Elective Treatments Research Articles

Laser-Assisted Delivery Of Cold Atmospheric Plasma In Unresectable Cutaneous Metastasis In Melanoma Patients

According to the World Health Organization, the incidence of melanoma is increasing faster than that of any other major cancer in the world. Melanoma is the fifth most common cancer in the United States, posing a substantial health and economic burden. Treatment of early and multiple cutaneous unresectable metastasis in melanoma patients is a major therapeutic problem. Cold atmospheric plasma (CAP) contains electrons, charged particles, radicals, various excited molecules, UV photons, and transient electric fields. These various compositional elements have the potential either to enhance cellular activity, or to disrupt it. In particular, based on this unique composition, CAP could offer a minimally-invasive surgical approach allowing for specific cancer cell or tumor tissue removal without influencing healthy cells. Topical application of treatment agents is a basic principle of dermatological therapy. However, the effective barrier function of the skin significantly impairs the bioavailability of most topical drugs. Fractional ablative lasers represent an innovative strategy to overcome the epidermal barrier in a standardized, contact-free manner. The bioavailability of topical agents can be significantly enhanced using laser-assisted delivery. Ablative fractional laser resurfacing creates vertical channels that might assist the delivery of topically applied cold plasma into cutaneous melanoma metastasis. For lesions refractory to elective treatments, the laser-assisted drug delivery technique combined with cold atmospheric plasma may present a new potential option. We report on a pilot study showing a proof of concept for enhancing topical cold atmospheric plasma permeation into depth by ablative fractional laser technique.

Unplanned admissions to inpatient psychiatric treatment and services received prior to admission

BackgroundInpatient bed numbers are continually being reduced but are not being replaced with adequate alternatives in primary health care. There is a considerable risk that eventually all inpatient treatment will be unplanned, because planned or elective treatments are superseded by urgent needs when capacity is reduced. Aims of the studyTo estimate the rate of unplanned admissions to inpatient psychiatric treatment facilities in Norway and analyse the difference between patients with unplanned and planned admissions regarding services received during the three months prior to admission as well as clinical, demographical and socioeconomic characteristics of patients. MethodUnplanned admissions were defined as all urgent and involuntary admissions including unplanned readmissions. National mapping of inpatients was conducted in all inpatient treatment psychiatric wards in Norway on a specific date in 2012. Binary logit regressions were performed to compare patients who had unplanned admissions with patients who had planned admissions (i.e., the analyses were conditioned on admission to inpatient psychiatric treatment). ResultsPatients with high risk of unplanned admission are suffering from severe mental illness, have low functional level indicated by the need for housing services, high risk for suicide attempt and of being violent, low education and born outside Norway. ConclusionSpecialist mental health services should support the local services in their efforts to prevent unplanned admissions by providing counselling, short inpatient stays, outpatient treatment and ambulatory outpatient psychiatry services. Implications for health policiesThis paper suggests the rate of unplanned admissions as a quality indicator and considers the introduction of economic incentives in the income models at both service levels.

Endovascular Repair of 40 Visceral Artery Aneurysms and Pseudoaneurysms with the Viabahn Stent-Graft: Technical Aspects, Clinical Outcome and Mid-Term Patency.

