Elective Ones Research Articles

Pattern of surgical admissions to Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia: A five-year retrospective study

Background: Tikur Anbessa specialized hospital (TASH) is Ethiopia’s largest tertiary teaching and referral hospital admitting and treating surgical patients under various specialties. This study aims to analyze the magnitude and pattern of surgical admissions to this facility. Methods: A five-year Cross sectional retrospective analysis was done on all adult surgical admissions to TASH from Sept. 2010 to Sept. 2015. Results: There were a total of 8,698 surgical admissions of which, 4471 (51.4%) were male and 4227 (48.5%) were female with male to female ratio of 1.06:1. Their age ranged from 13 to 95, with mean age being 38.8 ± 16.2 years. Three thousand two hundred twenty two (46.5%) patients were from Addis Ababa. Of all admissions, 4706 (54.1%) were elective ones of which obstructive uropathy, 997(21.1%), esophageal diseases, 716(15.2%) and Urolithiasis, 573(12.2%) respectively are the top three. The rest, 3992 (44.9%), were emergency admissions, the top three ones being trauma, 1435(35.9%), appendicitis 281(7%) and Intestinal obstruction, 190(4.7%) respectively. General surgical (gastrointestinal, endocrine and vascular) cases account for 3414 (39.25%) of all admissions followed by urosurgical cases, 2114 (25.31%), cardiothoracic surgical cases, 1942 (22.33%), and neurosurgical cases, 1139 (13.1%). There were a total of 280 deaths with an overall mortality rate of 4% of which, 3.2% were from elective admissions and 5.2% from emergency ones. Mortality rate was the highest among neurosurgical patients being 6.3% followed by 4.3%, 3.8% and 3.5% in cardiothoracic, general surgical and urosurgical cases respectively. Conclusions: The admission pattern indicates quite a big number and diversity of cases though the bed capacity is limited. There are significant number of cases that could be treated at other secondary level hospitals. Trauma is the leading cause of emergency admissions and significant cause of mortality. We recommend increasing the number of beds, organizing separate trauma center and admitting only cases requiring tertiary level care. Keywords: pattern of surgical diseases; surgical admissions; Tikur Anbessa Specialized Hospital

Colonoscopy complications: experience with 8968 consecutive patients in a single institution.

to evaluate the incidence, epidemiological characteristics, diagnosis and evolution of patients who returned to the emergency care units of the Albert Einstein Hospital in São Paulo/SP with signs and symptoms suggestive of colonoscopy complications up to 30 days after the procedure. we conducted a retrospective, uni-institutional study of patients submitted to colonoscopy in 2014 who returned to the Emergency department (ED) within 30 days after the procedure. 8968 patients underwent colonoscopies, 95 (1.06%) of whom had complaints related to possible complications. Most of the procedures were elective ones. Minor complications (nonspecific abdominal pain/distension) were frequent (0.49%) and most of the patients were discharged after consultation at the ED. Severe complications were less frequent: perforation (0.033%), lower gastrointestinal bleeding (0.044%), and intestinal obstruction (0.044%). ED consultations in less than 24 hours after the procedure was associated with a higher index of normal colonoscopies (p=0.006), more diagnosis of fever (p=0.0003) and dyspeptic syndrome (p=0.043), and less diagnosis of colitis/ileitis (p=0.015). The observation of fever in patients treated at the ED was associated with the diagnosis of polyps at colonoscopy (p=0.030). the data corroborate the safety of the colonoscopy exam and points to a reduction in major complications rates.

ORGANIZATIONAL APPROACHES TO DIAGNOSTICS AND TREATMENT OF PATIENTS WITH INFLAMMATORY INTESTINAL DISEASES

Aim. Increasing of efficacy of special medical care to patients with inflammatory intestinal diseases by means of the new organizational approaches to diagnostics and treatment.Materials and methods. An analysis of treatment of 79 patients with inflammatory intestinal diseases in City clinical hospital Nr 2, Krasnodar from 2010 to 2012 and Regional clinical hospital Nr 2 Ministry of Health care of Krasnodar Region from 2012 to 2017 is presented. 46 patients (58.2%) had ulcerative colitis, and 33 patients (41.8%) had the Crohn’s disease.Results. The conservative therapy was administrated to all patients depending on inflammation severity after additional examination and diagnostics. Due to the absence of therapeutical efficacy, different kinds of surgery were carried out. 34 operations were performed on patients with ulcerative colitis (12 urgent ones and 22 elective ones), 22 operations were performed on patients with Crohn’s disease (17 elective ones and 5 urgent ones).Conclusion. An opportunely performed surgery with the use of the low-invasive technologies on the patients with inflammatory intestinal diseases allowed diminishing a frequency of surgical complications and decreasing of lethality

Modifiable and non-modifiable risk factors for surgical site infection after colorectal surgery: a single-center experience.

