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PubMedDate not supplied

[A comparison of neuro-endoscopic techniques with other surgical procedures in the treatment of arachnoid cysts in children].

The aim of the study was to evaluate the use of neuroendoscopic techniques (in comparison with other surgical procedures) in the treatment for arachnoid cysts in children. The analysis was performed on results of treatment 22 children with arachnoid cysts submitted to neuroendoscopic procedures. The group consisted of 6 girls and 16 boys, aged from 1 day to 18 years (mean age 5.3 years, SD +/- 5.6). The control group treated with other, non-endoscopic surgical procedures consisted of 61 patients (20 girls and 41 boys aged from 10 days to 17 years, mean age 7 years, SD +/- 6). Criteria of success varied according to the type of surgical treatment. In the case of procedures other than shunt implantation, the treatment was regarded as effective, if there was no need to change the surgical method, while shunt implantation was considered effective, if shunt revision was not necessary. The operative treatment outcome was assessed using the Glasgow Outcome Scale. Post-treatment changes in the clinical state were graded as improvement, no change, or deterioration. In terms of the assumed criteria of success in the treatment for arachnoid cysts, neuroendoscopic procedures and microsurgical cyst excisions were among the most effective methods. As many as 90.9% of neuroendoscopically treated children needed no other operation, in comparison with 92.6% of patients submitted to microsurgical procedures, who needed no change in the operative treatment. In the group of neuroendoscopically treated patients the effectiveness of neuroendoscopic operations varied according to the type of procedure used. Cystocysternostomies or cystoventriculostomies were successful in 100%. The analysis of clinical outcome has shown that deterioration was observed only in 13% of the patients with shunt implantation. Analyzing each type of arachnoid cyst separately, a statistically significant relationship was found between improvement of the clinical state and the use of craniotomy in the surgical treatment for cysts localized in the posterior fossa. Improvement in the case of neuroendoscopically treated children was related to a larger reduction in the cyst size after surgery and to a lower intensity of intraoperative bleeding. Neuroendoscopic techniques allowed to reduce the average period of hospitalization. Neuroendoscopic cystocysternostomy and cystoventriculostomy were the most effective techniques, besides microsurgical excision of arachnoid cysts. Neuroendoscopic treatment efficacy depends on the type of procedure used. The application of neuroendoscopic techniques allows to reduce the period of hospitalization.

Adolescent↗
PubMed2004

Informed consent for invasive procedures in a community hospital medical intensive care unit.

OBJECTIVE: To describe the informed consent practices in the medical intensive care unit (MICU) of a university-affiliated, community teaching hospital. DESIGN: Prospective, observational study. SUBJECTS: 177 critically ill patients. MEASUREMENTS: Study personnel identified all critically ill patients who had an invasive medical procedure during the study period (120 days). It was first determined whether written informed consent was obtained for the procedure. If it was, standardized questionnaires were used to determine whether consent-givers recalled the indications, complications, and alternatives of invasive medical procedures. Documentation of consent and of the performance of invasive procedures in the medical records was also examined. An educational in-service was created to help improve the informed consent process. After a 45-day lead-in (control) period, the in-service was administered and IC was again studied for 75 days. RESULTS: A total of 181 procedures were performed on 112 patients over 120 days in the MICU. The rates of written consent for invasive procedures averaged 89%; rates of consent were not affected by the educational in-service. Following administration of the in-service, consent-givers recalled a greater number of complications (2.5 to 4.1, P=0.01) and documentation of consent improved. CONCLUSIONS: These results suggest that informed consent can be obtained procedure-by-procedure, as needed, at a high frequency, and with reasonable consenter comprehension.

Adult↗
PubMed1995

[Long-term results of Bentall and modified Bentall procedure in aortic root replacement].

Between 1976 and 1994, sixteen patients who had annulo-aortic ectasia required aortic root replacements. Ten patients had annulo-aortic ectasia and 6 patients had aortic dissections. The operative techniques included Bentall procedure in 6, Cabrol procedure in 3 and Carrel patch procedure in 7. No hospital death was noted, although there were three major late complications and two of them died. First patient having Bentall procedure died from acute myocardial infarction because of the compressed left coronary artery by the wrapping aneurysmal wall. Second patient having Bentall procedure had enlargement of residual false lumen. Third patient having Cabrol procedure developed false aneurysm at the ostial anastomosis and died of cerebral haemorrhage. In contrast, no late complication has been noted in patients having Carrel patch procedure. Although further long-term follow-up is required, our experience suggests that Carrel patch procedure has less late complication.

