Influences on length of stay in an enhanced recovery programme after colonic surgery.

AIM: Enhanced recovery after surgery (ERAS) programmes have been shown to accelerate and enhance functional recovery after colonic surgery. We analysed prospectively collected data to investigate potentially modifiable factors that may influence the length of stay (LOS) in the ERAS setting at a single institution. METHOD: Between October 2005 and November 2008, prospective data were collected on consecutive patients who underwent elective colonic surgery without a stoma. Patients with rectal cancer, those unable to participate in preoperative ERAS components because of their inability to communicate effectively in English, those with cognitive impairment and those with an American Society of Anesthesiologists (ASA) grade of ≥ 4 were excluded. Statistical analyses were performed using the Mann-Whitney U-test and Cox regression modelling. RESULTS: A total of 100 (79 malignancies) patients underwent elective colon resection during the study period. There were 57 right-sided, 41 left-sided and two total colectomies. The median age of the patients was 67.5 (range 31-92) years and the median day stay was 4 (range 3-46) days. Factors with significant correlations for reduced LOS were female gender, the surgeon, operative severity, high-dependency unit (HDU) admission and incision type favouring laparoscopic and transverse approaches. Age, operation site, indication for surgery and body mass index were not significant predictors of hospital stay. Gender, operative severity, HDU admission and surgeon did not have any independent correlation with LOS; in contrast to the ASA score and the type of incision, which did. CONCLUSION: Lower ASA score, transverse incision laparotomy and laparoscopy correlated independently with reduced postoperative LOS within the ERAS setting.

Observation of resonant diffusive radiation in random multilayered systems.

Diffusive radiation is a new type of radiation predicted to occur in randomly inhomogeneous media due to the multiple scattering of pseudophotons. This theoretical effect is now observed experimentally. The radiation is generated by the passage of electrons of energy 200 KeV-2.2 MeV through a random stack of films in the visible light region. The radiation intensity increases resonantly provided the Cerenkov condition is satisfied for the average dielectric constant of the medium. The observed angular dependence and electron resonance energy are in agreement with the theoretical predictions. These observations open a road to application of diffusive radiation in particle detection, astrophysics, soft-x-ray generation, etc.

Effects of carbon dioxide-saturated normal saline and Ringer's lactate on postsurgical adhesion formation in the rabbit.

OBJECTIVE: To evaluate the effect of combining carbon dioxide gas (CO2) with normal saline versus CO2 with lactated Ringer's solution on adhesion formation in the rabbit model. METHODS: Sixty New Zealand white rabbits underwent surgery based on a proven experimental adhesion model. Following abdominal closure, the animals were randomly assigned to three groups: Group 1 underwent abdominal CO2 insufflation only; group 2 underwent abdominal irrigation with CO2-saturated normal saline; group 3 underwent abdominal irrigation with CO2-saturated lactated Ringer's solution. Three weeks later, the rabbits were sacrificed and the adhesions were scored in a blinded fashion based on the extent, type, and tenacity, with a maximum possible score of 11. RESULTS: The mean (+/- standard deviation) adhesion scores were 7.75 +/- 2.82 in group 1, 7.85 +/- 2.58 in group 2, and 4.75 +/- 2.95 in group 3. There was no difference in severity of adhesions between groups 1 and 2. However, the mean adhesion score was significantly lower in group 3 (lactated Ringer's with CO2) than in either group 1 (CO2) or group 2 (normal saline with CO2) (P = .004 and P = .002, respectively). CONCLUSION: It appears that when CO2 is the insufflating gas, lactated Ringer's solution has a protective effect against adhesion formation in the rabbit model.

Selective localization of interleukin-1 receptor antagonist in eutopic endometrium and endometriotic implants.

OBJECTIVES: To determine whether interleukin-1 receptor antagonist (IL-1ra) expression was concordant in eutopic endometrium and endometriotic implants. DESIGN: Paired samples of endometrium and endometriotic implants from eight patients with endometriosis were used. MAIN OUTCOME MEASURES: Interleukin-1 receptor antagonist was demonstrated immunohistochemically on frozen sections of eutopic and ectopic endometria. A sandwich technique with polyclonal rabbit anti-IL-1ra antibody and an avidin-biotin reagent (Vector Laboratories, Inc. Burlingame, CA) was used. RESULTS: Seven of eight (88%) eutopic endometrial sections revealed staining of glandular epithelium with complete absence of any staining of the stromal compartment. In the counterpart sections of endometriosis, the glandular as well as the stromal compartments were negative for IL-1ra in all patients. CONCLUSION: These data suggest a differential production of the IL-1ra in eutopic endometrium and endometriotic implants. The potential clinical implications of this finding are discussed.

