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The requirement of RMS (voltage and current) measurements under a fraction of the AC period has become increasingly attractive in power systems. Some of these power applications are responsible for voltage stabilization in distribution lines when the voltage correction should be made in a short time, no more than one or two periods of the AC signal. Previously developed RMS correction applications must be validated in real-world situations characterized by an abrupt change (discontinuity) in voltage magnitude occurring even during a single AC period. Such circumstances can substantially influence the RMS estimation and, therefore, should be considered. This article suggests a mathematically based approach, validated in the laboratory, that improves the accuracy of a voltage RMS estimation for the appropriate measurement devices. It produces better results in cases where the RMS assessment should be done in a fraction of the AC period.

The increasingly widespread occurrences of fast-changing loads, as in, for example, the charging of electrical vehicles and the stochastic output of PV generating facilities, are causing imbalances between generated and consumed power flows. The deviations in voltage cause noteworthy technical problems. The tap-changers in today's transformers are slow-reacting and thus cannot effectively correct the imbalance. Tap-changers should be replaced by special appliances, installed in distribution lines, that can effectively estimate voltage RMS and refine imbalances during a fraction of the AC period, preferably less than half. This article suggests specially developed methods for RMS assessment based on approximating instantaneous voltage magnitudes using harmonics and correcting coefficients.

Background: Volvulus is one of the leading causes of colonic obstruction with a high recurrence rate following endoscopic decompression. Although colonic resection remains the treatment of choice, it is often associated with significant morbidity and mortality, especially in elderly patients. Colonic fixation with extra-peritonealization has been suggested as an alternative to colonic resection. The aim of this study was to evaluate the surgical outcomes of patients with colonic volvulus in our initial experience with this procedure., Methods: A retrospective analysis of a prospectively maintained database of all patients who underwent colonic extra-peritonealization for volvulus between January 2016 and April 2021 in Sheba medical center (Ramat-Gan, Israel) was performed. Patients' demographics, clinical, peri-operative and post-operative data were recorded and analyzed., Results: One hundred and thirty nine patients were admitted due to acute colonic volvulus, 48 of whom were treated surgically. Eleven patients underwent extra-peritonealization of the sigmiod or cecum during the study period. Mean age was 64.5 years. Six patients (54.55%) were males. Seven patients (63.63%) presented with sigmoid volvulus and 4 (36.36%) with cecal volvulus. Median American Society of Anesthesiologists (ASA) class was 3 (range 2-4). One patient (9.09%) was required urgent surgery. The majority of patients was operated on using a laparoscopic approach (10 patients, 90.9%). Median length of stay was 3 days (range 1-6 days) and no post-operative complications or readmissions within 30 days after surgery were recorded. Median length of follow-up was 283 days (range 21-777 days). During the follow-up period, three patients (27.27%) presented with recurrent volvulus and required an additional surgical intervention with colonic resection. Of the patients with volvulus recurrence, one patient (9.09%) required an urgent surgical intervention., Conclusions: Extra-peritonealization of colonic volvulus is feasible and safe. Although recurrence rates are fairly high, the low morbidity associated with the procedure makes it an appealing alternative to colonic resection, especially in patients with high risk for post-operative complications., (© 2022. Springer Nature Switzerland AG.)

Background: The 2019 coronavirus disease (COVID-19) pandemic drastically reduced learning opportunities for medical students. We sought to determine the cost and success of implementation of a podcast for a surgical department in a large academic hospital., Methods: We created a podcast series for Israeli medical students during the COVID-19 epidemic based on the Medical Student Core Curriculum of the American College of Surgeons / Association for Surgical Education. Episodes were available for free download or streaming on a designated website and popular podcast platforms. Podcast analytics were used to measure public listeners and uptake., Results: Total development time was 90 hours at an estimated cost of $7091 USD. A total of 10 episodes were released between March 21, 2020 and August 31, 2020. An average of 9 ± 1.26 h (range 2-6) was required to generate each episode, including 3.4 ± 1.26 h (2-6) for content review and 5.6 ± 2 h (4-10) for audio production. An average episode ran for 35.9 ± 4.3 min (28-42). Podcasts recorded a total of 5678 downloads, with an average of 228 and 336 downloads per episode in the first 30 and 90 days, respectively. The average daily downloads before the students returned to clinical rotations (March 21-April 30) was 48 ± 58.3 (7-283;) compared to 16 ± 7.4 after their return (1-38; P< 0.01). Estimated costs to produce a video-based education series would have been significantly more., Conclusion: Podcasts can serve as a cost-effective and quickly produced instructional tool to supplement online learning. Further research is required to determine the efficacy of podcasts versus video-based education modules., (Copyright © 2021. Published by Elsevier Inc.)

