Imaging Pulmonary Foreign Body Reaction Using [125I]iodo-DPA-713 SPECT/CT in Mice

Molecular Imaging and Biology - Foreign body reactions elicit granulomatous inflammation composed of reactive macrophages. We hypothesized that [125I]iodo-DPA-713 single-photon emission computed...     

Use of the CTrach Laryngeal Mask Airway in adult patients: a retrospective review of 126 cases

Study ObjectiveTo evaluate the effectiveness of the CTrach Laryngeal Mask Airway (LMA) when used electively.DesignRetrospective analysis.SettingOperating room of an academic hospital.MeasurementsData from 126 patients who were electively intubated with the CTrach LMA over a 16-month period were reviewed. Each patient's weight, height, ASA physical status classification, Mallampati score, thyromental distance, and cervical spine range of motion were recorded.Main ResultsSuccessful ventilation was achieved in 100% of patients, while successful intubation was achieved in 89.7% of patients. The most common reason for failure to intubate was poor airway visualization and the inability to appropriately position the device anterior to the vocal cords.ConclusionsThe major advantage of the CTrach LMA is that it is the only device that allows airway visualization during patient ventilation; however, it does not have 100% success with intubation.     

Establishing a reproducible large animal survival model of laparoscopic Roux-en-Y gastric bypass

BACKGROUND: The advent of metabolic surgery and the increasing focus on the substantial resolution rate of type 2 diabetes after laparoscopic Roux-en-Y gastric bypass (LRYGB) call for additional fundamental investigations as to the mechanisms behind this effect. These investigations require an adequate animal model. Our objective was to develop a reproducible survival model of LRYGB performed in a large animal at a tertiary university hospital. METHODS: LRYGB was performed on 11 Yorkshire pigs that where then followed for 6 weeks. The operative time, morbidity, and mortality were recorded for each case. Necropsy was performed, and the anastomoses were harvested and inspected for leaks. RESULTS: The surgical technique and difficulties are carefully described. Of the 11 pigs, 10 survived to the end of the study period. The 1 death was from intraoperative cardiac dysrhythmia. The postoperative complications consisted of a postoperative febrile episode in 2 pigs. The mean initial weight was 31.5 ± 3.4 kg. The mean operative time was 214 ± 71 minutes. No anastomotic leaks were identified at necropsy or on histologic examination of anastomoses. The mean weight gain at the end of the study period was .8 ± 1.4 kg compared with an expected 17.5 kg weight gain. CONCLUSION: We have described an effective survival porcine model of LRYGB that can be consistently reproduced. This will enable additional investigation into the complex physiologic mechanisms that control hunger, weight loss, and the development, as well as resolution, of type 2 diabetes, potentially leading to the development of novel, targeted bariatric procedures and diabetic treatments.     

A new algorithm for hip fracture surgery. Reoperation rate reduced from 18 % to 12 % in 2,000 consecutive patients followed for 1 year

Background and purpose

Treatment of hip fracture patients is controversial. We implemented a new operative and supervision algorithm (the Hvidovre algorithm) for surgical treatment of all hip fractures, primarily based on own previously published results.

Methods

2,000 consecutive patients over 50 years of age who were admitted and operated on because of a hip fracture were prospectively included. 1,000 of these patients were included after implementation of the algorithm. Demographic parameters, hospital treatment, and reoperations within the first postoperative year were assessed from patient records.

Results

931 of 1,000 operative procedures were performed according to the algorithm, as compared to only 726 of 1,000 prior to its introduction (p < 0.001). After implementation of the algorithm, junior registrars still performed half of the operations, but unsupervised procedures declined from 192 of 1,000 to 105 of 1,000 (p < 0.001). The rate of reoperations declined from 18% to 12% (p < 0.001 in a multiple Cox regression analysis), with a decline of 24% to 18% for intracapsular fractures and a decline of 13% to 7% for extracapsular fractures. The proportion of bed-days caused by reoperations was reduced from 24% of total hospitalization before the algorithm was introduced to 18% after it was introduced.

Interpretation

It is possible to implement an algorithm for treatment of all hip fracture patients in a large teaching hospital. In our case, the Hvidovre algorithm both raised the rate of supervision and reduced the rate of reoperations. The reduced reoperation rate saved many hospital bed-days.The surgical treatment of hip fracture patients is controversial, with high reoperation rates and long hospitalization time (Foss et al. 2007, Palm et al. 2006). In the last decades, some evidence has been put forward for more optimized treatment and general guidelines have appeared (Kyle et al. 1995, Parker and Gurusamy 2005, Palm et al. 2006, Danish Orthopedic Society 2008). However, in everyday clinical practice, the exact choice of implant often remains controversial, and here an easily used surgical algorithm for all hip fracture patients is warranted. To our knowledge, no such algorithm has ever been presented.Based on a review of the literature and own previously published studies of predictors for reoperation (Palm et al. 2006, 2007a, 2009, 2011), we developed an evidence-based algorithm for the surgical treatment of all hip fracture patients—solely based on fracture classification and patient age (Figure). We included demands for supervision, as unsupervised junior registrars have been shown to be an independent risk factor for reoperation (Palm et al. 2007b).Open in a separate windowThe algorithm for hip fracture surgery.We investigated whether such an algorithm could be implemented in everyday clinical practice at a large teaching hospital and whether it could reduce the need for reoperations.