Transvaginal sonographic detection of endometrial polyps with fluid contrast augmentation.

Injection of the endometrial cavity with isotonic solutions during transvaginal sonography was used to confirm the presence and location of endometrial polyps. Fourteen infertility patients, 13 of them asymptomatic, had polyps detected in this manner. Confirmation and treatment took place via hysteroscopy. Potential indications for this readily available and inexpensive technique vary from infertility to menometrorrhagia.

Rupture of a rudimentary horn pregnancy with a combined intrauterine pregnancy. A case report.

In the first reported case of a rudimentary horn pregnancy coexistent with an intrauterine pregnancy, the patient presented at 19 weeks' gestation with acute abdominal distress. A ruptured left rudimentary horn pregnancy was found at laparotomy. The rupture was repaired. Preterm labor ensued 24 hours later, with resultant delivery of the second twin from the right cornu despite aggressive tocolysis.

Endometrial carcinoma: transvaginal ultrasonography prediction of depth of myometrial invasion.

Myometrial invasion greater than 33% negatively affects the prognosis of endometrial carcinoma. Since the endometrium is readily differentiated from myometrium via high-resolution transvaginal sonography (TVS), this prospective study was undertaken to evaluate the efficacy of TVS in determining the depth of myometrial invasion in women with endometrial adenocarcinoma. Eighteen subjects underwent TVS utilizing 5.0- and 7.5-MHz probes by a single examiner blinded to stage and grade of adenocarcinoma. Predicted TVS ratios were categorized as less than 33% or greater than or equal to 33% and compared to actual histologic invasion. Ultrasound predicted that TVS ratios greater than or equal to 33% are significantly associated with deep (greater than 33%) histologic invasion (P less than 0.01, Fisher's test). When histologic invasion was greater than or equal to 33%, TVS was 100% accurate with no false negatives. The two cases in which TVS ratios erroneously indicated invasion greater than or equal to 33% contained adenomyosis and leiomyomas. TVS is a highly accurate and convenient method for preoperatively evaluating myometrial invasion. Potentially this evaluation could influence the selection of therapy for poor-surgical-risk candidates or direct appropriate referral of patients with deeper invasion to a gynecologic oncologist.

Vitamin B6 is effective therapy for nausea and vomiting of pregnancy: a randomized, double-blind placebo-controlled study.

Fifty-nine women completed a randomized, double-blind placebo-controlled study of pyridoxine hydrochloride (vitamin B6) for the treatment of nausea and vomiting of pregnancy. Thirty-one patients received vitamin B6, 25-mg tablets orally every 8 hours for 72 hours, and 28 patients received placebo in the same regimen. Patients were categorized according to the presence of vomiting: severe nausea (score greater than 7) or mild to moderate nausea (score of 7 or less). The severity of nausea (as graded on a visual analogue scale of 1-10 cm) and the number of patients with vomiting over a 72-hour period were used to evaluate response to therapy. Twelve of 31 patients in the vitamin B6 group had a pre-treatment nausea score greater than 7 (severe) (mean 8.2 +/- 0.8), as did ten of 28 patients in the placebo group (mean 8.7 +/- 0.9) (not significant). Following therapy, there was a significant difference in the mean "difference in nausea" score (ie, baseline - post-therapy nausea) between patients with severe nausea receiving vitamin B6 (mean 4.3 +/- 2.1) and placebo (mean 1.8 +/- 2.2) (P less than .01). In patients with mild to moderate nausea and in the group as a whole, no significant difference between treatment and placebo was observed. Fifteen of 31 vitamin B6-treated patients had vomiting before therapy, compared with ten of 28 in the placebo group (not significant). At the completion of 3 days of therapy, only eight of 31 patients in the vitamin B6 group had any vomiting, compared with 15 of 28 patients in the placebo group (P less than .05).(ABSTRACT TRUNCATED AT 250 WORDS)

Intrauterine transfusion treatment of nonimmune hydrops fetalis secondary to human parvovirus B19 infection.

Congenital human parvovirus B19 infection presented in this case as nonimmune hydrops fetalis that resulted from aplastic anemia at 20 weeks' gestation. Intravascular transfusion therapy led to resolution of the hydrops and a term delivery of an appropriately grown neonate.