Adult↗
PubMed1995

[A modified Damus-Kaye-Stansel anastomosis for restrictive bulvoventricular foramen developed 5 years after Fontan procedure].

An one-year old girl, who had pulmonary artery (PA) banding and balloon atrioseptostomy done in the newborn period, underwent modified Fontan procedure on an emergency basis without cardiac catheterization, because of right heart failure. Echocardiogram showed no subaortic stenosis at Fontan procedure. Five years later, subaortic stenosis was documented with a 65 mmHg of ventricular-aortic pressure gradient at catheterization. A modified Damus-Kaye- Stansel (D-K-S) procedure was successfully performed using an end-to-end anastomosis of the distal aorta and a common stump, consisting of previously suture-closed main PA stump and the proximal aorta. At postoperative catheterization, the pulmonary valve was functioning well at LV outlet portion without regurgitation and stenosis. Significant subaortic stenosis may develop after Fontan procedure in patients with morphological narrowing without demonstrable pressure gradient. Such patients should have surgical intervention to the narrowing at the time of Fontan procedure. The modified D-K-S procedure can be an effective procedure to relieve subaortic stenosis after Fontan procedure.

Anastomosis, Surgical↗
PubMed1997

Ambulatory and inpatient procedures in the United States, 1994.

OBJECTIVES: This report presents estimates of surgical and nonsurgical procedures performed in the United States during 1994. Data are presented by characteristics of patients, region of the country, and procedure categories for ambulatory and inpatient procedures separately and combined. METHODS: Estimates in this report are based on data collected from the National Hospital Discharge Survey (NHDS) and the National Survey of Ambulatory Surgery (NSAS). The NHDS provides data on hospital inpatient care, and the NSAS provides data on ambulatory surgery in hospitals and in freestanding ambulatory surgery centers. For the NHDS, data were collected for approximately 277,000 discharges from 478 non-Federal short-stay hospitals (93 percent response rate). For the NSAS, data were collected for about 118,000 ambulatory surgery discharges from 494 hospitals and freestanding ambulatory surgery centers (80 percent response rate). RESULTS: An estimated 68.4 million procedures were performed on 38.0 million discharges from hospitals and freestanding ambulatory surgery centers during 1994: 40.7 million procedures were for inpatients, and 27.7 million were for ambulatory patients. Females had more procedures than males did and the rate of procedures increased with age in both ambulatory and inpatient settings. The leading procedures for ambulatory surgery patients and inpatients combined were endoscopy of large intestine, arteriography and angiocardiography, endoscopy of small intestine, and extraction of lens.

Adolescent↗
PubMed2004

Nitrous oxide analgesia for minor pediatric surgical procedures: an effective alternative to conscious sedation?

BACKGROUND/PURPOSE: Minor surgical procedures in children, while usually not requiring general anesthesia, need effective control of pain, anxiety, and motion. Certain techniques of conscious sedation may result in loss of protective airway reflexes. Nitrous oxide, however, when inhaled at levels below 50% maintains protective reflexes and does not require fasting or postprocedure monitoring. This study prospectively examines the efficacy of nitrous oxide analgesia in children undergoing outpatient surgical procedures. METHODS: Over a 2-year period (2000 to 2002), 150 consecutive children were given nitrous oxide analgesia as an alternative to a general anesthetic, sedation, or local anesthetic alone. Nitrous oxide (<50%) was administered by our practice's sedation-certified nurse practitioner without an anesthesiologist present. The children used the Wong-Baker Faces Scale (0-5) to score pain at different intervals (preprocedure, at injection, during procedure, and postprocedure) and event memories were tabulated. RESULTS: Of 150 children, 5 were uncooperative and could not participate. One hundred forty-five children, ages 1 to 20 years (Mean, 9.83 +/- 4.92 years) successfully underwent procedures (58 cyst/nevus excisions, 49 abscess drainages, 38 other) using nitrous. Two patients were too young to score pain. Pre- and postprocedure pain scores were significantly higher in the abscess group (P <.0001); during the procedures, however, all groups reported pain scores less than 1, with parents citing 100% satisfaction with the technique. Of 128 children receiving local anesthesia, 107 (84%) had no recall of the injection. Complications were limited to 4 patients; 2 experienced nausea, and 2 vomited. All resolved without interrupting the procedure. CONCLUSIONS: Nitrous oxide analgesia is a cost-effective and efficacious alternative to conscious sedation or general anesthesia for minor pediatric surgical procedures. In the office or outpatient setting, the technique provides for almost pain/anxiety-free surgery, no postoperative monitoring, and a high degree of satisfaction for patients, parents, and staff.

