Davenporthorowitz0576

Introduction Every surgical procedure is followed by thorough and descriptive documentation. The Royal College of Surgeons (RCS) introduced official guidelines in 2014 on the proper documentation of operative notes. These guidelines are concise, targeted, and easy to adapt to any surgical specialty. Methods and results An audit was conducted from April to September 2019 at District Headquarter Hospital in Rawalpindi, Pakistan. We analyzed 215 operative notes of elective and emergency cases during the first three months (pre-implementation), and after comparing the notes against the RCS orthopedic notes guidelines, we developed a dedicated notes format for use in the second three months (post-implementation). A panel reviewed 235 notes postimplementation for legibility and compliance with the 2014 RCS guideline data. Operative diagnosis was written in 80% pre-implementation notes and 100% of post-implementation notes. Pre-implementation of RCS guidelines, 78% of operative notes included the names of the anesthetist and the operative staff, 88% included assistant names, and 90% included the name of the operating surgeon. Post-implementation, these numbers increased to 92%, 93%, and 99%, respectively. All domains of the guideline were filled, and data point inclusion statistically significantly improved (0.001 less then P less then 0.005) after the implementation of RCS guidelines. Conclusion Following the RCS guidelines resulted in a significant improvement in all deficient fields in operative notes.Pheochromocytomas (PHEO) and paragangliomas (PGL) are rare tumors originated in cells derived from the neural crest. The first ones are located in the adrenal medulla, and the second ones in the sympathetic and parasympathetic nervous system. These kind of tumors may secrete excess catecholamines, including epinephrine, norepinephrine, dopamine and/or their metabolite metanephrine, normetanephrine and 3-methoxytyramine, respectively. Its clinical manifestations depend on the location, the secretory profile and the malignant potential of the tumor. These tumors are frequently benign in their presentation. Some arise in the context of familiar syndromes, accounting for up to one-third of the total of diagnosis. The metastatic form is the most common presentation of the tumors with familiar origin and due to their rarity, their diagnosis and management is often difficult. Over the years, our knowledge and perception of PHEO and PGL has greatly expanded and changed. This review article aims to focus on the genetic, clinical, diagnostic, therapeutic and prognostic approaches, to give the clinician knowledge of the most recent updates regarding these themes.Objective Postoperative recovery process following laparoscopic cholecystectomy depends on many factors such as pain, fatigue and exhaustion. The objective of this study was to investigate whether the administration of dexamethasone, a glucocorticoid, has positive effects of postoperative patient comfort in patients who underwent laparoscopic cholecystectomy in our clinic. Methods Patients who presented to the general surgery clinic of our hospital and scheduled for laparoscopic cholecystectomy due to cholelithiasis were included in this study. Patients in Group 1 received dexamethasone 90 minutes before the skin incision, while patients in Group 2 were given placebo (normal saline). Pain scores, presence of nausea and vomiting in the postoperative period were compared between the study and control groups. https://www.selleckchem.com/products/sgc707.html Results No statistically significant difference was observed between the groups in terms of incisional pain at rest and in motion and visceral pain at rest at postoperative 6th, 12th and 24th hours. Although there was a difference between the groups in terms of visceral pain in motion at the postoperative 12th and 24th hours, this was not statistically significant (p > 0.05). Although the need for additional analgesics and antiemetic drugs was lower in the study group compared to the control group, the difference between the groups was not statistically significant (p > 0.05). Conclusion We can expect better results with the use of multimodal analgesic and anti-emetic combination instead of a single agent in studies to be performed about the prevention of postoperative pain, nausea and vomiting.Numerous snapping syndromes have been reported in the musculoskeletal system. Identifying the cause of these symptoms can often be challenging as the underlying abnormality may not be appreciable on routine static examinations. We report a 30-year-old female who presented with an unusual snapping sensation in her right anterior shoulder. This was readily reproducible during shoulder abduction with a palpable clicking evident on clinical examination. Dynamic ultrasound revealed this to be secondary to an accessory coracobrachialis muscle, which subluxed suddenly over the anterior subscapularis tendon during abduction. An accessory coracobrachialis muscle is a rare normal variant that is often asymptomatic. Extra-articular causes of shoulder snapping have been rarely reported, and this is the first case report of an accessory coracobrachialis muscle causing a snapping shoulder phenomenon.The purpose of this review is to look at the incidence of post-laminectomy kyphosis in achondroplasia patients and to determine whether skeletal maturity and the number and location of laminectomies predict kyphosis in this patient population. Our review of the literature included all articles from MEDLINE/PubMed and Ovid from inception to 2019. After removing duplicates and checking for relevancy, the final number of articles yielded was eight. The results of this review summarize the incidence of post-laminectomy kyphosis in achondroplasia patients. In conclusion, we suggest fusion be considered in conjunction with multilevel laminectomies due to a high incidence of kyphosis with a need for stabilization in the pediatric achondroplastic patient population.The depiction of superheroes and comic book characters in television shows has become incredibly popular. The objective of this study was to determine the positive and negative themes depicted in a select number of superhero-based television shows. A total of 49 episodes from 10 superhero-based television shows were analyzed by four independent reviewers. The average number of positive and negative themes was 18.8 and 36.9 mean events per hour, respectively, for all included episodes. The most common positive themes in our sample were associated with service, teamwork, and encouragement, and the most common negative themes were associated with violence, bullying, and alcohol use. Although exposure to positive themes depicted in superhero-based television shows may be beneficial to the development of children and adolescents, pediatric health care providers should counsel families in an attempt to limit their exposure to violence and other negative themes depicted in this genre of television shows.