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Annals of The Royal College of Surgeons of England logoLink to Annals of The Royal College of Surgeons of England
. 2007 May;89(4):442–444. doi: 10.1308/003588407X183490

Publication of Abstracts from the Best Regional Presentations

Editor: Linda de Cossart
PMCID: PMC1963595
Ann R Coll Surg Engl. 2007 May;89(4):442. doi: 10.1308/003588406X130723

Is Your Phone Bugged? The Incidence of Pathogenic Bacteria on Healthcare Personnel's Mobile Phones

RRW Brady 1, A Wasson 1, I Stirling 1, C Mcallister 1, NN Damani 1

Introduction

Previous research has identified articles present in a clinical setting which harbour pathogenic bacteria. However, no previous study has been published regarding the colonisation of the mobile or cellular phone. This study aims to detect the rate of bacterial colonisation, especially that causing nosocomial infection, on the mobile phones of healthcare personnel and their usage of mobile phones within the hospital environment.

Materials and Methods

Without warning, 148 (85 doctors and 63 nursing or auxiliary staff) in-hospital healthcare staff from Craigavon Area Hospital were asked to complete a questionnaire regarding their usage of mobile phones. Those questioned in possession of their mobile phone underwent immediate bacteriological sampling of those phones. Two sterile bacterial swabs were rotated over the surface and side of each phone's keypad and immediately streaked onto two bacterial plates which underwent bacterial growth and identification by normal methods.

Results

Of respondents, 70.9% (105) had their phones available for sampling (63.5% doctors, 79.7% nurses). Of the phones, 96.1% grew bacteria on sampling (keypad 83%, side 87%). Fifteen (14.3%) phones grew bacteria which cause nosocomial infections. Healthcare staff had owned their phones for an average 18.25 months. Overall, 68.2% of doctors and 84.5% of nursing staff brought their phones to work every day. 40.1% of healthcare staff used their phones at work at least once a day. Only 20.1% of medical personnel had cleaned their phone in the previous month. The type of phone (i.e. clam-shell/flip-top, sliding design) did not significantly affect the incidence of nosocomial pathogenic bacterial growth on the keypad. Of questionnaire respondents, 78% thought that doctors should be allowed to carry phones in hospitals.

Conclusions

Mobile phones can provide a reservoir for potentially pathogenic bacteria. Guidelines on mobile phone usage and enforcement of advice regarding hand hygiene should be introduced to reduce risk from cross contamination.

Ann R Coll Surg Engl. 2007 May;89(4):442–443. doi: 10.1308/003588406X130723

Role of Endovenous Laser Treatment in the Management of Chronic Venous Insufficiency

MA Sharif 1, CV Soong 1, LL Lau 1, B Lee 1, RJ Hannon 1

Introduction

Endovenous laser therapy has been a feasible option in the treatment of uncomplicated varicose veins. This study aimed to evaluate its effectiveness in the management of chronic venous insufficiency.

Patients and Methods

Patients with chronic venous insufficiency, resistant to compression therapy, were selected for endovenous laser treatment using diode laser (DIOMED) in an out-patient setting from May 2003 to April 2004. Compression was not used following successful treatment and patients were assessed for evidence of ulcer healing, long saphenous vein occlusion and satisfaction at 3, 12 and 22 months.

Results

A total of 23 limbs in 20 patients with a median age of 59 years (range, 32–76 years) and a female preponderance of 57% were treated. All patients had evidence of chronic venous insufficiency, graded at C5 or greater on the CEAP classification (C5: 16, C6: 7). The cumulative 3-, 12- and 22-month healing rates were 87% (20/23), 100% (23/23) and 96% 22/23), respectively. The only patient having a recurrent ulcers at 22 months had mid-calf perforator incompetence which was treated successfully with compression hosiery. The duplex occlusion at 3, 12 and 22 months was demonstrated in 100% (23/23), 95% (19/20) and 86% (12/14), respectively. Overall, 87% (20/23) of patients were satisfied with the results of treatment without any major, procedure-related complication.

