What about sentinel node practice in early-staged cutaneous melanoma in France in 2003?

AIM: The aim of this study was to establish the status of sentinel lymph node (SLN) biopsy procedure in cutaneous melanoma in France in 2002. MATERIAL AND METHODS: This study was based upon the statistics of the main French melanoma centers. A short questionnary was sent to Head Physician by email. The authors asked for the global attitude as far as SLN was concerned, number of cutaneous melanoma diagnosed during year 2002 and of SLN procedures performed, critters of inclusion and postoperative management in each case. Abstension could be argued in a free item. Answers were sent back by email. RESULTS: The authors collected 22 answers coming from overall territory; 64% performed SLN procedure (14 centers), 36% applied "wait and watch" policy. Staffs performing SLN diagnosed a mean of 101 (8-400) melanoma and biopsied a mean of 21 (0-53) sentinel nodes. The others diagnosed a mean of 151 (15-250) melanoma. Patients were enrolled for Breslow thickness upper to 1.5 mm in 71%, to 1 mm in 29%. Ulceration was a critter of inclusion in 93% (21 staffs), 100% enrolled patients whose tumor presented signs of regression. SLN was performed for primary sites located overall body in 71%, only in limbs and trunk in 29%. Positive node lead to regional lymph node clearance, then observation or interferon protocol. Negative node lead to "wait and watch policy" in 14%, different interferon protocols according to Breslow thickness in 86%. CONCLUSION: SLN procedure is not homogenous in France. France is divided as far as SLN is concerned. If 64% are performing SLN, more than 50% of the new melanoma are not included in the trial.     

Traumatic lacunar infarction in basal ganglion in children

Ｔ　ＤｅｐａｒｔｍｅｎｔｏｆＮｅｕｒｏｓｕｒｇｅｒｙ，ＳｅｃｏｎｄＡｆｆｉｌｉａｔｅｄＨｏｓｐｉｔａｌ，ＦｕｊｉａｎＭｅｄｉｃａｌＵｎｉｖｅｒｓｔｉｔｙ，Ｑｕａｎｚｈｏｕ３６２０００，Ｃｈｉｎａ（ＹａｎｇＢ，ＹａｎｇＧＹ）ｒａｕｍａｔｉｃｌａｃｕｎａｒｉｎｆａｒｃｔｉｏｎｉｎｂａｓａｌｇａｎｇｌｉｏｎｉｎｃｈｉｌｄｒｅｎｕｎｄｅｒ１０ｙｅａｒｏｌｄｉｓｍｏｒｅｌｉａｂｌｅｔｏｏｃｃｕｒ．ＢｅｆｏｒｅＣＴｗａｓａｖａｉｌａｂｌｅ，ｔｈｅｎａｔｕｒｅａｎｄｌｏｃａｌｉｚａｔｉｏｎｏｆｔｈｅｌｅｓｉ…     

A population-based study on trend in incidence of distal radial fractures in adults in Taiwan in 2000�C2007

Summary  

This population-based study was conducted using claims data obtained from the National Health Insurance to investigate the trend in incidence of distal radial fractures in adults in Taiwan from 2000 to 2007. Our results revealed an increasing trend, particularly among women >50 years of age.     

Dantrolenbevorratung in Anästhesie und Intensivmedizin in Deutschland

Background

A malignant hyperthermia (MH) crisis is a potentially fatal complication in anesthesia and intensive care units (ICU). Rapid administration and adequate dosage of dantrolene is the only known effective pharmacological and causal treatment of an MH crisis. International anesthesiology societies recommend an initial dose of 2.0–2.5?mg/kg body weight (BW). The necessary total dosage should be titrated up to 10?mg/kg BW depending on the effectiveness.

Objective

The goal of this study was an analysis of the stocking situation of dantrolene in Germany. A national survey was conducted amongst members of the German Society of Anaesthesia and Intensive Care (DGAI).

Material and methods

A questionnaire consisting of 19 items was posted online to all DGAI members from 2 September to 30 September 2015. The questionnaire dealt with characterization of the participants, the administration of triggering substances in the operating room and in the ICU of the respective hospitals. The main part covered the amount of stocked dantrolene, the place of storage and emergency availability of stocked dantrolene from elsewhere.

