Usefulness and limitations of colonoscopy in a proctological clinic

Summary Colonoscopy is a superior diagnostic tool for the detection of cancer of the colon. Its limitations include that it is not always available and there is a great deal of discomfort for the patient. It should therefore be used as effectively as possible. The goal of this retrolective cohort study was to analyze the usefulness of colonoscopy, especially by relating it to the subsequent therapeutic impact. Indication-related groups included rectal bleeding, other symptoms suggestive of malignancy, and follow-up. In 714 patients selected as a result of admission to the proctological unit of our surgical clinic, a carcinoma was discovered in 9% and an adenoma in 13.4%. Patients with rectal bleeding were found to benefit most from colonoscopy since active therapeutic management followed in 56% of the cases. On comparison, there was a direct therapeutic impact in only 10% of the colonoscopies performed for follow-up. Identification of additional factors such as mucosal proliferation markers may help to improve the efficiency of endoscopy by more specifically designating the populations at risk for colonic neoplasia.     

Organizational and methodologic aspects of antibiotic therapy in a surgical clinic

The article presents modern ideas of the most rational methods of antibiotic therapy in treatment of patients in the surgical clinic.     

Organizational aspects of organ harvesting in France

Organ transplantation of kidneys, liver, heart, lungs and pancreas is a routine practice in numerous French surgical centers with very good long-term results. Tissue transplantation of cornea, blood vessels, bone, and cardiac valves has also shown its efficacity and these tissues should be harvested whenever possible. Brain death is defined as the complete and irreversible destruction of the brain stem and cerebral cortex. The diagnosis of brain death is largely clinical but must be confirmed by EEG and cerebral arteriography. The Law of Caillavet has established the concept of "presumed consent" and has defined the judicial framework to permit organ harvesting. Nevertheless, there is still a high level of refusal of organ donation (in a third of cases) by the family of the decedent. At local and regional levels, control and coordination are provided by trained teams in liaison with the French Establishment for Transplantation (Etablissement fran?ais de greffes). The number of organ harvests grows steadily (18/million inhabitants in 2001) yet remains insufficient to meet the needs of the ever lengthening list of patients awaiting transplant. The profile of potential donors has also changed with time and poses increasing problems with regard to the quality of harvested organs.     

Organizational and social aspects of pediatric surgery

Inadequately utilized reserves of rendering surgical aid to children are analysed. The author discusses particular problems linked with prevention, diagnosis, tactics, treatment, and research in the field of pediatric surgery. The prospects of the specialty are intimately connected with general surgery and public health care as a whole and are caused by social reconstructions and stage-by-stage organizational decisions.     

Organizational and technical aspects of organ removal

The only efficient way to obtain adequate numbers of kidneys for transplantation is to perfect the technical and organisational method or organ harvesting. Careful attention to the details of organ procurement is as essential to the outcome of the transplantation as the procedure itself. To obtain optimal results, an effective collaboration between the central and peripheral hospital is necessary. A mobile medical and surgical team, coming from the central hospital for donor procurement was found to be most effective. Success in a major transplantation program requires continued improvement in the relationship between peripheral hospital physicians and the central transplant unit.     

Family planning services in hospital

In India, family planning is accorded top priority in the 5-year plans for health and economic development. The 1st step in getting family planning services integrated with other health services was to integrate them with maternity and child health services at the primary health centers. Services rendered by the hospital were only back-up services. The proposed legislation for abortions, when implemented, will create a greater need for gynecological beds which are already too few. As a result, after abortion the partially motivated person may not be immediately sterilized. When family planning services are functioning in a hospital, staff personnel are likely to better motivated. The family planning services in a hospital should form a unit functioning in a single place. The staffing pattern should include a full-time doctor, a public health nurse, and an extension educator. All hospital personnel should be oriented toward family planning. Cooperation by the obstetrical, gynecological, and pediatric departments is needed in motivating patients. Good motivation of patients is essential for long-run success. Follow-up services are important. To do this, suitable budgetary and transport provision are needed. An adequate system of records should be evolved. To attract patients, the clinic might open earlier than the general outpatient timing. A small exhibit in the central hall with a family planning worker in attendance to give advice and distribute contraceptives would help attract people.     

Patients' perception of surgical services in a district general hospital

BACKGROUND: In addition to studying the outcomes of surgery in terms of mortality and morbidity rates and performance, it is also important to consider how patients perceive the delivery of the service given to them. METHODS: A patient satisfaction survey was carried out by the Surgical Epidemiology and Audit Unit of the Royal College of Surgeons of England, on patients undergoing surgical procedures by the Department of Surgery at Wrexham Maelor Hospital. No day cases were included in the study. Two hospitals in southern England (undergoing the same survey) designated X and Y were used for comparison. RESULTS: Some 2000 questionnaires were sent out twice; 1666 subjects (83 per cent) responded to the first questionnaire and 1445 (87 per cent) of these responded to a second questionnaire 6 weeks later (overall response 72 per cent). A total of 35 per cent of patients were older than 65 years of age. Some 76 per cent of patients with a malignant condition were seen within 4 weeks of referral compared with 38 per cent of those with a benign condition (P < 0.0001). A total of 78 per cent of patients with cancer were admitted within 4 weeks compared with 84 and 88 per cent in hospitals X and Y. Some 23 per cent of patients were admitted as an emergency. Eighteen per cent of patients did not know who presented a consent form to them before surgery compared with 13 and 17 per cent in hospitals X and Y (P < 0.0001). Some 26 per cent of patients perceived that they had complications after surgery compared with 27 and 25 per cent for hospitals X and Y. A total of 35 per cent of patients did not receive a follow-up appointment and 20 per cent of these patients were unhappy about this. Two areas of major concern revealed by the responses were the lack of written information and the overall poor scores generally attained by the emergency admission ward. However, 94 per cent of patients said that they would return to the same consultant. CONCLUSION: Patients were generally happy with their surgical care and there was little difference between the three hospitals studied. Lower scores were given when patients were admitted to emergency admission wards. Higher scores were given when patients received printed information.