Evaluation of cost and length of stay, linked to complications associated with major surgical procedures.

INTRODUCTION: A lot of studies have demonstrated the possibility of reducing the number of post-operative complications in the domain of major surgical procedures with the use of medical preventive techniques. However, complications following surgical procedures are unfortunately frequent and are a major problem, not only because of the impact for the patient, but also because of economic consequences that they provoke. The aim of the present study is to evaluate the extra length of stay and the extra cost, born by the hospital and the social security, linked to complications, incurring after major surgical procedures. MATERIAL AND METHODS: Study based on the data from 13 Belgian hospitals for the year 2012. Complications were extracted through medical discharge summaries. The cost born by the social security was assessed on the basis of the billing data, hospital cost are taken from cost accounting studies. RESULTS: The rate of complication for all the hospitals is 6.6%. About 30.3% of inpatient stays having a major or extreme severity of index had a complication during the stay, 1.8% of stays with a minor or moderate severity of index had a complication. The extra length of stay is 19.38 days when the stay has had a complication (p < 0.001). The additional mean cost borne from the hospital perspective is €21 353.07 and €8 026.65 for the social security. This additional mean cost varies greatly from one hospital to another. DISCUSSION/CONCLUSION: The present study has shown that the actual financing do not cover real hospital costs in the field of major surgical procedures having caused complications. Results should encourage Belgian authorities to propose and finance preventive measures in order to reduce these complications, which represent major economic impacts, not only for authorities but also for hospitals.

X-ray computed microtomography characterizes the wound effect that causes sap flow underestimation by thermal dissipation sensors.

Insertion of thermal dissipation (TD) sap flow sensors in living tree stems causes damage of the wood tissue, as is the case with other invasive methods. The subsequent wound formation is one of the main causes of underestimation of tree water-use measured by TD sensors. However, the specific alterations in wood anatomy in response to inserted sensors have not yet been characterized, and the linked dysfunctions in xylem conductance and sensor accuracy are still unknown. In this study, we investigate the anatomical mechanisms prompting sap flow underestimation and the dynamic process of wound formation. Successive sets of TD sensors were installed in the early, mid and end stage of the growing season in diffuse- and ring-porous trees, Fagus sylvatica (Linnaeus) and Quercus petraea ((Mattuschka) Lieblein), respectively. The trees were cut in autumn and additional sensors were installed in the cut stem segments as controls without wound formation. The wounded area and volume surrounding each sensor was then visually determined by X-ray computed microtomography (X-ray microCT). This technique allowed the characterization of vessel anatomical transformations such as tyloses formation, their spatial distribution and quantification of reduction in conductive area. MicroCT scans showed considerable formation of tyloses that reduced the conductive area of vessels surrounding the inserted TD probes, thus causing an underestimation in sap flux density (SFD) in both beech and oak. Discolored wood tissue was ellipsoidal, larger in the radial plane, more extensive in beech than in oak, and also for sensors installed for longer times. However, the severity of anatomical transformations did not always follow this pattern. Increased wound size with time, for example, did not result in larger SFD underestimation. This information helps us to better understand the mechanisms involved in wound effects with TD sensors and allows the provision of practical recommendations to reduce biases associated with wounding in field sap flow measurements.

Comparison of species classification models of mass spectrometry data: Kernel Discriminant Analysis vs Random Forest; A case study of Afrormosia (Pericopsis elata (Harms) Meeuwen).

