O.V.Tamazjan - the assistant to the head physician on surgery
Russian surgeon Sergey Stonogin outlines suggestions to improve surgical services for children at the Tooshino hospital
To control the spread of infec-tions and speed up diagnosis of possible surgical cases, ultrasonic examinations would have to be increased from two to five per day. The 'Ray Diagnostics Department' for the infectious diseases ward should have a dig-ital scanner SA-8800 MT (made by the Medison Company) with convex detector for 3-7 mega-hertz, colour Doppler system, pulse Doppler system, and image archiving system.
Ultrasonic examination is best performed on the evening of admission, so stationary or portable ultrasonic equipment would be needed in the admis-sions area.
To decrease post-operative complications due to suppura-tion (putrefaction), and to reduce in-patient stay for those with gangrenous appendicitis compli-cated by infections such as pneu-monia, maxillary sinusitis, suppurant otitis, etc, medication should include 3rd and 4th gen-eration cephalosporins; com-bined preparations of penicillin and clavulan acid; Fluorine-Quinolon preparations. Adminis-tration of these should be 30-40 minutes before surgery as well as post-operatively.
Being highly effective and hav-ing few side effects, fluorine-quinolon preparations should be used for cases needing lengthy treatment (post-operative infiltration of the abdominal cavity, osteomyelitis, soft tissue suppu-ration in various areas, etc). The preparations should be available both as solutions for infusion or as tablets (250-500 mg)
Laparoscopy, colonoscopy, EGDS and bronchoscopy should be available 24 hours a day to speed up diagnoses.
Patients with no surgical pathology should be taken to wards as soon as possible to lower risk of post-operative com-plications.
To improve both surgery and cosmetic results, and to minimise intra- and post-surgical complica-tions, the theatre should have Sonosurg - an ultrasonic scalpel made by Olympus.
The theatre should also have equipment for ozonised solu-tions, for cleaning abscessed appendix cavities, abdominal cavities and during intra-venous injections.
FM radio telephones and pagers were also recommended to ensure direct contact with sur-geons.
For the infectious diseases ward a PC with Excel 7.0, Word 2000 and Power Point (graphic editor programme) was recom-mended, to help during analysis and treatment and when prepar-ing case reports (weekly, month-ly, annually).