The Iowa Homemaker vol.39A, no.3

Halloween-Time for Fanciful Goodies, Rachel Davis, page 5 Checkerboard Summer, Jane Gibson, page 6 Imagination + Independence Encouraged By Honors Program, Carol Shellenbarger, page 8 Honoraries Stress Scholarship, Diane Houser, page 9 Have You Lost Your Marbles?, Carol Armstrong Wolf, page 10 Add a Jibber to Your Wardrobe, Marty Keeney, page 12 Dishpan Hands Soon Obsolete, Beth Beecher, page 13 Key to Personality – Your Walk, Suzanne Guernsey, page 14 How Do You Rate With Your Professor?, Mary Stoner, page 15 What’s Going On, page 1

The Iowa Homemaker vol.39A, no.5

People Without a Country, Carol Shellenbarger, page 4 Foster Parent Plan Aids Needy Children, Marcena Christian, page 5 The Music Goes Round and Round, Tom Emmerson, page 6 The History of Hose, Diane Houser, page 8 Milady’s Heels, Martha Glenn, page 9 Knit Your Own Squaw Valley Sweater, Suzanne Guernsey, page 10 Mincemeat – a Rich History, Sue Ellen Lieder, page 12 Christmas in Our Newest States, Beth Beecher, page 14 Christmas Shopping Section, Kay Thompson Maas, page 16 Futuristic Music Sphere, Mary Stoner, page 1

Hospital tests and patient related factors influencing time-to-theatre in 1000 cases of suspected appendicitis: a cohort study

Background: Acute appendicitis is increasingly being managed in the setting of a dedicated emergency theatre. However understanding of hospital factors that influence time-to-theatre (TTT) is poor. Thus, the aim of this study is to identify factors that influence TTT and to observe the effect of prolonged TTT on patient outcome. Methods: A retrospective review of an electronic prospectively maintained database was performed over a 2 year period. Factors thought to influence TTT were highlighted. A delay was defined as TTT > 8 hours. Data analysis was performed using SPSS 20. Results: 1,000 cases of suspected acute appendicitis were identified. Median age was 19 years. Appendicectomy was performed in 90.7%. 68.1% underwent laparoscopic appendicectomy. Overall mean TTT was 12 hours, 27 minutes. There was a significant association between delayed TTT and female gender (p = 0.017), older age (p = 0.001), pre-operative radiology (< 0.001), normal WCC (p < 0.001), normal neutrophils (p < 0.001) and histological non-perforated appendix (p < 0.001). However, on multivariate analysis, younger age, a neutrophilia and presence of a perforation had a shorter TTT. Delayed TTT did not affect outcome variables including post-operative collection (3.59% v 4.38%, p = 0.528), readmission rate (6.54% v 5.72%, p = 0.403) and length of stay (3.1 days v 3.34 days, p = 0.823). Conclusions: This study highlights key hospital factors that influence TTT in patients with suspected appendicitis. Identification of these influential factors adds greatly to our understanding of patient prioritisation. Finally, TTT delays greater than 8 hour do not appear to affect short-term patient outcomes

Hospital tests and patient related factors influencing time-to-theatre in 1000 cases of suspected appendicitis: a cohort study

Background: Acute appendicitis is increasingly being managed in the setting of a dedicated emergency theatre. However understanding of hospital factors that influence time-to-theatre (TTT) is poor. Thus, the aim of this study is to identify factors that influence TTT and to observe the effect of prolonged TTT on patient outcome. Methods: A retrospective review of an electronic prospectively maintained database was performed over a 2 year period. Factors thought to influence TTT were highlighted. A delay was defined as TTT > 8 hours. Data analysis was performed using SPSS 20. Results: 1,000 cases of suspected acute appendicitis were identified. Median age was 19 years. Appendicectomy was performed in 90.7%. 68.1% underwent laparoscopic appendicectomy. Overall mean TTT was 12 hours, 27 minutes. There was a significant association between delayed TTT and female gender (p = 0.017), older age (p = 0.001), pre-operative radiology (< 0.001), normal WCC (p < 0.001), normal neutrophils (p < 0.001) and histological non-perforated appendix (p < 0.001). However, on multivariate analysis, younger age, a neutrophilia and presence of a perforation had a shorter TTT. Delayed TTT did not affect outcome variables including post-operative collection (3.59% v 4.38%, p = 0.528), readmission rate (6.54% v 5.72%, p = 0.403) and length of stay (3.1 days v 3.34 days, p = 0.823). Conclusions: This study highlights key hospital factors that influence TTT in patients with suspected appendicitis. Identification of these influential factors adds greatly to our understanding of patient prioritisation. Finally, TTT delays greater than 8 hour do not appear to affect short-term patient outcomes

Diagnostic dilemmas due to fish bone ingestion: Case report & literature review

Introduction: The diagnosis of abdominal complications due to fish bone ingestion is particularly difficult as the presentation may mimic common abdominal pathologies. Presentation of case: 65 year-old male presented with a two day history of right iliac fossa pain. He denied any nausea and vomiting. He had no systemic systems including fever, change in bowel habit. He had tenderness and guarding localized to the right iliac fossa. He had raised inflammatory markers. A CT scan of the abdomen was performed which showed fat standing in proximity to the terminal ileum, with the appearance of Crohn’s disease. The clinical picture did not match the imaging and so the patient underwent a diagnostic laparoscopy. Findings included an acutely inflamed terminal ileum. A foreign body was identified piercing through at the small bowel wall at the terminal ileum. The foreign body was removed and revealed a fish bone. Intracorporeal sutures were inserted at the site of the microperforation. The patient was discharged well two days post operatively. Discussion: Fish bone perforation is not a common cause of gastrointestinal perforation. Unfortunately the history is often non-specific and these people can be misdiagnosed with acute appendicitis & other pathologies. CT scans can be useful to aid diagnostics. It is not however fully sensitive in detecting complications arising from fishbone ingestion. Conclusion: Management therefore, should be based taking into account primarily the clinical picture & may necessitate diagnostic laparoscopy

The reverse thomas position for thoracolumbar fracture height restoration: relative contribution of patient positioning in percutaneous balloon kyphoplasty for acute vertebral compressions

Background Standard positioning for percutaneous balloon kyphoplasty requires placing a patient prone with supports under the iliac crests and upper thorax. The authors believe that hip hyperextension maximises pelvic anteversion creating anterior longitudinal ligamentotaxis, thus facilitating restoration of vertebral height. Methods Radiographic imaging including pre-operative, post-positioning, post balloon tamp inflation and post-operative lateral radiographs were analysed for anterior and posterior column height, wedge angle of the affected vertebra and 3-level Cobb angle in patients with recent fractures of T11-L1. Fracture dimensions of the index vertebra were expressed as percentage of the analogous dimension of the referent vertebra. Results From a total of 149 patients, a full imaging sequence was available on 21 cases of vertebral compression fractures. The described positioning technique created a mean anterior column height increase from 68.3% to 75.3% with positioning (p = 0.15), increasing to 82.3% post balloon inflation. Average Cobb and wedge angle improvement of 4.7 degrees (p= 0.004) and 3.6 degrees (p= 0.002) from positioning along were also recorded. Conclusion The Reverse Thomas Position is a safe and effective technique for augmenting thoracolumbar fracture height restoration in percutaneous balloon kyphoplasty