Effect of different managerial systems on productive and reproductive traits, blood plasma hormones and serum biochemical constituents of geese.

A flock of 117, 10-month-old Egyptian geese consisting of 90 females and 27 males were utilized in this investigation. Birds were randomly divided into three equal groups, each made up of three replicates of 10 females and 3 males each. The first group was kept under a pasture system (PS) and allowed to swim in water ducts during the daytime (PS) and kept inside the house during the night. The second group of birds were kept in confinement in a house and fed ad libitum on a commercial feed (intensive system (IS)). Birds in the third group (semi-intensive system (SIS)) were released from the house for 6 h a day and given access to the pasture and water ducts. Each group was housed in three pens (replicates) in the SIS. They were given ad libitum access to the commercial feed when in the house. Each pen measured (2 × 3 m2). Natural mating was practiced during the period from November to the end of May. BW of geese under ISS was significantly (P ⩽ 0.05) higher than those under PS and SIS. Egg number, weight and mass of geese in the SIS system were significantly (P ⩽ 0.05) greater than those of geese in the PS and IS systems. Fertility and hatchability percentages were significantly (P ⩽ 0.05) greater in the PS (84.2% and 88.6%) than in the IS (77.5% and 82.8%) and SIS systems (80.7% and 85.5%). Shell weight and thickness were significantly (P ⩽ 0.05) better in the IS and SIS systems than in the PS system. Geese in the PS and SIS systems exhibited significantly higher plasma estradiol-17 and progesterone than those in the IS. Testosterone was significantly higher in IS than in the other systems. Semen quality factor was significantly higher in the PS and SIS systems than in the IS system. Carcass weight was significantly greater in IS and SIS geese than in PS geese, but the PS system resulted in a decreased percentage skin, abdominal fat and liver. Total amount of meat produced per geese was significantly greater in the SIS than in the IS system and greater in the IS than in the PS system.

Some epidemiological aspects of needle stick injuries among the hospital health care workers: Eastern Province, Saudi Arabia.

This study was conducted to provide some epidemiological aspects of needle stick injuries among health care workers in the eastern province in Saudi Arabia. Data about 282 injuries reported from the hospitals of the Eastern Province of Saudi Arabia were collected through specially designed questionnaire retrospectively from 1995 to 1997. Results showed that 50% of injuries occurred in the first 3 years of employment. Workers in medical and surgical specialties suffered an equal degree of reported exposure. The highest percentage (46.8%) of injuries occurred during syringe related actions. Patients' wards were the major location of incidents (48.5%) followed by ICUs and dialysis units (17.7%), theatres (15.6%) and accidents and emergency departments (13.8%). There was no significant association between injuries and type of shifts. The middle hours of the shifts showed a significant association with injuries. The pattern of injuries was significantly associated with over loaded periods of medical practices. Deficiencies in implementing the standard recommendations for prevention and control of needle stick injuries were noted in the studied hospitals.

Frequency of and prevention measures for needle-stick injuries among hospital healthcare workers in Saudi Arabia.

This study was undertaken to determine the frequency of needle-stick injuries among healthcare workers in hospitals in the Eastern Province of Saudi Arabia from 1995 to 1997, and to gather information about the measures these hospitals are taking to protect their employees against these injuries. Precautionary measures taken to protect healthcare workers from injury and the follow-up after injuries were surveyed. The total overall prevalence rate of needle-stick injuries was significantly lower among healthcare workers in governmental hospitals than among those in private hospitals. The extremely low prevalence rate of needle-stick injuries indicated that there were serious defects in the reporting systems of the hospitals studied. All hospitals should have a mandatory, clear, and unified policy to help reduce the number of needle-stick injuries. Hospitals must adopt a policy to ensure that precautions are taken to reduce healthcare workers' accidental exposures to potentially infected blood.

Analysis of factors affecting outcome after hepatectomy of patients with liver cirrhosis and small hepatocellular carcinoma.

OBJECTIVE: To review our policy of screening patients at risk of developing hepatocellular carcinoma (HCC), and to present 10 years' experience of hepatic resection for small HCC (< 5 cm). DESIGN: Retrospective study. SETTING: Teaching hospital, Germany. SUBJECTS: 861 patients with hepatic cirrhosis and oesophageal varices of whom 151 (18%) had HCC confirmed histologically; 30 of these tumours (20%) were less than 5 cm in diameter and suitable for resection. INTERVENTIONS: Segmentectomy (n = 14) bisegmentectomy (n = 10), and oncologically defined wedge resection (n = 6). MAIN OUTCOME MEASURES: Mortality, morbidity, and survival. RESULTS: 4 patients died within 30 days of liver failure and sepsis (n = 20, liver failure (n = 1), and bronchopneumonia (n = 1). The main beneficial prognostic factors were Child classification, donation of autologous blood, and an encapsulated tumour. The main indicators of a poor prognosis were invasion of the liver, venous invasion, invasion of the resection margin, and the presence of microsatellite tumours and nodules. 12 of the 26 survivors developed recurrences during the first five years postoperatively (46%). Kaplan-Meier survival curves showed that survival at 1 year was 80%, at 3 years 65%, and 5 years 50%, and at 10 years 30%. CONCLUSION: Hepatic resection is a useful treatment for small HCC, but its success depends on early detection and careful selection of patients.