RATIONALE: The genus Pericopsis includes four tree species of which only Pericopsis elata (Harms) Meeuwen is of commercial interest. Enforcement officers might have difficulties discerning this CITES-listed species from some other tropical African timber species. Therefore, we tested several methods to separate and identify these species rapidly in order to enable customs officials to uncover illegal trade. In this study, two classification methods using Direct Analysis in Real Time (DART™) ionization coupled with Time-of-Flight Mass Spectrometry (DART-TOFMS) data to discern between several species are presented. METHODS: Metabolome profiles were collected using DART™ ionization coupled with TOFMS analysis of heartwood specimens of all four Pericopsis species and Haplormosia monophylla (Harms) Harms, Dalbergia melanoxylon Guill. & Perr. Harms, and Milicia excelsa (Welw.) C.C. Berg. In total, 95 specimens were analysed and the spectra evaluated. Kernel Discriminant Analysis (KDA) and Random Forest classification were used to discern the species. RESULTS: DART-TOFMS spectra obtained from wood slivers and post-processing analysis using KDA and Random Forest classification separated Pericopsis elata from the other Pericopsis taxa and its lookalike timbers Haplormosia monophylla, Milicia excelsa, and Dalbergia melanoxylon. Only 50 ions were needed to achieve the highest accuracy. CONCLUSIONS: DART-TOFMS spectra of the taxa were reproducible and the results of the chemometric analysis provided comparable accuracy. Haplormosia monophylla was visually distinguished based on the heatmap and was excluded from further analysis. Both classification methods, KDA and Random Forest, were capable of distinguishing Pericopsis elata from the other Pericopsis taxa, Milicia excelsa, and Dalbergia melanoxylon, timbers that are commonly traded.

Modelling three-dimensional fungal growth in response to environmental stimuli.

Most fungi grow by developing complex networks that enable the translocation of nutrients over large distances. Spatially explicit mathematical models are able to capture both the complexity of the fungal network and the biomass evolution, as such providing a powerful alternative to classical modelling paradigms. Unfortunately, most of these models restrict growth to two dimensions or confine it to a lattice, thereby resulting in unrealistic representations of fungal networks. In addition, interactions between fungi and their environment are often neglected. In response, this work presents a lattice-free three-dimensional fungal growth model that accounts for the interactions between the in silico fungus and different substrates and media. A sensitivity analysis was carried out to identify the key model parameters for future calibration. Finally, a scenario analysis covering a variety of growth conditions was conducted to illustrate the broad scope of the model and its ability to replicate in situ growth scenarios.

Automated image-based analysis of spatio-temporal fungal dynamics.

Due to their ability to grow in complex environments, fungi play an important role in most ecosystems and have for that reason been the subject of numerous studies. Some of the main obstacles to the study of fungal growth are the heterogeneity of growth environments and the limited scope of laboratory experiments. Given the increasing availability of image capturing techniques, a new approach lies in image analysis. Most previous image analysis studies involve manual labelling of the fungal network, tracking of individual hyphae, or invasive techniques that do not allow for tracking the evolution of the entire fungal network. In response, this work presents a highly versatile tool combining image analysis and graph theory to monitor fungal growth through time and space for different fungal species and image resolutions. In addition, a new experimental set-up is presented that allows for a functional description of fungal growth dynamics and a quantitative mutual comparison of different growth behaviors. The presented method is completely automated and facilitates the extraction of the most studied fungal growth features such as the total length of the mycelium, the area of the mycelium and the fractal dimension. The compactness of the fungal network can also be monitored over time by computing measures such as the number of tips, the node degree and the number of nodes. Finally, the average growth angle and the internodal length can be extracted to study the morphology of the fungi. In summary, the introduced method offers an updated and broader alternative to classical and narrowly focused approaches, thus opening new avenues of investigation in the field of mycology.

Self-treatment of acute migraine with subcutaneous sumatriptan using an auto-injector device: comparison with customary treatment in an open, longitudinal study.

In a multicenter open longitudinal clinical trial where 479 patients suffering from migraine with or without aura were recruited, patients treated at home one to three migraine attacks with their customary treatment, and subsequently, over a 3-month period, one to three migraine attacks with 6 mg sumatriptan sc using an autoinjector. The headache response to customary treatment was 19% at 1 h and 30.5% at 2 h, and was not significantly different when only attacks treated "adequately" according to accepted treatment recommendations were considered: 16% at 1 h and 35% at 2 h. In contrast, 69% and 82% of patients treated with 6 mg sumatriptan sc had mild headache or no headache at 1 and 2 h respectively, regardless of migraine type or duration of symptoms prior to treatment. Other migraine symptoms (nausea, vomiting, photo- and phonophobia) were effectively treated with sumatriptan. Recurrence of migraine was observed in 31% of patients and was well controlled by a second injection of sumatriptan. It is concluded that 6 mg sumatriptan sc, self-administered using an autoinjector, is well tolerated and more effective than most currently used acute treatments for migraine in a population of severely affected patients consulting a neurologist.