Endovascular repair of true visceral artery aneurysms (VAAs) and pseudoaneurysms (VAPAs) with stent-grafting (SG) can simultaneously allow aneurysm exclusion and vessel preservation, minimizing the risk of ischemic complications. Our aim was to report a single-center experience on SG of visceral aneurysms, focusing on technical aspects, clinical outcome and mid-term patency. Consecutive patients affected by VAAs-VAPAs and submitted to endovascular treatment were retrospectively reviewed, and SG cases with the self-expandable peripheral Viabahn stent-graft were analyzed (2003-2017). Aneurysm type, patient number, SG clinical setting, procedural data, peri-procedural complications, technical success, 30-day clinical success, 30-day mortality and follow-up period (aneurysm exclusion, stent-graft patency, ischemic complications) were analyzed. SG was performed in 40 patients (24 VAPAs/16 VAAs) and in 44 procedures (25 in emergency, 19 in elective treatments), via transfemoral in 37 cases (transaxillary in 7 cases). One peri-procedural complication was recorded (a splenic artery dissection successfully converted to transcatheter embolization). The overall technical and clinical success rates were, respectively, 96 and 84%, with excellent trend in elective treatments (both 100%). Overall 30-day mortality was 12.5% (septic shock after pancreatic surgery). Stent-graft thrombosis occurred in 2 patients within 3months, with aneurysm exclusion and without ischemic complications. Stent-graft patency and aneurysm exclusion were confirmed at 6, 12 and 36months in 18, 12 and 7 patients, respectively. SG of VAAs and VAPAs was safe and effective, particularly in elective treatments. The Viabahn stent-graft, flexible and without shape memory, is suitable for endovascular repair of tortuous visceral arteries.

The Impact of Reimbursement Policy on Social Welfare, Revisit Rate and Waiting Time in a Public Healthcare System: Fee-for-Service vs. Bundled Payment

This paper examines the impact of Fee-for-Service and Bundled Payment reimbursement schemes on the social welfare, the patient revisit rate, and the patient waiting time in a three-tiered public healthcare system comprising: (a) a public funder who decides on the reimbursement rate to maximize the social welfare, (b) a public healthcare provider (HCP) who decides on the service rate (which affects the revisit rate and operating cost), and (c) a pool of (waiting time-sensitive) patients who decide whether or not to seek elective treatments. We focus our analysis on: (1) a Fee-for-Service (FFS) scheme under which the HCP receives the payment each time a patient visits (or revisits); and (2) a Bundled Payment (BP) scheme under which the HCP receives a lump sum payment for the entire episode of care for each patient (regardless of the number of revisits). By considering an M/M/1 queueing model with endogenous arrivals and revisits, we analyze a three-stage Stackelberg game to determine the patients' initial visit rate, the HCP's service rate (which affects the revisit rate), and the funder's reimbursement rate. This analysis enables us to compare the equilibrium outcomes (social welfare, revisit rate and waiting time) associated with the FFS and BP schemes. We find that when the patient pool is large, the BP scheme dominates in terms of higher social welfare and lower revisit rate, but the FFS scheme dominates in terms of waiting time. However, when the patient pool is small, the BP scheme dominates the FFS scheme in all three performance measures.

Pathophysiology and Treatment Considerations for Erosive Pustular Dermatosis

In this issue of JAMA Dermatology, Mervak et al1 describe the rare condition of erosive pustular dermatosis (EPD) that presented in a series of patients after undergoing fully ablative carbon dioxide laser resurfacing or deep chemical peel. Several weeks to months after the procedure, the patients exhibited facial nonhealing erythematous plaques with overlying pustules, erosions, and yellow crust. Results of histologic and microbial work-up were nondiagnostic, which was consistent with EPD. Each patient experienced an arduous and lengthy healing regimen, as is expected with this difficult diagnosis. The authors conclude that tincture of time and reassurance in addition to antibiotics, anti-inflammatories, and immunomodulators are warranted in the treatment of EPD.1 In the wake of increasing demand for elective surgical treatments, this case series highlights an important and fortunately rare adverse effect of ablative procedures. This phenomenon begs the questions, Are these cases underreported? What is the pathophysiology of EPD? What other options exist for treatment?

Five-year survival after surgery in nonagenarian patients.

