Retained Fractured Fragment of A Central Venous Catheter: A Minimally Invasive Approach to Safe Retrieval

BACKGROUND: Complication following fracture of a central venous catheter can be catastrophic to both the patient and the attending doctor. Catheter fracture has been attributed to several factors namely prolong mechanical force acting on the catheter, and forceful removal or insertion of the catheter.CASE DETAILS: In the present case, the fracture was suspected during the process of removal. The tip of the catheter was notably missing, and an emergency chest radiograph confirmed our diagnosis of a retained  fracture of central venous catheter. The retained portion was removed by the interventional radiologist using an endovascular loop snare and delivered through a femoral vein venotomy performed by the surgeon.CONCLUSION: Endovascular approach to retrieval of retained fractured catheters has helped tremendously to reduce associated morbidity and the need for major surgery. The role of surgery has become limited to  instances of failed endovascular retrieval and in remote geographical locations devoid of such specialty.KEYWORDS: Central venous catheter, fracture, endovascular, interventional radiolog

CHANGES IN EATING BEHAVIOURS FOLLOWING BARIATRIC SURGERY: A PROSPECTIVE STUDY

Adopting healthy eating behavior is important in achieving successful weight loss after bariatric surgery. This study aims to determine the changes in eating behaviors 6 months after surgery. Fifty-seven patients who went through bariatric surgery in two tertiary referral hospitals were recruited and interviewed before surgery (T0), three (T1), and six (T2) months after surgery. Eating behaviors were assessed using the Dutch Eating Behavior Questionnaire (DEBQ), which measured emotional, external, and restrained eating. Higher subscale scores indicate strong behavioral traits. Other information including psychological distress, quality of life, socio-demography, and morbidity were collected. Generalized Estimating Equation (GEE) model was developed to study the change in eating behaviors and its’ predictors over time. Participants of the study were mostly women, from the Malay ethnic group and the average age at the time of surgery was 39.4 years. Emotional and external eating scores changed significantly over time with the values recorded at various time intervals as follows: 2.06 and 2.86 before surgery; 1.64 and 2.25 three months after surgery; and 1.81 and 2.40, 6 months after surgery. Reduction in the third month followed by a slight increase at the sixth was noted. Restrained eating did not show a significant change. The presence of diabetes was also associated with higher emotional and external eating scores. Further, higher anxiety scores were associated with higher external eating. Favorable changes in eating behaviors were noted after bariatric surgery. However, a risk of a reversal in the improvement was present. The emotional and external eating behaviors in surgical candidates should be identified and addressed accordingly with special attention to diabetic patients

Perioperative practices concerning sleeve gastrectomy: a survey of 863 surgeons with a cumulative experience of 520,230 procedures

Background Sleeve Gastrectomy (SG) is the most commonly performed bariatric procedure worldwide. There is currently no scientific study aimed at understanding variations in practices concerning this procedure. The aim of this study was to study the global variations in perioperative practices concerning SG. Methods A 37-item questionnaire-based survey was conducted to capture the perioperative practices of the global community of bariatric surgeons. Data were analysed using descriptive statistics. Results Response of 863 bariatric surgeons from 67 countries with a cumulative experience of 520,230 SGs were recorded. A total of 689 (80%) and 764 (89%) surgeons listed 13 absolute and relative contraindications, respectively. 65% (n = 559) surgeons perform routine preoperative endoscopy and 97% (n=835) routinely use intraoperative orogastric tube for sizing the resection. A wide variation is observed in the diameter of the tube used. 73% (n=627) surgeons start dividing the stomach at a distance of 3-5 cm from the pylorus, and 54% (n=467) routinely use staple line reinforcement. Majority (65%, n=565) of surgeons perform routine intraoperative leak test at the end of the procedure, while 25% (n=218) surgeons perform a routine contrast study in the early postoperative period. Lifelong multivitamin/mineral, iron, vitamin D, calcium, and vitamin B12 supplementation is advocated by 66%, 29%, 40%, 38% and 44% surgeons, respectively. Conclusion There is a considerable variation in the perioperative practices concerning SG. Data can help in identifying areas for future consensus building and more focussed studies

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Platelet changes in healthy male smokers.Scientific views

[No Abstract Available