Conclusions

These results demonstrate that endovenous laser treatment, carried out in an out-patient setting, is effective in the treatment of chronic venous insufficiency, with good patient satisfaction and no major complication. A randomised control trial is required to evaluate further the efficacy of endovenous laser treatment in chronic venous insufficiency.

Ann R Coll Surg Engl. 2007 May;89(4):443. doi: 10.1308/003588406X130723

Histological Examination of Circular Stapled ‘doughnuts’: Questionable Routine Practice

A Morgan 1, PM Dawson 2, JJ Smith 3

Introduction

Histopathological evaluation of cancer resection specimens provides pivotal prognostic and therapeutic information in patients with colorectal cancer. Many surgeons practice routine submission of ‘doughnuts’ of circular stapling devices for histological examination. RCP guidelines state: ‘the decision to examine ‘doughnuts’ is a local one’; the decision is not evidence-based. The aim of this study is questioning the need for this practice by providing our own experience of the impact of ‘doughnut’ submission on patient management.

Patients and Methods

A consecutive series of 100 patients were identified, median age 77 years (range, 44–88 years), who had undergone a stapled resection anastomosis (1998–2004) and where ‘doughnuts’ had been submitted for histological examination. Histopathological and clinical records were reviewed and evaluation of impact on decision-making was documented on a Microsoft Access database merged with the cancer database.

Results

Median distance from DRM 4 cm (range, 1–27 cm). Two abnormal sets with inflammatory changes and a metaplastic polyp. Three patients had LR. Original histology did not show any abnormalities in the doughnuts. Financial cost of processing the specimens was £70.00 per set of ‘doughnuts’. Furthermore, it takes 30 min of a pathologist's time.

Conclusions

This study has shown no benefit in performing routine histological examination of the ‘doughnuts’ which has a considerable impact in terms of time and resource use but with no impact on patient management. Recommendation can be given to abandoning this practice unless there is over-riding clinical concern.

Ann R Coll Surg Engl. 2007 May;89(4):443. doi: 10.1308/003588406X130723

Increasing SHO Training in Light of Reduced Working Hours – A Workable Solution?

SL Littlewood 1, BM Dobbins 1, MI Aldoori 1

Introduction

With the reduction in training hours that has resulted from implementation of the European Working Time Directive, more use is being made of the Day Surgery Unit (DSU) to maximise operative exposure for surgical trainees. We aim to assess the educational value of a compulsory, protected, rotating ‘Day Surgery Week’ (DSW) for surgical senior house officers (SHOs) in a district hospital.

Materials and Methods

Prospective questionnaire analysis of surgical experience gained by 8 SHOs on a 1 in 8 rota, attached on a weekly basis to the DSU over a 4-month period, totalling 2 cycles per SHO.

Results

Over the study period, 66 lists ran totalling 338 procedures. There was 91% SHO attendance giving an average of 4 lists and 17 procedures per SHO each week. Of lists, 92% were consultant led. Procedures listed included ‘lump’ excision (27.5%), inguinal hernia repair (17.3%), examination under anaesthesia (13.7%), and laparoscopic procedures (10.9%). On average, SHOs assisted with 68% of procedures, observed 13.5% and performed 18.5% either independently or under supervision. Extrapolated over a 6-month period, the new DSW would give each SHO an average of 51 procedures (range, 40–80 procedures) compared with an average 36 procedures (range, 6–84 procedures) on the old ‘firm’-based rota.

Conclusions

The DSW offers all SHOs regardless of firm attachment, equal opportunity for one-on-one consultant-led training. Over a 6-month period, trainees are exposed to significantly more procedures in all surgical sub-specialities. The DSW is the best way of providing balanced and equal operative exposure for SHOs in the present training climate.

