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*

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.

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 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*

Background/Aims: The adenoma detection rate (ADR) is used as a quality indicator for screening and surveillance colonoscopy. The study aimed to determine if moderate versus deep sedation affects the outcomes of the ADR and other quality metrics in the veteran population. Methods: A retrospective review of colonoscopies performed at Memphis Veterans Affairs Medical Center over a one-year period was conducted. A total of 900 colonoscopy reports were reviewed. After exclusion criteria, a total of 229 index, average-risk screening colonoscopies were identified. Data were collected to determine the impact of moderate (benzodiazepine plus opioids) versus deep (propofol) sedation on the ADR, polyp detection rate (PDR), and withdrawal time. Results: Among 229 screening colonoscopies, 103 (44.9%) used moderate sedation while 126 (55%) were done under deep sedation. The ADR and PDR were not significantly different between moderate versus deep sedation at 35.9% vs. 37.3% (p=0.82) and 58.2% vs. 48.4% (p=0.13), respectively. Similarly, there was no significant difference in withdrawal time between moderate and deep sedation (13.4 min vs. 14 min, p=0.56) during screening colonoscopies. Conclusions In veterans undergoing index, average-risk screening colonoscopies, the quality metrics of the ADR, PDR, and withdrawal time are not influenced by deep sedation compared with moderate sedation.

Purpose: Reconstruction of the proximal femur after tumour resection can be performed with proximal femoral endopros-theses (PFE). Many studies have reported that bipolar hemiarthroplasty (BHA) reduce the risk of dislocation after oncological resections. However, progressive cotyloiditis which might require acetabular resurfacing (total hip arthroplasty [THA]) has been reported. The aim of this study is to compare the results of BHA and THA after proximal femur resection. Materials and Methods: A total of 104 consecutive patients affected by primary (n=52) and metastatic (n=52) bone tumours were included. Ninety patients underwent BHA and 14 patients underwent THA. Complications were recorded and classified according to the Henderson classification. At final follow-up, patients with the implant in site were functionally evaluated with modified Harris hip score (HHS). Results: The mean follow-up was 50 months (range, 2-171 months). Twenty-four (23.1%) patients developed major complications. Eleven (12.2%) BHA required acetabular resurfacing. Patients affected by primary bone tumours showed an increased risk of THA conversion (P=0.042). A reduced risk was observed in patients younger than 35 years (P=0.043) and in those older than 65 years (P=0.033). Dislocation occurred in four case (3.8%), in particular after THA (P=0.021). At final follow-up, 93 patients had the prosthesis in site (80 BHA and 13 THA). Mean postoperative HHS was 70 (range, 30-90). Conclusion The risk of dislocation is lower for bipolar endoprosthesis compared to THA. However cotyloiditis and acetabular resurfacing might occurred.

Background/Aims: The adenoma detection rate (ADR) is used as a quality indicator for screening and surveillance colonoscopy. The study aimed to determine if moderate versus deep sedation affects the outcomes of the ADR and other quality metrics in the veteran population. Methods: A retrospective review of colonoscopies performed at Memphis Veterans Affairs Medical Center over a one-year period was conducted. A total of 900 colonoscopy reports were reviewed. After exclusion criteria, a total of 229 index, average-risk screening colonoscopies were identified. Data were collected to determine the impact of moderate (benzodiazepine plus opioids) versus deep (propofol) sedation on the ADR, polyp detection rate (PDR), and withdrawal time. Results: Among 229 screening colonoscopies, 103 (44.9%) used moderate sedation while 126 (55%) were done under deep sedation. The ADR and PDR were not significantly different between moderate versus deep sedation at 35.9% vs. 37.3% (p=0.82) and 58.2% vs. 48.4% (p=0.13), respectively. Similarly, there was no significant difference in withdrawal time between moderate and deep sedation (13.4 min vs. 14 min, p=0.56) during screening colonoscopies. Conclusions In veterans undergoing index, average-risk screening colonoscopies, the quality metrics of the ADR, PDR, and withdrawal time are not influenced by deep sedation compared with moderate sedation.