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Postoperative Care (postoperative + care)
Selected AbstractsThe Laser-Assisted Neck Lift: Modifications in Technique and Postoperative Care to Improve ResultsDERMATOLOGIC SURGERY, Issue 6 2002F. Richard Noodleman MD background. Conventional submental tumescent liposuction has proved disappointing for some patients with anterior neck laxity, ptotic platysma muscles, and increased subplatysmal fat. Many of these patients are facelift candidates but are unwilling to undergo this extensive procedure. We describe our hybrid approach, which offers consistently improved results and enhanced patient satisfaction. objective. To establish a sharper cervicomental angle by more completely removing subplatysmal fat. We also wished to achieve more consistent, smoother results, minimizing ripples, folds, and hematomas with a novel postoperative dressing system. methods. Extensive tumescent liposuction of the lower face, jowls, and anterior neck was performed. Following this, subplatysmal fat was removed by dissection, the platysma muscle was imbricated, and the CO2 laser utilized in a defocused, low-power mode to partially treat the dermal undersurface and underlying muscle. Our postoperative dressing included a 10 cm mineral oil polymer gel disc in the submental location, covered by tape, silicone foam, and a lower face and neck garment to provide both support and even compression over the entire neck for at least the first 24 hours. results. Results proved uniformly satisfying for most patients, even those in their senior years. Benefits included an improved cervicomental angle, a decrease in jowling, and a marked reduction in the laxity and wrinkling of the neck skin and horizontal neck creases. Problems related to postoperative rippling or folding of the redraped skin and hematoma formation were minimized. conclusion. Laser neck tightening combined with tumescent liposuction and an advanced postoperative dressing for superior support and uniform compression has resulted in consistently excellent outcomes with improved patient satisfaction. [source] Polymer-assisted regeneration therapy with Atrisorb® barriers in human periodontal intrabony defectsJOURNAL OF CLINICAL PERIODONTOLOGY, Issue 1 2004Lein-Tuan Hou Abstract Aim: This study compared clinical results of 40 periodontal osseous defects treated by two types of absorbable barrier materials. Material and Methods: Thirty patients (23 males and seven females) suffering from moderate to advanced periodontitis (with comparable osseous defects) were randomly assigned to receive either Atrisorb® barrier (n=22; group A) or Resolut XT® barrier (n=18; group B) therapy. Periodontal phase I treatment and oral hygiene instruction were performed before periodontal surgery. Papillary preservation, partial thickness flap, citric acid root conditioning, and decortication procedures were applied during the operation. Bone defects were filled with demineralized freeze-dried bone allograft and minocycline mixture (4:1 ratio). Postoperative care included 0.10% chlorhexidine rinse daily and antibiotic medication for 2 weeks. Clinical assessments including probing depth (PD), clinical attachment level (CAL), gingival recession (GR), plaque index (PlI), gingival index (GI), and radiographic examinations were taken at the baseline, preoperatively and at 3 and 6 months after regenerative surgery. Results: Six months following therapy, both Atrisorb® and Resolut XT® groups had achieved comparable clinical improvement in pocket reduction (3.9 versus 4.4 mm), attachment tissue gain (clinical attachment gain; 3.5 versus 3.6 mm), and reduction in the GI and in the PlI. Within-group comparisons showed significant attachment gain and pocket reduction between baseline data and those at both 3 and 6 months postoperatively (p<0.01). There were no statistically significant differences in any measured data between groups A and B. Conclusions: The results of this study indicate that a comparable and favorable regeneration of periodontal defects can be achieved with both Atrisorb® and Resolut XT® barriers. Further long-term study and histologic observations of tissue healing are needed to evaluate whether Atrisorb® is promising for clinical use. [source] Noninvasive Lower Eyelid Blepharoplasty: A New Technique Using Nonablative Radiofrequency on Periorbital SkinDERMATOLOGIC SURGERY, Issue 2 2004Javier Ruiz-esparza MDArticle first published online: 3 FEB 200 Background. Laxity and rhytids of the lower eyelids are common cosmetic concerns. Historically, correction has either been surgical through either transcutaneous or transconjunctival blepharoplasty or ablative through laser resurfacing or chemical peeling. Therapeutic options usually require significant postoperative healing and have the potential risk of scarring ectropion or pigmentary loss. Objective. To report the use of a new technique that uses nonablative radiofrequency (NARF) to tighten noninvasively and nonsurgically the flaccid skin of the lower eyelids by treating the periorbital area to produce cosmetic improvement. Methods. Nine patients with skin flaccidity of the lower eyelids had a single treatment session with NARF in a small area of skin in the periorbital region, specifically the zygomatic and/or temporal areas. All patients were treated with topical anesthesia only. The treatment lasted approximately 10 minutes. No postoperative care was required. Results. All of the nine patients in the study achieved cosmetic improvement of the eyelids ostensibly through skin contraction. All patients were able to return to their normal routines immediately. Although the results were gradual, patient satisfaction was remarkable. No complications were seen in this study. Conclusion. This new procedure using NARF was successful in providing a safe, noninvasive, cosmetic improvement in these patients with excessive skin laxity of the lower eyelids. Postoperative morbidity, including down time and complications, was not seen. [source] Caecal impactions managed surgically by typhlotomy in 10 cases (1988,1998)EQUINE VETERINARY JOURNAL, Issue S32 2000C. T. ROBERTS Summary Surgical management of caecal impactions has included several different procedures suggested over the years. Complete bypass of the caecum through an ileocolic or jejunocolic anastomosis has become common practice for first time caecal impaction management, especially when dysfunction is suspected. In our practice, however, caecal impactions have been managed surgically by typhlotomy alone and of the 10 cases (July 1988-June 1998), 9 underwent surgery for first time caecal impactions, received a typhlotomy, and