A Case Report: Intestinal Obstruction Due to Acute Appendicitis

Appendicitis has always been the most common surgical case in our daily practices; however, appendicitis presenting mechanical intestinal obstruction is quite rare and it has never been reported in Immanuel Hospital. In this report we present a young man who was admitted with small bowel obstruction and was successfully treated with laparotomy appendectomy, which made a full recovery

Mesenterial Infark

Sumbatan akut dari pembuluh-pembuluh darah mesenterial mempunyai angka letalitas yang sangat tinggi, yang hanya dapat dikurangi dengan pembedahan sedini mungkin. Oleh karena itu dapat dibenarkan bila pada suspek penyumbatan pembuluh-pembuluh darah mesenterial, walaupun tanda-­tandanya sedikit, segera dilakukan laparotomi. Diagnosis ditegakkan berdasarkan gejala klinis (nyeri yang timbul dengan akut, leukositosis) dan hasil-hasil dari X-foto abdomen. Hanya angiografi yang dapat menunjukkan letak sumbatannya secara tepat sebelum pembedahan. Pada waktu pembedahan bagian usus yang rusak harus diangkat seluas mungkin. Bila situasi meragukan maka harus dilakukan “Second-look-operation” setelah 8-12 jam

Choledochal Cyst in an Adult – a Case Report

Choledochal  cyst,  an  anomalous  dilatation  of  the  biliary  tract,  is  a congenital disease. However, a very few cases of this condition have been diagnosed in adults. We report a case of a 58-year-old man with symptoms related to biliary tract pathology. On investigations, he was found to have a type-II choledochal cyst.  &nbsp

Gambaran Umum Perawatan Ulcus Diabeticum Pada Pasien Rawat Inap Di Rumah Sakit Immanuel Bandung Periode Juli 2007-Agustus 2008

The treatment of diabetic ulcer will determine its outcome. The purpose of this study is to describe the general treatment of diabetic ulcer in Immanuel Hospital Bandung, in July 2007--August 2008. The data of this descriptive-retrospective study were collected from the medical records of the hospitalized patients during that period. There were 41 patients: 37% male, 63% female, 46% > 60 years old, 39% 45-60, and 15% 15-45 years old. Conventional dressing was applied to 63% patients, while the 37% were given advanced dressing. Necrotomy-debridement procedure was used to treat 83% patients. Whereas IV nutrition supplementation was given to 7% patients, subcutaneous insulin was given to the patients in 46% cases. The patients hospitalized less than three days were 12% (40% dead case, 40% amputated, 20% discharged without improvement). The patients hospitalized for 3-4 days were 49% (65% with improvement, 10% without improvement, 15% amputated, 10% dead case), The patients hospitalized > 7 days were 39% (52.94% with improvement, 5.88% without improvement, 35.29% amputated, and no dead case). Cases treated with advanced dressing, necrotomy debridement procedure, IV nutrition supplementation and without subcutaneous insulin showed a better outcome; those showing improvement respectively were 86.67%, 55.88%, 54.54%, 63.63%, and those showing shorter hospitalization period respectively  were 80%, 47.05%, 63.63%, 54.54%

Competencies of the nurses in the limitation of therapeutic effort in the intensive care unit: An integrative review

Objective: Nurses inevitably encounter patients who require care aimed at limiting therapeutic effort (LTE), even though many of them are not prepared to provide support to individuals with terminal illnesses and their families. One of the contexts in which the LTE is considered is the intensive care unit (ICU). This review is to describe the competencies for the execution of a nursing professional role in the LTE in the ICU. Method: An integrative review of the literature published between the years 2010 and 2023. The search was carried out in five databases: Medline, Wiley Online Library, SciELO, ScienceDirect, and Web of Science. The Critical Appraisal Skills Programme in Spanish was used as the template for study evaluation. The methodology of the Oxford Center for Evidence-Based Medicine (CEBM) was used to assess the level of evidence and the degree of recommendation. Result: A total of 25 articles in a wide range of studies were included. The findings suggest that the competencies for LTE in the ICU are direct patient care, family-centered care, and the role of the nurse within the team. However, more high-quality studies are needed to confirm these conclusions. Three categories were identified: (a) competencies as defender agent between the patient, his family, and the interdisciplinary team; (b) competencies for decision-making in limiting the therapeutic effort; and (c) competencies for nursing therapeutic interventions at the end of life. Conclusion: The competencies of the nursing professionals who work in the adult ICU in the LTE are essential to the patient's quality of life, dignity of their death, and comprehensive family support for coping with grief

Size-Dependent Regulations, Firm Size Distribution, and Reallocation

In France, firms with 50 employees or more face substantially more regulation than firms with less than 50. As a result, the size distribution of firms is visibly distorted: there are many firms with exactly 49 employees. We model the regulation as the combination of a sunk cost that must be paid the first time the firm reaches 50 employees, and a payroll tax that is paid each period thereafter when the firm operates with more than 50 employees. We estimate the model using indirect inference by fitting the discontinuity of the size distribution. The key finding is that the regulation is equivalent to a combination of a sunk cost approximately equal to about one year of an average employee salary, and a small payroll tax of 0.04%. Our structural model fits well the discontinuity in the size distribution. Removing the regulation improves labor allocation across firms, leading in steady-state to an increase in output per worker slightly less than 0.3%, holding the number of firms fixed. However, if firm entry is elastic, the steady-state gains are an order of magnitude smaller