Adolescent↗
PubMed2000

Intussusception following the Ladd procedure.

HYPOTHESIS: The Ladd procedure for malrotation predisposes children to postoperative intussusception (POI). DESIGN: Retrospective case-control review. SETTING: University-affiliated tertiary care pediatric hospital. PATIENTS: Five of 159 patients undergoing the Ladd procedure between 1995 and 1998 developed POI. Predisposing factors were sought by comparison with age-matched controls who underwent the Ladd procedure during the same period. The entire Ladd group was compared with all 1717 patients undergoing any other laparotomy during the same period for incidence of POI. MAIN OUTCOME MEASURES: Differences in weight, percentile weight, age, length of nasogastric suction, time to oral intake, and length of stay between Ladd patients developing POI and age-matched controls from the Ladd group were compared using the Mann-Whitney U test. Incidence of POI after the Ladd procedure and "other laparotomy" was compared using chi2 analysis. RESULTS: In the Ladd group, there were 5 cases of POI (3.1%). There was 1 case of POI (0.05%) after all other laparotomies (P<.001). Symptoms developed at a mean +/- SD of 7.2 +/- 2.1 days. Upper gastrointestinal tract with small bowel follow-through showed partial bowel obstruction in 4 cases and was normal in 1 case. Reexploration took place at a mean +/- SD of 9.2 +/- 2.8 days. Children developing POI after undergoing the Ladd procedure were less likely to be small for their age (P= .03) than age-matched controls undergoing the Ladd procedure. CONCLUSIONS: The Ladd procedure predisposes children to POI. Aggressive investigation, including reexploration, should not be delayed if a child has symptoms of prolonged ileus within 2 weeks after undergoing a Ladd procedure.

Case-Control Studies↗
PubMed2006

Formal procedural skills training using a fresh frozen cadaver model: a pilot study.

Graduating medical students are expected to be proficient in a number of procedural skills. A structured curriculum is infrequently available. In addition, the use of a mannequin tends to be unrealistic and students continue to have some anxiety when performing procedures on patients. This pilot study was designed to demonstrate the utility of a fresh frozen cadaver model in practicing procedural skills as compared to mannequins. Seven third-year students carried out a number of basic procedural skills using a mannequin model and a fresh frozen cadaver. We surveyed the students after they had carried out the procedures on the different models with regards to ease of procedure, the sense of realism and their success rate. The pilot course improved the overall confidence of the students in performing basic skills. In addition, despite the fact that the mannequin was somewhat easier to perform a number of procedures on, the fresh frozen cadaver was a more realistic model and the preferred model for practicing the skills. The fresh frozen cadaver is a feasible and valid instructional tool for training procedural skills and has the advantage of being more realistic than a typical mannequin model.

Anatomy↗
PubMed2006

Enhancement of human papilloma virus type 16 E7 specific T cell responses by local invasive procedures in patients with (pre)malignant cervical neoplasia.

