Complaints procedure

Many complaints by patients can be dealt with at ward level through discussion and an apology but others are more serious. All hospitals must have a complaints procedure in place and nurses must be aware of the steps complaints can take.     

Unlike any other procedure

The paper presents several mnemonics to assist clinicians in recalling DSM-IV diagnostic criteria for personality disorders. The mnemonics are acronyms, and each letter is associated with a specific criterion. Each acronym reflects a facet of the related disorder; for example, the acronym for the diagnostic criteria for paranoid personality disorder is SUSPECT, and for histrionic personality disorder it is PRAISE ME. The mnemonics have been used to teach students and residents the conceptual nature of DSM-IV disorders and to help them remember the criteria.     

Role of extra-articular procedure

This article describes the 1993 role of extra-articular procedures in the treatment of anterior cruciate-deficient knees. Twenty years ago, most operative effort was concentrated on elimination of the pivot shift phenomenon. Newer operative reconstructions made most of the advantages attributed to extraarticular procedures (shorter operating room time, less soft tissue injury, shorter postoperative rehabilitation) no longer true.     

Ilizarov procedure in pseudarthrosis

The treatment of nonunions has made an important development through the work of Ilizarov describing the principles of compression and distraction by using the ring-fixator. While local compression is sufficient in hypertrophic nonunions, the treatment of choice for atrophic infected nonunions with bony defects is a corticotomy followed by a segmental transport, especially in case of an osseous defect larger than 3 cm. Primary shortening poses a better starting point both for soft-tissue reconstruction and for early docking. External fixation systems are the ring-fixator, the unilateral fixator and hybrid systems combining both fixation methods. The use of a ring-fixator makes a shorter time of osseous consolidation possible when compared to a unilateral system (25,8 d/cm - 35,8 d/cm). Soft-tissue reconstruction before initiation of transport also shortens the time of osseous consolidation compared to later soft-tissue coverage. A docking-region in the metaphyseal area is supported by minimal internal fixation and cancellous bone graft. Segmental transport is complicated by local infection, regenerate failure (4.3% and regenerate fracture (2.9%).     

Fontan''s procedure in two stages

Abdominal (truncal) fat distribution reflected by an elevated waist to hip ratio (WHR) predicts metabolic abnormalities such as diabetes and dyslipidemia as well as hypertension and stroke, all of which are associated with obesity. The pathogenesis is not known, although elevated splanchnic serum free fatty acid levels and reduced hepatic insulin clearance have been implicated. WHR and body fat (BF) by 40K-counting and 3H2O were measured before liver biopsy during antiobesity surgery in 68 severely obese women (body mass index [BMI], 48.9 +/- 1.1 SEM) and 15 men (BMI, 49.0 +/- 3.1) without histories of liver disease, diabetes, or hepatotoxic exposure. Biopsies were graded for fat content semiquantitatively (0 to 4+) by the hepatologist who was blinded to the patients' clinical characteristics. All 15 men had fatty infiltration (score, 2.5 +/- 0.3 v 1.4 +/- 0.1 in women; P < .001). The correlation between WHR and liver fat was .44 (P < .0005), while BF (-.16), weight (.15), or BMI (.04) did not correlate significantly with steatosis (all NS). As expected, percentage body fat (BF%) was greater in women than in men (40.3 +/- 0.8 kg v 33.9 +/- 2.0, P < .007), and accordingly liver fat was inversely related to BF% (r = -.32, P < .002). Steatosis was significantly greater in 14 men (2.5 +/- 0.3) than in 20 women (1.7 +/- 0.3, P < .04) matched for BF%. In multiple regression analysis R2 = .49, P < .0001), WHR and sex accounted for the variance in liver fat content without any further contribution from weight, BMI, BF, or BF%.(ABSTRACT TRUNCATED AT 250 WORDS)     

Therapeutic procedure in prospective cytodiagnosis

If the prospective cytology speaks for an intraepithelial atypia, it is possible, due to an extended gynecologic indication, (descensus uterus myomatosus, etc.) to make a primary hysterectomy, avoiding a conisation. As well the complication of the conisation and the eventually following hysterectomy, as as second hospitalisation will thus be avoided. Only twice in 101 cases the cytologic prospective statement of pre-invasion could not be confirmed. These were cases of microinvasion in the sense of a "reticular infiltration". We made no further error "upwards". This proceeding for the diagnosis and therapy of early alterations at the portio uteri can only be carried out in clinics with gynecologically-clinically experienced cytologists. The clearing by conisation of cytologically not definite findings continues to remain the leading principle.     

Laparoscopic pull-through procedure for Hirschsprung''s disease

BACKGROUND: We investigated the suitability of two commercially available in-vitro bleeding tests (IVBT), the PFA-100 and the Hepcon HMS, to predict blood loss following operations with extracorporeal circulation (ECC) and compared them with conventional coagulation studies. METHODS: In 40 patients subjected to elective open heart surgery with ECC a blood sample was taken before and after ECC to measure platelet count, prothrombin time, aPTT, D-dimers, fibrinogen, and PFA-100 and Hepcon HMS data. The postoperative blood loss was recorded hourly until removal of drains. RESULTS: A significant correlation was found between total blood loss (250-1750 ml) and the preoperative PFA-100 (r = 0.41, p = 0.022), the preoperative platelet count (r = -0.42, p = 0.007), the preoperative D-dimer concentration in the plasma (r = 0.41, p = 0.01), and duration of ECC (r = 0.35, p = 0.044). There was no significant correlation between blood loss and the Hepcon HMS system. CONCLUSIONS: Although a significant correlation was found between blood loss and the PFA-100 IVBT, the practical value of these tests in the clinical situation is limited due to a great variability in individual results.     

The surgical procedure in splenic injuries

An analysis of the character of operations in 106 patients with traumas of the spleen has been made. Organ-preserving operations with a laser scalpel were fulfilled on 28 patients. Absolute indications for performing the organ-preserving operation were revealed in 28% of the patients. Relative indications were found in 53%. Methods of laser coagulation are proposed which helped to preserve the spleen in 46% of the patients during the last 4 years.     

Localized osteomyelitis following a restorative procedure

This case report describes a localized interproximal soft-tissue lesion in the anterior maxillary area that may have been caused by a composite curing light. Following clinical examination and histological analysis, the diagnosis of acute osteomyelitis was made. Palliative treatment and debridement resulted in complete resolution.     

Tetraplegia after a tracheal resection procedure

We describe a 27-year-old patient who was admitted to our hospital for a tracheal stenosis caused by an adenocystic carcinoma. A tracheal resection procedure was performed and the head was fixed to the anterior chest wall by two sutures. Postoperatively he became tetraplegic, from which he completely recovered after the sutures were removed. We think that the decreased blood flow in the arterial spinal artery with flexion of the neck in combination with hypotension was the direct cause of this major complication.