Treatment options for spontaneous and postoperative sclerosing mesenteritis.

Sclerosing mesenteritis is a rare pathology with only a few described cases in the literature. The etiology is unclear; however, several potential triggers, including abdominal surgery and abdominal trauma, have been discussed. The pathology includes a benign acute or chronic inflammatory process affecting the adipose tissue of the mesenterium. Despite it being a rare disease, sclerosing mesenteritis is an important differential diagnosis in patients after abdominal surgery or patients presenting spontaneously with signs of acute inflammation and abdominal pain. We present here three cases with sclerosing mesenteritis. In two cases, sclerosing mesenteritis occurred postoperatively after abdominal surgery. One patient was treated because of abdominal pain and specific radiological signs revealing spontaneous manifestation of sclerosing mesenteritis. So far there are no distinct treatment algorithms, so the patients were treated differently, including steroids, antibiotics and watchful waiting. In addition, we reviewed the current literature on treatment options for this rare disease.

Five-year Follow-up and Recurrence Rates Following Surgery for Acute and Chronic Pilonidal Disease: A Survey of 421 Cases.

OBJECTIVE: The aim of the present study was to investigate the outcomes of different treatment options for acute and chronic pilonidal disease in a single large cohort of patients. MATERIALS AND METHODS: Four hundred and twenty-one consecutive patients (171 with chronic disease and 250 with acute abscess formation) who underwent surgery between 2003 and 2012 were included in the present study. Primary outcomes included symptomatic recurrence, time to wound healing, and time off from work. The median follow-up was 5.3 years. RESULTS: In patients with acute abscess formation, the relapse rate was significantly higher (P = 0.0001) if they were treated with abscess excision (38.9%) compared with a wide local excision (13.3%). Time to relapse was significantly longer (P = 0.0205) in patients treated with wide local excision (median 7 vs 3 months), whereas time to wound healing and the days off from work were similar among groups. In chronic disease, the relapse rate was similar in patients treated with wide local excision followed by secondary wound healing (11.3%) when compared with patients treated with limited excision (27.6%) or wide excision with primary wound closure (26.8%). The time to wound healing was shortest in patients with primary wound closure following wide local excision, and the time off from work was not significantly different between groups. CONCLUSION: Wide local excision with secondary wound healing seems to be the favorable operation method for acute and chronic pilonidal disease.

Perforated sigmoid diverticulitis in a lumbar hernia after iliac crest bone graft--a case report.

BACKGROUND: The combination of perforated diverticulitis in a lumbar hernia constitutes an extremely rare condition. CASE PRESENTATION: We report a case of a 66 year old Caucasian woman presenting with perforated sigmoid diverticulitis localized in a lumbar hernia following iliac crest bone graft performed 18 years ago. Emergency treatment consisted of laparoscopic peritoneal lavage. Elective sigmoid resection was scheduled four months later. At the same time a laparoscopic hernia repair with a biologic mesh graft was performed. CONCLUSION: This case shows a very seldom clinical presentation of lumbar hernia. Secondary colonic resection and concurrent hernia repair with a biologic implant have proven useful in treating this rare condition.

Female surgeons' mentoring experiences and success in an academic career in Switzerland.

PRINCIPLES: An increasing proportion of women are working in medicine, although only very few choose surgical specialties and the interest in an academic pursuit is generally smaller among women compared to their male colleagues. The aim of the present study was to analyse factors critical for a successful academic career for female surgeons in Switzerland and to assess the value of mentor-mentee relationships in this context. METHODS: An anonymous national survey among board-certified female surgeons and female residents was conducted in Switzerland during spring 2008. The support in career advancement was investigated with five scales: networking, career planning, coaching, role model and emotional support scale. Career development was assessed based on the following criteria: number of talks at scientific conferences, number of peer-reviewed publications, participation in research projects, months of research as a fulltime activity, amount of awarded scholarships, amount of obtained third-party funds and number of research awards obtained. RESULTS: In total, 189/318 (59.4%) questionnaires were returned. Mentor-mentee relationships were reported by 109/189 (58%) respondents. The bivariate analysis showed a positive influence on the sum score regarding the respondents who were in a mentor-mentee relationship or who had support in doing household work (p = 0.09). CONCLUSIONS: A supporting network, especially in terms of a mentor, is crucial so that female physicians interested in an academic career get the opportunity to accomplish their purpose. There is considerable potential for improvement as almost half of the respondents did not have a mentor in this survey.

Women in surgery: a survey in Switzerland.

An increasing proportion of women work in medicine; however, only few choose surgical specialties. The objective of this study was to analyze the current situation of female surgeons and surgical residents in Switzerland concerning their personal and professional fulfillment. Of 318 female surgeons and surgical residents included in our study, 189 (59.4%) returned the anonymous questionnaire. Mentor-mentee relationships were mentioned by 110 (58.2%) of the 189 respondents. On the basis of a 7-point Likert scale, these women responded that they were moderately satisfied with their professional (mean score [SD], 2.7 [1.3]) and personal (mean score [SD], 3.0 [1.7]) lives. Of the 189 respondents, 113 (59.8%) mentioned that they felt underappreciated. The most important ways suggested for increasing the attractiveness of a surgical career for women were a reduction in workload (49 respondents [25.9%]), more flexible working hours (38 respondents [20.1%]), and better structured residency programs (23 respondents [12.2%]).

Primary care emergency services utilization in German-speaking Switzerland: a population-based cross-sectional study.

BACKGROUND: Traditionally, emergency consultations have been done by a general practitioner (GP) in Switzerland. Over the last years, there seems to have been a shift between general practice to hospital emergency ward utilisation. There are several local initiatives of general practitioners and hospitals to change the organisation of emergency care. To plan a new organisation form of emergency care, delivery should be based on population based data. OBJECTIVE: The aim of the study was to investigate the epidemiology and distribution of emergency consultations of primary care in a hospital and in a practice of general practitioners. In addition, factors of clinical performance in emergency consultations are of great public health interest. METHODS: For this survey, all emergency patient contacts of general practitioners from the catchment area of Bülach, serving 27 088 inhabitants, were assessed by a questionnaire during the fourth quarter of 2006. Sex, age, time, duration of the contact and triage diagnosis were assessed. In addition, all patients seen by the emergency ward at the local hospital were assessed. Contact rates and hospitalisation rates per 100 000 inhabitants were determined. In addition, a multiple linear regression model was performed to determine factors associated with consultation time as a marker for clinical performance. RESULTS: Between October 1th and December 31th 2006, 1001 patient contacts were registered at the same time period in the hospital and general practice. The patient contact rate was 94.8 contacts per 100 000 inhabitants per day, and the hospitalisation rate was 9.1 patient per 100 000 inhabitants. Patients seen at the hospital were older than in general practice (41.2 ± 22.8 vs. 32.6 ± 26.3 years) and consultation and waiting time was longer in the hospital than consultation time with the GP (144.8 ± 106.5 vs. 19.6 ± 17.6 minutes). CONCLUSION: Nearly 1 out of 1000 inhabitants were looking for emergency primary care help, and 10% of the patients were seen urgently by general practitioners and hospital staff and were hospitalised. These numbers are important information for planning emergency primary care facilities. The most prevalent triage diagnoses in practice are infections, traumatological reasons and ENT-problems, whereas in hospital the most frequent triage diagnosis is a traumatological disorder, followed by thoracic pain and infections. In addition, GP's treat patients more rapidly than a hospital does and treat patients in shorter time intervals.