Importance: Previous studies have shown that uniform pathologic review of all splenectomy surgical specimens reveals new clinically actionable diagnoses only in a minority of cases., Objective: To examine whether the aggregate of clinical, laboratory, imaging, and pathologic preoperative data is associated with a clinically beneficial pathologic study for routine splenectomy surgical specimens., Design, Setting, and Participants: This single-center retrospective cohort study included all patients who underwent splenectomy from January 1, 2013, through December 31, 2018, at a single center. Clinical, imaging, and pathologic data were extracted from the institution's electronic medical records system. Data analysis was conducted from June to November 2020., Exposures: Undergoing splenectomy for trauma or diagnostic or therapeutic indications., Main Outcomes and Measures: Spleen pathology study resulting in a new medical diagnosis or change in medical management., Results: Overall, 90 patients (53 [59%] men) with a median (range) age of 59 (19-90) years underwent splenectomy for therapeutic purposes in 41 patients (45%), trauma in 24 patients (27%), diagnostic purposes in 15 patients (17%), and combined therapeutic and diagnostic purposes in 9 patients (10%). In 14 patients (15%) a new malignant neoplasm was found, and in 8 patients (9%), a new nonneoplastic medical condition was diagnosed. A new pathologic diagnosis resulted in change in medical management in 16 patients (18%). In patients without a prior diagnosis of cancer, 41 of 56 pathology biopsies (73%) were found to be normal whereas in 7 biopsies (13%), a new diagnosis of a hematologic malignant neoplasm was revealed (P < .001). Patients with clinical splenomegaly were significantly more likely to have a new pathologic diagnosis of cancer compared with patients without splenomegaly (15 of 26 [58%] vs 4 of 64 [7%]; P < .001). In 39 of 43 patients (91%) with normal presurgery imaging studies, normal spleen pathology was revealed, whereas in 14 of 17 patients (82%) with abnormal imaging studies, a new hematological malignant neoplasm was diagnosed following pathologic review of the spleen specimen (P < .001). Patients with gross abnormalities on macroscopic examination had a significantly increased likelihood of a hematological cancer diagnosis (17 of 40 [43%]) and a solid cancer diagnosis (4 [10%]) compared with patients with grossly normal specimens (4 of 49 [8%]; P < .001)., Conclusions and Relevance: In this cohort study, routine pathologic review of spleen specimens was clinically beneficial in patients with splenomegaly, abnormal imaging results, a prior diagnosis of cancer, and with grossly abnormal spleens.

Background: The coronavirus disease-2019 (COVID-19) outbreak had an effect on healthcare., Objectives: To evaluate the presentation and management of patients with acute appendicitis., Methods: A retrospective study was conducted of all patients presenting with acute appendicitis to the emergency department of a large tertiary center during March and April 2020. Clinical features, diagnostic workup, and management were compared., Results: Seventy-four patients presented with acute appendicitis during the pandemic compared to 60 patients during the same time the year before. There were no significant differences in patient demographics: age (P = 0.65), gender (P = 0.73), smoking status (P = 0.48). During COVID-19 patients were more likely to complain of right lower quadrant pain (100% vs. 78.3%, P < 0.01). Rates of surgical treatment was similar (83.8% vs. 81.7%, P = 1); mean operative time was longer during COVID-19 (63 ± 23 vs. 52 ± 26 minutes, P = 0.03). There were no significant differences in intra-operative findings including the presence of appendiceal perforation (16.3% vs. 14.5%, P = 0.8), abscess (6.1% vs. 9.7%, P = 0.73), or involvement of cecum or terminal ileum (14.28% vs. 19.63%, P = 1). Postoperative treatment with antibiotics was more prevalent during COVID-19 (37.1% vs. 18%, P = 0.04). Length of stay (1.82 ± 2.04 vs. 2.74 ± 4.68, P = 0.2) and readmission rates (6% vs. 11.3%, P =0.51) were similar., Conclusions: The COVID-19 pandemic did not significantly affect the presentation, clinical course, management, and outcomes of patients presenting with acute appendicitis.