Surgical site infection (SSI) is the most common complication of colorectal surgery, resulting in significant burden in terms of morbidity and length of hospital stay. The aims of this study were to establish the incidence of SSI in patients undergoing colorectal surgeries and to identify potentially modifiable risk factors to reduce overall SSI rates. This retrospective study analyzed patients who underwent colorectal resection at our Department. Patients were identified using a prospective SSI database. Univariate and multivariate analyses were used to identify risk factors. A total of 687 patients were enrolled in the study and the overall SSI rate was 19.9% (137 patients). Superficial incisional surgical site infections (SSSIs) developed in 52 (7.6%) patients, deep incisional surgical site infections (DSSIs) developed in 15 (2.2%), and organ/space infections (OSIs) developed in 70 (10.1%). Univariate and multivariate analyses confirmed that age, diabetes, emergency surgery, and a high infection risk index are risk factors for SSI. There are some modifiable and non-modifiable risk factors for SSI. IRI and age are non-modifiable, whereas the timing of surgery and diabetes can be modulated by trying to defer some emergency procedures to elective ones and normalizing the glycemia of diabetic patients.

Prevalence of gallbladder cancer In patients submitted to cholecystectomy: experience of the University Hospital, Faculty of Medical Sciences, State University of Campinas - UNICAMP.

to evaluate the prevalence of gallbladder carcinoma in patients submitted to cholecystectomy for chronic cholecystitis at the University Hospital of the State University of Campinas. we conducted a retrospective prevalence study through the analysis of histological specimens from January 2010 to May 2015. we analyzed 893 patient reports. Emergency cholecystectomies amounted to 144, and elective ones, 749 (16.2% and 83.8%, respectively). Regarding gender, 72.8% were female and 27.2% male. Gallbladder adenocarcinoma occurred in 12 patients (1.3%) and non-Hodgkin's lymphoma in one (0.1%). In patients with cancer, seven (53.8%) were associated with cholelithiasis and two (15.3%) with gallbladder polyps. prevalence results of gallbladder adenocarcinoma in this study were similar to those of Western studies and the main risk factor was cholelithiasis, followed by the presence of gallbladder polyps.

Robotic repair of a Morgagni diaphragmatic hernia

Robotic surgery is a high technology minimally invasive system. Morgagni's hernia is a rare congenital diaphragmatic hernia subtype that occurs in relation to the sternum anteriorly. Classically, symptomatic Morgagni's hernia is repaired by open abdominal approaches to reduce the hernia contents and suture the defect primarily or by patching large defects with a synthetic mesh. Recently, authors advocate the use of laparoscopic surgical techniques to repair such hernias especially the elective ones. This case discusses Morgagni's hernia repair using robotic surgery.

Completeness of manual anaesthesia records in a tertiary facility in Nigeria

Introduction: The human brain, as efficient as it is, cannot remember everything. It is legally required by law that healthcare providers maintain a record for each of their patients. In anaesthesia, every aspect of the anaesthetic care from preoperative to postoperative care needs to be documented. It is, therefore, essential to review the efficiency of manual record keeping and explore possible ways of improving it. Materials and Methods: This was a retrospective study of all patients of obstetrics undergoing caesarean section between 1st July, 2013 and 30th June, 2014. Study participants were identified from Institutional Anaesthesia record books and clinical record (case notes). With the aid of a questionnaire, relevant information concerning patients’ biodata, names of health personnel involved in the surgery and clinical information about vital signs and drug administration were documented from the records. Results: The chart completion rate was 63.88%. Emergency procedures had an average chart completion rate of 51.68% while the charts in elective procedures had a completion rate of 73.4%. The patients’ name was the most frequently recorded item. The Apgar score was not recorded in any of the charts reviewed. Critical incidents were poorly charted with a chart completion rate of 36.59%. Conclusion: Manual recording of anaesthesia information is unreliable and results in incomplete anaesthesia records. It is poorer in emergency surgeries as compared to elective ones. A comprehensive approach that would include structured teaching on the importance of chart completion and the use of automated information systems in recording may correct this anomaly.

