Laparoscopic Nissen fundoplication in a community hospital: patient satisfaction survey

OBJECTIVES

To assess the efficacy of laparoscopic Nissen fundoplication for esophageal reflux in a community hospital.

METHODS

One hundred nineteen patients (76%) of 157 patients having laparoscopic fundoplication for symptomatic reflux disease completed a questionnaire. All patients were evaluated with esophagoscopy, esophageal motility, and pH studies.

RESULTS

Mean follow-up was 49 months. Ninety-three patients (78%) no longer had heartburn. Seven patients still had daily heart-burn (5.9%). One hundred three patients (86.6%) had no sour regurgitation. Seventy-five patients (63%) had no dysphagia after surgery. Forty-two patients had some dysphagia after surgery (36.8%). Six patients (5.0%) had significant dysphagia. Only 4 patients stated that dysphagia interfered with their quality of life. Twenty-six patients (22.8%) thought that belching and bloating were worse, whereas 42 patients (36.8%) thought that belching and bloating were better after surgery. Antacids, histamine-2 antagonist, and proton pump inhibitors were still being used by 12.6%, 14.3%, and 21.8% of patients, respectively.

CONCLUSIONS

Eighty-seven patients were completely satisfied (73.1%), 26 patients somewhat satisfied (22.8%), and 6 patients unsatisfied (5.3%) with surgery. Overall satisfaction with the surgery was 94.7%. One hundred five patients (88.2%) would recommend the surgery to others. Laparoscopic Nissen fundoplication can be effectively done in a community hospital setting.

Laparoscopic Nissen fundoplication in a community hospital: analysis of 202 patients

We analyzed 202 patients undergoing Laparoscopic Nissen fundoplication. One hundred and three patients (90.6%) had typical reflux symptoms. Hiatal hernias were present in 84.6%. Most patients had erosive esophagitis; sixty-four patients (31.6%) had strictures. Complications occurred in 38 patients (18.8%), with major complications in 15 patients (7.4%). Major complications included bleeding in six, two requiring transfusion, slipped Nissen in three, pneumothorax in two, and esophageal leak in two patients. Eleven patients had postoperative dysphagia that responded to dilation therapy within three months. There was no mortality.

Evaluating provider prescribing practices for the treatment of tuberculosis in Virginia, 1995 to 1998: an assessment of educational need

BACKGROUND

Although the use of epidemiologic studies to demonstrate learning needs appears to be infrequent, this study addressed the discrepancies in the prescribing practices for the initial treatment of tuberculosis in Virginia between public and private clinicians, comparing them with the treatment regimens recommended by the Centers for Disease Control and Prevention and the American Thoracic Society (CDC-ATS).

METHODS

Data examined were the 1995 to 1998 reported cases of tuberculosis within the Commonwealth of Virginia. The study population consisted of 770 laboratory-confirmed tuberculosis cases, living in Virginia, whose isolates were tested for isoniazid susceptibility and were prescribed an initial drug regimen. Prevalence rates, prevalence odds ratios, and logistic regression were used to determine the estimated risk for receipt of the CDC-ATS treatment regimen.

RESULTS

Of the 770 cases, 28.7% did not receive the CDC-ATS recommended drug regimen. Prevalence rates and odds for not receiving the recommended regimen were highest among persons of United States origin, Caucasians, females, persons under age 15, and persons from the southwest region of Virginia. Logistic regression indicated a slight increase in the estimated risk of not receiving the CDC-ATS regimen from a private physician (OR: 1.40; CI: 0.97, 2.04) when compared to a public physician.

FINDINGS

Private tuberculosis care providers were less compliant with CDC-ATS guidelines than public tuberculosis care providers. Because providers did not follow the recommended treatment guidelines universally, it is advised that all tuberculosis care providers in Virginia would benefit from increased education regarding adequate treatment regimens for tuberculosis and the prevention of multidrug-resistant tuberculosis.

Advances in balloon dissection

The use of a balloon as a dissecting tool was pioneered by Gauer and Kieturakis in the early 1990s.This newapplication of balloon dissection in surgery allows the creation of a working space in which a procedure is performed. This is combined with minimally invasive techniques that confer the advantages of shorter recovery and less pain for several different procedures.

The IVEX refraction system: a clinical comparison

A new refraction system employing traditional modes of testing combined with microprocessor-based electronics and new optical technology was evaluated in a controlled study to determine if the instrument produced subjective refractions corresponding to the traditional refractor. Subjects ranged in age from 14 to 25 years and the study excluded any individual exhibiting ocular or systemic diseases and binocular problems. In addition, tests were made to determine if "instrument myopia" was present. The results showed that data from the IVEX Refraction System correlated highly with data from the standard refractor, but a small amount (0.25 D to 0.37 D) of instrument myopia was present in most instances.