Background: In the past decade, deep learning has revolutionized medical image processing. This technique may advance laparoscopic surgery. Study objective was to evaluate whether deep learning networks accurately analyze videos of laparoscopic procedures., Methods: Medline, Embase, IEEE Xplore, and the Web of science databases were searched from January 2012 to May 5, 2020. Selected studies tested a deep learning model, specifically convolutional neural networks, for video analysis of laparoscopic surgery. Study characteristics including the dataset source, type of operation, number of videos, and prediction application were compared. A random effects model was used for estimating pooled sensitivity and specificity of the computer algorithms. Summary receiver operating characteristic curves were calculated by the bivariate model of Reitsma., Results: Thirty-two out of 508 studies identified met inclusion criteria. Applications included instrument recognition and detection (45%), phase recognition (20%), anatomy recognition and detection (15%), action recognition (13%), surgery time prediction (5%), and gauze recognition (3%). The most common tested procedures were cholecystectomy (51%) and gynecological-mainly hysterectomy and myomectomy (26%). A total of 3004 videos were analyzed. Publications in clinical journals increased in 2020 compared to bio-computational ones. Four studies provided enough data to construct 8 contingency tables, enabling calculation of test accuracy with a pooled sensitivity of 0.93 (95% CI 0.85-0.97) and specificity of 0.96 (95% CI 0.84-0.99). Yet, the majority of papers had a high risk of bias., Conclusions: Deep learning research holds potential in laparoscopic surgery, but is limited in methodologies. Clinicians may advance AI in surgery, specifically by offering standardized visual databases and reporting.

Background: The novel coronavirus disease (COVID-19) pandemic changed medical environments worldwide., Objectives: To evaluate the impact of the COVID-19 pandemic on trauma-related visits to the emergency department (ED)., Methods: A single tertiary center retrospective study was conducted that compared ED attendance of patients with injury-related morbidity between March 2020 (COVID-19 outbreak) and pre-COVID-19 periods: February 2020 and the same 2 months in 2018 and 2019., Results: Overall, 6513 patients were included in the study. During the COVID-19 outbreak, the daily number of patients visiting the ED for acute trauma declined by 40% compared to the average in previous months (P < 0.01). A strong negative correlation was found between the number of trauma-related ED visits and the log number of confirmed cases of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in Israel (Pearson's r = -0.63, P < 0.01). In the COVID-19 period there was a significant change in the proportion of elderly patients (7% increase, P = 0.002), admissions ratio (12% increase, P < 0.001), and patients brought by emergency medical services (10% increase, P < 0.001). The number of motor vehicle accident related injury declined by 45% (P < 0.01)., Conclusions: A significant reduction in the number of trauma patients presenting to the ED occurred during the COVID-19 pandemic, yet trauma-related admissions were on the rise.

