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Cholecystectomy is the standard of care in acute cholecystitis (AC). Percutaneous cholecystostomy (PC) is an effective alternative for high-risk surgical cases. A retrospective analysis is presented of AC patients treated with PC drainage at a single tertiary institution over a 21 month period, assessing outcome and complications. Of 119 patients, 103 had clinical improvement after PC insertion. There were 7 peri-procedural deaths (5.9%), all in elderly high-risk cases. Overall, 56/103 cases (54%) were definitively managed with PC drainage with 41 patients (40%) undergoing an elective cholecystectomy (75% performed laparoscopically). The timing of PC insertion did not affect AC resolution or drain-related complications, although more patients underwent an elective cholecystectomy if PC placement was delayed (>24 h after admission). In AC, drainage by a PC catheter is a safe and effective procedure. It may be used either as a bridge to elective cholecystectomy or in selected cases as definitive therapy.

Object The massive typhoon Haiyan (Yolanda) ripped across the central Philippines on November 8, 2013, and damaged infrastructure including hospitals. The Israeli Defense Forces field hospital was directed by the Philippine authorities to Bogo City in the northern part of the island of Cebu, to assist the damaged local hospital. Hundreds of patients with neglected diseases sought for medical treatment which was merely out of reach for them. Our ethical dilemmas were whether to intervene, when the treatment we could offer was not the best possible. Methods Each patient had an electronic medical record that included diagnosis, management and aftercare instructions. We retrospectively reviewed all charts of patients. Results Over 200 patients presented with neglected chronic diseases (tuberculosis, goiter, hypertension and diabetes). We limited our intervention to extreme values of glucose and blood pressure. We had started anti-tuberculosis medications, hoping that the patients will have an option to continue treatment. We examined 85 patients with a presumed diagnosis of malignancy. Without histopathology and advanced imaging modality, we performed palliative operations on three patients. Eighteen patients presented with inguinal hernia. We performed pure tissue repair on seven patients with large symptomatic hernias. We examined 12 children with cleft lip/palate and transferred two of them to Israel. We operated on one child with bilateral club feet. Out of 37 patients with pterygium, our ophthalmologist repaired the nine patients with the most severe vision disturbance. Conclusion Medical delegations to disaster areas should prepare a plan and appropriate measures to deal with non-urgent diseases.

Background: Early prognostication of acute pancreatitis (AP) patients for those at high risk of complications during hospitalization can facilitate clinical decision-making. Sarcopenia has been proven to be a risk factor for poor prognosis in patients with AP. We aimed to evaluate the association between the muscle parameters measured in computed tomography (CT) and the clinical outcomes of hospitalized patients with AP. Methods: A total of 132 consecutive patients hospitalized between 1 January 2015 and 31 December 2021 for AP with a valid CT scan were analyzed. The first CT conducted during hospitalization was analyzed for psoas muscle area (PMA), index (PMI), and density (PMD) at the L3 vertebral level. The main adverse outcomes indicating a worse prognosis were the development of extrapancreatic complications, infections, ICU transfer, in-hospital mortality, and hospitalization length. Results: The lowest tertile of PMI, as a surrogate for sarcopenia, was significantly correlated with increased rates of extrapancreatic complications, infections, and longer hospitalizations. It was additionally correlated with a worse CT severity index. The results for PMA and PMD also showed worse outcomes, largely mirroring the results for PMI. Although in-hospital mortality was relatively low, none of the patients died in the highest tertile of PMI. A clear cutoff with sufficient predictive capability could not be found. Conclusions: A low psoas muscle index can serve as an additional potential predictive marker for more severe disease and worse outcomes in hospitalized acute pancreatitis patients. More studies are needed to determine its combination with existing prediction tools.

An Israeli medical relief team that usually deploys a freestanding, self-sufficient field hospital found in the Philippines that when a local facility is partly functional, there are important short- and long-term benefits to full integration with the local units. The powerful typhoon that struck the Philippines on November 8, 2013, was the strongest in local history, causing massive destruction and affecting 25 million people. 1 More than 5000 people were confirmed dead, 22,000 were still reported missing when our team arrived in the country, and many others had lost their homes. The damage to the infrastructure left many areas without running water and electricity and caused total devastation in others. Some hospitals were shut down altogether, and some continued to work at partial capacity, leaving many of the injured without access to medical assistance. Various countries and relief organizations responded . . .

