May I Curse a Referee? Swear Words and Consequences

The purpose of this study was to determine whether male and female soccer (football) referees would execute the Laws of the Game despite players’ verbal abuse. Law 12 (Fouls and misconduct) instructs the referees as to how they should react when a player, substitute or substituted player expresses a swear word. The player should be issued a red card. Referees (n = 113) were presented with 28 swear words and asked how they would respond if this situation occurred in a real game (red card, yellow/blue card [blue cards are used in juvenile games, player leaves field of game for 10 minutes], admonition, no reaction). The selected words were divided into categories (such as pertaining to intelligence or sexual abuse) indicating different degrees of insult. Approximately half of the referees would have responded to players saying swear words in a game by issuing a red card (55.7% red card, 25.2% yellow/blue card, 12.1% admonition, and 7.0% no reaction). The response was independent of the referees’ qualification and experience. It was found that the insulting content of a swear word determines the referee’s decision. Referees would apply Law 12 only in one half of the cases, depending on the insulting content. The findings are discussed in the context of game management.

Key points

• Lack of consistency in referees’ response to a verbal offence.
• Referees’ qualification as well as the duration of serving as a referee did not influence the effect.
• The insulting content is crucial for a red card.

     

Who Gets a Second Heart? A Current Picture of Cardiac Retransplantation

Background

Heart retransplantation (HRT) accounts for 2.6% of heart transplantation (HT) indications. We performed a retrospective analysis of our recent HRT experience.

Methods

From January 2000 to June 2012, 820 HTs were performed; 798 (97.3%) were primary HTs and 21 (2.5%) 2nd HTs. Indications for HRT included: 57% cardiac allograft vasculopathy, 33% nonspecific graft failure, 5% primary graft failure (PGF), and 5% refractory acute rejection. The primary outcome was overall survival. Our results were compared with the most representative publications reporting HRT experiences before January 2000.

Results

Mean age at HRT was 39.9 ± 14.3 years, and there was a predominance of male patients (62%). Overall mortality was 52%; 30-day mortality was 19%. Eight patients (38%) developed PGF after HRT and 3 of them (38%) died within 30 days. Overall actuarial survivals at 1 month and 1, 3, and 5 years were 81.0%, 70.8%, 59.9%, and 53.3%, respectively. No significant risk factors for mortality could be identified.

Conclusions

We observed improved short- and medium-term survival after HRT. This finding is probably related to changing recipient profiles, with less patients being retransplanted for PGF and more patients undergoing late retransplantation. Higher rates of PGF after HRT reflect our efforts to broaden the allograft pool by using marginal donors.     

Can a living kidney donor become a kidney recipient?

The living kidney donor represents a good resource for kidney transplantation. These grafts display better function and long-term graft survival at 5 and 10 years of follow-up. Furthermore, living donors prefer the possibility to increase kidney donation for a large waiting list of patients with end-stage renal disease (ESRD). However, kidney donation is a major surgical procedure associated with benefits and risks. The risks of donation have been studied in large series of living donors to focus on morbidity and mortality rates associated with the surgical procedure. New surgical laparoscopic techniques promote living kidney donation. While the benefits to the recipient are obvious, those for the donor are subjective and not quantifiable. However, donors describe donation as a great experience in life. The risk of kidney donation may be divided into the perioperative and the long-term risks. The evaluate the long-term risks for kidney donors requires a long follow-up. The main source of kidney donors in our transplant center has been living-related and -unrelated donors, with a minor percentage of cadaveric donors. In this report we present four kidney donors who developed ESRD thereafter, three becoming kidney recipients.     

Can bacterial translocation be a beneficial event?

Infection is a major concern in intestinal transplant recipients. Bacterial migration to extraintestinal sites is a central component of the gut hypothesis of sepsis. However, some studies have cited the beneficial effects of bacterial translocation (BT) on the host acquired immune system. We evaluated the role of previous BT on a subsequent BT challenge, examined the BT index in organs as well as changes in white blood cell (WBC) count in mesenteric lymph and blood for correlation with outcomes. Wistar rats (n = 60) were divided into a BT group (n = 20), which underwent inoculation of 10 mL of 10(10) CFU/mL Escherichia coli R-6 confined to the small intestine as opposed to a BT1-14 group (n = 20), which underwent the BT procedure on days 1 and 14 or a S1-BT14 group (n = 20) that received 10 mL of saline on day 1 and the BT procedure on day 14. Half of the animals were killed 2 hours following the BT procedure. Samples from different compartments were collected for culture. Mesenteric lymph and peripheral blood were examined for WBC counts. The other half of the hosts was subjected to outcome evaluation concerning weight gain and mortality. Animals undergoing double BT showed a significantly lower index of bacterial recovery (liver, spleen, and blood) compared with those having a single BT (P < .05). The WBC count of mesenteric lymph cells after double BT was similar to na?ve animals, but significantly lower than the single BT group (P < .05). The outcome was unchanged among double BT versus other groups. A previous BT challenge was efficient to generate a host-defense mechanism against a second BT episode induced by intestinal overgrowth with the same bacterial strain.     

