Endoscopic stapling diverticulotomy: an audit of difficulties, outcome, and patient satisfaction.

OBJECTIVE: To evaluate the procedure in terms of technical difficulties, patient satisfaction, symptom relief, recurrence, and further management. STUDY DESIGN: Retrospective study including 41 patients who underwent endoscopic stapling diverticulotomy. Clinical notes were reviewed, and patients were sent a patient satisfaction questionnaire. Statistical analysis was done using the chi(2) square test. SETTING: Teaching hospital. RESULTS: Larger pouches had the best results; 81.578% were satisfied with the surgery, and 86.84% had improved swallowing. Complications presented in 6 patients (15%), including a perforated pouch and an esophageal perforation. Complications were more frequent in small pouches. CONCLUSIONS AND SIGNIFICANCE: Endoscopic stapling diverticulotomy offers rapid recovery in most patients, with early oral intake and short hospital stay. There is a high degree of symptoms relief, and the patient's satisfaction rate is high. The assessment of the pharyngeal pouch size is an important factor when deciding the best management for a patient with a pharyngeal pouch.     

Early predictors of mortality in refractory cardiogenic shock following acute coronary syndrome treated with extracorporeal membrane oxygenator

We aimed to analyze the outcome and identify predictors of hospital mortality in patients with refractory cardiac arrest (CA) complicating acute coronary syndromes (ACS) and requiring veno-arterial extracorporeal membrane oxygenation (VA-ECMO) treatment. Between Jan-2005 and Dec-2019, 51 patients underwent urgent VA-ECMO implantation for CA in ACS. Patients were divided in two groups: “in-hospital” cardiac arrest (IHCA) and “out-of-hospital” cardiac arrest (OHCA). Prospectively collected data were retrospectively analyzed and compared between groups. Predictors for hospital mortality were investigated. IHCA and OHCA patients were 32 (62.7%) and 19 (37.3%), respectively. The groups differed for: male gender (72% vs 95%; p?=?0.070), lactate peak level (8.5?±?4.3vs10.7?±?2.9; p?=?0.023), total elapsed time from CA to VA-ECMO implantation in both groups (p?<?0.001) and elapsed time from CA (IHCA group) or hospital arrival (OHCA group) to VA-ECMO implantation (38 min vs 80 min; p?=?0.001). At logistic regression analysis, concomitant lactate level greater than 8.0 mmol/L and elapsed time from CA to VA-ECMO?≥?30 min were predictors of increased mortality (OR 3.9; 95% CI 1.19–12.79; p?=?0.025) for the entire population. In-hospital mortality was 60.8% (31/51 patients): 68.4% in OHCA group and 56.2% in IHCA group. No risk factors related to 30-day mortality resulted significant at univariable analysis. When rapidly instituted, VA-ECMO improves survival in patients with refractory cardiac arrest allowing coronary syndrome treatment. The association of an elapsed time from CA to VA-ECMO implantation longer than 30 min and a preoperative lactate peak level over 8.0 mmol/L predict a poor outcome, independently from being IHCA or OHCA.

     

Correlates of serum lycopene in older women

Experimental and epidemiological evidence suggests that lycopene, a predominant carotenoid found in human serum, may reduce the risk of certain cancers. We examined the association of dietary, physiological, and other factors with serum lycopene concentrations in a subsample of 946 postmenopausal women participating in the Women's Health Initiative. Pearson partial correlation coefficients and linear regression coefficients were calculated after adjustment for age, ethnicity, and serum low-density-lipoprotein (LDL) cholesterol. Serum lycopene was correlated with serum LDL cholesterol (r = 0.23) and dietary lycopene (r = 0.17, both p < 0.001). Individual food items found to be correlated with serum lycopene after adjustment included fresh tomatoes or tomato juice (r = 0.11), cooked tomatoes, tomato sauce, or salsa (r = 0.17), and spaghetti with meat sauce (r = 0.19, all p < 0.01). Age and body mass index were negatively associated with serum lycopene levels (both p < 0.001). Serum lycopene levels were highest in the summer and highest for those living in the northeastern United States. If we postulate that high serum lycopene levels reduce cancer risk, it becomes apparent that we have limited ability to detect this association from studies of lycopene intake. An understanding of factors associated with serum lycopene levels can be useful for the interpretation of studies of dietary lycopene and disease risk.     

LYMPHANGIOMA PRESENTING AS A NECK MASS IN THE ADULT

Lymphangiomas are uncommon congenital lesions of the lymphatic system which usually present in childhood. We report a case of adult lymphangioma, localised in the neck, and discuss the presentation, diagnosis and management of this tumour.     

Return-to-work status 1 year after muscle reconditioning in chronic low back pain patients

OBJECTIVE: To evaluate return-to-work status 1 year after a physical deconditioning program in manual laborers with chronic low back pain. METHODS: In this open prospective study, a questionnaire was sent to 125 patients and their physicians (115 men and 10 women, mean age 40 years). Mean sick leave duration at program initiation was 4 months. All participants had followed a physical reconditioning program 12 months earlier. The program for the present study included 6 h of physical and occupational therapy each day, 5 d a week for 3 weeks. RESULTS: One hundred and nine questionnaires were evaluable. Fifty-seven patients (52.3%) were working, 39 (35.8%) full time and 18 (16.5%) part time. The remaining 52 patients were on disability leave. Among the study variables, only a favorable subjective evaluation by the patient at completion of the program and absence of clinical evidence of nonorganic pain at study inclusion significantly predicted return-to-work within 1 year. CONCLUSION: This intensive reconditioning program for low back pain patients had positive effects on return-to-work status after 1 year.     

Prospective evaluation of internal hospital requests for consultation of an Otolaryngology department

This was a prospective study and analysis of the clinical nature and severity of consultation, patient age and sex, place of consultation, grade of attending doctor and management strategy of in-patients referred for a specialist opinion to a Department of Otolaryngology. Internal requests for consultation were evaluated at the North Manchester General Hospital between October 1999 and August 2000 (n = 101). Patients referred to the Otolaryngology department were of a varied clinical nature with head and neck complaints being the largest group. Forty-six of the patients had minor complaints. Patients were found to be predominantly male and older than 50 years of age. The grade of attending doctor was predominantly a Specialist Registrar and the management strategy was most frequently conservative. Many of the requests for consultation were regarding minor problems that could be referred to a routine out-patient clinic. There is a need to improve the indication criteria for internal consultation, as well as the information provided in them.