It has been suggested that local invasive procedures may alter the natural course of (pre)malignant cervical disease. This could be due to partial excision of the lesions, or via induction of cellular immunity against human papillomavirus (HPV) by the local invasive procedures. We studied the influence of local invasive procedures on HPV-16 E7 specific immune responses in patients with different grades of cervical intra-epithelial neoplasia (CIN) and different stages of cervical cancer. Blood was obtained at intake and after invasive procedures from patients with CIN or cervical cancer. Antigen specific T-cell responses were measured by IFN-gamma ELISPOT analysis, after stimulation with recombinant HPV-16 E7 protein. As expected, HPV-16 E7 specific IFN-gamma T cell responses were more frequent in HPV-16 DNA positive patients compared with that in HPV-16 DNA negative patients (39/50 vs. 16/36, (p=0.006, chi2 test). After invasive procedures, a small number of HPV-16 DNA positive CIN patients, but a considerable proportion of HPV-16 DNA positive cervical cancer patients, showed an enhancement of T cell responses against HPV-16 E7. Induction of T cell reactivity was most pronounced in cervical cancer patients who had undergone previous invasive procedures. Both CD4+ and CD8+ T cells showed E7 specific IFN-gamma production upon in-vitro stimulation. Our study shows that invasive procedures may enhance HPV-specific cell-mediated immunity in a considerable number of patients with cervical cancer, but in only a minority of CIN patients. Our data indicate that invasive procedures should be considered as possible confounding factors when analyzing the effectiveness of therapeutic immunization studies, especially, when induction of HPV-specific immune responses is used as intermediate end-point.

Antigen Presentation↗
PubMed2001

Adverse reactions associated with mobile therapeutic apheresis: analysis of 17,940 procedures.

In order to evaluate the nature and frequency of adverse reactions associated with Therapeutic Apheresis (TA), database information from two large mobile apheresis services was analyzed. A total of 17,940 procedures performed on 3,583 patients were studied using an Access Database. Seventy percent (12,558) of the procedures were performed on a Fresenius AS104 blood cell separator and 30% (5,382) were performed on a COBE Spectra. The five most commonly treated diseases were Guillain-Barre Syndrome (25%), thrombotic thrombocytopenic purpura (20%), myasthenia gravis (18%), the hyperviscosity syndrome (12%), and chronic inflammatory demyelinating polyneuropathy (9%). All patients received calcium gluconate supplement during the procedures. Cardiac monitoring was used during 80% of the procedures and blood pressure monitoring was used during all procedures. All procedures were supervised by a physician. Both apheresis services fully comply with the ASFA Guidelines for Therapeutic Apheresis Providers. Adverse reactions occurred in 3.9% of all procedures. The following adverse reactions were documented: reactions related to ACD toxicity (3%), vasovagal reactions (0.5%), vascular access related complications (0.15%), reactions related to FFP (0.12%), hepatitis B from FFP (0.06%), arrhythmias (0.01%), hemolysis due to inappropriate dilution of 25% albumin (0.01%), and one death (from underlying disease) during a TA procedure (0.006%). These data demonstrate that therapeutic apheresis is associated with a low rate of side effects when performed by well-trained and certified nurses under the direction of experienced physicians, even in the diverse setting of large mobile therapeutic apheresis programs.

Blood Component Removal↗
PubMed2005

Site-select procedure for non-palpable breast lesions: feasibility study with a 15-mm cannula.

BACKGROUND: As screening mammography becomes more commonplace, increasing numbers of non-palpable breast lesions are being found. The aim of this prospective study was to evaluate the feasibility, utility, and patient-perceived cosmesis and satisfaction of the Site-Select procedure in women with non-palpable breast lesions. METHODS: Thirty-two consecutive patients underwent the Site-Select procedure, performed under local anesthesia by the same surgeon. The Site-Select procedure was included in a protocol for small (<15 mm) breast imaging reporting and data system (BI-RADS) grade 3 and 4 breast lesions. The pathologic diagnosis, specimen size, length of the procedure, perioperative and postoperative complications, subsequent interventions, patient satisfaction, and esthetic results were documented. RESULTS: The Site-Select procedure was successful in all 32 patients (mean age, 56 years; range, 44-79 years). Mammographic lesions corresponded to microcalcifications in 21 patients, microcalcifications with architectural distortion in 4 patients, microcalcifications with nodules in 2 patients, and architectural distortion alone in 5 patients. The Site-Select procedure was used on an outpatient basis. Carcinomas were diagnosed in five patients (15.6%). No complications occurred during the procedure. The only postoperative complication was a hematoma, which did not require surgical drainage. No missed cancers were detected by follow-up mammography (mean 8 months later; range, 1-18 months). The esthetic results and patient satisfaction were excellent. CONCLUSIONS: This study demonstrates that the Site-Select procedure is an effective diagnostic method in selected cases. It has a low complication rate, high patient satisfaction, and excellent esthetic results.