Sneddon's syndrome: generalized livedo reticularis and cerebrovascular disease. Importance of hemostatic screening.

We report two cases of Sneddon's syndrome. Both cases had widespread livedo reticularis with repeated cerebrovascular accidents without persistent neurological deficit. In one case, hemostatic examination revealed an imbalance of plasminogen activator-inhibitor values, possibly related to the thrombogenic propensity of the syndrome. Treatment with acetylsalicylic acid led to normalization of hemostatic parameters and resulted in a symptom-free period of more than 10 months. The importance of hemostatic screening in patients with Sneddon's syndrome is discussed.

Apparent late-onset Cockayne syndrome and interstitial deletion of the long arm of chromosome 10 (del(10)(q11.23q21.2)).

We present the history and data on a 24-year-old man with clinical and neurological symptoms similar to the findings in patients with late-onset Cockayne syndrome. Prometaphase chromosome studies documented an interstitial 10q211 deletion in all cells. This finding may indicate that the gene for late Cockayne syndrome is at 10q211.

Diffuse fasciitis after bone marrow transplantation.

This report describes a patient in whom the clinical, laboratory, and histologic features of diffuse fasciitis with eosinophilia developed several months after allogeneic bone marrow transplantation for acute lymphoblastic leukemia. Numerous reports detail the association between diffuse fasciitis and hematologic diseases; a patient in whom diffuse fasciitis developed in the setting of chronic graft-versus-host disease following bone marrow transplantation for acute leukemia is discussed. Treatment of the chronic graft-versus-host disease improved the symptoms of the diffuse fasciitis.

Treatment of advanced colorectal and gastric adenocarcinomas with 5-fluorouracil combined with high-dose folinic acid. An update.

Sixty-six patients with advanced colorectal adenocarcinoma and 24 with advanced gastric adenocarcinoma were treated; all had measurable tumors. The treatment was based on biochemical and cell culture studies which have demonstrated that an excess of intracellular reduced folates is necessary to provide optimal inhibition of thymidylate synthetase and to increase the cytotoxic effect of fluoropyrimidines. The treatment comprised 5-fluorouracil (5-FU) (370-400 mg/m2/day) and high dose folinic acid (200 mg/m2/day) given simultaneously for 5 consecutive days with a 21-day interval between courses. Of the 66 patients with colorectal carcinoma, 44 had not been previously treated with cytostatics and 22 were resistant to previous chemotherapy with 5-FU given either as a single agent or combined with other drugs. The response rates both complete (CR) and partial (PR) were 45% and 18% in the previously untreated and the previously treated patients, respectively. Time to disease progression in the 20 previously untreated patients ranged from 2 to 34.5+ months (median, 10.3 months) and that of the 4 patients previously resistant to 5-FU was 7, 10, 12 and 15 months, respectively. Median survival for the 24 responders was 20.4 months. Survival in responders was significantly superior to that observed in patients with progressive disease (P less than 10(-8)). Of the 24 patients with gastric adenocarcinoma, 23 had not been previously treated with cytostatics and one was resistant to a 5-FU containing regimen. The response rate (CR + PR) was 50% (12 patients). The single previously treated patient failed to respond. Time to disease progression in the 12 responders ranged from 2.1 to 28.9 months (median, 5.6 months).(ABSTRACT TRUNCATED AT 250 WORDS)

Early onset myophosphorylase deficiency (Mc Ardle's disease) with absence of myophosphorylase protein on SDS electrophoresis. The role of the ischemic forearm test.

The authors present a case report of early onset myophosphorylase deficiency (Mc Ardle's disease) with absence of myophosphorylase protein on SDS-electrophoresis. The different varieties of myophosphorylase deficiency and the clinical investigations which may lead to the diagnosis are reviewed. In particular, the relevance and possible dangers of an ischemic forearm exercise test and the suggestion of using a needle biopsy as a preliminary screening in similar cases of metabolic myopathies are discussed.

[Thymectomy in myasthenia gravis]. / Thymectomie bij myasthenia gravis.