Background: Technological advances have led to the development of state-of-the-art simulators for training surgeons; few train basic surgical skills, such as vessel ligation., Methods: A novel low-cost bench-top simulator with auditory and visual feedback that measures forces exerted during knot tying was tested on 14 surgical residents. Pre- and post-training values for total force exerted during knot tying, maximum pulling and pushing forces and completion time were compared., Results: Mean time to reach proficiency during training was 11:26 min, with a mean of 15 consecutive knots. Mean total applied force for each knot were 35% lower post-training than pre-training (7.5 vs. 11.54 N (N), respectively, p = 0.039). Mean upward peak force was significantly lower after, compared to before, training (1.29 vs. 2.12 N, respectively, p = 0.004)., Conclusions: Simulator training with visual and auditory force feedback improves knot-tying skills of novice surgeons., Competing Interests: Declaration of competing interest The authors have no conflicts of interests or financial ties to disclose., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: Vessel ligation with a knot is one of the most fundamental tasks surgeons must master. We developed a simulator designed to enable novices to acquire and refine gentle knot tying capabilities., Methods: A bench-top, knot-tying simulator with computer-acquired assessment was tested on expert surgeons and surgery residents at an academic medical center during the years 2016 to 2018. Each participant tied a total of 8 knots in different settings (superficial versus deep) and techniques (1-handed versus 2 hands). The simulator measured vertical forces and task completion time., Results: Fifteen experienced surgeons and 30 surgery residents were recruited. The expert group exerted considerably less total force during placement of the knots than the novice residents (3.8 ± 2.0 vs 9.2 ± 6.1 N, respectively; P = .0005) and the peak force exerted upward was less in the expert group (1.31 ± 0.6 vs 1.75 ± 0.84 N; P = .02). The experts also completed the task in less time (10.9 ± 3.4 vs 18.3 ± 7.2 seconds; P = 0.001)., Conclusion: The simulator can offer residency programs a low-cost, bench-top platform to train and assess objectively the knot-tying capabilities of surgery residents., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: Gastrointestinal (GI) bezoars are the most common foreign bodies causing obstruction in the GI tract. They are frequently seen following upper GI tract surgery and surgical intervention is required often. The aim of this study is to describe the surgical management of GI bezoars., Materials and Methods: A retrospective cohort study, including all patients diagnosed with bezoars between May 2008 and May 2017, was conducted. Patient charts were reviewed, and demographics, clinical, surgical, and postoperative data were collected and analyzed., Results: Forty-five patients were included, with a mean age of 62.04 years (Range 18-91). Thirty patients underwent previous surgery (66.6%), most commonly surgical interventions for peptic ulcer disease (22 patients, 73.3%). Obstruction was most common in the ileum (27 patients, 60%). Thirty-nine patients (86.7%) required surgical intervention. Laparoscopy was attempted in 20 patients (51.2%), but conversion to open procedure was required in 11 patients (55%). Postoperative complication rate was 41%. No preoperative factors were found to be correlated with postoperative complications. Postoperative complications were associated with a longer length of stay (P = .006) and a higher readmission rate (P = .04). Patients treated with laparoscopy tended to have a lower BMI (P = .04), less previous surgeries (P = .04), and a bezoar located more proximally (P = .03), however, laparoscopy showed no benefit in complications rate, readmissions, and length of stay., Conclusions: GI bezoars require surgical intervention at high rates. Postoperative complications are common. Completion of an upper GI endoscopy is important and should be performed at an early stage of management.

Background: Preoperative preparation of patients with Crohn's disease is challenging and there are no specific guidelines regarding nutritional support. The aim of this study was to assess whether preoperative nutritional support influenced the postoperative outcome., Methods: A retrospective, cohort study including all Crohn's disease patients who underwent abdominal surgery between 2008 and 2014 was conducted. Patients' characteristics and clinical and surgical data were recorded and analyzed., Results: Eighty-seven patients were included in the study. Thirty-seven patients (42.5%) received preoperative nutritional support (mean albumin level 3.14 vs. 3.5 mg/dL in the non-optimized group; p < 0.02) to optimize their nutritional status prior to surgery. Preoperative albumin level, after adequate nutritional preparation, was similar between the 2 groups. The 2 groups differ neither in demographic and surgical data, overall post-op complication (p = 0.85), Clavien-Dindo score (p = 0.42), and length of stay (p = 0.1). Readmission rate was higher in the non-optimized group (p = 0.047)., Conclusion: Nutritional support can minimize postoperative complications in patients with low albumin levels. Nutritional status should be optimized in order to avoid hazardous complications., (© 2017 S. Karger AG, Basel.)

Background: Jejunal diverticulitis is a rare clinical entity often overlooked by physicians as a cause for abdominal pain. Although diagnostic capabilities improved in recent years, there is little data about diverticular disease in the proximal small bowel. The aim of this study is to present the clinical course and management in a series of eight cases of jejunal diverticulitis and possible therapeutic interventions., Methods: A cohort retrospective analysis of all patients admitted for acute jejunal diverticulitis between January 2010 and June 2015 was conducted. Patient demographics, clinical, and surgical outcome were recorded and analyzed., Results: Eight patients were admitted for acute jejunal diverticulitis with a mean age of 72.1 (range 55-87) years. Clinical presentation included six patients (75%) with a sealed perforation and only one patient demonstrated distant pneumoperitoneum. All patients were treated initially without surgery and only one patient required surgery because of diverticular complications. Recurrent episodes occurred in two patients (25%). Colonoscopy was performed in all patients after hospitalization that revealed large bowel diverticulosis in all patients (100%). Median follow-up was 8.2 months (3-15 months)., Conclusion: Jejunal diverticulitis can be initially treated conservatively but complicated disease should be considered for surgical management. Further study is required on the relationship between small and large bowel diverticulosis.

