Effect of the 50-hour workweek limitation on training of surgical residents in Switzerland

The 50-hour workweek limitation for surgical residents in Switzerland has a major effect on surgical training, resident quality of life, and patient care.

The Risk of Paradoxical Embolism (RoPE) Study: initial description of the completed database

BACKGROUND: Detecting a benefit from closure of patent foramen ovale in patients with cryptogenic stroke is hampered by low rates of stroke recurrence and uncertainty about the causal role of patent foramen ovale in the index event. A method to predict patent foramen ovale-attributable recurrence risk is needed. However, individual databases generally have too few stroke recurrences to support risk modeling. Prior studies of this population have been limited by low statistical power for examining factors related to recurrence. AIMS: The aim of this study was to develop a database to support modeling of patent foramen ovale-attributable recurrence risk by combining extant data sets. METHODS: We identified investigators with extant databases including subjects with cryptogenic stroke investigated for patent foramen ovale, determined the availability and characteristics of data in each database, collaboratively specified the variables to be included in the Risk of Paradoxical Embolism database, harmonized the variables across databases, and collected new primary data when necessary and feasible. RESULTS: The Risk of Paradoxical Embolism database has individual clinical, radiologic, and echocardiographic data from 12 component databases, including subjects with cryptogenic stroke both with (n = 1925) and without (n = 1749) patent foramen ovale. In the patent foramen ovale subjects, a total of 381 outcomes (stroke, transient ischemic attack, death) occurred (median follow-up 2·2 years). While there were substantial variations in data collection between studies, there was sufficient overlap to define a common set of variables suitable for risk modeling. CONCLUSION: While individual studies are inadequate for modeling patent foramen ovale-attributable recurrence risk, collaboration between investigators has yielded a database with sufficient power to identify those patients at highest risk for a patent foramen ovale-related stroke recurrence who may have the greatest potential benefit from patent foramen ovale closure.

Delayed volume resuscitation during initial management of ruptured abdominal aortic aneurysm

In acute traumatic bleeding, permissive arterial hypotension with delayed volume resuscitation is an established lifesaving concept as abridge to surgical control. This study investigated whether preoperatively administered volume also correlated inversely with survival after ruptured abdominal aortic aneurysm (rAAA).

Initial results of a computerized screening alert for abdominal aortic aneurysm in patients undergoing vascular assessment

Although routine ultrasound screening for abdominal aortic aneurysm (AAA) reduces mortality in subjects at risk, it is often omitted in clinical practice. Because computerized alerts may systematically identify subjects at risk of AAA, we hypothesized that such alerts would encourage physicians to perform an ultrasound screening test.

Initial results of in vivo high-resolution morphological and biochemical cartilage imaging of patients after matrix-associated autologous chondrocyte transplantation (MACT) of the ankle

OBJECTIVE: The aim of this study was to use morphological as well as biochemical (T2 and T2* relaxation times and diffusion-weighted imaging (DWI)) magnetic resonance imaging (MRI) for the evaluation of healthy cartilage and cartilage repair tissue after matrix-associated autologous chondrocyte transplantation (MACT) of the ankle joint. MATERIALS AND METHODS: Ten healthy volunteers (mean age, 32.4 years) and 12 patients who underwent MACT of the ankle joint (mean age, 32.8 years) were included. In order to evaluate possible maturation effects, patients were separated into short-term (6-13 months) and long-term (20-54 months) follow-up cohorts. MRI was performed on a 3.0-T magnetic resonance (MR) scanner using a new dedicated eight-channel foot-and-ankle coil. Using high-resolution morphological MRI, the magnetic resonance observation of cartilage repair tissue (MOCART) score was assessed. For biochemical MRI, T2 mapping, T2* mapping, and DWI were obtained. Region-of-interest analysis was performed within native cartilage of the volunteers and control cartilage as well as cartilage repair tissue in the patients subsequent to MACT. RESULTS: The overall MOCART score in patients after MACT was 73.8. T2 relaxation times (approximately 50 ms), T2* relaxation times (approximately 16 ms), and the diffusion constant for DWI (approximately 1.3) were comparable for the healthy volunteers and the control cartilage in the patients after MACT. The cartilage repair tissue showed no significant difference in T2 and T2* relaxation times (p > or = 0.05) compared to the control cartilage; however, a significantly higher diffusivity (approximately 1.5; p < 0.05) was noted in the cartilage repair tissue. CONCLUSION: The obtained results suggest that besides morphological MRI and biochemical MR techniques, such as T2 and T2* mapping, DWI may also deliver additional information about the ultrastructure of cartilage and cartilage repair tissue in the ankle joint using high-field MRI, a dedicated multichannel coil, and sophisticated sequences.

Impact of educational posters on the lay knowledge of school teachers regarding emergency management of dental injuries

The purpose of this study was to investigate the knowledge of school teachers about the emergency management of dental trauma, after an educational poster campaign. A total of 1000 questionnaires were sent to 100 schools in the area where the poster had been distributed. This was compared to another 100 schools (1000 questionnaires) in an area, Where the poster had not been distributed. The questionnaire surveyed demographic data, basic knowledge of emergency management of tooth fracture, luxation and avulsion injuries. A total of 511 questionnaires were returned (25.5%) and analyzed. Results showed differences between the two assessed areas. Teachers, who worked in the area with poster distribution, had better knowledge in handling tooth injuries. For the management of tooth fractures the portion of teachers, who knew the correct handling procedure, was 78.9% (area with poster campaign) vs 72.1% (area with no poster campaign), for the management of tooth luxation it was 87% vs 84% and for the management of tooth avulsion it was 71% vs 54%. In the area with the poster campaign 49% (n = 90 out of 185) of the teachers stated to have gained some knowledge about this topic beforehand. Out of these, 75 teachers (75/90 = 83%), had gained their information from the educational poster. Out of the 75 teachers, who had seen a poster on this topic, 68 (68/75 = 91%) would have managed such an emergency correctly. The present study shows the positive effect of educational poster campaigns. It therefore should encourage professionals in this field to embark on similar projects.

Strangulation signs: initial correlation of MRI, MSCT, and forensic neck findings

PURPOSE: To evaluate multislice spiral computed tomography (MSCT) and magnetic resonance imaging (MRI) findings in hanging and manual strangulation cases and compare them with forensic autopsy results. MATERIALS AND METHODS: Postmortem MSCT and MRI of nine persons who died from hanging or manual strangulation were performed. The neck findings were compared with those discovered during forensic autopsy. In addition, two living patients underwent imaging and clinical examination following severe manual strangulation and near-hanging, respectively. For evaluation, the findings were divided into "primary" (strangulation mark and subcutaneous desiccation (i.e., soft-tissue thinning as a result of tissue fluids being driven out by mechanical compression) in hanging, and subcutaneous and intramuscular hemorrhage in manual strangulation) and "collateral" signs. The Wilcoxon two-tailed test was used for statistical analysis of the lymph node and salivary gland findings. RESULTS: In hanging, the primary and most frequent collateral signs were revealed by imaging. In manual strangulation, the primary findings were accurately depicted, with the exception of one slight hemorrhage. Apart from a vocal cord hemorrhage, all frequent collateral signs could be diagnosed radiologically. Traumatic lymph node hemorrhage (P = 0.031) was found in all of the manual strangulation cases. CONCLUSION: MSCT and MRI revealed strangulation signs concordantly with forensic pathology findings. Imaging offers a great potential for the forensic examination of lesions due to strangulation in both clinical and postmortem settings.