No abstract

INTRODUCTION According to the National Confidential Enquiry into Perioperative Deaths (NCEPOD), out-of-hours operating in trauma and orthopaedics should be reserved for life or limb threatening cases only. The aim of our study was to determine the nature of non-emergency work carried out in our trust at night in 2015. The overall efficacy and clinical safety of the services provided was evaluated. METHODS Surgical activity undertaken after 9pm was reviewed along with patient ASA (American Society of Anesthesiologists) grade, grade of operating surgeon and any complications that occurred following the procedure. Furthermore, the clinical urgency and safety of cases was assessed based on whether there was any record of life or limb threatening indications at the time of admission. RESULTS Overall, 131 procedures were performed after 9pm, with 102 performed between 9pm and midnight, and 29 after midnight. Consultants performed 16 cases and the remaining 115 cases were operated on by middle grades or specialty trainees. A fifth (20%) of the cases were genuinely life or limb threatening. A total of 123 procedures were classed as having good outcomes. The complication rate was 8%. CONCLUSIONS In our study, 80% of the procedures performed after 9pm could not be categorised as life or limb threatening. Appropriate NCEPOD classification would ensure that only life or limb threatening cases were listed for theatre after 9pm. Alternative methods of operating within working hours should be considered.

Der von Valsalva im Jahre 1707 zur Untersuchung des Trommelfells angegebene Preßversuch, welcher es ermöglicht, durch Pressen bei geschlossenem Mund und zugehaltener Nase Eiter durch eine Trommelfellperforation aus dem Mittelohr nach außen zu pressen, hat eine viel allgemeinere Bedeutung deshalb, weil eine Reihe normaler physiologis.cher Vorgänge mit einer Steigerung des intrapulmonalen Druckes verbunden sind. Hierauf hat schon vor über 100 Jahren der Physiologe Weber (i4) hingewiesen, da die Bedingungen des Valsalva-Versuches bei jeder großen Anstrengung, zum Beispiel beim Husten, Niesen, Erbrechen, beim Heben schwerer Gewichte, beim UBERSICHTEN Kreislaufwirkung des Valsalva-Versuches Stemmen, bei der Darmentleerung, bei den PreBweheil des Geburtsaktes und schließlich auth bei gewissen starken Emotionen ,, willentlich" hervorgerufen würden.

In order to evaluate more clearly the possible physiological effects of insulin on the lens, insulin was measured in the aqueous humor and plasma of rabbits in the fasting state and at hourly intervals after refeeding. The mean insulin concentration in plasma rose from 1,200 to a peak of 3,000 pg/ml at 1 h, while in aqueous humor it rose from 28 to a peak of 48 pg/ml at 3 h (1 pg = 0.025 µU). The results suggest that the blood-aqueous barrier is relatively impermeable to insulin. Glucose concentrations in aqueous humor and plasma were correlated with the insulin concentrations. Possible insulin-mediated metabolic consequences of uveitis and diabetes to the lens are discussed.

No abstract