Radiation dosage in the urolithiasis population: Do we over-radiate our patients?

Introduction: There is increasing concern about the amount of radiation that patients with urolithiasis receive. Ensuring patients are exposed to the minimum necessary radiation is imperative. Here we review the radiation dosages that newly diagnosed urolithiasis patients received in the year following their presentation, both those presenting acutely and those referred electively. Patients and methods: A retrospective study of 95 treatment-naïve patients (47 acute, 48 elective) referred for management of urolithiasis was undertaken. The analysis included all imaging modalities related to stone disease for both patient groups within one year following presentation. The total effective dose (mSV) in one year was calculated by summing the dose for each individual radiation exposure. Results: An average of 5.6 radiological investigations (range 1–14) was carried out for acute patients and 4.57 for elective patients (range 1–11). The mean total effective dose was 14.45 mSV for the acute cases and 12.87 mSV for the elective cases. The maximum radiation dose reached 30.1 mSV in acute patients and 36.51 mSV in elective ones. None of the patients exceeded the maximal annual dose recommended by the International Commission on Radiological Protection (ICRP) of 50 mSV. Conclusion: Management of acute and elective urolithiasis patients can be achieved with acceptable radiation dose exposure. It is extremely important to keep the hazards of radiation in mind whilst managing patients with urolithiasis and clinicians need to remember adherence to the ALARA principle.

Sejmiki szlachty sieradzkiej w Szadku w latach 1668–1695. Zestawienie chronologiczne

The presented list of the local diets (sejmiki) was based on the analysis ofthree sources, the city court books of Sieradz, the Pawiński Files Teki Pawińskiego and Pstrokoński Files Teki Pstrokońskiego. In the case of the first one I made use of a collection of accounts where lauda, local diets universals, protestations and confederation acts were included. In the case of Teki Pawińskiego and Teki Pstrokońskiego there were the 19th century copies from the above mentioned city court books of Sieradz and Piotrkow that no longer exist. The collation allowed to prepare the chronology of Sieradz diets and to eliminate mistakes particularly as far as surnames are concerned.   The records concerning local diets, including lauda, were included in city court books, which was to confirrn the validity ofacts and to constitute the source of knowledge about decisions taken before. In the case of the town of Sieradz both lauda and protestations as well as manifestations of political nature related to local diets were included in account books which was similar to the practice followed in Wielkopolska. The list does not com­prise all the local diets that took place during the reigns of two monarchs Michał Korybut Wisniowiecki and Jan III Sobieski as their lauda have not survived until the present. The local diets in the Sieradz voivodship were called by the monarch, while the elective ones by the voivode or the castellan of Sieradz, who twice called the nobility to gather at local diets. Occasionally the local diets lauda lacked the place or date of transcription or two different ones were stated.

Obstetric Outcomes at Advanced Maternal Age

Objective: To compare obstetric outcomes among women at advanced maternal age in relation to another group of 20 to 29 years. Methods: this is an observational descriptive study. Women of advanced maternal age were 40 and older at the first pregnant control (N = 154). The control group were pregnant women between 20 and 29 years (N = 3900). Odds ratio (CI 95%), mean and standard deviation, median and Fisher exact test were used to compare. Results: The rate of chronic hypertension, preeclampsia, diabetes, and bleeding were higher in the study group when compared with the control group. The rate of caesarean sections (due to a great number of elective ones), preterm delivery <37 weeks and lower birth weight (< 2500g) were also higher in the study group. Conclusion: women at advanced maternal age have an increased risk of adverse outcomes during pregnancy and delivery compared to pregnant women between 20 and 29 years. This electronic document is a “live” template. The various components of your paper [title, text, heads, etc.] are already defined on the style sheet, as illustrated by the portions given in this document.