Influence of dietary calcium, phosphorus, zinc and sodium phytate level on cataract incidence, growth and histopathology in juvenile chinook salmon (Oncorhynchus tshawytscha)

To determine the influence of wide variations in dietary levels of calcium, zinc and phytic acid (as sodium phytate) on growth and cataract incidence, juvenile chinook salmon held at 10-11 degrees C were fed daily to satiation for 105 d one of nine purified diets containing one of three levels (grams/kilogram) of calcium (averaged 4.8, 17.7, 50.2), zinc (averaged 0.05, 0.15, 0.39) and phytic acid (1.62, 6.46, 25.8). Diets were formulated to have a calcium-phosphorus ratio of close to unity when considering phosphorus sources other than sodium phytate. High dietary phytic acid concentration (25.8 g/kg) depressed chinook salmon growth, food and protein conversion [protein efficiency ratio (PER)] and thyroid function, increased mortality, promoted cataract formation (zinc at 0.05 g/kg) and induced anomalies in pyloric cecal structure. Calcium at 51 g/kg (or phosphorus) exacerbated the effects of high dietary phytate and low dietary zinc on cataract incidence. Moreover, high dietary levels of calcium (48-51 g/kg) coupled with phosphorus significantly impaired the growth and appetite of low phytic acid (1.62 g/kg) groups and led to nephrocalcinosis in low and high phytic acid groups. Plasma zinc levels were directly related to dietary zinc concentration and inversely related to dietary phytic acid level. Calcium (51 g/kg) and/or phosphorus reduced zinc bioavailability when the diet concurrently contained 0.05 g zinc and 25.8 g of phytic acid per kilogram. It is concluded that zinc is essential for normal eye development in juvenile chinook salmon. Further, zinc deficiency could not be induced in chinook salmon fed diets with high ratios of calcium (or phosphorus) to zinc alone. This required the simultaneous presence of a strong mineral (zinc)-binding agent.

Traps, male lures, and a warning system for Queensland fruit fly, Dacus tryoni (Frogg.) (Diptera, Trypetidae)

The attractiveness of eight prospective lures for male Queensland fruit fly was tested in a simple olfactometer. Six of these compounds were found to be attractive and these were ranked in field trials in which traps were baited with a mixture of each lure and malathion.Trap catches varied with lure, trapping site, weather (including wind speed), and season. Cue lure, 4-(p-acetoxyphenyl)butan-2-one, was the most attractive compound. Baits made by mixing cue lure and malathion were of unchanged attractiveness after more than 6 months but mixtures of cue lure and DDVP declined in attractiveness within 6–12 days. Funnel traps baited with cue lure and malathion and spaced 0.4 km apart in a square grid pattern caught 4.1% of newly emergent flies and 9% of mature flies (2–3 weeks old) released in the centre of the grid. The use of such a grid in early warning systems is discussed.

The use of sterile males to control populations of Queensland fruit fly Dracus tryoni (Frogg) (Diptera : Tephritidae) II. Field experiments in New South Wales

In the field trials of sterile males against the Queensland fruit fly, Dacus tryoni, irradiated pupae of this species were distributed in three towns of western New South Wales in the period September 1962 to March 1965. All these towns and a number of others which served as controls had a previous history of heavy infestation by Dacus tryoni. The success of this method was estimated by comparing the rate of infestation of ripe fruit in treated and untreated towns. The first sign of success came in Manilla in spring (October) 1963 when 51.0% of the eggs deposited in loquats were estimated to be infertile compared with 6.7% in three control towns. However, our production of pupae at this stage was too low to maintain control in Manilla in the summers of 1962-63 and 1963-64. From late April 1963 to late March 1964 most of our production was released in the town of Warren. With a total release in this period of 5.7 x 106 pupae we achieved infestation rates of 2-8% in the summer fruit between early December 1963 and late March 1964, compared with infestation rates of 8-75% in three control towns during the same period. Towards the end of March 1964 the infestation rates began to rise in Warren apparently owing to the immigration of inseminated females along the Macquarie River. An infestation rate of 20% was reached in Warren in April 1964. Between early December 1964 and late March 1965 the rates of infestation in Warren were even more depressed, reaching values of 0 - 7.5% compared with 10-57% in the new control town of Baradine. The total number of pupae released within the town between August 1964 and March 1965 was 12.57 x l06. However, immigrants again brought the infestation up to 10% in April 1965 even though an additional 2.67 x l06 pupae had been distributed along the river for 6 km on either side of the town. In the same period (summer 1964-65) Dacus tryoni was eradicated from Trangie where its numbers had been brought down by trapping out the males with a male lure (Bateman 1966). No infestation was found from October 1964 to April 1965 after the release of 5.33 x l06 pupae between late August 1964 and late March 1965. The rate of infestation in the control town of Gilgandra which had also been treated with cue-lure in the previous summer rose from 0% on October 21, 1964 to 16.2% by April 23,1965. The method could be used to suppress incipient outbreaks of Dacus tryoni in southeastern Australia and even for the eradication of established populations where these are isolated and can be brought low by other means.