An evaluation of combat application tourniquets on training military personnel: changes in application times and success rates in three successive phases.

INTRODUCTION: Haemorrhage from the injured extremity is a significant cause of preventable death in military settings. This study evaluated the effect of training on the efficacy of the combat application tourniquet (CAT) and to define standards for military personnel. METHOD: Participants from a training tank battalion were randomised. Data collected included age, body mass index, mean arterial pressure, hand dominance, femoral artery diameter and skin thickness. The study involved tourniquet application times (AT) and application success rates in basic, after-training and eyes-closed phases. Doppler ultrasound was used to identify the presence or absence of popliteal, radial and ulnar artery pulses. RESULTS: A total of 102 trainees participated. In the after-training phase, the left and right upper extremity ATs were 35 ± 13.1 s, and 34.8 ± 13.5 s and the right and left lower extremity ATs were 20.6 ± 6.0 s and 20.5 ± 5.5 s, respectively. The overall tourniquet success rates in three successive study phases were 69.6%, 82.4% and 91.2%, respectively. A negative significant relationship was found between extremity circumference and tourniquet success. DISCUSSION: The results show that the efficacy of CAT application increases with training. Further studies are required to investigate the reasons underlying application failures. This single group prospective randomised study involves level of evidence 4.

De Garengeot's hernia: the importance of early diagnosis and its complications.

De Garengeot's hernia is a rare condition of acute appendicitis in an incarcerated femoral hernia. A 65-year-old woman was admitted to the emergency room with a 3-day history of a painful and non-reducible mass in her right groin. The patient underwent emergency surgery. At exploration, an acute appendicitis in an incarcerated femoral hernia was identified, likely prediagnosed by computed tomography. The postoperative period was uneventful. In De Garengeot's hernia, early diagnosis is important to reduce the morbidity rate. The surgical approach should be designed according to the condition of the patient, the anatomical position of the appendix vermiformis, and the likelihood of complications.

Natural behaviour and surgical treatment of appendiceal carcinoids: an analysis of 2,376 consecutive emergency appendectomies.

OBJECTIVE: Carcinoid tumor of appendix is a rare condition. Its rarity may give rise to variances in its management. We aimed to demonstrate the occurrence and form of presentation of carcinoid tumor of appendix, as well as variations in its treatment. METHODS: All appendicectomies that took place between 2000 and 2008 were considered for study. RESULTS: A total of 2,376 appendicectomies were performed during this period while carcinoid tumours were diagnosed in 27 patients (1.13%). The mean age of patients with carcinoid tumor (26.7 years) was almost the same as that of patients with non-carcinoid pathology (28.1 years). The incidence of male patients was higher than that of females amongst the carcinoid tumor group (female/male ratio: 1/4). None of the carcinoid tumors were identified at operation. One patient (3.7 %) required right hemicolectomy. This patient was followed-up in an inconsistent manner. CONCLUSIONS: Carcinoid tumour of the appendix remains an incidental diagnosis. Patients with carcinoid were significantly younger than those with non-carcinoid conditions in the study. Re-operation rate was low. The interval to definitive surgery was very short and only one patient was followed up. No consideration as to whether the surgery was complete or not was done in the study (Tab. 1, Fig. 1, Ref. 29).

Effects of prevention of oxidative and nitro-oxidative stress on experimental rat colon anastomosis using acetylcysteine, Ebselen and 1400w.

UNLABELLED: Oxygen radicals and radicals derived from nitrogen metabolism are important in wound and anostomotic healing. In particular, nitrous oxide, originating from induced nitrous oxide synthetase, retards the wound healing process by producing peroxynitride. Therefore induced nitric oxide synthase (INOS) inhibitors and peroxynitride cleansing agents seem helpful in promoting healing. The purpose of this study was to investigate the effects of N-acetylcysteine (antioxidant), ebselen (peroxynitride cleansing agent) and 1400w (INOS inhibitor) on experimental colonic anastomotic wound healing. MATERIAL AND METHODS: 45 randomized Sprague-Dawley rats received colonic anastomosis, and all animals were treated for four days with drugs specific for each group except for the sham and control groups. All rats were given a relaparatomy on the fifth day of the study and evaluated for study parameters indicating anastomotic healing, burst pressure, tissue malondialdehit (MDA), superoxide dismutase (SOD), glutathione peroxidase (GPx) and hydroxyproline (OH-proline). RESULTS: when compared to the control group, increased (p < 0.01) burst pressure, OH-proline and decreased MDA, and SOD levels were noted in the 1400w group. Furthermore, the GPx levels were higher (p < 0.05) in rats given NAC therapy. CONCLUSIONS: the positive results of selective INOS inhibition using 1400w in this study confirm the adverse effects of the INOS enzyme on anastomotic wound healing. Therefore, we have concluded that 1400w may be helpful in promoting anastomotic healing.

Is removal of the stent at the end of 2 weeks helpful to reduce infectious or urologic complications after renal transplantation?

OBJECTIVE: Ureteral stents are used to reduce urologic complications after renal transplantation. However, they predispose to infection. The optimal time to keep them in the urinary tract has not yet been defined. The aim of this study was to evaluate the effect of early removal at the end of 2 weeks on urinary tract infections and early urologic complications (within 3 months), such as ureteroneocyctostomy leakage as well as ureteral anastomosis stricture or obstruction. METHODS: We retrospectively analyzed the medical records of 48 patients who underwent renal transplantation using a ureteral stent. The patients were divided into two groups according to the time of stent removal: at the end of 2 weeks (group A; n = 10) versus at a later time (group B; n = 38). RESULTS: The urologic complication rate was 0% in group A and the urinary tract infection rate, 2%. The urologic complication rate was 0% in group B and the urinary tract infection rate, 35%. CONCLUSION: Early removal of the stent at the end of 2 weeks after renal transplantation is decreased the rate of urinary tract infections.

A rare complication after thyroidectomy: perforation of the oesophagus: a case report.

Perforation of the cervical oesophagus after thyroidectomy is an exceptionally rare complication. Total thyroidectomies, particularly for recurrent cases might possess an increased risk. Although rare, it has high mortality and morbidity. A patient that developed oesophagus perforation after a total thyroidectomy in a peripheral hospital for recurrent nodular goitre was treated and followed-up in our clinic. This well-documented case is discussed in conjunction with the information presented in the literature.

Effect of intraoperative magnesium sulphate infusion on pain relief after laparoscopic cholecystectomy.

INTRODUCTION: The aim of the study is to evaluate the analgesic efficiency of perioperative magnesium sulphate infusion in patients undergoing laparoscopic cholecystectomy (LC). METHODS: In a randomized, double-blind trial study, 83 patients were divided into two groups. Group MT received 50 mg/kg i.v. magnesium sulphate in 100 ml of 0.9% normal saline and Group T received the same volume of isotonic saline during the intraoperative period. The cumulative post-operative tramadol consumption was measured to assess the analgesic effect using a patient-controlled analgesia device. Pain intensities at rest and while coughing were evaluated at 0, 2, 4, 8, 12, and 24 h post-operatively. RESULTS: The pain scores in Group MT were significantly lower than Group T at 0, 4, and 12 h post-operatively. The average of visual analogue scale at rest and during cough during 24 h post-operatively was found to be statistically significant between groups. The total dose of tramadol the 24-h period in Group MT and Group T was found to be 281.34 +/- 90.82 and 317.46 +/- 129.59, respectively. CONCLUSION: Per-operative 50 mg/kg magnesium sulphate infusion is effective in reducing post-operative pain in patients undergoing LC.