Mesocaval interposition shunt with small-diameter polytetrafluoroethylene grafts in sclerotherapy failure.

Fifty-seven patients with failed sclerotherapy received a mesocaval interposition shunt with an externally supported, ringed polytetrafluoroethylene prosthesis of either 10 or 12 mm diameter. Thirty-one patients had Child-Pugh grade A disease and 26 grade B; all had a liver volume of 1000-2500 ml. Follow-up ranged from 16 months to 6 years 3 months. Three patients (5 per cent) died in the postoperative period. There were two postoperative recurrences of variceal haemorrhage and one recurrent bleed in the second year after surgery. The cumulative shunt patency rate was 95 per cent and the incidence of encephalopathy 9 per cent; the latter was successfully managed by protein restriction and/or lactulose therapy. The actuarial survival rate for the whole group at 6 years was 78 per cent, for those with Child-Pugh grade A 88 per cent and for grade B 67 per cent. Small-lumen mesocaval interposition shunting achieves portal decompression, preserves hepatopetal flow, has a low incidence of shunt thrombosis, prevents recurrent variceal bleeding and is not associated with significant postoperative encephalopathy.

Prophylactic sclerotherapy for esophageal varices in high-risk cirrhotic patients selected by endoscopic and hemodynamic criteria: a randomized, single-center controlled trial.

Controlled trials of sclerotherapy for the prevention of the first variceal hemorrhage in cirrhotics have given conflicting results, in spite of an initial positive controlled trial. We designed therefore a new study in which only 89 of 396 investigated patients were randomized to sclerotherapy (44 patients) or a control group (45 patients). The admission criteria were: no history of variceal bleeding, the presence of high risk varies, i.e., varices of degrees III and IV with minivarices on the surface of them, and portal pressure over 16 mmHg. Sclerotherapy sessions were performed at 0, 7, 14, 21, and 28 days, until the varices were reduced in size and completely covered by fibrous tissue. Follow-up endoscopy was performed at four-month and thereafter at six-month intervals. The control patients underwent repeated clinical investigation and endoscopy at six-month intervals. Bleeding episodes were treated by emergency endoscopic sclerotherapy in both groups, whenever possible. The mean follow-up was 33 months. The results were analyzed using Student's t-test and the log-rank test. Variceal bleeding occured in 11 sclerotherapy patients (25%) and 34 controls (75.6%) (p < 0.05). The overall mortality was 25% (11 patients) among the sclerotherapy patients and 69% (31 patients) in the controls (p < 0.01). Prophylactic endoscopic sclerotherapy was able to prolong survival in Child-Pugh classes A and B, but not in C. It is concluded that prophylactic endoscopic sclerotherapy does reduce the incidence of first variceal bleeding in cirrhotic patients, and is able to prolong survival if only high-risk patients are selected and the treatment is performed by endoscopic experts.

[Elective-selective Warren splenorenal shunt operation. Prognosis of liver function and esophageal varices hemorrhage after repeat sclerotherapy in liver cirrhosis]. / Elektiv-selektive splenorenale Shunt-Operation nach Warren. Prognose der Leberfunktion und Oesophagusvaricenblutung nach wiederholter Sklerosierung bei Lebercirrhose.

From March 1st, 1982 to March 1st 1990 399 patients were admitted to the Heinz-Kalk-Hospital with recurrent bleeding from esophageal varices. Therapy of first choice was acute or elective endoscopic sclerotherapy. Early recurrences and uncontrollable hemorrhage were treated by Linton-Nachlas tube or if unsuccessful by devascularisation procedure. Two early or late bleeding recurrences were defined as sclerotherapy failures and choosen after passing a selection analysis (liver volume 1000 to 2500 ml, portal perfusion more than 30%, liver biopsy without activity or progression, exclusion of stenosis in the arterial supply of the liver and Child-Pugh classification A and B) for a selective-elective splenorenal Warren shunt (SRS). In 10 of 44 selected patients (11%) with an underlying disease of intrahepatic block in 95%, mostly alcoholic origin (65%) intraoperatively the performance of an SRS was technically problematic or impossible. Therefore, a mesocaval interposition shunt was carried out. Early mortality of 34 SRS was 5.9% (2 patients) and late mortality 17.6% (6 patients). No encephalopathy and shunt thrombosis were recorded. Postoperative angio- and sequential scintigraphies proved that portal perfusion was preserved during the first two years, but diminished. Liver function remained stable, too. One case of early rebleeding could be successfully managed by emergency endoscopic sclerotherapy. Five- and eight-years survival rate, according to the method of Kaplan-Meier is about 70%. We conclude that the SRS is the treatment of choice for elective management of recurrent bleeding of esophageal varices refractory to sclerotherapy. Its performance should be not enforced; in case of technical difficulties narrow-lumen mesocaval interposition shunt is an excellent alternative.

