Reaching proficiency in laparoscopic splenectomy

Abstract

AIM:To study the association between self-reported peptic ulcer and childhood adversities. METHODS:The Health and Social Support Study (HeSSup) population consisted of a stratified random sample drawn from the Finnish Population Register in four age groups: 20-24, 30-34, 40-44 and 50-54. The survey was carried out by postal questionnaire during 1998, with a response rate of 40.0%. A follow-up questionnaire was sent during 2003 to all those who responded to the first. Altogether 19 626 individuals returned the follow-up questionnaire; a response rate of 75.8%. The subjects were asked whether a doctor had told them that they have or have had peptic ulcer. The analyses covered those who responded affirmatively to both the baseline and the follow-up enquiries (n = 718). Those not reporting a peptic ulcer in either of the two questionnaires (n = 17 677) were taken as controls. The subjects were further requested (through six questions) to think about their childhood adversities. RESULTS:The most common adversities mentioned were long-lasting financial difficulties in the family, serious conflicts in the family, and a family member seriously or chronically ill. All the adversities reported, except parental divorce, were more common among peptic ulcer patients than among controls (P values varied between < 0.001 and 0.003). Age-and sexadjusted odds ratios (OR) of childhood adversities in the multivariate logistic analysis for self-reported peptic ulcer varied between 1.45 and 2.01. Adjusting for smoking, heavy drinking, stress and nonsteroidal antiinflammatory drug use had no further influence (ORs between 1.22 and 1.73). CONCLUSION:Our findings suggest that childhood adversities maintain a connection with and have a predictive role in the development of peptic ulcer.

Vergleich der laparoskopischen Splenektomie in Steinschnittlage mit der Hanging-Spleen-Technik bei idiopathischer thrombozytopenischer Purpura

“…Beim Vergleich der mittleren Operationszeiten ergab sich im longitudinalen Verlauf in einer univariaten Analyse eine signifikante Abnahme der mittleren Operationszeit. Wir gehen davon aus, dass es sich hier um einen Lernkurveneffekt handelt[11,12]. In der Literatur wurde beschrieben, dass es durch die Änderung der Patientenpositionierung zu einer Verkürzung der Operationszeit kam[13], diesen Unterschied konnten wir nicht bestäti-gen. Es ist davon auszugehen, dass ein Teil des Effektes aus der Literatur auch auf die Lernkurve zurückzuführen ist.…”