Umbilical temperature correlation with core and skin temperatures at rest,in the heat and during physical activity

Purpose: to determine the correlation of umbilical temperatures (T_umb) with simultaneously recorded chest wall temperature (T_chest) and rectal temperature (T_rectal) in adults during rest, heat exposure and exercise.

Methods: A total of 28 healthy men, wearing different types of clothing (athletic garb, a spandex full body heating garment, firefighter bunker gear) had average and peak umbilical, chest wall and rectal temperature measurements taken during sedentary temperature stabilisation stages, heat exposure periods and active exercise phases.

Results: Curvilinear relationships were noted between T_chest and T_umb compared with T_rectal and their association became noticeably positive and linear at approximately 35.5?°C. Polynomial regression analysis of T_rectal with linear and quadratic forms of T_chest and T_umb indicated an overall R² of 0.657 and 0.767, respectively. Bivariate analysis of a restricted data set (where T_chest and T_umb?≥35.5°), indicated that T_umb was significantly associated with T_rectal (r_average?=?0.710, p?<0.001; r_peak =?0.841, p?<0.001) and T_chest was also significantly associated with T_rectal, but less so (r_average?=?0.570, p?<0.001; r_peak?=?0.699, p?<0.001).

Conclusions: the umbilicus offers a non-invasive, peripheral site for measurement of temperature that more closely correlated with body core temperature than T_chest when core temperature was ≥35.5?°C.     

Diabetic retinopathy screening with non-mydriatic retinography by general practitioners: 2-year results

AimsTo ascertain in real practice the diagnosis rate of diabetic retinopathy (DR) in patients considered to have positive screening test by general practitioners (GPs) and what are the reasons for the false positive diagnosis.MethodsFour GPs previously instructed in the interpretation of retinal photographs evaluated the digital retinography images of patients with diabetes obtained during a 2-year period. When the images were considered normal, a new appointment was scheduled for 1 year later and a report was emailed to the referring physician. Patients with any sign of DR or other suspicious retinal alterations and those whose images were considered difficult or impossible to assess were referred to an ophthalmologist.ResultsA total of 2750 patients were referred for screening. The images of 2036 (74%) patients were considered normal, and the images of 714 (26%) patients were sent to ophthalmologists. Among the referred patients, 392 (55%) did not have DR, 244 (34%) had DR, and 78 (11%) had unreadable images. The retinal images of 240 patients whose fundi were considered normal were read again by ophthalmologists to evaluate false negatives. Of them, 16 patients (7%) had DR but only two patients (1%) had treatable DR.ConclusionsAfter adequate training, GPs can screen for DR with a high level of accuracy using non-mydriatic retinography. There is a need to strengthen the training of GPs in order to recognize non-visual threatening abnormalities.     

Transvaginal organ extraction: potential for broad clinical application

Background

Natural orifice transluminal endoscopic surgery procedures have evolved over the past few years. A transvaginal approach is a promising alternative for intraperitoneal procedures. Our objective was to evaluate the safety and feasibility of transvaginal organ extraction.

Methods

This institutional review board-approved protocol involved retrospective review of an ongoing prospective study. Female subjects who presented to our hospital for elective cholecystectomy, appendectomy, or sleeve gastrectomy were offered participation in the study. Eligible patients met the following criteria: age between 18 and 75, diagnosis of gallbladder disease, acute appendicitis, or morbid obesity who desired surgical treatment. A hybrid transvaginal natural orifice approach was used in this series.

Results

Thirty-four women underwent transvaginal organ extraction between September 2007 and January 2012. The mean age was 40 ± 12.1 years (range 23–63 years). The mean body mass index was 27 ± 6.4 kg/m² (range 16–43 kg/m²). All patients had an American Society of Anesthesiologists classification of two or below. The mean operative time for cholecystectomy, appendectomy, and sleeve gastrectomy was 90, 71, and 135 min, respectively. There were no conversions to open operation and no intraoperative complications. The mean hospital stay was 2 days for all cases. Patients were followed for a mean of 24 months (range 1–61 months). There were two pregnancies and two successful vaginal deliveries. Six patients (18 %) had minor complaints of spotting or heavy menses in the immediate postoperative period that resolved with conservative measures. There were no abdominal wall complications. There were no long-term complications and no mortalities.

Conclusions

This initial experience suggests that this surgical approach is safe, does not increase length of stay, and has no long-term vaginal complications. Given this attractive profile, a transvaginal approach may prove to be a superior mode of organ extraction, although randomized studies and long-term follow-up are needed.     

Left Ventricular Assist Device Therapy for Destination Therapy: Is Less Invasive Surgery a Safe Alternative?

Introduction and objectives

The number of older patients with congestive heart failure has dramatically increased. Because of stagnating cardiac transplantation, there is a need for an alternative therapy, which would solve the problem of insufficient donor organ supply. Left ventricular assist devices (LVADs) have recently become more commonly used as destination therapy (DT). Assuming that older patients show a higher risk-profile for LVAD surgery, it is expected that the increasing use of less invasive surgery (LIS) LVAD implantation will improve postoperative outcomes. Thus, this study aimed to assess the outcomes of LIS-LVAD implantation in DT patients.