Bailey and Love's Short Practice of Surgery

测定：FVC需要测试者尽力呼出肺内气体，这一过程约需20s，老年人或有严重肺疾病患者的体力常不堪耐受。常规的FVC测定值也会因气道阻塞者或健康高龄人的呼气时间而受影响。作者使用6s内用力呼气量(FEV6.0)代替FVC作为肺功能指标，探讨其对诊断气道阻塞和呼吸受限的优越性。

用FEV6．0代替FVC诊断气道阻塞和肺功能受限[英]／Swanney MP…∥Am J Respir Crit Care Med．

Epidemiology of colorectal cancer

Objective We sought to evaluate the degree of patients' understanding of several aspects of the informed consent process for surgery and clinical research. Methods We conducted a systematic search of PubMed (1961–2006) to identify relevant articles. Results We retrieved 23 and 30 eligible for inclusion articles regarding informed consent for surgery and clinical research, respectively. Regarding surgery, adequate overall understanding of the information provided and of the risks associated with surgery was shown in 6 of 21 (29%) and 5 of 14 (36%) studies providing relevant data, respectively. Regarding clinical research, adequate understanding of the aim of the study, the process of randomization, voluntarism, withdrawal, and the risks and the benefits of treatment was shown in 14 of 26 (54%), 4 of 8 (50%), 7 of 15 (47%), 7 of 16 (44%), 8 of 16 (50%), and 4 of 7 (57%) of studies providing relevant data, respectively. Satisfaction by the amount of the given information was shown in 7 of 12 (58%) studies involving surgery and 12 of 15 (80%) studies involving clinical research. Conclusions Further attention should be drawn on enhancing patients' understanding regarding several components of the informed consent process for surgery and clinical research.

Informed consent: how much and what do patients understand?

The risk of recurrent venous thromboembolism in men and women

Background Deep vein thrombosis (DVT) is the formation of blood clots (thrombi) in the deep veins. It commonly affects the deep leg veins (such as the calf veins, femoral vein, or popliteal vein) or the deep veins of the pelvis. It is a potentially dangerous condition that can lead to preventable morbidity and mortality. Aim To present an update on the causes and management of DVT. Methods A review of publications obtained from Medline search, medical libraries, and Google. Results DVT affects 0.1% of persons per year. It is predominantly a disease of the elderly and has a slight male preponderance. The approach to making a diagnosis currently involves an algorithm combining pretest probability, D-dimer testing, and compression ultrasonography. This will guide further investigations if necessary. Prophylaxis is both mechanical and pharmacological. The goals of treatment are to prevent extension of thrombi, pulmonary embolism, recurrence of thrombi, and the development of complications such as pulmonary hypertension and post-thrombotic syndrome. Conclusion DVT is a potentially dangerous condition with a myriad of risk factors. Prophylaxis is very important and can be mechanical and pharmacological. The mainstay of treatment is anticoagulant therapy. Low-molecular-weight heparin, unfractionated heparin, and vitamin K antagonists have been the treatment of choice. Currently anticoagulants specifically targeting components of the common pathway have been recommended for prophylaxis. These include fondaparinux, a selective indirect factor Xa inhibitor and the new oral selective direct thrombin inhibitors (dabigatran) and selective factor Xa inhibitors (rivaroxaban and apixaban). Others are currently undergoing trials. Thrombolytics and vena caval filters are very rarely indicated in special circumstances.

/pdf/deep-vein-thrombosis-a-clinical-review-35wsiz6048.pdf

Deep vein thrombosis: a clinical review.