In countries with longer life expectancies, the nonagenarian population is increasing. Therefore, there is greater demand for healthcare, including surgical procedures. The aim of the present study was to determine the outcomes of surgery carried out on nonagenarians in terms of long-term survival after the procedure. We carried out a cross-longitudinal study on a cohort of 159 nonagenarian patients, who underwent a non-cardiac, non-traumatic surgical procedure in our institution between January 1999 and December 2011. The following variables were recorded: sociodemographic characteristics, American Society of Anesthesiologists score, Charlson Comorbidity Index, surgical site, postoperative complications, operative mortality and long-term survival. The output variable was long-term survival. Of the 159 patients,99 women (62%) and 60 men (38%), with a mean age of 91.8years (SD±2.0years), 44 cases were operations for malignant disorders (28%), 117 cases (74%) under emergency conditions and 42 cases (26%) were elective treatments. The operative mortality was 29%, 4.8% for elective surgery and 37.6% for emergency surgery (P<0.001). The postoperative complication rate, including death, was 60%. The probability of survival at 1, 3, and 5years was 59.6%, 35.8% and 24.1%, respectively. In multivariate analysis, American Society of Anesthesiologists score (HR 2.07, 95% CI 1.58-2.72), emergency surgery (HR 1.64, 95% CI 1.05-2.57) and postoperative medical complications (HR 2.58, 95% CI 1.73-3.85) were independently related to 5-year survival. These findings support the perioperative safety of elective general surgery in nonagenarian patients. In selected nonagenarian patients with no cognitive impairment, surgery must not be denied. These data might be useful for surgical decision-making or informed consent for nonagerians. Geriatr Gerontol Int 2017; 17: 2389-2395.

Outsourcing day surgery to private for-profit hospitals: the price effects of competitive tendering.

Setting prices for elective patient treatments in private for-profit (PFP) hospitals in traditional tax-funded health systems is challenging since both the organisation of these hospitals and the tasks they perform differ considerably from what we find in public hospitals. From the year 2000, Norway became one of a few countries to gradually implement a procurement system based on competitive tendering when outsourcing elective surgery. In this study we analyse the effect of introducing competitive tendering on the prices paid to PFP hospitals. Pricing data were collected from the formal contracts awarded to PFP hospitals and defined in terms of both absolute and relative prices. We found that PFP hospitals performed day surgeries at markedly lower prices than public hospitals and that competitive tendering triggered the price reduction. We speculate that the PFP hospitals' lack of acute services, less severe patient population, reduced teaching responsibilities and ability to streamline production, as well as other factors, explain the lower prices at PFP hospitals.

Efficacy of contrast computed tomography scan over clinical palpation and ultrasonogram for the evaluation of neck nodes metastasis in case of oral squamous cell carcinoma

Background: Cervical metastasis has a tremendous impact on the prognosis in patients with carcinomas of the head and neck and the frequency of such spread is greater than 20% for most squamous cell carcinomas. It is possible to reduce the risk of undiagnosed metastasis with accurate contrast computed tomography (CT) imaging techniques and thus probably reduce the number of elective neck treatments. Objective: Aim of the study was to assess the accuracy of contrast CT scan over clinical palpation and ultrasound in prediction of lymph node metastasis in oral squamous cell carcinoma. Methods: 26 patients with oral squamous cell carcinoma who underwent 26 neck dissections (6RND, 20 SOND) were included. All the patients underwent examination of neck preoperatively by palpation, ultrasound and CT with contrast CT for number detection. Results: Clinical palpation for cervical lymph nodes had a sensitivity of 80%, specificity 28% and accuracy 58%. The sensitivity for ultrasound scanning was 80%, while the specificity was 72% and the accuracy was 52%. CT scan was found to be the best modality in assessment of metastases in cervical lymph nodes. The sensitivity was 93%, the specificity was 82% and the accuracy was 88%. The positive predictive value for CT scan was 88% and the negative predictive value was 90%. Conclusion: Contrast CT scan is the most accurate technique in assessing metastatic lymph nodes in neck in patients with oral squamous cell carcinoma.

Passport to healthcare: NHS charges become the new normal for overseas patients

Anne Gulland looks at government plans to improve identification of ineligible patients Chris Wormald, permanent secretary at the Department of Health, told the public accounts committee earlier this week that...

