URETERIC INJURIES FOLLOWING PELVIC OPERATIONS

Background: Iatrogenic injuries to the ureter are hazardous complications of pelvicoperations, causing severe morbidity and even mortality.Objective: To present our 10 years experience in the management of such uretericinjuries.Design: A retrospective study carried out between January 1990 and December 1999.Setting: Two busy health institutions, namely Ife State hospital and Wesley GuildHospital, both of the Obafemi Awolowo University (OAU) Teaching Hospitals Complex,Ile-Ife, Nigeria.Results: The incidence of iatrogenic injury was 0.4%. Ureteral transection was thecommonest lesion (58%). Ureteroneocystostomy was performed in 70% of the operatedcases. Those diagnosed at the time of injury and treated with end-to-end anastomosishad the best results.Conclusion: The proper identification and, when necessary, isolation of the ureter duringoperations in which there is a risk is crucial in reducing the incidence of ureteral injurie

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

URETERIC INJURIES FOLLOWING PELVIC OPERATIONS

ABSTRACTBackground: Iatrogenic injuries to the ureter are hazardous complications of pelvicoperations, causing severe morbidity and even mortality.Objective: To present our 10 years experience in the management of such uretericinjuries.Design: A retrospective study carried out between January 1990 and December 1999.Setting: Two busy health institutions, namely Ife State hospital and Wesley GuildHospital, both of the Obafemi Awolowo University (OAU) Teaching Hospitals Complex,Ile-Ife, Nigeria.Results: The incidence of iatrogenic injury was 0.4%. Ureteral transection was thecommonest lesion (58%). Ureteroneocystostomy was performed in 70% of the operatedcases. Those diagnosed at the time of injury and treated with end-to-end anastomosishad the best results.Conclusion: The proper identification and, when necessary, isolation of the ureter duringoperations in which there is a risk is crucial in reducing the incidence of ureteral injurie

Inclined lidar observations of boundary layer aerosol particles above the Kongsfjord, Svalbard

An inclined lidar with vertical resolution of 0.4 m was used for detailed boundary layer studies and to link observations at Zeppelin Mountain (474 m) and Ny-Ålesund, Svalbard. We report on the observation of aerosol layers directly above the Kongsfjord. On 29 April 2007, a layer of enhanced backscatter was observed in the lowest 25 m above the open water surface. The low depolarization ratio indicated spherical particles. In the afternoon, this layer disappeared. The ultrafine particle concentration at Zeppelin and Corbel station (close to the Kongsfjord) was low. On 1 May 2007, a drying process in the boundary layer was observed. In the morning, the atmosphere up to Zeppelin Mountain showed enhanced values of the backscatter coefficient. Around noon, the top of the highly reflecting boundary layer decreased from 350 to 250 m. The top of the boundary layer observed by lidar was confirmed by radiosonde data

Global cancer surgery: delivering safe, aff ordable, and timely cancer surgery

Surgical oncolog

Beta Blockade and Clinical Outcomes in Aneurysmal Subarachnoid Hemorrhage

BACKGROUND: Aneurysmal subarachnoid hemorrhages are frequently complicated by hypertension and neurogenic myocardial stunning. Beta blockers may be used for management of these complications. We sought to investigate sympathetic nervous system modulation by beta blockers and their effect on radiographic vasospasm, delayed cerebral infarction, discharge destination and death. METHODS: Retrospective chart review of 218 adults admitted to the ICU between 8/2004 and 9/2010 was performed. Groups were identified relevant to beta blockade: 77 were never beta blocked (No/No), 123 received post-admission beta blockers (No/Yes), and 18 were continued on their home beta blockers (Yes/Yes). Records were analyzed for baseline characteristics and the development of vasospasm, delayed cerebral infarction, discharge destination and death, expressed as adjusted odds ratio. RESULTS: Of the 218 patients 145 patients developed vasospasm, 47 consequently infarcted, and 53 died or required care in a long-term facility. When compared to No/No patients, No/Yes patients had significantly increased vasospasm (OR 2.11 (1.06-4.16)). However, these patients also had significantly fewer deaths or need for long term care (OR 0.17 (0.05-0.64)), with decreased tendency for infarcts (OR 0.70 (0.32-1.55)). When compared to No/No patients, Yes/Yes patients demonstrated a trend toward increased vasospasm (OR 1.61 (0.50-5.29)) that led to infarction (OR 1.51 (0.44-5.13)), but with decreased mortality or need for long term care in a facility (OR 0.13 (0.01-1.30)). CONCLUSION: Post-admission beta blockade in aneurysmal subarachnoid hemorrhage patients was associated with increased incidence of vasospasm. However, despite the increased occurrence of vasospasm, beta blockers were associated with improved discharge characteristics and fewer deaths