Ann R Coll Surg Engl. 2007 May;89(4):444. doi: 10.1308/003588406X130723

Haem Oxygenase-1 Preconditioning Agents Differentially Modulate Hepatocyte Function

SJ Mcnally 1, EM Harrison 1, JA Ross 1, OJ Garden 1, SJ Wigmore 1

Introduction

Haem oxygenase 1 (HO-1) is a strong survival factor produced by cells in response to injury. It can be induced pharmacologically to protect cells from injury as a ‘preconditioning’ treatment. This has the potential to improve outcomes after elective liver surgery and liver transplantation, and there is on-going research to develop a suitable HO-1 inducing agent for therapeutic use. Such an agent must not impair the specialised functions of the target organ. This study assesses the effect of HO-1 induction on differentiated hepatocyte function using three pharmacological agents with an established preconditioning profile.

Materials and Methods

Curcumin, cobalt chloride and haemin were studied. Both the HUH7 cell line and primary cultures of isolated human hepatocytes were used. Acute phase protein synthesis, cytochrome P450 activity, urea synthesis and ATP levels were used as markers of differentiated hepatocellular function.

Results

Cobalt inhibited production of all acute phase proteins tested (P < 0.05) and prevented the response to IL-6, whilst curcumin and haemin had minimal effects. Cobalt induced all tested isoforms of cytochrome P450. Curcumin and haemin induced the 1A2 and 2C9 isoforms, respectively (P < 0.05). ATP levels were unaffected. Urea synthesis was halved by curcumin, but increased by cobalt or haemin treatment (P < 0.05).

Conclusions

Haemin treatment has the least effect on differentiated hepatocellular function, and is suitable for human use. However, the different profiles of these three agents may allow selective use of certain HO-1 inducers for specific clinical circumstances.

Ann R Coll Surg Engl. 2007 May;89(4):444. doi: 10.1308/003588406X130723

Can Fenestrated EVAR be Justified?

JR Scurr 1, JA Brennan 1, GL Gilling-Smith 1, D Gould 2, PL Harris 1, SR Vallabhaneni 1, J West 1, RG Mcwilliams 2

Introduction

The objective of this study was to report intermediate-term experience and outcomes with fenestrated endovascular aneurysm repair (EVAR) from a single centre.

Patients and Methods

Between February 2003 and July 2006, 40 patients underwent primary (36) or secondary (4) fenestrated EVAR of a juxtarenal abdominal aortic aneurysm (AAA) with a customised fenestrated Zenith (Cook) stent-graft.

Results

All repairs were completed successfully with preservation of all target vessels. One accessory renal vessel was lost. The median maximum aneurysm diameter was 69 mm (range, 55–100 mm) and median age 73 years (range, 53–85 years). The number of target vessels per patient ranged from 1–4, with 30 (75%) patients requiring > 2 fenestrations. Total number of target vessels was 101 (68 renal, 31 superior mesenteric, 2 coeliac). Seventy-two target vessels were stented (56 uncovered, 16 covered). There was one 30-day death (myocardial infarction) and one in-hospital death at 3 months (athero-embolisation leading to multi-organ failure). One patient has refused surveillance follow-up. A median follow-up of 20 months (range, 1–42 months) has confirmed all aneurysms to be excluded and to be stable or shrinking. Two target vessels have been lost (98% target vessel patency) with no clinical sequelae. There have been 5 secondary interventions (SMA and iliac angioplasties, 2 limb extensions, and a cuff extension for component separation). No late ruptures, conversions to open repair or graft-related endoleaks have occurred. Two late deaths were cancer related and one followed acute pancreatitis.

Conclusions

Intermediate-term results justify the continued use and evaluation of fenestrated EVAR, in selected cases, as an alternative to high-risk surgery in patients with juxtarenal AAA.

Articles from Annals of The Royal College of Surgeons of England are provided here courtesy of The Royal College of Surgeons of England

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