Mucocele of the appendix during pregnancy: What to do?

Abstract The term mucocele is simply defined as the macroscopic description of an appendix that is grossly distended by intraluminal accumulation of mucoid material. Its incidence ranges from 0.2% to 0.7% of all appendectomies and during pregnancy it is even less frequent. After a mucocele diagnosis, the selection of an adequate surgical method is, in general, very important. But during pregnancy it is an even more complicated decision because of the lack of experience and evidence on elective surgical treatments in pregnant women. We present a commentary based on a case of a low-grade appendiceal mucinous neoplasm of the appendix, found on an appendectomy specimen because of a mucocele in a second trimester pregnant woman.

Evaluation of Cervical lymphnode Metastasis in Oral Squamous Cell Carcinoma: Comparison between Palpation, USG, CT Scan & Histopathology

Background:The presence or absence of nodal metastasis has a great impact on the prognosis and survival of patients with head and neck cancer. The risk of occult metastasis is related to the method by which the lymph nodes are evaluated. It is possible to reduce the risk of undiagnosed metastasis with accurate imaging techniques and thus probably reduce the number of elective neck treatments. Aims and objectives:To assess the accuracy of clinical palpation, CT Scan and Ultrasound in prediction of lymph node metastasis in oral squamous cell carcinoma so that a suitable surgical neck dissection can be carried out. Methods :Twenty patients with oral squamous cell carcinoma who underwent 20 neck dissections (15MRND, 5 SOHND) were included. All the patients underwent examination of neck pre operatively by palpation, Computed Tomography with contrast and Ultrasound for node detection. The findings were correlated with the results of histopathologic examination of the neck specimen. The results were obtained after statistical analysis. Results:Ten neck dissection specimens showed metastatic lymph node involvement in postoperative histopathology. Lymph node involvement was identified preoperatively by palpation in 8 necks, CT in 6necks and US in 17 necks. The palpation showed 80% sensitivity, 30% specificity. CT showed sensitivity of 50%, specificity of 90% and US showed sensitivity of 90%, specificity of 20%. Conclusion:We recommend that the use of preoperative US and CT scanning of the neck by an experienced radiologist is essential and useful for diagnosis , staging and therapy choices which will help to reduce patient

Minimum Caseload Requirements and In-hospital Mortality: Observational Study using Nationwide Hospital Discharge Data from 2006 to 2013

Background: In order to improve hospital care, minimum caseload requirements for certain elective hospital treatments have been defined by law in Germany. This study analyses retrospectively if adherence to this regulation is associated with the outcome of hospital treatment. Differences in in-hospital mortality were analyzed for complex esophageal and pancreatic surgery, liver and kidney transplantation, stem cell transplantation and total knee replacement. Methods: Within individual inpatient data of the nationwide German hospital discharge data (DRG statistics) all inpatient episodes subject to the minimum volume requirements were identified and annual caseloads per hospital were calculated. Inpatient episodes were assigned to 2 groups: Patients treated in hospitals with a caseload equal to or greater than the minimum caseload (≥ MC) and patients treated in hospitals with a caseload below the minimum caseload (< MC). Logistic regression was used to calculate adjusted in-hospital mortality. Results: In total, 28 931 esophageal surgeries, 78 879 pancreatic surgeries, 7 984 liver transplantations, 21 773 kidney transplantations, 51 064 stem cell transplantations and 1 093 296 total knee replacements were analyzed. Adjusted in-hospital mortality in hospitals with a caseload≥MC was significantly lower than in hospitals with a caseload<MC for esophageal surgery (9.2% [95% KI 8.8-9,6] vs. 12.1% [11.4-12.9]), pancreatic surgery (8.6% [8.3-8.8] vs. 11.8% [11.2-12.5]), kidney transplantation (1.7% [1.4-1.8] vs. 3.3% [2.1-5.0]) and total knee replacement (0.13% [0.12-0.14] vs. 0.18% [0.14-0.23]). For liver transplantation, no significant difference in adjusted mortality was found (15.5% [14.7-16.5] vs. 15.9% [12.9-19.3]). For stem cell transplantation mortality in hospitals with a caseload≥MC was significantly higher than in hospital with a caseload<MC (6.0% [5.7-6.2] vs. 4.0% [3.2-4.9]). Conclusion: For 4 of the 6 studied treatments, a significantly lower risk of in-hospital death was observed in hospitals that adhere to the minimum caseload requirement. This implies that, for those treatments, full implementation of the minimum caseload regulation could improve the quality of hospital care in Germany.