Conservative and semi-invasive modalities for treating bleeding esophageal varices.

Although controversial, pharmacological therapy aimed at controlling acute variceal bleeding is widely used. A combination of intravenous vasopressin and nitroglycerin or glypressin alone with the aim of lowering portal pressure is currently recommended. Immediate endoscopy is mandatory to confirm that the patient is bleeding from varices. When variceal bleeding is detected, the patient should be immediately submitted to sclerotherapy, if expert treatment is available, or have the bleeding controlled by balloon tamponade or by pharmacological means, with subsequent performance of sclerotherapy with the use of a flexible endoscope within 6 to 24 hours, or transportation of the patient to a special center during this time. If bleeding has stopped, sclerotherapy can be performed immediately, or the patient can be observed while appropriate long-term management is planned. Patients who do not respond to immediate or delayed emergency sclerotherapy should be identified early and their suitability for a shunt or devascularisation procedure assessed. There is no question that at least after one or two early or even late recurrences of variceal hemorrhage, surgery should be planned and initiated. Although sclerotherapy is the favored form of emergency treatment, a nonshunting procedure or a portosystemic shunt operation should be recommended and thoroughly evaluated in order to determine whether this may be a preferable therapeutic option in a minority of patients, representing about 20% of all patients bleeding from esophageal varices referred to our institution.

Surgical procedures for bleeding esophagogastric varices when sclerotherapy fails: a prospective study.

In a 7-year period, 692 patients were admitted to the Heinz-Kalk Hospital with bleeding esophageal varices. All patients were first treated with endoscopic sclerotherapy (ES). Fourteen patients exsanguinated during the first 2 hours of admission or refused treatment. Long-term injection sclerotherapy was performed in 311 Child-Pugh C patients. Among the remaining 367 patients, 182 were in class A and 185, class B. In 194 patients, ES was successful. In 173 patients with at least two rebleeding episodes despite long-term sclerotherapy, specific selection criteria were used to assess suitability for a shunt. Eighty-eight patients received a shunt: 54, a narrow-lumen mesocaval (NLMS) shunt; 32, a distal splenorenal shunt; 1, a portacaval shunt; and 1, a proximal splenorenal Linton shunt. There was no significant difference in mortality at 30 days; however, late mortality in the ES group was 36% and in the shunt group, 17%. This difference was statistically significant in favor of the shunt operation (p less than 0.01). Thus, using specific selection criteria, shunt procedures performed in Child-Pugh class A and B patients are the best form of treatment for bleeding esophagogastric varices resistant to long-term ES. Furthermore, the narrow-lumen mesocaval shunt is a good alternative to the distal splenorenal shunt if the latter is technically impossible to perform or hemodynamically not advisable.

[Surgical measures in recurrent hemorrhage from esophageal and gastric varices after sclerotherapy--a prospective study]. / Chirurgische Massnahmen bei Rezidivblutungen aus Osophagus- und Magenvarizen nach Sklerosierungstherapie--eine prospektive Studie.

From Jan 1, 1982 to Jan 1, 1990 692 patients were admitted because of acute or recurrent hemorrhage from esophagogastric varices. Initial management was endoscopic sclerotherapy. 14 pat. were excluded. In 26 of 311 Child-Pugh C-patients a gastroesophageal disconnection and in 5 because of a portal pressure over 30 mmHg a narrow-lumen mesocaval interposition shunt (NLMCS) were performed because of uncontrollable hemorrhage. Hospital mortality was 31%. 182 pat. belonged to Child-Pugh class A and 185 to B. In 194 long-term injection sclerotherapy was successful; 173 were sclerotherapy failures and selected for shunt operation at the end of the selection analysis. 85 refused shunt operation or did not fulfill selection criteria. Thus, 88 pat. were shunted mainly by NLMCS and distal splenorenal shunt. Sclerotherapy and shunt group were comparable. Hospital mortality showed no difference. Five year life-expectancy was significantly higher in shunted patients. Thus, in sclerotherapy failures early a shunt-indication should be discussed.