Myasthenia gravis is an autoimmundisease characterized by muscle fatigability due to a reduction in available acetylcholinereceptors at neuromuscular junction. Although the role of the thymus in the pathophysiology remains obscure, the results of thymectomy are out of discussion. However, controversy continues concerning the indications for thymectomy. In a period of six years and a half, 24 patients underwent a thymectomy. 22 of the patients benefited from the procedure. Their was no relation with sex, age, and severity of the disease; but how sooner we operate, how greater the changes for a total remission. With this results we propose thymectomy as essential in the treatment of myasthenia gravis. We found no relationship between anatomopathological results and these of the thymectomy. But we can confirm that a reduction in the acetylcholine antibodies titer is not essential for clinical benefit.

Diagnostic value of CT scanning in neuromuscular diseases.

The diagnosis of myopathies has become easier since the CT technique is available. In this article the possibilities of CT for diagnostic procedures of neuromuscular diseases are pointed out. Density measurements increase differentiation of atrophy or hypertrophy of muscles as well as other pathological changes.

Motor neuron rigidity. An electrophysiological, pharmacological and pathological study.

A 28-year-old male with generalized muscle stiffness and widespread muscle twitching is described. Continuous electrical activity was present at rest and could be abolished only by succinylcholine, curare, and block of the distal part of the peripheral nerve. Muscle biopsy revealed mild myopathic changes. In addition glycogen depletion was found in muscle fibres which were type IIb in one region of the biopsy and type I in another. With carbamazepine treatment marked improvement occurred both clinically and electromyographically. It is concluded that the abnormal electrical activity originated in the terminal branches of the peripheral motor nerve and that this activity was confined to muscle fibres belonging to single motor unit territories.

Pulmonary function in moderate neuromuscular disease without respiratory complaints.

Pulmonary function studies were carried out in 29 patients with moderate neuromuscular disease who had virtually no respiratory complaints. The earliest and most pronounced abnormalities were decreased transrespiratory pressures. Next a restrictive pulmonary defect with increased residual volume and a proportional decrease of maximal expiratory flows occurred, together with a decrease in static lung compliance. Because of a decrease in transpulmonary pressure at total lung capacity and often an increase in diffusing capacity per unit lung volume the above mentioned restrictive defects were attributed to muscular weakness and interstitial lung disease was excluded. Finally, some ventilation inequality could be found, probably originating in the poorly ventilated supradiaphragmatic regions.

[Shulman's syndrome. Diffuse fasciitis with eosinophilia. A differential diagnosis from polymyositis (author's transl)]. / Un diagnostic différentiel de la polymyosite: le syndrome de Shulman. Fasciite diffuse avec éosinophilie.

A case of diffuse fasciitis with eosinophilia is reported. The clinical pattern of this disease has some resemblance with polymyositis. In 1974, Shulman described this syndrome as a new entity. The differential diagnosis of those inflammatory and sclerodermatous changes in the perimuscular fascia is considered. An histological, immunological and electrophysiological investigation has been performed. We propose an auto-immunological mechanism in the etiopathogenesis of this syndrome.

Computed tomography of muscle.

Computed tomography (CT) scans of skeletal muscles of 3 patients with pseudohypertrophic muscular dystrophy are presented. Different patterns of muscle alterations and particularly of pseudohypertrophy are described. The significance of the radiological findings for clinical examination, electromyography, and needle biopsy is discussed.

Computed tomography of the normal and pathologic muscular system.

A standard program of computed tomographic (CT) scanning of the human skeletal muscular system was developed. Scans were obtained on five levels: the neck, the shoulder girdle, the pelvic girdle, the thigh, and the lower leg. The normal size and density of several muscles were determined. CT scans were also obtained in patients with various neuromuscular diseases. Several types of lesions were found, and their morphologic descriptions and quantitative data are presented. It is concluded that CT opens new possibilities for the evaluation of muscular atrophy and hypertrophy.

Familial muscle cramps with autosomal dominant transmission.

A family is described with generalized muscle cramps inherited as an autosomal dominant trait and with maximal expression during adolescence. The age of onset varies between 10 and 15 years. Muscle enzymes are elevated with a peak level between 15 and 25 years. The complaints seem to disappear after the age of 25 years. EMG and muscle biopsies suggest a neurogenic origin of the cramps.