Stapler versus scalpel resection followed by hand-sewn closure of the pancreatic remnant for distal pancreatectomy.

Resections of the pancreatic body and tail reaching to the left of the superior mesenteric vein are defined as distal pancreatectomy. Most distal pancreatectomies are elective treatments for chronic pancreatitis, benign or malignant diseases, and they have high morbidity rates of up to 40%. Pancreatic fistula formation is the main source of postoperative morbidity, associated with numerous further complications. Researchers have proposed several surgical resection and closure techniques of the pancreatic remnant in an attempt to reduce these complications. The two most common techniques are scalpel resection followed by hand-sewn closure of the pancreatic remnant and stapler resection and closure. To compare the rates of pancreatic fistula in people undergoing distal pancreatectomy using scalpel resection followed by hand-sewn closure of the pancreatic remnant versus stapler resection and closure. We searched Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, Biosis and Science Citation Index from database inception to October 2015. We included randomised controlled trials (RCTs) comparing stapler versus scalpel resection followed by hand-sewn closure of the pancreatic remnant for distal pancreatectomy (irrespective of language or publication status). Two authors independently assessed trials for inclusion and extracted the data. Taking into consideration the clinical heterogeneity between the trials (e.g. different endpoint definitions), we analysed data using a random-effects model with Review Manager (RevMan), calculating risk ratio (RR) or mean difference (MD) with 95% confidence intervals (CI). In two eligible trials, a total of 381 participants underwent distal pancreatic resection and were randomised to closure of the pancreatic remnant either with stapler (n = 191) or scalpel resection followed by hand-sewn closure (n = 190). One was a single centre pilot RCT and the other was a multicentre blinded RCT. The single centre pilot RCT evaluated 69 participants in five intervention arms (stapler, hand-sewn, fibrin glue, mesh and pancreaticojejunostomy), although we only assessed the stapler and hand-sewn closure groups (14 and 15 participants, respectively). The multicentre RCT had two interventional arms: stapler (n = 177) and hand-sewn closure (n = 175). The rate of postoperative pancreatic fistula was the main outcome, and it occurred in 79 of 190 participants in the hand-sewn group compared to 65 of 191 participants in the stapler group. Neither the individual trials nor the meta-analysis showed a significant difference between resection techniques (RR 0.90; 95% CI 0.55 to 1.45; P = 0.66). In the same way, postoperative mortality and operation time did not differ significantly. The single centre RCT had an unclear risk of bias in the randomisation, allocation and both blinding domains. However, the much larger multicentre RCT had a low risk of bias in all domains. Due to the small number of events and the wide confidence intervals that cannot exclude clinically important benefit or harm with stapler versus hand-sewn closure, there is a serious possibility of imprecision, making the overall quality of evidence moderate. The quality of evidence is moderate and mainly based on the high weight of the results of one multicentre RCT. Unfortunately, there are no other completed RCTs on this topic except for one relevant ongoing trial. Neither stapler nor scalpel resection followed by hand-sewn closure of the pancreatic remnant for distal pancreatectomy showed any benefit compared to the other method in terms of postoperative pancreatic fistula, overall postoperative mortality or operation time. Currently, the choice of closure is left up to the preference of the individual surgeon and the anatomical characteristics of the patient. Another (non-European) multicentre trial (e.g. with an equality or non-inferiority design) would help to corroborate the findings of this meta-analysis. Future trials assessing novel methods of stump closure should compare them either with stapler or hand-sewn closure as a control group to ensure comparability of results.