Results

The questionnaire was posted online to 12,415 DGAI members with a response rate of 13.5% (n = 1673). The highest response rate was from 259 directors and heads of anesthesiology units representing 28.3%. In total 93,7% of participants use volatile anesthetics and 82,3% use succinylcholine. In the event of an MH-crisis 40.4% of participants have 36 or more vials of dantrolene available within 5?min, 27.4% have only 24 vials and 18.7% only have 12 vials. Of the anesthesiologists in outpatient surgery 70.6% have a dantrolene stock of less than 36 vials. In those cases with insufficient dantrolene stock, 35.5% of hospitals have no agreement with neighboring hospitals. In the ICU setting, 51.8% of responding participants indicated the use of volatile anesthetics, but only 25.7% stock dantrolene in the ICU. For succinylcholine, 77.3% stated using the drug in the ICU, and 26.0% have a dantrolene stock in the ICU.

Conclusion

Almost all anesthesiologists participating in the online survey use volatile anesthethics and/or succinylcholine. Whereas almost all participants have access to dantrolene, more than half of the units have a stock of dantolene, which is less than that recommended by the DGAI. In the case of low dantrolene stock, only 61% of anesthesia departments have access to additional dantrolene within a time frame of 15min?. The results of this online survey demonstrate that the stock of dantrolene may be insufficient in some German hospitals and anesthesiology practices.

     

Assistentensprecher in Orthopädie und Unfallchirurgie in Deutschland

In most German hospitals there are resident representatives to stand in for the rights and interests of residents. The precise number of representatives in orthopaedic and trauma surgery is unknown, as well as the field of duty and the rights of this position.     

Could variations in technical skills acquisition in surgery be explained by differences in cortical plasticity?

SUMMARY/BACKGROUND: Variations in technical performance in surgery are known to exist but are poorly understood. Gaining an appreciation of these differences may have implications for technical skills training, assessment, and selection. Investigators attempting to correlate technical skill with visuospatial or perceptual tests have failed to identify surrogate markers of surgical aptitude. Evidence from unrelated fields suggests that studying brain function may advance our understanding of disparate technical performance in surgery. METHODS: A literature search was conducted to identify relevant studies assessing both motor skills learning and changes in brain function. RESULTS: The brain is dynamic and patterns of activation vary with experience and training, a property referred to as "neuroplasticity." Functional neuroimaging studies of complex nonsurgical skills have demonstrated smaller, more refined neuronal networks in experts compared with novices. Novel unrefined performance places a significant burden on generic areas of attention and control such as the anterior cingulate cortex and the prefrontal cortex (PFC). These regions are recruited less as skills are performed with increasing automaticity. Persistent PFC activation has been shown to herald poor bimanual coordination learning in studies involving nonsurgical tasks. CONCLUDING HYPOTHESIS: It is suspected that alterations in brain activation foci accompany a transition through phases of surgical skills learning and that those patterns of activation may vary according to technical ability. Validating this hypothesis is challenging because it requires studying brain function in ambulant subjects performing complex motor skills. In a surgical knot-tying study involving over 60 subjects of varying expertise, PFC activation was identified in novices but not in trained surgeons. Further work should aim to determine whether PFC activation attenuates in the context of learning success in surgery.     

What education means in surgery? A surgery among chirurgical residents in university hospital in Strasbourg

OBJECTIVE: Numerous tools for surgical education are available. The objective of the study is to know how future surgeons do feel about these different possibilities to learn and what do they think about the place of e-learning, or virtual universities and on-line training and learning in their formation. METHODS: A questionnaire has been sent to each surgical student of Strasbourg University. Learning and training methods were evaluated: observation, fellowship, Internet, reading videos, reading books or scientific journals, discovery of pathology by oneself or performing surgical procedures by oneself, sharing meetings, playing pedagogic games. RESULTS: Fellowship is voted by plebiscite, as using Internet which grows the usual book contents thanks to interactivity, videos, quickenings and actuality of the inquiries. The difficulties to approach this tool is emphasized : the cost, availability, time consuming, lack of any tutor, ability with a computer. Dissection of corpses or live animals is wished by the majority of young surgeons. Using simulators or robots remains something for the future and must be evaluated. CONCLUSION: Fellowship is voted by plebiscite for learning surgery. The interest for new technologies of communication is more out of curiosity than necessity.     

Can the increase in body mass index explain the rising trend in asthma in children?