PMS22 - Barriers of Access to Elective Orthopedic Procedures in Rio De Janeiro, Brazil

Currently, in Rio de Janeiro state, barriers to patient care who require elective surgical procedures in orthopedics are found, thus many patients remain long periods on hold until the attendance. This study aims to analyze the frequency of hospitalization procedures (HP), total inhospital cost (IC), and total number of inhospital days (ID) related to orthopedic elective procedures in Rio de Janeiro state, Brazil, from the public perspective in order to identify potential barriers of access. Orthopedic procedures that require hospitalization were selected from the public official hospital information system, for the year 2011. These procedures were separated into elective or urgent according to treatment indication, and validated by an expert panel. Costs are expressed in 2012 Brazilian Real (BRL). A public secondary database was accessed to evaluate HP, IC, and ID separated by cities. Rio de Janeiro state is composed by 92 municipalities. Total population consists of 15,989,929 inhabitants, and 6,320,446 (39.53%) live in the capital (Rio de Janeiro city). In 2011, 18,564 elective HP were performed, with a total IC of 21,977,085 BRL, and 145,295 ID. Data from the capital show 10,724 elective HP, total IC of 14,399,281 BRL, and 98,458 ID, which represent 57.77%, 65.52%, and 67.76% of the state, respectively. When only urgency procedures were analyzed, these rates fell to 43.73%, 46.46%, and 49.35%, respectively. Hospitalizations for elective orthopedic procedures in Rio de Janeiro state do not present homogeneous distribution among municipalities. The capital houses less than 40% of total population and accounts for more than 65% of costs and inhospital days. Data suggest that municipalities are able to absorb urgency occurrences, but not elective ones, creating difficulties for the treatment of patients in need of elective procedures. Decentralization of care may be able to reduce such barriers.

Pattern of Splenectomy Indications in Kashan Shahid-Beheshti Hospital, : A 5-Year Study

BackgroundThe spleen is amongst the most vulnerable organs which are easily injured in abdominal trauma. Nowadays, blunt trauma is the most prevalent indication of splenectomy.ObjectivesWe conducted this study to determine the pattern of indications for open splenectomies carried out during the past five years in Shahid-Beheshti hospital, a central hospital in Kashan, Iran.Patients and MethodsDemographic data of all patients who had undergone an open splenectomy in Kashan Shahid-Beheshti hospital during the past five years (2007-2012), indications for this type of surgery and outcome of patients were collected and entered into the study.ResultsDuring the study period, the data from a total of 99 open splenectomies were entered in our study. Sixty-eight (68.7%) patients were male and 31 (31.1%) female. The mean age was 31.64 years, 75.8% of the cases had indications of trauma and 24.2% were elective. The most prevalent indication for trauma was motor-bike rider accidents and for elective ones portal hypertension.ConclusionsMost cases of splenectomy in our center caused by trauma, and among the different types of trauma, blunt trauma is the dominant cause. Road traffic accidents, in particular motor vehicle accidents, especially motorbike injures, are the most frequent cause of splenectomy. Due to the instability of trauma patients, a mortality rate of 8% seems to be reasonable for splenectomy.We recommend that more research be conducted in this area and more cases enrolled with a reasonable follow-up period for splenectomy complications in this study.

Erreurs médicamenteuses en anesthésie : enquête prospective au niveau des CHU Marocains

IntroductionMedication errors are a major public health problem because of their morbidity and financial costs. In anesthesia, few articles publications, mostly retrospective, have assessed its incidence and outcomes. By our prospective study, we intend to identify and describe the drug errors in anesthesia in four university hospitals in Morocco. Material and methodsAfter approval of our ethics committee, a prospective study was conducted in nine hospitals affiliated to four university hospitals (Rabat, Casablanca, Fes and Marrakech) from October 2009 to June 2010. Data collection was carried out by an anesthesiologist at each hospital who was designated by the investigator. Informations were based on practitioner's statements. Medication errors were divided into distinct categories: substitution errors, omission errors, errors of the way of administration, dosage and dilution errors. The consequences were classified into four levels according to their severity. ResultsDuring the study period, 9199 anesthetic procedures were reported (mean response of 36%). General anesthesia was performed in 75% of patients. Sixteen cases of drug errors were reported (an incidence of 1/575 with 1/405 in a pediatric setting). The drugs involved were dominated by hypnotics (six cases/16) and morphine (four cases/16). Medication errors were mainly due to labeling mistakes (seven cases/16) and to attention deficit due to fatigue and stress (seven other cases) leading to substitution error in most of cases (10 cases/16. Errors were mainly made by the less experienced practitioners (14 cases/16). They occurred during the induction phase (seven cases/16) as well as during the interview process (nine cases/16), and also during emergent surgeries (seven errors/16) as well as during elective ones (nine errors/16). No errors caused death. Pulmonary edema (recognized as a grade III severity incident) was secondary to inappropriate administration of adrenaline. ConclusionOur study helped us to set recommendations, which are approved by the Moroccan pharmacovigilance center, and in accordance with the international committees to prevent the occurrence of medication errors in our daily anesthetic practice.

