3.29 (d.f. 17) P < 0.004. BTA may provide an effective treatment in the management of idiopathic neck and chest wall flushing.
The rarity and variable presentation of primary hyperparathyroidism can make its diagnosis a challenge - especially in the developing world where malnutrition may mask hypercalcaemia. Our case report is of a 25-year-old Yemeni woman who presented at AL Buraihi General Hospital with a pathological fracture of the right femur and a past history of multiple limb fractures. The diagnosis of primary hyperparathyroidism was suspected after full history and examination. It was then confirmed biochemically by raised PTH and serum calcium levels, and radiologically by ultrasonography of the patient's neck, which demonstrated a right inferior parathyroid adenoma. The patient underwent open reduction and internal fixation of her right femoral fracture but suffered a fracture of her left femur which was treated conservatively so as not to delay parathyroidectomy. Post-operatively, the patient suffered from transient hypocalcaemia, which was treated medically, and eventually went on to make a full recovery.
The advent of endoscopic retrograde cholangio-pancreatography (ERCP) has enabled physicians and surgeons to carry out a range of diagnostic and therapeutic procedures pertaining to various pathologies found within the hepato-biliary system. Despite being relatively less invasive when compared to traditional methods of surgery, ERCP still carries recognized complications that are a cause for morbidity amongst patients. Furthermore, rarer complications can occur in difficult circumstances that are potentially fatal. We report two cases whereby the patients sustained serious splenic injuries as a consequence of the procedure. Splenic lacerations were diagnosed on computer tomography scanning in both patients who subsequently underwent emergency splenectomy. The patients made an uneventful recovery and returned home after surgery.To date twelve cases have been reported in current medical literature regarding injury to the spleen following ERCP. These aforementioned injuries have arisen particularly when the endoscopist has encountered difficult or variations in anatomy whilst performing ERCP. In addition to presenting two cases, we review the literature and discuss the implications of these complications and how this may affect the way in which clinicians take informed consent from patients before conducting ERCP.
This treatment method for nasal hyperhidrosis is simple, well tolerated, and effective, and significantly improves the quality of life of the affected individuals.
Background
The Clavien–Dindo classification is perhaps the most widely used approach for reporting postoperative complications in clinical trials. This system classifies complication severity by the treatment provided. However, it is unclear whether the Clavien–Dindo system can be used internationally in studies across differing healthcare systems in high‐ (HICs) and low‐ and middle‐income countries (LMICs).
Methods
This was a secondary analysis of the International Surgical Outcomes Study (ISOS), a prospective observational cohort study of elective surgery in adults. Data collection occurred over a 7‐day period. Severity of complications was graded using Clavien–Dindo and the simpler ISOS grading (mild, moderate or severe, based on guided investigator judgement). Severity grading was compared using the intraclass correlation coefficient (ICC). Data are presented as frequencies and ICC values (with 95 per cent c.i.). The analysis was stratified by income status of the country, comparing HICs with LMICs.
Results
A total of 44 814 patients were recruited from 474 hospitals in 27 countries (19 HICs and 8 LMICs). Some 7508 patients (16·8 per cent) experienced at least one postoperative complication, equivalent to 11 664 complications in total. Using the ISOS classification, 5504 of 11 664 complications (47·2 per cent) were graded as mild, 4244 (36·4 per cent) as moderate and 1916 (16·4 per cent) as severe. Using Clavien–Dindo, 6781 of 11 664 complications (58·1 per cent) were graded as I or II, 1740 (14·9 per cent) as III, 2408 (20·6 per cent) as IV and 735 (6·3 per cent) as V. Agreement between classification systems was poor overall (ICC 0·41, 95 per cent c.i. 0·20 to 0·55), and in LMICs (ICC 0·23, 0·05 to 0·38) and HICs (ICC 0·46, 0·25 to 0·59).
Conclusion
Caution is recommended when using a treatment approach to grade complications in global surgery studies, as this may introduce bias unintentionally.
A 10 months girl infant was brought by her family with a progressive swelling of left side of face since birth involving nose and obscuring left orbit; associated with occasional mild bleeding. What it could be: 1.Malignant tumor 2.Abcess 3.Hemangioma 4.Bone tumor
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