Changes in hospital costs for an appendectomy: 1955, 1965, and 1975

A reduction in the number of postoperative bed days for patients who underwent appendectomy led to a study of changes in hospital costs of appendectomies for the years 1955, and 1965, and 1975. No significant changes were found in the total hospital costs. However, the postoperative costs decreased by 36 percent from 1955 to 1975 due to a decrease in the mean duration of hospital stay. During the same period of time, the perioperative costs increased by 90 percent due to increased length of operation time correlated with an increasing proportion of inexperienced operating surgeons. At present, there seem to be few possible ways to increase the cost efficiency of treating appendicitis.     

Treatment of liver cancer with regional intraarterial 5-FU infusion.

The results of a retrospective three year study of forty-six patients with cancer of the liver treated with regional intraarterial infusion of 5-FU are reported. No primary mortality was noted. Oblective overall remission rate was 43 per cent. Overall median survival from onset of treatment was six months. The one year survival rate was 33 per cent and the two year survival rate 11 per cent. Patients with an objective response had a significantly prolonged survival as compared with nonresponders, especially in the colorectal group: sixteen months versus four months. Survival was not related to tumor size and involvement of the liver. During treatment 42 per cent of the patients developed extrahepatic metastases. Quality of life was improved in 63 per cent of the patients. The results indicate that infusion therapy induces reasonable response and palliation but is inadequate for the control of extrahepatic tumor growth.     

Prophylactic oophorectomy in colorectal carcinoma

It is a well established fact that women with recurrent colorectal carcinoma have a high frequency of ovarian metastases. This study was undertaken to see if microscopic metastases could be found in serial sections of ovaries removed at the time of primary operation. Of 58 patients, 4 had microscopic metastases and an additional 2 patients had macroscopic metastases. This finding, plus the risk of the development of a primary ovarian carcinoma, favors prophylactic oophorectomy in women with colorectal carcinoma.     

Release of acid hydrolases in hemorrhagic shock after pretreatment with hydrocortisone in the pig

An experimental study of the effect of pharmacologic doses of hydrocortisone in hemorrhagic shock in the pig is described. Oligemic hypotension was induced for sixty minutes by maintaining the mean arterial blood pressure at 30 mm Hg. Pretreatment with hydrocortisone (50 mg/kg of body weight) suppressed the plasma activity of the acid hydrolases β-D-glucosidase and β-D-galactosidase compared with that in a control group. In addition, treatment with steroids reduced the degree of metabolic acidosis and hyperpotassemia. After reinfusion of the shed blood the arterial blood pressure was higher in the group treated with steroids.The results of this study indicate that glucocorticoids have a protective effect in hemorrhagic shock in pigs. This action seems to occur primarily at a metabolic level rather than by direct interference with the general circulation.     

Relationship between postoperative temperature and survival in patients resected for colorectal cancer

The present study suggests that the prognosis of patients undergoing resection for colorectal carcinoma might be improved if there is an increase in body temperature during the postoperative period.     

Changes in blood clotting and fibrinolysis after liver ischemia in pigs

Ten pigs were subjected to fifteen minutes of liver ischemia and four pigs to sixty minutes of liver ischemia. After fifteen minutes of ischemia three of ten animals showed a significant prolongation in the recalcification time. There was no decrease in clotting factors to explain the prolongation. The increase in fibrinolytic activity was similar in the three pigs with and the seven pigs without a prolonged recalcification time. There were no changes in fibrinogen concentration in any of the animals. Dilution tests for determining the circulating anticoagulants strongly indicated the presence of an anticoagulant in the plasma samples with a prolonged recalcification time.All four animals subjected to sixty minutes of liver ischemia showed a moderate prolongation in the recalcification time of longer duration but not of the same magnitude as that of the animals having fifteen minutes of liver ischemia. The prolongation in the recalcification time in this group was probably a result of a decrease in clotting factors.     

Ambulatory inguinal hernia repair compared with short-stay surgery

Two groups of patients operated on for inguinal hernia, one outpatient group and one inpatient group, are compared with respect to subjective distress and immediate postoperative complications. The groups were chosen at random and matched for sex and age. A large number of those who received treatment as outpatients suffered marked distress during the first postoperative days. Some form of intermediary or light nursing should be tried out for the outpatients so that if necessary they can stay the night after operation at the hospital. The number of postoperative complications was equal in the two groups. With suitable patient selection and with a small number of reserve places in a light-care ward, the majority of inguinal hernia operations can be performed on outpatients, resulting in a considerable economic saving and shorter waiting time.     

Natural history of patients with untreated liver metastases from colorectal cancer

One hundred fifty-five patients, laparotomized because of colorectal cancer, were retrospectively evaluated with special attention given to the natural course of untreated synchronous liver metastases. The median survival time for patients with synchronous liver metastases was 4.5 months. The survival time was mainly influenced by the extent of tumor involvement in the liver. Patients with elevated levels of serum-alkaline phosphatase at the time of operation had a significantly shorter survival time than those with normal values. Serum alkaline phosphatase levels are a good indication of prognosis. The incidence of synchronous liver metastases was 16 percent. This low rate is partly explained by the development of metachronous liver metastases in five patients within 1 year. Comparison with previous reports, often more than 10 years old, revels that the poor prognosis of patients with untreated liver metastases from colorectal cancer has remained unchanged.     

