HUMANS FEMALE CHILD NEOPLASMS NEOPLASMS BY HISTOLOGIC TYPE NEOPLASMS ; VASCULAR TISSUE HEMANGIOMA CENTRAL NERVOUS SYSTEM VENOUS ANGIOMA HEMANGIOENDOTHELIOMA HEMANGIOMA ; CAPILLARY RESPIRATORY SYSTEM LARYNX

Background: Unlike in the USA and Europe, there are no work hour limitations for residents training or working in hospitals in the Philippines and most Asia. There is also no baseline data on the quantity and quality of working hours of residents in the Philippines. To determine and analyze the work and non-work activities among surgical residents in the country, a prospective study was done in selected accredited training programs. Methods: The study involved first year and graduating (4th or 5th year) general surgery residents in selected training hospitals in Manila, Cebu and Mindanao. The subjects were asked to accomplish a 24-hour diary describing the details of their activity for a period of 14 consecutive days. The residents likewise completed a survey regarding satisfaction with their lifestyle and their training activities. The work and non-work hours, and the various activities of the residents were analyzed using appropriate statistical tests. Results: A total of 85 residents (29 senior and 56 first years) from 11 hospitals participated in the study. The average total working hours was 111.2 per week and overall average sleep time was 4.7 hours per day. There were significant differences in total work hours and the amount of time spent for various activities between senior and first year residents, and between residents in private hospitals and government hospitals. There was a significant correlation between total work hours and satisfaction with lifestyle but no correlation with the level of satisfaction within their training activities and desire to reform training. Conclusions: During their training, a significant number of surgery residents in the Philippines experience: 1) Prolonged working hours and potential sleep deprivation, 2) wide disparity in the working hours between senior and first year residents, 3) high proportion of time four scut work and 4) low proportion of time form academic activity, study and out-patient work. Reforms need to be instituted not only to reduce the working hours of surgical residents but also to improve their educational experience in order to promote patient safety, quality of care and the health and well- being residents. Key words: Residents work hours, surgical training
WORKING HOURS

No abstract available.
Bacteria* ; Neutrophils*

BACKGROUND: Breast cancer is complicated by a high incidence of chronic postoperative pain (25%–60%). Regional anesthesia might play an important role in lowering the incidence of chronic pain; however it is not known if the pectoral nerve block (PECS block), which is commonly used for breast surgery, is able to prevent this complication. Our main objective was therefore to detect any association between the PECS block and chronic pain at 3, 6, 9, and 12 months in patients undergoing breast surgery. METHODS: We conducted a prospective, monocentric, observational study. We enrolled 140 consecutive patients undergoing breast surgery and divided them in patients receiving a PECS block and general anesthesia (PECS group) and patients receiving only general anesthesia (GA group). Then we considered both intraoperative variables (intravenous opioids administration), postoperative data (pain suffered by the patients during the first 24 postoperative hours and the need for additional analgesic administration) and development and persistence of chronic pain (at 3, 6, 9, and 12 mo). RESULTS: The PECS group had a lower incidence of chronic pain at 3 months (14.9% vs. 31.8%, P = 0.039), needed less intraoperative opioids (fentanyl 1.61 μg/kg/hr vs. 3.3 μg/kg/hr, P < 0.001) and had less postoperative pain (3 vs. 4, P = 0.017). CONCLUSIONS: The PECS block might play an important role in lowering incidence of chronic pain, but further studies are needed.
Analgesics, Opioid ; Anesthesia, Conduction ; Anesthesia, General ; Anesthesia, Local ; Breast Neoplasms ; Breast ; Chronic Pain ; Clinical Study ; Humans ; Incidence ; Nerve Block ; Observational Study ; Pain, Postoperative ; Prospective Studies ; Thoracic Nerves

Purpose: We performed the sutureless “Slim-Mesh” laparoscopic procedure to repair ventral hernias in overweight/obese patients in order to decrease operative time and complications. Materials and Methods: Between 2009 and November 2018, 67 consecutive overweight/obese patients affected by ventral hernia were operated on at our center with the “Slim-Mesh” technique. This was a prospective (65%)-retrospective study. Results: Our study included 36 males and 31 females; the patients’ mean age was 59 years old and mean BMI 31. There were 28 overweight patients, 28 Class I obese patients, and 11 Class II-III obese and superobese patients. Ventral hernia operative size was 3-10 cm (small/medium ventral hernia), 10-20 cm (large/giant) and ≥20 cm (massive) in 45, 17 and 5 cases respectively. Mean surgical time for overweight patients, Class I obese patients, and Class II-III obese and superobese patients was 95 minutes, 103 minutes, and 103 minutes respectively. In 28.3% of cases, ventral hernia operative size was larger than preoperative size, and in 16.4% laparoscopy detected additional fascial defects. We employed a composite mesh in 91% of patients and absorbable straps for mesh fixation in 85%. Mean length of hospital stay was 2.6 days. Mean follow-up time was more than 3.5 years. There were 3 cases (4.4%) of hernia recurrence. Conclusion The sutureless “Slim-Mesh” technique in overweight/obese patients has several advantages, including a reduction in operative time, recovery, and rate of recurrence. The use of this approach would be fast, safe and simple option for overweight/obese patients.