Introduction: Laparoscopic adrenalectomy is the surgical treatment for various adrenal diseases. The procedure is a common surgical practice for urologists and general surgeons and requires fundamental laparoscopic skills, nowadays common in the surgical education of residents in these practices. The aim of this study is to assess whether laparoscopic adrenalectomy differs in outcome between certified and trained surgeons and surgical residents and whether the learning curve changes the endpoint of the surgery., Materials and Methods: A cohort retrospective study, including all adult patients who underwent laparoscopic adrenalectomy between June 2008 and June 2014, was conducted. Patients' demographic, clinical, and surgical data were recorded and analyzed., Results: Fifty-three patients were included in the database (21 men, 32 women) with a mean age of 54 years (range 17-77). The cause for surgery was most commonly a benign adrenal tumor (27 patients, 50.9%) followed by large nonfunctioning adrenal tumors (16 patients, 30.1%), and adrenal cancer (8 patients, 15%). Eighteen patients (33.9%) were operated by residents (4-6 years into the residency) and 35 patients by a certified senior surgeon (66.1%). Left-sided adrenalectomy was preferred to right-sided adrenalectomy for resident tutoring (P = .03). Overall, intraoperative complications were seen in 6 patients (11.3%) and postoperative complications were seen in 9 patients (16.9%). There were no differences in operation time (P = .36), intraoperative complications (P = .76), postoperative complications (P = .96), and length of stay (P = .34) between the patients operated by senior residents and certified surgeons., Conclusion: Laparoscopic adrenalectomy is a complex surgical procedure that should be a part of the surgical training of surgery residents, as it is safe in guided hands.

Objective: Acute diverticulitis has been traditionally associated with worse outcome in young patients, indicating a more aggressive surgical approach is required for them. The aim of this study was to assess whether acute diverticulitis was more virulent in young patients., Methods: A retrospective, cross-sectional study included all patients who were admitted for a first episode of acute diverticulitis between January 2004 and December 2013. The patients were divided into two groups (≤50 years and >50 years) based on their age. Patients' characteristics, clinical and surgical data were recorded and analyzed., Results: Overall, 636 patients were included in the database, including 177 (27.8%) in the younger group and 459 in the elder group. There were no significant differences between the groups in disease complexity, peritonitis, laboratory work-up, vital signs on presentation, bowel obstruction or the presence of fistula and abscess in need of drainage. Younger patients had more free extra-luminal air on computed tomography (CT) scan (P = 0.03). Surgical data, including the intra-operative modified Hinchey score and the need for emergency and additional surgery did not significantly differ between the two groups. Young patients had more readmissions (P = 0.01) due to acute diverticulitis, diverticular complications and elective surgery. Length of hospital stay (P = 0.0001) was longer and postoperative complications were more common in the elder patients., Conclusions: The clinical presentation of acute diverticulitis does not seem to be worse in the young population. Younger patients tend to have a more severe presentation on CT scan and more readmissions, but this did not translate to a more severe disease course., (© 2016 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd.)

Background: Medical simulation is an increasingly recognized tool for teaching, coaching, training, and examining practitioners in the medical field. For many years, simulation has been used to improve trauma care and teamwork. Despite technological advances in trauma simulators, including better means of mobilization and control, most reported simulation-based trauma training has been conducted inside simulation centers, and the practice of mobile simulation in hospitals' trauma rooms has not been investigated fully., Methods: The emergency department personnel from a second-level trauma center in Israel were evaluated. Divided into randomly formed trauma teams, they were reviewed twice using in situ mobile simulation training at the hospital's trauma bay. In all, 4 simulations were held before and 4 simulations were held after a structured learning intervention. The intervention included a 1-day simulation-based training conducted at the Israel Center for Medical Simulation (MSR), which included video-based debriefing facilitated by the hospital's 4 trauma team leaders who completed a 2-day simulation-based instructors' course before the start of the study. The instructors were also trained on performance rating and thus were responsible for the assessment of their respective teams in real time as well as through reviewing of the recorded videos; thus enabling a comparison of the performances in the mobile simulation exercise before and after the educational intervention., Results: The internal reliability of the experts' evaluation calculated in the Cronbach α model was found to be 0.786. Statistically significant improvement was observed in 4 of 10 parameters, among which were teamwork (29.64%) and communication (24.48%) (p = 0.00005)., Conclusion: The mobile in situ simulation-based training demonstrated efficacy both as an assessment tool for trauma teams' function and an educational intervention when coupled with in vitro simulation-based training, resulting in a significant improvement of the teams' function in various aspects of treatment., (Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

