Predictors of complications in gynaecological oncological surgery: a prospective multicentre study (UKGOSOC-UK gynaecological oncology surgical outcomes and complications).

BACKGROUND: There are limited data on surgical outcomes in gynaecological oncology. We report on predictors of complications in a multicentre prospective study. METHODS: Data on surgical procedures and resulting complications were contemporaneously recorded on consented patients in 10 participating UK gynaecological cancer centres. Patients were sent follow-up letters to capture any further complications. Post-operative (Post-op) complications were graded (I-V) in increasing severity using the Clavien-Dindo system. Grade I complications were excluded from the analysis. Univariable and multivariable regression was used to identify predictors of complications using all surgery for intra-operative (Intra-op) and only those with both hospital and patient-reported data for Post-op complications. RESULTS: Prospective data were available on 2948 major operations undertaken between April 2010 and February 2012. Median age was 62 years, with 35% obese and 20.4% ASA grade ⩾3. Consultant gynaecological oncologists performed 74.3% of operations. Intra-op complications were reported in 139 of 2948 and Grade II-V Post-op complications in 379 of 1462 surgeries. The predictors of risk were different for Intra-op and Post-op complications. For Intra-op complications, previous abdominal surgery, metabolic/endocrine disorders (excluding diabetes), surgical complexity and final diagnosis were significant in univariable and multivariable regression (P<0.05), with diabetes only in multivariable regression (P=0.006). For Post-op complications, age, comorbidity status, diabetes, surgical approach, duration of surgery, and final diagnosis were significant in both univariable and multivariable regression (P<0.05). CONCLUSIONS: This multicentre prospective audit benchmarks the considerable morbidity associated with gynaecological oncology surgery. There are significant patient and surgical factors that influence this risk.

Effects of glucocorticoids on plasma levels of thyroid hormones (T4 and T3) and testicular activity in catfish, Clarias gariepinus during different phases of annual breeding cycle.

Effects of short-term administration of corticosterone and cortisol on plasma levels of thyroid hormones, gonado-somatic index and testicular histology have been reported in catfish, Clarias gariepinus during different phases of its breeding cycle. Corticosterone administration had no significant effect on plasma levels of T4, T3 and T3/T4 ratio, irrespective of doses and phases of breeding cycle. However, 5 microg dose of cortisol significantly increased plasma levels of T3 and the T3/T4 ratio during quiescent and regressive phases, while it significantly decreased plasma levels of T4 during progressive phase. During breeding phase, 2 microg and 5 microg doses of cortisol significantly decreased plasma levels of T4 and T3, respectively, while 5 microg dose of cortisol alone reduced T3/T4 ratio. Irrespective of phases of annual breeding cycle and doses, short-term administration of corticosterone and cortisol had no significant effect either on GSI or testicular histology. These findings suggest that corticosterone is ineffective in stimulating plasma levels of thyroid hormones, while cortisol, depending on dose and phase/season, may differentially increase, decrease or have no effect on plasma levels of thyroid hormones in C. gariepinus.

The role of advocacy in implementing the South African abortion law.

In order to translate the abortion law in South Africa into services that ensure equity of access and women's right to control their bodies, interventions are needed to change judgemental views on abortion. This paper describes formative research conducted in the Northern Cape Province among 436 community members, 29 women seeking an abortion and 80 health service providers, to develop appropriate interventions to these ends. Based on the findings, two interventions were developed. These interventions appeared to substantially influence personal views by getting people to make a connection between the need for abortion services and the circumstances in which unwanted pregnancies occur. There was a shift towards greater support for women's right to choose in relation to abortion among women community members, though not among men, who resisted this right for married women. Amongst providers (almost all women) there was an increase in willingness to support service provision and to support staff working in abortion services. These tools could be used in sexuality education in schools and in nurse-midwifery/medical training, to complement current advocacy initiatives taking place at policy and programme levels in South Africa, to help to reduce the public health problem of unsafe abortion.

Left over bowels: an unique complication in a surviving twin.

Conjoint twins have always been a surgical challenge. The authors report an unusual finding in a surviving epigastric heteropagus twin. A 17 year old boy who underwent laparotomy for acute intestinal obstruction revealed a blind ending but complete duplication of the large bowel and an accessory liver in the falciform ligament, along with a separate gall bladder but with fused bile ducts. The findings suggest that the duplicated bowel loop and the accessory liver were remnants of the incomplete parasite twin, assimilated into the body of the autosite, which remained asymptomatic for 17 years. This case is being reported because of the uniqueness of the finding.

Maternal health services in South Africa. During the 10th anniversary of the WHO 'Safe Motherhood' initiative.

The tenth anniversary of the World Health Organisation's 'Safe Motherhood' initiative is being celebrated this year and the organisation is using the opportunity to assess critically its gains, its strengths and its weaknesses. South Africa has taken some bold steps to address maternal health services, specifically introducing free health care for pregnant women and children under 5. In this paper we explore what further steps are necessary to ensure improved health outcome for pregnant women. South African health care administrations are, in some cases, engaged in broad health systems interventions at provincial level. This approach to improving health services is nonetheless frustrated by programme-specific initiatives, such as the introduction of female condoms or other piecemeal additions. We argue that making the systems function is the essential, primary step in the success of any intervention. The case of maternal health is explored in this paper.

Synthesis and structural characterization of functionalized dimeric aluminophosphonates and a monomeric gallophosphonate anion.

Reaction of t-BuP(O)(OSiMe(3))(OH) with Me(3)Al leads to the formation of [Me(2)Al(mu-O)(2)P(OSiMe(3))(t-Bu)](2) (1) whereas Me(2)AlCl reacts with Ph(2)P(O)(OH) to yield [(Cl)(Me)Al(mu-O)(2)PPh(2)](2) (2). These compounds represent the first examples of functionalized dimeric four-ring type aluminophosphonate systems. The double four-ring type gallophosphonate, namely, [t-BuPO(3)GaMe](4), reacts with n-Bu(4)NHF(2) under ambient conditions, resulting in the formation of a monomeric gallophosphonate [n-Bu(4)N][MeGa[t-BuPO(2)(OH)](3)] (3). These derivatives have been adequately characterized using various spectroscopic techniques and X-ray diffraction studies.