The occurrence of Austroboletus subflavidus and Fistulinella gloeocarpa is documented from the Dominican Republic. The latter species is reported for the first time outside its original locality in Martinique, extending the geographic range for this uncommon pinkish-spored bolete. A detailed morphological description is provided for each species and accompanied by color pictures of fresh basidiomes in habitat and line drawings of the main anatomical features. Both species represent independent lineages within their respective genera based on phylogenetic inference. In addition, A. subflavidus clusters in a sister lineage to the core Austroboletus clade (Austroboletus clade I) here named as Austroboletus clade II. In order to confirm the accuracy of species identification, their identity and relationships were subjected to multilocus phylogenetic analyses of three gene markers (ITS, nrLSU, RPB2) including genetic material already available in public databases. Austroboletus subflavidus is a widely distributed species in North and Central America, whereas F. gloeocarpa is apparently highly localized and seems to appear sparingly in the Dominican Republic, Martinque, and southern Florida. Comparisons with morphologically similar and molecularly inferred allied species are also presented and discussed.

The superficial femoral artery (SFA) is a relatively rare location for lower limb aneurysmatic disease. In the literature, this disease is described an association between a relatively high growth rate and/or the rupture of aneurysms and chemotherapeutic agents. We report a case of the rupture of a giant SFA aneurysm in a patient during chemotherapy for acute lymphatic leukemia.
Aneurysm* ; Arteries ; Drug Therapy* ; Femoral Artery* ; Humans ; Leukemia ; Lower Extremity ; Rupture*

Prosthesis retention is not recommended for multidrug-resistant Acinetobacter prosthetic joint infection due to its high failure rate. Nevertheless, replacing the prosthesis implies high morbidity and prolonged hospitalization. Although tigecycline is not approved for the treatment of prosthetic joint infection due to multidrug resistant Acinetobacter baumannii, its appropriate use may preclude prosthesis exchange. Since the area under the curve divided by the minimum inhibitory concentration is the best pharmacodynamic predictor of its efficacy, we used tigecycline at high dose, in order to optimize its efficacy and achieve implant retention in 3 patients who refused prosthesis exchange. All patients with prosthetic joint infections treated at our Institution are prospectively registered in a database. Three patients with early prosthetic joint infection of total hip arthroplasty due to multidrug resistant A. baumannii were treated with debridement, antibiotics and implant retention, using a high maintenance dose of tigecycline (100 mg every 12 hours). The cases were retrospectively reviewed. All patients signed informed consent for receiving off-label use of tigecycline. Tigecycline was well tolerated, allowing its administration at high maintenance dose for a median of 40 days (range 30–60). Two patients were then switched to minocycline at standard doses for a median of 3.3 months in order to complete treatment. Currently, none of the patients showed relapse. Increasing the dose of tigecycline could be considered as a means to better attain pharmacodynamic targets in patients with severe or difficult-to-treat infections. Tigecycline at high maintenance dose might be useful when retention of the implant is attempted for treatment for prosthetic joint infections due to multidrug resistant Acinetobacter. Although this approach might be promising, off-label use of tigecycline should be interpreted cautiously until prospective data are available. Tigecycline is probably under-dosed for the treatment of implant and biofilm associated infections.
Acinetobacter baumannii ; Acinetobacter* ; Anti-Bacterial Agents ; Arthroplasty, Replacement, Hip ; Biofilms ; Debridement* ; Hospitalization ; Humans ; Informed Consent ; Joints* ; Microbial Sensitivity Tests ; Minocycline ; Off-Label Use ; Prospective Studies ; Prostheses and Implants ; Prosthesis Retention ; Recurrence ; Retrospective Studies

Three dogs were evaluated for severe hyperproteinemia and hyperglobulinemia secondary to Leishmania infantum. Double filtration plasmapheresis (DFPP) was performed in two dogs at days 1, 2, and 6 after presentation. The third dog received DFPP at days 1 and 3 after presentation and eleven hemodialysis treatments. Significant reduction in serum total protein (p < 0.0001), alpha-1 (p = 0.023), alpha-2 (p = 0.018), gamma globulins (p = 0.0105), and a significant increase in albumin/globulin ratio (p = 0.0018) were found. DFPP may be a promising therapeutic technique for rapid resolution of signs of hyperproteinemia in dogs affected by L. infantum.
Animals ; Dogs ; Filtration ; gamma-Globulins ; Leishmania infantum ; Leishmania ; Plasmapheresis ; Renal Dialysis

Periprosthetic joint infection (PJI) is one of the most serious complications following total knee arthroplasty (TKA). The demand for TKA is rapidly increasing, resulting in a subsequent increase in infections involving knee prosthesis. Despite the existence of common management practices, the best approach for several aspects in the management of periprosthetic knee infection remains controversial. This review examines the current understanding in the management of the following aspects of PJI: preoperative risk stratification, preoperative antibiotics, preoperative skin preparation, outpatient diagnosis, assessing for infection in revision cases, improving culture utility, irrigation and debridement, one and two-stage revision, and patient prognostic information. Moreover, ten strategies for the management of periprosthetic knee infection based on available literature, and experience of the authors were reviewed.
Anti-Bacterial Agents ; Arthroplasty ; Debridement ; Diagnosis ; Humans ; Infection Control ; Joints ; Knee Prosthesis ; Knee ; Outpatients ; Reoperation ; Skin