Breast and emergency surgery

The book under review is a collection of works written mainly by a team of employees of the hospital surgical clinic, led by prof. BA Korolev, and published in connection with his fiftieth birthday, highlights the topical problems of modern surgery of the heart, lungs, esophagus and cardia and issues of urgent surgery of the abdominal organs.

EP.WE.381Daycase Parathyroidectomy for Primary Hyperparathyroidism: Our Experience

Aims Concerns due to postoperative complications following parathyroid surgery have precluded its consideration as a Daycase procedure. However recent BAETS guidelines have supported Daycase parathyroid surgery. To assess the outcomes of Daycase parathyroidectomy pathway we established in our Hospital since April,2018. Methods Retrospective review of all patients who underwent parathyroidectomy for Primary Hyperparathyroidism between April,2018 and October,2020. Patients with ASA 3 and above and patients undergoing total-parathyroidectomies were excluded. Outcome measures include length of stay, prerequisite for overnight stay, complications, and readmission rates. All patients were assessed and counselled for suitability for Daycase in surgical clinic and given detailed information leaflets. Results In this period, 40patients underwent surgery for primary hyperparathyroidism. Of these, 30 patients (75%), 8 males and 22 females with a median age of 59years fulfilled the criteria for Daycase surgery. 19 patients (63.3%) were successfully discharged on the day of surgery. 11 patients (36.7%) were discharged the following morning. The reasons for overnight stay are - 5patien ts(16.7%) developed post-anaesthetic nausea and drowsiness; in 5patients(16.7%) surgery started after 2pm and delayed postoperative return to ward lead to inadequate time for safe discharge; 1patient(3.3%) needed hospital transport. The readmission and postoperative complication rates were nil. Conclusions Daycase parathyroidectomy is safe in carefully selected patients. Adequate preoperative counselling, robust perioperative management to minimize postop morbidity and clear patient support package upon discharge are vital for wider acceptance. All Daycase patients should be operated first on the list and prior to 2pm to ensure safe discharge allowing adequate time for postoperative recovery.

EP.FRI.511 Optimising Ambulatory Ultrasound in Emergency Surgery

Aims Service provision and assessing the impact of future innovations can best be assessed by accurate reproducible data collection. The traditional model for our ambulatory surgical clinic with ultrasound allowed booking directly from the Emergency Department (ED) without discussion with the Surgical Team. We questioned whether this was the correct model and changed to a model of discussion with the Surgical team before booking in an effort to better utilise resource and reduce unnecessary footfall in the hospital. Methods We reviewed the outcome data of consecutive ambulatory ultrasound clinic referrals before and after implementation of this change in practice (1 month before and after the change) Results Ninety four ambulatory Ultrasound referrals were reviewed. In the first cohort 30 of 50 patients came directly from ED without discussion. A positive USS report was recorded in 8 of the 30 (27% USS positivity rate). After the change in practice to discuss with the surgical team, 11 of 43 patients originated primarily from ED with a positive finding in 4 patients (36%). Conclusions A key aim of service improvement is to optimise / improve utilisation of resource. This must be achieved without missing pathology. In this study we reduced the number of scans performed by ED whilst increasing the likelihood of a positive scan. This change in practice better utilised resource and reduced unnecessary footfall in the hospital.

About the development of bone tissue in goiter

In May 1921, a patient with a significant goiter came to the Faculty Surgical Clinic of Kazan University for an outpatient appointment with a request for an operation. The patient was admitted to the clinic, and in view of the rare and extremely interesting features that the goiter presented in her during its objective study, this case was kindly provided to me by the then temporarily in charge of the clinic, prof. VN Larin for research and description.

Hypothyroidism and effects on gastrointestinal function. Thomas Brown reports (Journ. A. M. A. 931, 97, 8)

Thomas Brown reports (Journ. AM A. 931, 97, 8) about one patient who went to a surgical clinic with complaints of chronic, refractory constipation; removed appendix in the past; constipation was due to partial narrowing due to surgery, X-ray gave atony colonis

The Psychometric Properties of the Turkish Version of Individual Workload Perception Scale for Medical and Surgical Nurses

Background and PurposeThis study is aimed to analyze the validity and reliability of the Individual Workload Perception Scale in Turkish (IWPSTR).MethodsExploratory factor analysis (EFA), confirmatory factor analysis (CFA), reliability analysis, test–retest, and descriptive statistics were used to analyze data. The sample group of the study consisted of 569 medical and surgical clinic nurses working in hospitals.ResultsThe content validity index was .983. The factor loadings of the IWPSTR were between .359 and .875, the variance accounted for in this study was 62.86%. Cronbach’s alpha value was found to be .923 for the IWPSTR, and between .721 and .937 for its subscales. Test–retest reliability correlation was found .826.ConclusionsIt was concluded that the Turkish version of IWPSTR, which includes 29 items and 5 subscales, could also be applied to nurses in Turkey.

GARDNER’S SYNDROME AS THE FIRST MANIFESTATION OF FAP IN PATIENT WITH METASTATIC RECTAL CANCER - AN EXTREMELY RARE OCCURRENCE

Familial adenomatous polyposis [FAP] is a rare autosomal disorder. FAP presenting with Gardner syndrome is even rarer. Gardner syndrome as the first manifestation of FAP without any prior family history is even scarcer. We hereby report the case of 32 years healthy male referred to our otolaryngology clinic with a neck mass and ultimately diagnosed with a case of Gardner syndrome with FAP and advanced rectal Cancer. The patient had a successful gastrointestinal surgery with follow up chemotherapy. Subsequently the patient was followed up at the gastroenterology, oncology and surgical clinic. Literature searched was done and the extra colonic manifestations of the diseases are highlighted in our discussion.

Replacement of extensive skull defects

In recent years, at the Hospital Surgical Clinic of Kazan University, there have been several rather interesting cases of replacement of extensive defects of the skull after traumatic injuries, accompanied by epileptic seizures.

A case of bladder purpura

In March 1921, a sick peasant woman was admitted to the Hospital Surgical Clinic with complaints of hematuria, which appeared 3-4 days after a slight malaise. The rest of the patient felt healthy. Objectively, the patient did not represent any deviation from the norm. In particular, her t is normal, there are no symptoms of scurvy. For hematuria, cystoscopic examination. Cystoscopy revealed: the orifices of the ureters are normal, on the normal mucous membrane there are scattered red spots the size of a pinhead and larger, very similar to flea bites; these specks are scattered in various parts of the bladder, mainly at the bottom of it; there are no infiltrates around the spots and other changes.