Health implications resulting from the timing of elective cesarean delivery

BackgroundThe literature is nearly unanimous in recommending elective cesarean delivery at 39 weeks of gestation because of the lower rates of neonatal respiratory complications compared to 38 weeks. However, elective cesarean delivery at 39 weeks or more may have maternal and other fetal consequences compared to delivery at 38 weeks, which are not always addressed in these studies.DiscussionBetween 38 and 39 weeks of gestation, approximately 10% - 14% of women go into spontaneous labor; meaning that a considerable number of women scheduled for an elective cesarean delivery at 39 weeks will deliver earlier in an unscheduled, frequently emergency, cesarean delivery. The incidence of maternal morbidity and mortality is higher among women undergoing non-elective cesarean deliveries than among those undergoing elective ones. Complications may be greater among women after numerous repeat cesarean deliveries and among older women. Other than reducing the frequency of non-elective cesarean deliveries, bringing forward the timing of elective cesarean delivery to 38 weeks, may occasionally prevent intrauterine fetal demise which has been shown to increase with increasing gestational age and to avoid other fetal consequences related to the emergency delivery. All these considerations need to be weighed against the medical and the economic impact of the increase in neonatal morbidity resulting from births at 38 weeks compared to 39 weeks.SummaryUntil prospective randomized trials are conducted, we are unlikely to be able to precisely answer all risk:benefit questions as to the best timing of scheduled elective cesarean delivery. Older women, and women with numerous prior cesarean deliveries, are of particular concern. It is reasonable to inform the pregnant women of the risk of each of the above options and to respect her autonomy and decision-making.

Between socially-instituted parental relationships and elective ones : A retrospective analysis of parent figures in France from 1930 to 1965

<titre>R&#233;sum&#233;</titre>&#192; partir des donn&#233;es de l&#8217;enqu&#234;te Biographies et entourage r&#233;alis&#233;e par l&#8217;Ined en 2001 aupr&#232;s de 2 830 Franciliens &#226;g&#233;s de 50 &#224; 70 ans, l&#8217;article propose une analyse d&#233;taill&#233;e de l&#8217;univers parental des enqu&#234;t&#233;s. Outre les parents biologiques, les parents adoptifs et les beaux-parents, cet univers est compos&#233; de l&#8217;ensemble des personnes cit&#233;es par les enqu&#234;t&#233;s pour avoir exerc&#233; un r&#244;le parental lorsqu&#8217;ils &#233;taient enfants. En nous appuyant sur un mat&#233;riau r&#233;trospectif, obtenu aupr&#232;s des b&#233;n&#233;ficiaires de ces attentions parentales et non de ceux qui les ont prodigu&#233;es, nous proposons une v&#233;ritable approche pratique de la parent&#233;, qui r&#233;v&#232;le les ressources familiales et extra-familiales dont ont b&#233;n&#233;fici&#233; les individus des ann&#233;es 1930 jusqu&#8217;aux ann&#233;es 1960. Ainsi, un enqu&#234;t&#233; sur cinq cite la pr&#233;sence d&#8217;au moins une personne ayant jou&#233; un r&#244;le parental, en compl&#233;ment ou en substitution des parents. La mention des grands-parents et plus sp&#233;cifiquement de la grand-m&#232;re maternelle se distingue. L&#8217;examen des fonctions attribu&#233;es &#224; ces &#171;&#160;parents d&#8217;&#233;lection&#160;&#187; souligne le caract&#232;re tr&#232;s concret de la prise en charge et de l&#8217;accompagnement des enfants. La force du lien affectif avec l&#8217;enqu&#234;t&#233; conjugu&#233;e aux fonctions pratiques de la parent&#233; constituent les deux crit&#232;res d&#8217;identification d&#8217;une figure parentale qui n&#8217;appartient pas forc&#233;ment &#224; la sph&#232;re familiale, 16&#160;% des personnes cit&#233;es &#233;tant non apparent&#233;es &#224; l&#8217;enqu&#234;t&#233;.