Can a short spinal cord produce scoliosis?

Some patients with scoliosis have a relatively short vertebral canal. This poses the question of whether a short spinal cord may sometimes cause scoliosis. The present paper presents two observations that may support this concept. It presents a scoliosis model demonstrating what effect a short, unforgiving spinal cord might have on the spinal column. The model uses two flexible parallel tubes with the facility to tighten one. It demonstrates that a short, unforgiving spinal cord could produce the abnormal rotatory anatomy observed at the apex in scoliosis, with first lordosis, then lateral deviation and finally a rotation of the vertebral column, with the rotation occurring between the canal and the vertebral body, around the axis of the cord. The anatomy of the apical vertebra is described from two museum specimens, a computed tomography (CT) myelogram and seven magnetic resonance imaging (MRI) studies. The study confirms that the vertebral canal and the intervertebral foraminae retain their original orientation. The spinal cord is eccentric in the canal towards the concavity of the curve; the major component of rotation occurs anterior to the vertebral canal and the axis of this rotation seems to be at the site of the spinal cord. These observations do not establish that a short spinal cord will result in scoliosis, but the results are compatible with this hypothesis, and that impairment of spinal cord growth factors may sometimes be responsible for scoliosis.     

What Do Physician Extenders in a General Surgery Residency Really Do?

OBJECTIVE: The 80-hour workweek has forced surgical training programs to employ physician extenders to reduce work hours and improve the educational environment. The purpose of our study was to document objectively the specific workload provided by physician extenders and to evaluate any objective or subjective benefit provided to the residency program. METHOD: Over 4 consecutive months, all orders written by 2 physician extenders associated exclusively with the general surgery residency program at our institution were reviewed. They were categorized as daytime or evening orders and were subdivided into admission, routine preoperative and postoperative, acute care, daily laboratories, pain medications, Pro re nata (PRN), wound care, and discharge orders. Acute care issues and PRN orders were individually examined and subdivided. The appropriateness, total volume, and the orders for each category were totaled and reviewed. RESULTS: Overall, 3101 total orders (1128 daytime and 1973 nighttime) were reviewed in a 4-month time period. On average, physician extenders at night wrote 35 orders per shift, compared with only 18.8 orders during the day. During the night, admission orders totaled 547 (27.7%), preoperative orders 442 (22%), acute care issues 324 (16.4%), PRN orders 239 (12%), and pain medication and PRN sleeping pills 156 (8%). During the day, routine postoperative orders totaled 305 (27%), daily laboratories 184 (16%), and discharge orders 253 (22%). CONCLUSION: Physician extenders wrote appropriate orders and reduced resident workload. Educational opportunities increased because fewer residents left conference for acute patient care issues, and 1 fewer resident was absent during the day secondary to 1 less resident being sent home postcall. Performance on the American Board of Surgery In-Training Examination (ABSITE) increased dramatically for a focused group of residents. As the expense of each extender is approximately $90,000, justification to administration is dependent on the institutional support and efficiency of the residency program. A clear simple outcome is that by improving standing orders and clinical pathways, and by using an electronic medical record system, noneducational work hours can be reduced significantly.     

Can sarcoidosis cause autoamputation of a finger phalanx?

Sarcoidosis is a multisystemic granulomatous disease. In the case presented, autoamputation of the distal phalanx of a little finger of the left hand was observed. The possibility of autodigital amputation as a result of sarcoidosis is discussed.     

Can a practicing surgeon detect early lymphedema reliably?

BACKGROUND: Lymphedema may be identified by simpler circumference changes as compared with changes in limb volume. METHODS: Ninety breast cancer patients were prospectively enrolled in an academic trial, and seven upper extremity circumferences were measured quarterly for 3 years. A 10% volume increase or greater than 1 cm increase in arm circumference identified lymphedema with verification by a lymphedema specialist. Sensitivity and specificity of several different criteria for detecting lymphedema were compared using the academic trial as the standard. RESULTS: Thirty-nine cases of lymphedema were identified by the academic trial. Using a 10% increase in circumference at two sites as the criterion, half the lymphedema cases were detected (sensitivity 37%). When using a 10% increase in circumference at any site, 74.4% of cases were detected (sensitivity 49%). Detection by a 5% increase in circumference at any site was 91% sensitive. CONCLUSIONS: An increase of 5% in circumference measurements identified the most potential lymphedema cases compared with an academic trial.