Adult↗
PubMed2004

Testing non-inferiority (and equivalence) between two diagnostic procedures in paired-sample ordinal data.

Before adopting a new diagnostic procedure, which is more convenient and less expensive than the standard existing procedure, it is essentially important to assess whether the diagnostic accuracy of the new procedure is non-inferior (or equivalent) to that of the standard procedure. In this paper, we consider the situation where test responses are on an ordinal scale with more than two categories. We give two definitions of non-inferiority, one in terms of the probability of correctly identifying the case for a randomly selected pair of a case and a non-case over all possible cut-off points, and the other in terms of both the sensitivity and specificity directly. On the basis of large sample theory, we develop two simple test procedures for detecting non-inferiority. We further conduct Monte Carlo simulation to evaluate the finite sample performance of these test procedures. We note that the two asymptotic test procedures proposed here can actually perform reasonably well in a variety of situations even when the numbers of studied subjects from the diseased and non-diseased populations are not large. To illustrate the use of the proposed test procedures, we include an example of determining whether the diagnostic accuracy of using a digitized film is non-inferior to that of using a plain film for screening breast cancer. Finally, we note that the extension of these results to accommodate the case of detecting (two-sided) equivalence is simply straightforward.

Breast Neoplasms↗
PubMed1994

On teaching bedside diagnostic and therapeutic procedures to medical students: an annotated bibliography of audiovisual materials.

OBJECTIVE: The teaching of procedures that involve risk of pain or morbidity deserves special care. The author set out to develop a teaching program for medical students to ensure quality control of bedside diagnostic and therapeutic procedures. DESIGN: A bibliography of available videotapes and related audiovisual teaching materials on 15 common bedside procedures was assembled following requests for materials from all U.S. medical schools. Audiovisual materials from nine institutions were reviewed. SETTING: Medical schools and teaching institutions. PARTICIPANTS: Medical schools and libraries. MAIN RESULTS: Seventy-three percent (24/33) of responding schools had no visual material on the procedures. There was ten times more material on physical diagnosis than on bedside procedures. About 20 videotapes were reviewed in an annotated bibliography. Some videos contained valuable insights on how to make good teaching materials. A set of criteria for quality videotapes is listed. CONCLUSIONS: Considerable work needs to be done to develop audiovisual materials and curricula for teaching bedside procedures. Videotape is a valuable medium for introducing procedures and ensuring uniformity of technique. After reviewing all available videotapes, the author decided that videotapes should be the initial part of a multidimensional program for teaching procedures.

Audiovisual Aids↗
PubMed2005

[The role of endoprostheses in the scope of hand surgery. Endoprostheses vs. traditional surgical procedures].

Alloarthroplasty has largely replaced traditional procedures in arthrosis of hip and knee joints. In contrast the role of alloarthroplasty in comparison to traditional procedures in hand surgery has been uncertain. To evaluate this question every registered hand surgery department (n=307) in Germany received a questionnaire requesting information on number and type of implanted prostheses and traditional procedures concerning the wrist joint, distal radioulnar joint (DRUJ), first carpometacarpal joint (CMC), metacarpal phalangeal joint (MP), interphalangeal joint (PIP), and preferred characteristics of the prostheses. Of the 307 hand surgery departments, 150 (57% of the hospitals and 42% of the visiting surgeons) participated in the inquiry. Per year, only 98 wrist prostheses were implanted (distributed among five different models) but 1534 traditional procedures were performed. The Sauve-Kapandji procedure was the most popular for the DRUJ and was performed 264 times per year. In comparison 24 hemiarthroplasties were implanted at the DRUJ. Trapezectomy remains the standard procedure for arthrosis of the first CMC joint (n=1399). The future importance of alloarthroplasty of the CMC joint is doubted by the majority of participating hand surgeons (90.3%). In contrast the majority (85.3/71.8%) is convinced that alloarthroplasty will be of importance for the MCP and PIP joints, respectively. Currently, the number of implanted prostheses is close to the number of traditional procedures performed at the MP joint. Irrespective of the joint involved, cementless anchorage is preferred as is the surface replacement anatomical design. The results confirm that alloarthroplasty in hand surgery is of minor importance. Thus, the role of alloarthroplasty differs depending on the joint involved. Traditional procedures except for the MP joint continue to be of major importance in hand surgery.