In this study new metrics were developed for assessing the performance of surgical knots. By adding sensors to a knot tying simulator we were able to measure the forces used while performing this basic and essential skill. Data were collected for both superficial tying and deep tying of square knots using the one hand and two hands techniques. Participants used significantly more force when tying a deep knot compared to a superficial knot (3.79N and 1.6N respectively). Different patterns for upward and downward forces were identified and showed that although most of the time upward forces are used (72% of the time), the downward forces are just as large. These data can be crucial for improving the safeness of knot tying. Combing these metrics with known metrics based on knot tensiometry and motion data may help provide feedback and objective assessment of knot tying skills.

Alpha thalassemia-mental retardation, X-linked (ATR-X) syndrome is a rare genetic disorder with a variety of clinical manifestations. Gastrointestinal symptoms described in this syndrome include difficulties in feeding, regurgitation and vomiting which may lead to aspiration pneumonia, abdominal pain, distention, and constipation. We present a 19-year-old male diagnosed with ATR-X syndrome, who suffered from recurrent colonic volvulus that ultimately led to bowel necrosis with severe septic shock requiring emergent surgical intervention. During 1 year, the patient was readmitted four times due to poor oral intake, dehydration and abdominal distention. Investigation revealed partial small bowel volvulus which resolved with non-operative treatment. Small and large bowel volvulus are uncommon and life-threatening gastrointestinal manifestations of ATR-X patients, which may contribute to the common phenomenon of prolonged food refusal in these patients., (© 2015 Wiley Periodicals, Inc.)

Background: In recent years the city of Eilat has come under threat of rocket attacks. This emphasized the need for an upgrade of the city's medical center capabilities in trauma care. Medical simulation has been used for many years in training and for the improvement of trauma care both at the field Level and in hospitals. Although there was significant improvement in the technological aspects of simulations, the use of simulators was restricted mainly to simulation centers and its effectiveness in training and assessment of trauma teams in situ in emergency departments was still not examined., Objectives: To train the personnel engaged in trauma care in a small rural medical center in the fastest and most comprehensive manner, using a mobile and highly sophisticated medical simulator., Methods: A team of simulation specialists from MSR, Israel Center for Medical Simulation, held a one week long course including all the staff members involved in trauma care, 38 doctors and nurses in total. All drills were recorded and then reviewed in the debriefing. Four staff members were trained in video debriefing at MSR. The participants were requested to complete questionnaires before and after training., Results: Subjective feelings of competence in the team's ability to treat trauma patients were found to improve after training. Airway management rating of very good improved from 21.05% prior to training to 50% after the course. Chest trauma management and hemorrhage control scores of very good rose from 10.53% and 26.32% before to 42.11% and 55.26% respectively after the course. The highest improvement was measured in teamwork performance, which was ranked as very good: 10.53% before training and elevated to 47.37% after training. A total of 74% of the responders stated that this training program contributed very significantly to their trauma care capabilities., Conclusions: The use of mobile medical simulations combined with instructors from within the hospital enabled the training and assessment of the trauma care in situ and in a short time.

Renal haematoma during severe preeclampsia is a rare uneventful event. It is usually associated with other organ injury such as cerebral or liver haematoma. Imaging (ultrasound or tomodensitometry examination) plays an important role in detecting this complication and following its evolution. In the current case report, we describe an isolated renal haematoma during a severe preeclampsia complicated by a HELLP syndrome. This patient was managed with a conservative treatment (control of arterial pressure and induction of delivery) and an imaging follow-up., (Copyright © 2014 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier SAS. All rights reserved.)