The factors influencing utilization of hospital services by adult sickle cell disease patients: a systematic review protocol.

REVIEW QUESTION / OBJECTIVE The research question is: what are the modifiable and non-modifiable factors that influence the utilization of hospital services by adult sickle cell disease patients? The objective of this systematic review is to determine what modifiable and non-modifiable factors influence utilization of hospital services by adult sickle cell disease patients. INCLUSION CRITERIA Types of participants The review will consider studies that include adult Sickle cell disease patients of both sexes who have utilized hospital services. The review will include adult Sickle cell disease patients who have visited emergency department s, been admitted to the hospital from the emergency department s or been admitted directly to the hospital from the community. This review will include adult Sickle cell disease patients who have utilized hospital services for acute or emergent care. The review will exclude participants who have utilized hospital services for elective treatments in order to determine factors that may be exclusive to the use of hospital services for acute care. Types of intervention(s)/phenomena of interest This review will consider studies that explore factors that influence utilization of hospital services (such as the frequency of emergency department visits and inpatient admissions among adult Sickle cell disease patients, and the risk of high utilization of hospital services). The factors will include non-modifiable (age, sex, ethnicity, Sickle cell disease genotype) and modifiable factors, such as socioeconomic (education, income, insurance status, availability of outpatient care), psychological (anxiety, depression, perceived optimism, perceived discrimination) and disease-related factors (Hgb level, presence of complications, presence TRUNCATED AT 250 WORDS

The factors influencing utilization of hospital services by adult sickle cell disease patients: a systematic review protocol

The factors influencing utilization of hospital services by adult sickle cell disease patients: a systematic review protocol

Balancing the risks and benefits associated with cosmetic dentistry - a joint statement by UK specialist dental societies.

Cosmetic dentistry has become increasingly popular, largely as a result of social trends and increased media coverage. This understandable desire for the alleged 'perfect smile' needs to be tempered with an appropriate awareness of the significant risks associated with invasive cosmetic procedures such as veneers and crowns. Patients need to be properly informed that elective removal of healthy enamel and dentine can result in pulpal injury and poorer periodontal health in the longer term, particularly if they are young. The duty of candour means that they ought to be informed that aggressive reduction of sound tooth tissue is not biologically neutral and results in structural weakening of their teeth. Less invasive procedures such as bleaching on its own or for example, combined with direct resin composite bonding, can satisfy many patient's demands, while still being kinder to teeth and having much better fall-back positions for their future requirements. It is the opinion of the British Endodontic Society, British Society for Restorative Dentistry, Restorative Dentistry UK, Dental Trauma UK, British Society of Prosthodontics and the British Society of Paediatric Dentistry that elective invasive cosmetic dental treatments can result in great benefit to patients, but that some aggressive treatments used to achieve them can produce significant morbidities in teeth which were previously healthy. This is a worrying and growing problem with many ethical, legal and biologic aspects, but many adverse outcomes for patients who request cosmetic dental improvements are preventable by using biologically safer initial approaches to treatment planning and its provision.

Concurrent Growth of Craniofacial Structures and the Aerodigestive Tract of Human Infants: Clinical Applications