Introduction: Mass-casualty triage is implemented when available resources are insufficient to meet the needs of all patients in a disaster situation. The basic principle is to do the maximum good for the most casualties with the least amount of resources. There are limited data to support the applicability of this principle in massive disasters such as the January 2010 earthquake in Haiti, in which the number of patients seeking medical attention overwhelmed the local resources. Objective: To analyze the application of a triage system developed for use in a mass-casualty setting with limited resources. The system was designed to admit only those patients who had medical conditions requiring urgent treatment that were within the capabilities of the hospital and had a good chance of survival after discharge. Priority was given to those whose treatment could be administered within a short hospital stay. Method: A retrospective, observational review of computerized registration forms of Haitian earthquake victims who sought medical care at a 72-bed field hospital within four to 14 days after the event. An analysis of the efficacy of the triage protocol that was used followed, using length of hospital stay to measure consumption of resources. Results: A total of 1,111 patients were triaged for treatment in the field hospital within 14 days of the earthquake. The median length of stay for all patients for whom data was available was 16 hours (mean = 29.7 hours). The majority of patients (n = 620, 65%) were discharged within 24 hours. Two hundred five patients underwent surgery and were discharged within a median of 39 hours (mean = 52.6 hours); of these, 124 (62%) were discharged within 48 hours. The total mortality of the treated patients was 1.5% (n = 17). Conclusions: Currently accepted triage principles for the most part are appropriate for efficiently providing medical care in a disaster area with extremely limited resources, but require extensive adaptation to local conditions.

The Securities and Exchange Commission has criticized earnings management—an effort among public firms to use financial derivatives to smooth earnings paths, transferring risk and volatility from one party to another. The problem is that little empirical research has been conducted on the impact of such derivatives on earnings volatility. The purpose of this study was to examine whether firms smooth earnings through financial derivative transactions and/or discretions in the accounting treatment of derivatives. Public firms have been reporting steady earnings growth since 1997. The research questions focused on whether these reported earnings represented real economic earnings, whether earnings have been smoothed by derivatives transactions, and whether accounting standards adequately report gains and losses from such derivatives. A regression-based causal comparative study of earnings volatility patterns with and without derivative use over the past ten years showed that firms with derivative use have lower earnings volatility (n = 500). This study also revealed the weakness in current accounting standards that allowed firms to transfer earnings volatility from one accounting period to another, resulting in smoother earnings pattern over time. These results could make a positive social contribution by providing new information that could be used to establish appropriate accounting standards to improve the quality of our financial reporting system.

Objectives: To evaluate the speed by which cuirass application, followed by biphasic extra-thoracic ventilation, can be instituted by full anti-chemical protective gear-wearing physicians. Materials and Methods: Ten physicians of variable subspecialties applied a cuirass on an adult volunteer and instituted biphasic extra-thoracic ventilation, using the RTX respirator (Medivent, London, UK). Endotracheal (ET) intubation and manual ventilation of a mannequin and its ventilation was comparatively assessed. Performances were conducted in a prospective, crossover, randomized manner. Times to successful applications as well as failure rates were recorded. Results: Cuirass application was performed more rapidly (102 ± 9 s, 177 ± 31 s, respectively, P < .01) and with a slightly lower failure rate than ET intubation. Conclusions: Physicians wearing full anti-chemical protective gear applied the cuirass and instituted biphasic extra-thoracic ventilation faster than ET intubation and manual positive pressure ventilation. Extra-thoracic ventilation should be further evaluated as an option for emergent respiratory support during toxic mass casualty events.

To assess the rate of infected bile in patients undergoing laparoscopic cholecystectomy (LC) and to study the influence on the postoperative infective complications in this group of patients. Bile samples of 247 patients undergoing LC were collected and cultured for aerobic and anaerobic bacteria. All patients were given prophylactic antibiotics. The overall rate of infected bile was 12.8% (56 positive cultures); of these, 54 were aerobic and 2 anaerobic bacteria. Only 2 patients developed infection at the umbilical site, and in both, the bile was sterile. None of the patients with positive bile cultures developed any signs of infection during a mean follow-up period of 26 months. The overall rate of septic complications following LC is extremely low, and at least in our study no correlation was found between infected bile and septic complications.

Later in Mr. [Stephen McDougall]'s article it is written: \"[Guy- Lin Beaudoin] said if the changes were not made by July 1, the OLF would fine the town $5,000 for each infraction\". This is far from the truth. I never stated that the OLF will fine the town $5,000 if we do not respect the July 1 deadline. In fact, I did not speak about fines, nor did I pretend that the OLF threatened us with such fines. The topic of fines arose when Councillor Gifford asked the mayor to ignore the OLF requests. Mayor Martel rightfully answered the town would comply with the requests, because the fines can be very high, and the town cannot afford to challenge the OLF in court. As for the deadline of July 1, it is a date that has been proposed by the Town of Richmond to the OLF, and not a date stipulated in any communication received by the Town of Richmond from the OLF. I have been very clear about this point in the interviews I gave to the Quebec media. As was clearly explained to your journalist, all the modifications proposed by the OLF were neither complex nor were they complicated. Therefore the changes could be implemented in a fast and efficient manner, even though we would have preferred to continue to act as a bilingual municipality.