Background: Postpartum anaemia (PPA) is a common postpartum complication. The goal of this study was to prospectively construct a predictive score for individual risk of PPA. PATIENTS ET METHOD: We prospectively analyzed factors associated with PPA (<10gdL(-1) at 48hours postpartum). Parameters analyzed were demographic data, pregnancy characteristics, delivery and postpartum characteristics. Univariate analysis was performed using Anova or X(2); the Cox model was used for multivariate analysis. The scoring system was validated using ROC curve., Results: Analysis was performed in 475 patients and validation was carried using an additional 95 patients. Multivariate analysis found four factors independently associated with PPA: anaemia during the third trimester of the pregnancy, Southeast Asian ethnic origin, episiotomy and severe postpartum haemorrhage (PPH) identified by the use of sulprostone. According to the score derived from the Cox model, patients were classified as low (22%, score=0), medium (55%, score=2 or 3) and high (86%, score>3) probability of PPA. Using the AUC of the ROC curve for both the first and the validation cohorts (performed on 95 further patients), we recorded AUCs of 72% and 70% respectively., Conclusions: This study allowed the derivation and validation of a predictive score of PPA. This score might be useful in targeting prophylactic strategies for PPA. Such strategies could include a more active treatment of iron deficiency (increasing oral iron treatment observance or intravenous iron therapy) especially in exposed population, improvement in the prevention and treatment of postpartum haemorrhage and decreasing the use of episiotomy. Future studies must focus on the external validation and generalisation of this scoring system., (Copyright © 2012 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier SAS. All rights reserved.)

13 high jejunal atresias, including 6 type IIIb apple peel small bowel deformities, have been treated by a one stage surgical procedure, including proximal jejunal resection, tapering duodenoplasty and end-to-end duodeno-jejunal or duodeno-ileal anastomosis. All 13 infants survived. There were no anastomotic leak or malfunction. 7 jejunal atresias with normal distal small bowel were fed a mean of 9 days post-operatively (range 4 to 12 days). Intra-venous fluids were discontinued at a mean of 18 days post-operatively (range 13 to 24 days). Patients, all premature babies, were discharged on the mean 30th post-operative day (range 24 to 40). 5 jejunal atresias with apple peel deformity were fed with an average post-operative delay of 21 days (range 12 to 24). All intra-venous fluids were discontinued at a mean of 48 days post-operatively (range 35 to 90). Average hospital stay was 78 days (45 to 120). In one case, an ileal diaphragm, unnoticed during the first operation was subsequently resected at age 45 days and an iterative tapering duodenoplasty was performed at the age of 8 months. Recovery was then uncomplicated and the child was discharged on a normal oral feeding at the age of 10 months. Functional obstruction of the intestine at the site of anastomosis often occurs in high jejunal atresias. 70% of mortality resulted from operative complications in atresias with apple peel deformity. Intestinal distension is the cause of anastomotic malfunction. After jejunal resection, the duodenum remains dilated and anastomosis cannot function properly.(ABSTRACT TRUNCATED AT 250 WORDS)

Malignant hyperthermia (MH), triggered by anaesthesia, is a rare and potentially fatal condition. It requires immediate and specific treatment. This review focuses on anticipation and organisation of treatment. Anticipation means that dantrolene should be available, that an anaesthetic machine should be kept free from all vapours of halogenated anaesthetics, and methods of cooling should be planned. A prompt availability in all operating theatres of dantrolene and the required machines is emphasized. Treatment of a MH episode includes stopping the administration of triggering agents, administering dantrolene, correcting metabolic and respiratory acidosis, and cooling. Different aspects of the cardiovascular pharmacology of dantrolene are discussed. Other drugs are seldom required if proper treatment is started soon enough after the crisis. Complications may arise during a fulminant episode. They are difficult to treat, and may lead to sequelae. A rational approach to the treatment of hyperkalaemia, circulatory and renal failure is discussed. After the crisis, dantrolene should be continued for a short time. Finally, the nonspecific signs which can give the earliest diagnosis possible of MH are discussed: an early diagnosis and early treatment with dantrolene are essential in reducing the mortality of malignant hyperthermia.