Arthroplasty, Replacement↗
PubMed1999

Towards quality assurance of the sentinel node procedure in malignant melanoma patients: a single institution evaluation and a European survey.

The status of the regional lymph node (LN) is a critical component in staging patients with malignant melanoma. Biopsy of the first tumour-draining LN (sentinel node, SN) may replace routine elective LN dissection. However, until now, the applied methods have differed widely. Therefore, the aim of this study was to formulate recommendations for the pre-operative identification and intra-operative retrieval of the SN. We present the results of an independent survey of the clinical practice of the SN procedure via a postal questionnaire among 136 nuclear physicians in different institutes throughout 16 European countries. Moreover, the results of the SN procedure in our institution in an open prospective intervention trial in 80 patients with malignant melanoma without palpable LNs are also presented. In our protocol, on average, 6 h prior to surgery, 80 MBq technetium-99m nanocolloid was injected intracutaneously around the circumference of the diagnostic excision scar of the primary melanoma. No additional blue dye procedure was used to judge the accuracy of the radioguided SN procedure on its own. For successful identification of the radiolabelled SN, dynamic and static images were performed and the skin projection of the detected SN was marked with a cobalt-57 source. For intra-operative mapping a hand-held gamma probe was used. Forty of the 83 respondents of the European-wide questionnaire (48%) performed the SN procedure. Although many different regimens are used, the following recommendations could be deduced for the SN procedure in patients with malignant melanoma and non-palpable LNs: (1) local, intradermal injection of 40 MBq 99mTc-nanocolloid around the diagnostic excision scar of the primary melanoma; (2) two-phase LS: dynamic imaging (20 frames of 60 s, 128x128 matrix, LEAP collimator) followed by static images 1-2 h later (180 s per record); (3) intra-operative retrieval of the SN with a gamma probe; (4) histopathological examination of the SN on serial sections. In our trial, surgical retrieval of the SN was successful in 95% of the cases. Dynamic lymphoscintigraphy (LS) contributed to the SN procedure by showing anatomically unpredictable lymph flow to extra-regional SNs (10% of the patients in this study) and multiple SNs. Of the 77 retrieved SNs, 13 contained metastatic disease (17%). Consequently, these patients underwent a formal LN dissection of the affected basin. In conclusion, the SN concept is a rational approach to select patients who could, theoretically, benefit from early LN dissection of the affected basin. Standardisation of the SN procedure will improve the results of this approach, and could be useful for quality control and for making comparisons with other countries in coming years.

Adolescent↗
PubMed2006

Role of the simultaneous sequential strategy for failed acute sinus restoration after modified left maze procedure for persistent atrial fibrillation with concomitant mitral surgery.

BACKGROUND: We assessed whether the simultaneous sequential strategy could (1) achieve additional sinus restoration for those patients who were not in sinus rhythm while coming off bypass after modified left maze procedure and (2) attain the same long-term success rates as the bi-atrial maze procedure in patients with persistent atrial fibrillation (AF) and mitral valve disease. MATERIALS AND METHODS: Twenty-seven consecutive patients - ten men and 17 women with a mean age of 52 +/- 13 years, all with persistent AF and mitral valve disease - underwent the modified maze procedure with the simultaneous sequential strategy. In the first phase, the modified left atrial maze operation was carried out with concomitant valvular surgery; the right side maze operation was subsequently carried out as a second phase of the sequential strategy only if AF re-appeared following the spontaneous restoration of heart beats during the operation. RESULTS: Twenty patients (74.1%) underwent the left atrial maze procedure only, and seven patients (25.9%) required the subsequent right atrial maze procedure as part of the sequential strategy. At a mean follow-up of 15.1 +/- 7.7 months, six of the 27 patients (22.2%) who underwent additional right atrial maze procedure had restored sinus rhythm. At a mean follow-up of 17.8 +/- 7.3 months, 24 of the 27 patients (88.9%) had restored sinus rhythm and 22 patients (81.5%) had restored bi-atrial transport function (right atrial filling fraction: 40.8 +/- 11.7%; left atrial filling fraction: 22.9 +/- 8.1%) after application of the sequential strategy. CONCLUSIONS: Compared with modified left atrial maze procedure, the application of the simultaneous sequential strategy successfully restored sinus rhythm in an additional 22.2% of patients with persistent AF. The overall sinus conversion rate of 88.9% was comparable with that of the standard bi-atrial maze procedure.