BACKGROUND Many of the cases of carcinoma of the breast we find in our clinic are advanced, sometimes with fungation. We believe that if women in Port Harcourt are knowledgeable about breast self-examination (BSE) and practise it, this scenario may not be so. AIM The study is intended to highlight the extent of their knowledge vis-a-vis their practice of BSE. METHOD A written questionnaire was distributed to 200 women from different walks of life in Port Harcourt to assess their attitudes to, knowledge and practice of BSE. Their responses were then collated and analyzed. RESULTS Ninety-eight percent of the respondents had formal education, majority having obtained tertiary education. Eighty-five point five percent of them had heard of BSE but 39.0% practised BSE only occasionally, while 24.0% did not practise it at all. Among 76 health workers who participated in the study, 60.0% of doctors and 53.7% of nurses practised BSE only occasionally. Only one doctor could describe how to perform BSE correctly. The news media, nurses and physicians were the commonest sources of information on BSE. CONCLUSION Most women in Port Harcourt, though aware of BSE and its usefulness never practise it. Those who care to practise it are ignorant of how to correctly do it. There is need for a vigorous health education programme on this subject for our women. It is hoped that this will help to reduce the morbidity and mortality associated with carcinoma of the breast.

Attitudes to, knowledge and practice of breast self-examination (BSE) in Port Harcourt.

Background : Hepatocellular carcinoma (HCC) is a complication of liver cirrhosis caused by hepatitis B viral infection, fungal infection and genetic factors. This disease though having a silent course is associated with variable morbidity and mortality in this environment. Methods : Previously prepared histologic slides were retrieved and re-evaluated to confirm the diagnosis. Clinical data such as the age, sex, clinical presentations, histologic grading and cause of death were extracted from the case notes, histology request forms and autopsy protocol forms. Results : Seventy five cases were used for the study during the period under review. The youngest was a 14 year old male while the oldest was a 66 years old male. Male to female ratio was 2:1. Majority (28%) occurred in the age group 40-49 years. Upper abdominal mass was the most common clinical presentation (30.7%) and well differentiated hepatocellular carcinoma was the most common (64.0%) histologic grade. Trabecular / sinusoidal pattern (49.3%) was the most common histologic type (pattern) while upper gastro-intestinal bleeding (38.7%) was the most common cause of death at autopsy. Conclusion : Hepatocellular carcinoma is a notable malignancy of the liver associated with variable morbidities and mortality as it has an insidious onset and very aggressive course.

/pdf/hepatocellular-carcinoma-in-port-harcourt-nigeria-4zc30glms5.pdf

Hepatocellular carcinoma in Port Harcourt, Nigeria: clinicopathologic study of 75 cases.

Wound dehiscence and its complications plague surgical practice. This study aims to identify the clinical features, etiological factors, and preventive measures of abdominal wound dihiscence (AWD). A Medline search from 1966 to February 2004 was done, using the terms abdominal wound dehiscence, burst abdomen, and abdominal wound closure. Accessible full texts of these, relevant references from them, and publications found in medical libraries were studied. Data extracted included authors' names, presenting symptoms and signs of AWD, ages of the patients, presumed etiology of dehiscence, methods of wound closure, and complications and outcome of both the dehiscence and its treatment. These were analyzed under selected headings. Abdominal wound dehiscence is as old as surgery. Predisposing factors are either patient or surgeon related. Despite several incisions and suture materials, controversy remains, with no consensus on the ideal methods or materials for closure of abdominal wounds to prevent dehiscence. At best, the incidence of AWD can be reduced.

Abdominal wound dehiscence: A review.

BACKGROUND: By casual interaction with patients our impression was that patients lacked adequate knowledge about their ailments and surgical treatment. There is now increasing educational exposure and legal awareness in the society. AIM: To reassess the extent of the practice of "informed consent" expose failures if any, and make appropriate recommendation. METHODS: A written questionnaire, randomly distributed to patients, sought to find out to what extent patients admitted into the University of Port Harcourt Teaching Hospital (UPTH) were adequately informed about their ailments and the implications of surgical treatment. RESULTS: One hundred and fifty patients were randomly recruited into the study and all responded to the questionnaire. Majority of the patients (75%) knew their diagnoses. Most patients (63%) did not know the problems that could be associated with their surgery while 75% did not know the complications of anaesthesia. CONCLUSION: There is need for a closer interaction in communication between patients and their surgeons. This will facilitate the participation of patients in decisions on treatment options and consequently help to maintain a satisfactory standard of practice and reduce litigation following an unfavourable outcome of surgical treatment.

Informed consent: how informed are patients?

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