“So What is the Appeal?” The Phenomenon of Japanese as a Foreign Language in Hong Kong

In spite of long-standing political tensions between Japan and the People's Republic of China, Japanese remains a highly popular language to learn in Hong Kong. This is evidenced by the growth in number of Japanese-related courses and programmes offered at schools and universities in the Special Administrative Region. Although Japan is a dominant economic force in the region, the trend is not entirely explained by demand for Japanese in the workplace. A questionnaire survey of samples of students at three Hong Kong tertiary institutions explored respondents' motivation to learn both compulsory languages (English and Putonghua) and elective ones (Japanese, French and German). Results confirmed the popularity of Japanese as a language of choice, and found the motivation to learn it both affective and pragmatic, but more affective. Follow-up interviews identified three major issues involved in students' choice of Japanese: the appeal of Japanese popular culture; the perceived usefulness (or otherwise) of the language; and geographical proximity. A sense of shared traditions and high culture between China and Japan did not appear to be an issue for these respondents. Current political issues between China and Japan also seemed to be irrelevant.

Hiperlactatemia à admissão na UTI é um determinante de morbimortalidade em intervenções cirúrgicas não cardíacas de alto risco

One of the greatest challenges found by the intensivists in their daily activities is tissue hipoperfusion control. Blood lactate is generally accepted as a marker of tissular hypoxia and several studies have demonstrated good correlation between blood lactate and prognosis during shock and resuscitation. The aim of this study was to evaluate the clinical utility of arterial blood lactate as a marker of morbidity and mortality in critically ill patients in the post-operative period of high risk non-cardiac surgeries. Prospective and observational cohort study realized in an ICU of a tertiary hospital during a four month period. Demographic data of the patients submitted to high risk surgeries were collected, besides arterial lactate measures and number and type of complications in the post-operative period. To the statistic analysis was considered as significant a p < 0.05. The predictive ability of the indexes to differentiate survivors from non-survivors was tested using ROC curves. Lenght of ICU stay estimation where calculated by Kaplan Meier method. Were included 202 patients. 50.2% were female and their mean age was 66.5 ± 13.6 years. APACHE II score was 17.4 ± 3.0 and the median of MODS score was 4 (2-6). Median lenght of surgeries was 4h (3-6h). 70.7% of the surgeries were elective ones. ICU and hospital mortality were 15.6% and 33.7%, respectively. The best lactate value to discriminate mortality was 3.2 mmol/L, with sensitivity of 62.5%, specificity of 78.8% and an area under the curve of 0.7. 62.5% of patients with lactate > 3.2 did not survive versus 21.2% of survivors (OR = 2.95 IC95% 1.98- 4.38, p < 0.0001). ICU lenght of stay was greater when > 3.2 mmol/L (log rank 0.007) lactate. High risk patients submitted to non cardiac surgeries and admitted to the ICU with hiperlactatemia, defined as an arterial lactate > 3.2 mmol/L, are prone to a longer ICU lenght of stay and to die.

Is There Life before the Cpm? Pre-Cpm and Related Noncredit Certificates in Public Administration

The Certified Public Manager (CPM) program has attracted some attention in the modest published literature on noncredit continuing education in public administration. However, this body of scholarship has not paid comparable attention to noncredit certificates affiliated formally or informally with CPM programs and awarded in the process of earning the full certification. This article presents results of an exploratory survey of these noncredit certificates. The results indicated that about a third of all CPM programs offer at least one midpoint certificate prior to a student's completion of the full certification. There were wide variations in titles, duration and price of the pre-CPM certificates. On the other hand, these certificates usually focused on required workshops rather than elective ones, on grading and on elements of pedagogy besides classroom attendance. Eight noncredit certificates in general public administration were not formally linked to CPM, but about a third of them had an informal relationship to the local CPM program, permitting the transfer of some or all of these workshop hours toward the full CPM certification. The results of this exploratory research indicate that this little-known phenomenon of pre-CPM certificates and other noncredit certificates that often have links to CPM may be emerging as a component of the CPM process and, therefore, might deserve a higher profile from pedagogues.