Herniography in athletes with groin pain

In the years 1974 to 1981, herniography was performed in 78 athletes with groin pain. The investigation comprised 101 painful groin sides in 23 athletes with bilateral symptoms. Before herniography, a hernia was palpated in only eight (7.9 percent) groins with pain. Hernias were found at herniography in 84.2 percent of the symptomatic groin sides and in 49.1 percent of the asymptomatic groin sides. Sixty-three hernia operations were performed. The herniographic and operative diagnoses corresponded well. Direct hernias dominated among the operated athletes, and were found in 55.6 percent of those below 30 years of age. Altogether 69.8 percent of the operated patients were cured by hernia repair and another 20.6 percent were improved. Tenoperiostitis of the adductor muscles was the most frequent diagnosis in those not cured by operation and among the nonoperated patients. Herniography was of great value in selecting those patients who needed a repair. A broad differential diagnostic approach when examining these patients is of the utmost importance.     

Role of obstruction in the pathogenesis of acute appendicitis

The role of obstruction in the pathogenesis of acute appendicitis was studied by measuring the pressure in the appendix perioperatively in 24 patients operated on with an appendectomy because of suspected acute appendicitis. The technique used involved inserting a fine needle through the apex into the appendix lumen and measuring the hydrostatic pressure required to inject saline solution. In three patients with a gangrenous appendix found at operation, and in two patients with a phlegmonous appendix, there were signs of obstruction of the appendix lumen as revealed by increased pressure within it. In 14 patients with a phlegmonous appendix found at operation, no signs of obstruction were found. These experimental data suggest that obstruction is not an important causative agent of acute appendicitis, but might develop as a result of the inflammatory process.     

Development of right inguinal hernia after appendectomy

The incidence of right inguinal hernia is significantly greater in patients who have undergone appendectomy than in the general population. The most likely cause of such hernias is injury to the segmental nerve supply to the inguinal musculature. The choice of incision at appendectomy may therefore be important, and the surgeon should avoid injury to the nerve branches and important structures in the inguinal region, especially below the horizontal line extending from the anterosuperior iliac spine to the rectus muscle.     

Tibial condylar fractures: Non-operative treatment of lateral compression fractures without impairment of knee-joint stability

Compression fractures of the lateral condyle of the tibia occur chiefly in elderly persons. Compression injury of the central and posterior parts of the condyle often leaves the stability of the extended knee-joint unaffected. Forty patients with central and posterior depression showed normal stability of the extended knee-joint, despite depression of the lateral joint surface between 5 and 20 mm. All were treated without operation and functional recovery was excellent. It is suggested that such fractures should be treated with early active exercises. Weight bearing may be allowed after a few weeks because the risk of secondary displacement is almost nil. Neither operation nor long-term immobilization is indicated in the treatment of these injuries.     

Isolated disruption of the transverse ligament of the atlas: an injury easily overlooked at post-mortem examination

Two cases of disruption of the transverse ligament of the atlas with concomitant injuries to the cervical medulla are reported. Such injuries are easily over-looked at post-mortem examination, especially because the external injury can be insignificant.     

Intraarterial infusion chemotherapy (5-fluorouracil) in patients with inextirpable or locally recurrent rectal cancer.

A retrospective analysis of the results of treatment of advanced rectal cancer of the pelvis with regional intraarterial infusion of 5-fluorouracil (5-FU) is reported. A special technic for positioning the catheters selectively in the internal iliac arteries justifies this analysis. Four patients with primary inextirpable rectal cancer and 10 patients with locally recurrent rectal cancer have been treated. No immediate mortality was noted. Relief of pain was noted in two-thirds of the patients. An objective tumor response was noted in three patients with locally recurrent disease. In one patient with primary inoperable cancer it was possible to extirpate the tumor after infusion therapy. An improvement in quality of life during the first 2 months after therapy was achieved in half of the patients as judged by their performance. Complications were not serious. Hematomas with infection were seen in one patient, two patients had septicemia, and three patients had transient oliguria. Transient thrombocytopenia was reported in two patients. The results indicate that infusion therapy produces a reasonable response such as palliation of pain. Only minor complications were seen and easily controlled. The advantages of infusion therapy are that it can be given in a reasonable time with only a short hospital stay.     

A comparison study of methods for estimation of a burn surface area: Lund and Browder,e-burn and Mersey Burns

IntroductionOne of the greatest challenges in burn care is the estimation of a total burn surface area (TBSA). It is especially challenging and needs to take into account the growing proportions and the age of a paediatric patient. The aims of this study is to: (1) assess the reliability of the three modalities (LB, MB, and EB) in calculating the extent of burn injuries and fluid resuscitation, and (2) compare the features in terms of usability and efficacy.MethodsParticipants were recruited from Women’s and Children’s Hospital (WCH), South Australia’s surgical and emergency department. Participants were introduced to LB, MB and EB, and then commenced calculation of TBSA on two simulated paediatric (patient A: 12 months, patient B: 4 years) burns. The participants were categorized into three groups; (1) Burns-naïve, (2) Burns-experienced, and (3) Burns-expert.ResultsA total of 45 participants took part in this validation study: doctors (49%), nurses (33%), nursing students (11%) and medical students (7%). The burns-naïve group demonstrated higher means in both patients and has greater variance, TBSA mean 28.8%, range 14–40.5% and mean 37.4%, range 20–52.3% in patient A and B respectively. Two-way ANOVA analysis shows a statistically significant interaction between the effects of level of experience and use of applications on estimation of TBSA in larger burns.ConclusionInnovative software and mobile applications demonstrate a high potential as clinical adjuncts in achieving better health outcomes in any health care system. Both Mersey Burns and e-burn reduced the risk of human error particularly from untrained or non-specialised clinicians, however, e-burn proved to be more favourable in our study. Technology-aided models are the future of burns assessment, and further studies are warranted to determine their impact on overall clinical outcome.