Acute Perforated Peptic Ulcer at El Obeid Hospital, Western Sudan

Background: The pattern of peptic ulcer disease and its complications has changed during the last two to three decades.Objectives: To state the frequency of acute peptic ulcer perforations and outcomes of their management at El Obeid Hospital, Western Sudan.Materials and Methods: This is an audit of patients with acute perforated peptic ulcer admitted to the emergency wards of the University Surgical Unit at El Obeid Teaching Hospital, Western Sudan during the period from January 2006 to December 2012.Results: There were 53 patients, 94.3% were males. The age ranged between 18 and 77 years. Most of the patients reported late and 45.3% during Ramadan and Shawal. All patients had emergency peritoneal lavage and simple closure with omental patch followed by anti-ulcer therapy. The postoperative mortality was 7.6%.Conclusions: Perforated peptic ulcer in this community was mainly  duodenal. Emergency peritoneal lavage and simple closure with omental patch followed by anti-ulcer therapy resulted in excellent outcomes. Old age, shock, peritonitis and septicaemia were the major risk factors formortality.Key words: Perforated duodenal and gastric ulcers

Utilisation of an operative difficulty grading scale for laparoscopic cholecystectomy

Background A reliable system for grading operative difficulty of laparoscopic cholecystectomy would standardise description of findings and reporting of outcomes. The aim of this study was to validate a difficulty grading system (Nassar scale), testing its applicability and consistency in two large prospective datasets. Methods Patient and disease-related variables and 30-day outcomes were identified in two prospective cholecystectomy databases: the multi-centre prospective cohort of 8820 patients from the recent CholeS Study and the single-surgeon series containing 4089 patients. Operative data and patient outcomes were correlated with Nassar operative difficultly scale, using Kendall’s tau for dichotomous variables, or Jonckheere–Terpstra tests for continuous variables. A ROC curve analysis was performed, to quantify the predictive accuracy of the scale for each outcome, with continuous outcomes dichotomised, prior to analysis. Results A higher operative difficulty grade was consistently associated with worse outcomes for the patients in both the reference and CholeS cohorts. The median length of stay increased from 0 to 4 days, and the 30-day complication rate from 7.6 to 24.4% as the difficulty grade increased from 1 to 4/5 (both p < 0.001). In the CholeS cohort, a higher difficulty grade was found to be most strongly associated with conversion to open and 30-day mortality (AUROC = 0.903, 0.822, respectively). On multivariable analysis, the Nassar operative difficultly scale was found to be a significant independent predictor of operative duration, conversion to open surgery, 30-day complications and 30-day reintervention (all p < 0.001). Conclusion We have shown that an operative difficulty scale can standardise the description of operative findings by multiple grades of surgeons to facilitate audit, training assessment and research. It provides a tool for reporting operative findings, disease severity and technical difficulty and can be utilised in future research to reliably compare outcomes according to case mix and intra-operative difficulty

Population‐based cohort study of outcomes following cholecystectomy for benign gallbladder diseases

Background The aim was to describe the management of benign gallbladder disease and identify characteristics associated with all‐cause 30‐day readmissions and complications in a prospective population‐based cohort. Methods Data were collected on consecutive patients undergoing cholecystectomy in acute UK and Irish hospitals between 1 March and 1 May 2014. Potential explanatory variables influencing all‐cause 30‐day readmissions and complications were analysed by means of multilevel, multivariable logistic regression modelling using a two‐level hierarchical structure with patients (level 1) nested within hospitals (level 2). Results Data were collected on 8909 patients undergoing cholecystectomy from 167 hospitals. Some 1451 cholecystectomies (16·3 per cent) were performed as an emergency, 4165 (46·8 per cent) as elective operations, and 3293 patients (37·0 per cent) had had at least one previous emergency admission, but had surgery on a delayed basis. The readmission and complication rates at 30 days were 7·1 per cent (633 of 8909) and 10·8 per cent (962 of 8909) respectively. Both readmissions and complications were independently associated with increasing ASA fitness grade, duration of surgery, and increasing numbers of emergency admissions with gallbladder disease before cholecystectomy. No identifiable hospital characteristics were linked to readmissions and complications. Conclusion Readmissions and complications following cholecystectomy are common and associated with patient and disease characteristics

Speciation of chromium in waters using dispersive micro-solid phase extraction with magnetic ferrite and graphite furnace atomic absorption spectrometry

The combination of a solid-phase microextraction process with graphite furnace atomic absorption spectrometry provides a very sensitive determination method for determining chromium in waters. Freshly prepared ferrite particles are used to retain the chromium species, and then separated by a magnet without the need for a centrifugation step. The solid phase is suspended in water and directly introduced into the graphite furnace to obtain the analytical signal. The complexation of Cr(III) with ethylenediaminetetraacetate allows the selective retention of Cr(VI), and thus the speciation of the metal. The procedure is sensitive (0.01 µg L−1 detection limit when using a 10 mL sample aliquot) and reproducible (5% relative standard deviation for five consecutive experiments at the 0.3 µg L−1 level). The reliability of the procedure is verified by analysing five certified water samples