Adult↗
PubMed2003

Informed consent for interventional radiology procedures: a survey detailing current European practice.

PURPOSE: Official recommendations for obtaining informed consent for interventional radiology procedures are that the patient gives their consent to the operator more than 24 hr prior to the procedure. This has significant implications for interventional radiology practice. The purpose of this study was to identify the proportion of European interventional radiologists who conform to these guidelines. METHODS: A questionnaire was designed consisting of 12 questions on current working practice and opinions regarding informed consent. These questions related to where, when and by whom consent was obtained from the patient. Questions also related to the use of formal consent forms and written patient information leaflets. Respondents were asked whether they felt patients received adequate explanation regarding indications for intervention, the procedure, alternative treatment options and complications. The questionnaire was distributed to 786 European interventional radiologists who were members of interventional societies. The anonymous replies were then entered into a database and analyzed. RESULTS: Two hundred and fifty-four (32.3%) questionnaires were returned. Institutions were classified as academic (56.7%), non-academic (40.5%) or private (2.8%). Depending on the procedure, in a significant proportion of patients consent was obtained in the outpatient department (22%), on the ward (65%) and in the radiology day case ward (25%), but in over half (56%) of patients consent or re-consent was obtained in the interventional suite. Fifty percent of respondents indicated that they obtain consent more than 24 hr before some procedures, in 42.9% consent is obtained on the morning of the procedure and 48.8% indicated that in some patients consent is obtained immediately before the procedure. We found that junior medical staff obtained consent in 58% of cases. Eighty-two percent of respondents do not use specific consent forms and 61% have patient information leaflets. The majority of respondents were satisfied with their level of explanation regarding indications for treatment (69.3%) and the procedure (78.7%). Fifty-nine percent felt patients understood alternative treatment options. Only 37.8% of radiologists document possible complications in the patient's chart. Comments from respondents indicated that there is insufficient time for radiologists to obtain consent in all patients. Suggestions to improve current local policies included developing the role of radiology nursing staff and the use of radiology outpatient clinics. CONCLUSIONS: More than 50% of respondents are unhappy with their policies for obtaining informed consent. Interventional societies have a role to play in advocating formal consent guidelines.

Attitude of Health Personnel↗
PubMed2003

Primary anastomosis after intraoperative colonic lavage vs. Hartmann's procedure in generalized peritonitis complicating diverticular disease of the colon.

BACKGROUND AND AIMS: For complicated diverticulitis Hartmann's procedure remains the favored option in patients with acute complicated sigmoid disease, but there has been increasing interest in primary resection and anastomosis with intraoperative colonic lavage. This study compared primary resection with intraoperative colonic lavage and Hartmann's procedure. PATIENTS AND METHODS: Between January 1994 and November 2001, 60 patients underwent emergency laparotomy for diverticular peritonitis (Hinchey stages III and IV). Primary resection and anastomosis with intraoperative colonic lavage was performed in 27 patients and Hartmann's procedure in 33. All data were collected prospectively on a standardized form. RESULTS: Mortality with intraoperative colonic lavage was 11% and with Hartmann's procedure 12%. The incidence of postoperative complication was significantly higher after Hartmann's procedure. The mean hospital stay was significantly longer after Hartmann's procedure than after primary resection with intraoperative colic lavage. CONCLUSION: Primary resection with intraoperative colonic lavage compares favorably with Hartmann's procedure for diffuse purulent peritonitis in complicated diverticulitis. It should be an alternative to Hartmann's procedure in stercoral peritonitis.

Adult↗