BACKGROUND: The reported association between asthma and obesity and the documented rise in each over time have led to suggestions that rising obesity might explain the increase in the prevalence of asthma. Trends in both in British children participating in the National Study of Health and Growth were marked from 1982 to 1994. METHODS: Odd ratios for trends in asthma and symptoms in 8 and 9 year old children were calculated with and without adjustment for body mass index (BMI). RESULTS: In a representative sample of white children the odds ratio per year for asthma was 1.09 (95% CI 1.07 to 1.11) before and after adjustment for BMI for boys and 1.09 (95% CI 1.07 to 1.12) and 1.09 (95% CI 1.05 to 1.12), respectively, for girls. Unadjusted and adjusted odds ratios were also virtually identical for wheeze and "asthma or bronchitis". The lack of effect of adjustment was due to a change in the association between BMI and symptoms with time. CONCLUSIONS: Trends in overweight and obesity do not explain the increase in asthma. The evidence points towards the association between asthma and obesity being of recent origin. This may be explained by obesity being a marker of recent lifestyle differences now associated with both asthma and overweight.     

2-Chloro-2′ deoxyadenosine prevents angiopathic changes in cerebral arteries in experimental SAH in rabbits

Summary We compared the morphology of the basilar artery walls in rabbits with experimental subarachnoid haemorrhage (SAH) without and with concomitant treatment with a novel immunosuppressive drug, 2-chloro-2-deoxyadenosine (2 CdA). The treatment was successful in the prevention of the angiopathic changes, most likely due to its ability to inhibit lymphocyte activation in response to mitogenic signals. Since lymphocyte (and monocyte?) activation may play an important role in the development of the delayed neurological deficits in patients following SAH, the use of 2 CdA to prevent these deficits shall be considered.     

Is calcium indicated in resuscitation? Experimental studies in dogs

This study compares the effect of epinephrine (11 dogs) with that of the combination of epinephrine with calcium (10 dogs) in CPR after anoxial cardiac arrest. In the epinephrine group resuscitation was successful in all 11 dogs within 4 minutes. In the calcium group only 7 out of 10 dogs could be resuscitated: 3 dogs died during CPR in cause of irreversible fibrillation (2 cases) and "stone heart" (1 case). High CPK-activity reflected severe myocardial cell damage. In the survivors of the calcium group cardiac function was significantly impaired: 1. decreased left ventricular pressure (LVP) and contractility (dp/dt max), 2. increased afterload, 3. decreased cardiac output inspite of increased heart rate, 4. as a consequence, reduced perfusion of the vital organs. - These results foster the conclusion that calcium should not be used henceforth in CPR. Epinephrine was and is still the drug of choice in resuscitation after cardiac arrest.     

What's new in liver surgery in the year 2000?

More than half a century ago, Ton That Tung, then Lortat-Jacob performed the first anatomic hepatectomies, marking the onset of the conquest of liver surgery. Shortly thereafter, a few pioneers took the leap, making the first attempts at total hepatectomy and liver transplantation. Within years, considerable progress was made in hepatobiliary surgery which rapidly became a full-fledged surgery specialty. Techniques were equally improved with new advances in imaging and technology. The last 15 years have been so rich at in the strict sense of the word, little is new in liver surgery in 2000. What has changed is the general perception that liver surgery is entering a new era in the third millennium: high-tech surgery, a surgery that is safe, self-confident, yet aggressive and ambitious, a surgery that is perfectly integrated into increasingly sophisticated and comprehensive therapeutic schemes.     

What must we respect in articular fractures in childhood?

Articular fractures in children are rare and occur mainly in the elbow and ankle joint. Condylar fractures of the humerus, olecranon fractures, medial malleolar, and transitional fractures of the distal tibia are the commonest, though there is an increasing incidence of avulsion fractures of the intercondylar tibial eminence. Conservative treatment is recommended in articular displacements of less than 2 mm, but dislocation of more than 2 mm is a commonly accepted indication for surgery. Although this widely accepted guideline is based on clinical results, it is not scientifically proven. In addition, it is unknown whether there is any difference in the outcome for articular fractures if there is a step or gap, if the joint is weight-bearing or not, or the joint is immobilized or mobilized post-operatively. In experiments with rats, rabbits, and sheep, some clues have suggested that exact reconstruction of the chondral surface, fixation with compression of the fragments, and early continuous passive motion are advantageous. A prospective clinical study with a pre- and postoperative MRI scan is needed, in weight-bearing and non-weight bearing joints to show the factors influencing the outcome of these injuries.