Results in split liver transplantation

Introduction The shortage in cadaveric grafts has prompted the development of alternative surgical techniques to expand the donor pool. Objective To evaluate the feasibility of split liver transplantation using an observational, retrospective, and longitudinal study. Materials and methods Between April 1986 and October 2002 we performed 875 liver transplants. From April 1991 to date, we performed 18 split liver transplantations in patients of mean age 42.27 ± 25.65 years; five children and 13 adults; and 83.3% women. Urgent transplants accounted for 38.9%. Mean patient weight was 52.29 ± 20.87 kg. Ex situ splitting was performed in 33%. The mean cold ischemia time was 460 ± 265.69 minutes with a mean warm time of 64.33 ± 11.78 minutes. Mean consumption of packed blood was 5.59 ± 4.87 units; of frozen fresh plasma, 11.56 ± 7.42 units; and of platelets 4.89 ± 4.99 units. Results After a mean follow-up of 10.83 ± 12.51 months, 55.56% of the recipients are alive. Actuarial patient and graft survival rates at 1 year are 55.6% and 44.12%, respectively. Actuarial patient and graft survival rates at 1 year, excluding operative mortality were 77% and 68%, respectively. Actuarial patient and graft survival rates at 1 year, comparing urgent and elective transplantations are: 14.29 and 14%, respectively, for urgent cases and 90.91 and 90% for elective ones. Operative mortality was 16.6% while mortality during follow-up was 26.6%. The late complications included arterial thrombosis ( n = 2): of whom the first needed liver retransplantation 4 months after split liver transplantation; chronic rejection ( n = 2), recurrence of hepatitis ( n = 1). Conclusions Split liver transplantation is a useful way to expand the graft pool and shows better results in elective liver transplantation.

Saltillo, 1770-1810: Town and Region in the Mexican North

Despite its location in the Mexican north, Saltillo, founded during the age of the Chichimeca wars of the mid–sixteenth century, is one of the older cities of Mexico. Looking at the settlement during the last decades of the eighteenth century, Offutt uses the careers and activities of politically important hacendados and merchants to construct a case for the importance of Saltillo in the region and in Mexican colonial history. Although she makes reference to a handful of more recent works throughout the book, her arguments, outlined in a brief introductory chapter, present a challenge primarily to the perspectives of François Chevalier and Herbert E. Bolton and the Boltonians—not exactly the most recent theoretical perspectives on the role of New Spain’s northern frontier in colonial history. As a result, the rest of the book, although it provides useful information on the mercantile and landed elites of Saltillo, feels stilted and narrow, and the reader never does get a good sense of “town and region”—only of select merchants and landowners.The mercantile sector gets attention first in a chapter that documents how the small merchant community of Saltillo closely mirrored patterns elsewhere in New Spain. She concludes that peninsular merchants, because they married into the local elite and made extensive investments locally, looked on the regional trading center as a permanent home rather than as a stepping stone to bigger and better things. The following chapters tackle issues of land ownership and use. A major handicap in these sections is the lack of substantial documentation on property size and production for the decades under study. In perhaps the best part of the book, chapter 4 presents three cases studies that provide a window on the activities, resources, and labor for three estates of varying sizes. Offutt concludes, not surprisingly, that while the operation of rural properties in the Saltillo region followed patterns for more central areas, they differed significantly in size and prosperity.By the end of the eighteenth century, Saltillo’s merchant elite had not only captured control of the local economy, but had also acquired the reins of power and status in the community. Offutt argues that the sale of town council posts increased because of crown pressure to raise revenue; a secondary effect was to increase the power of proprietary officeholders over elective ones. Combined with the Bourbon effort to reorganize government under the intendencia system, which also produced local representatives tied to the community, the movement away from elected offices served to further highlight the status and wealth of the powerful merchant group.A very brief final chapter advances the principal conclusion that on the eve of the Mexican War of Independence Saltillo more closely resembled central portions of the viceroyalty than it did hinterlands to the north. Unlike other parts of New Spain, where trouble was brewing as a result of growing economic ills, a wealthy and powerful merchant elite, consistent economic and demographic growth, and increased and more efficient royal administration made Saltillo a bright spot in the imperial landscape.Although Saltillo, 1770–1810 adds a northern, nonmining perspective to the field of late-colonial business history, it does not significantly enhance our knowledge of Saltillo as a community, an expectation created by the book’s title. There remains much to say on how Saltillo functioned as a Spanish colonial community and how the northeast fit into the late colonial imperial framework. Offutt’s work hints at some of the directions for future research.