Vital changes in form and function occur during the first four months of human postnatal life that allow for coordination of breathing and swallowing. These changes involve modifications in the gross anatomy of the skull, face and aerodigestive tract (ADT) structures, vocal fold histology, laryngeal chemoreflexes, formant frequency acoustics, audio pattern recognition, and limb control. Precise identification of ADT clinicopathologies that occur in this timeframe is essential to focusing the direction of this study. We here describe conditions with high incidence in infants from 0-4 months affecting growth and function of the ADT, skull, and craniofacial structures. Amongst the most noticeable are obstructive sleep apnea, sudden infant death syndrome, otitis media, cleft lip and palate and craniosynostosis. We also discuss clinical procedures and surgical techniques involved in elective and emergency treatments, including endotracheal intubation and surgical reconstructions of craniofacial structures. This study is part of a larger project charting the growth of skull and ADT structures from MRI images of infants from 0-4 months. Our hypothesis is that these structures develop with regularity, allowing for predictability and determination of normal growth trajectories. Better understanding of functional morphologic relationships between skull and ADT during this window of development may contribute to improving recognition, assessment, and treatment strategies/techniques for these conditions. Grant Funding Sources: American Association of Anatomists – AAA National Counsel of Technological Development – CNPq

Ventricular Fibrillation Caused by Traumatic Coronary Artery Dissection

Coronary artery dissection due to blunt chest trauma (traumatic coronary artery dissection [TCAD]) may heal spontaneously, and some surgeons believe that conservative or elective treat-ments are sufficient, provided that there are no progressing ischemic symptoms. However, we report a patient who experienced sudden ventricular fibrillation (VF) during initial medical care for trauma injuries. The 32-year-old woman was riding in a passenger car when an accident occurred, and was subsequently transported to our emergency department. Twelve-lead electrocardiography revealed ST segment elevation in leads II, III, and aVF, although her vital signs remained stable. Therefore, we prioritized assessing the trauma at other sites, and VF suddenly occurred. Coronary angiography was performed with repeated defibrillation and chest compressions, which resulted in recovery of spontaneous circulation. Occlusion was observed in the right coronary artery, which we treated with balloon angioplasty. However, intravascular ultrasonography (IVUS) subsequently revealed coronary artery dissection, a stent was placed, and the patient successfully recovered. Therefore, IVUS may be useful for diagnosing TCAD, and swift intervention is needed if TCAD is detected.

Quality and Safety of General Anesthesia with Propofol and Sevoflurane in Children Aged 1-14 Based on Laboratory Parameters.

Introduction:Knowledge of anatomic, physiological, biochemical and physical characteristics of children of all age groups, the existing illness and possible pathological response of the organism to the existing situation, require a pediatric anesthesiologist to participate in the preparation of a child for surgical treatment, to choose the best anesthesia technique and medications, and manipulative techniques to enable the scheduled surgical treatment with minimum anesthesia risks. The aim of this clinical study was to prove reliability and quality of propofol or sevoflurane general anesthesia in children in the age group of 1-14 years from the ASA I group and in the elective surgical treatments in duration of 60 minutes, based on preoperative and postoperative levels of laboratory findings (transaminases, blood sugar, urea and creatinine).Materials and methods:the study included 160 patients randomized in two groups based on different approaches: total intravenous anesthesia was used for the propofol group (n=80) (TIVA) and the inhalation technique was used for the sevoflurane group (n=80).Results:statistical evaluation of the obtained results indicates stability of laboratory findings in the immediate postoperative course (after 24 hours) in respect to the preoperative period. Based on the Mann Whitney test (P), preoperative and postoperative blood sugar levels in the sevoflurane vs. propofol group were P=0.152 vs. 0.021; creatinine levels P=0.113 vs. 0.325; urea levels P= 0.016 vs. 0.900; AST levels P=0,031 vs. 0,268 and ALT levels P=0.021 vs. 0.058. Level of significance was P<0.5.Conclusion:Analysis of the examined laboratory parameters show that propofol and sevoflurane provide full security and quality of general anesthesia in children age group 1-14 years, from the ASA I group. All analyzed laboratory levels in the postoperative course remained in their referential values in both groups of participants.

A comparison of outcomes of emergent, urgent and elective surgical treatments of colonic diverticulitis

A comparison of outcomes of emergent, urgent and elective surgical treatments of colonic diverticulitis