had survived an average of 43 months at time of case review. At the time of surgery, all were considered to have a dysfunctional caecum. All horses received routine postoperative care with the addition of anthelmintics as recovery of Anoplocephala perfoliata occurred in several cases. Typhlotomy should be considered an acceptable technique for surgical management of first time caecal impactions. Postoperative pyrantel pamoate and larvicidal anthelmintics should also be considered. [source] Shoulder and neck morbidity in quality of life after surgery for head and neck cancerHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 10 2004C. P. van Wilgen PT Abstract Background. Quality of life has become a major issue in determining the outcome of treatment in head and neck surgery with curative intent. The aim of our study was to determine which factors in the postoperative care, especially shoulder and neck morbidity, are related to quality of life and how these outcomes compared between patients who had undergone surgery and a control group. Methods. We analyzed physical symptoms, psychological symptoms, and social and functional well-being at least 1 year after surgery and evaluated the differences in quality of life between patients who had undergone head and neck surgery and a control group. Results. Depression scores contributed significantly to all domains of quality of life. Reduced shoulder abduction, shoulder pain, and neck pain are related to several domains of quality of life. The patient group scored significantly worse for social functioning and limitations from physical problems but scored significantly better for bodily pain and health changes. Conclusion. Depression and shoulder and neck morbidity are important factors in quality of life for patients who have undergone surgery for head and neck cancer. © 2004 Wiley Periodicals, Inc. Head Neck26: 839,844, 2004 [source] Microbiological assessment of bile during cholecystectomy: is all bile infected?HPB, Issue 3 2007G.J. MORRIS-STIFF Abstract Aims. To determine the prevalence of bactibilia in patients undergoing cholecystectomy and to relate the presence or absence of organisms to the preoperative and postoperative course. Patients and methods. Patients undergoing cholecystectomy under the care of a single consultant surgeon during a continuous 5-year period were identified from a prospectively maintained departmental database. Symptoms, clinical signs, findings of investigations, details of treatment and postoperative care were noted. Risk factors for bactibilia (acute cholecystitis, common duct stones, emergency surgery, intraoperative findings and age > 70 years) were documented. Patients were divided according to the presence (B +) or absence (B,) of bacteria on culture of their bile. Results. In all, 128/180 (70%) of cholecystectomies had full data available for analysis. Bacteria were identified in the bile of 20 (15.6%) patients (B+ group). The B+ group was significantly older at 63.78±9.7 versus 61.62±13.9 (p<0.05) and contained significantly fewer females than the B, group (p<0.05). All 20 patients (100%) in the B+ group had , 1 risk factor, while these factors were present in only 29/108 (30.3%) of patients in the B, group (p<0.05). The overall incidence of infective complications was 20% in the B+ group compared with 0.9% in the B, group (p<0.05) and the bile-related infections were higher in the B+ group (p<0.05). Conclusions. The study demonstrated that while patients with complicated gallstone disease frequently exhibit bactibilia, patients with uncomplicated cholelithiasis have aseptic bile. The findings would suggest that prophylactic antibiotics should be limited to patients with risk factors for bactibilia. [source] Nursing documentation of postoperative pain managementJOURNAL OF CLINICAL NURSING, Issue 6 2002Ewa Idvall PhD Summary ?,Previous studies have shown that nursing documentation is often deficient in its recording of pain assessment and treatment. In Sweden, documentation of the care process, including assessment, is a legal obligation. ?,The aim of this study was to describe nursing documentation of postoperative pain management and nurses' perceptions of the records in relation to current regulations and guidelines. ?,The sample included nursing records of postoperative care on the second postoperative day from 172 patients and 63 Registered Nurses from surgical wards in a central county hospital in Sweden. ?,The records were reviewed for content and comprehensiveness based on regulations and guidelines for postoperative pain management. Three different auditing instruments were used. The nurses were asked if the documentation concurred with current regulations and guidelines. ?,The result showed that pain assessment was based mainly on patients' self-report, but less than 10% of the records contained notes on systematic assessment with a pain assessment instrument. Pain location was documented in 50% of the records and pain character in 12%. About 73% of the nurses reported that the documentation concurred with current regulations and guidelines. ?,The findings indicate that significant flaws existed in nurses' recording of postoperative pain management, of which the nurses were not aware. [source] Impact of the extent and duration of cytoreductive surgery on postoperative hematological toxicity after intraperitoneal chemohyperthermia for peritoneal carcinomatosisJOURNAL OF SURGICAL ONCOLOGY, Issue 4 2005Dominique Elias MD Abstract Background Peritoneal carcinomatosis (PC) is a major disease, currently treated using complete cytoreductive surgery and intraperitoneal chemohyperthermia (IPCH). Morbidity is a significant limitation of this procedure, usually related to the extent of surgery, and hematological toxicity, which is considered as dependent upon the chemotherapy dosage alone. The aim of our study was to investigate whether surgery alone had an impact on the hematological toxicity associated with the standardized drug protocol that we routinely prescribed. Methods Data were prospectively recorded from 83 consecutive patients who underwent complete cytoreductive surgery followed by IPCH with intraperitoneal oxaliplatin (360 mg/m2) and irinotecan (360 mg/m2), in 2 L/m2 of dextrose over 30 min at 42,45°C, using the Coliseum technique. Sixty minutes prior to IPCH, patients also received an intravenous perfusion of leucovorin (20 mg/m2) and 5-fluorouravyl (400 mg/m2). The doses and volume of IPCH were determined on the basis of the body surface area, so that all patients received the same concentration of drugs. Severe aplasia were defined as a leucocyte count of <500/ml, platelets <50,000/ml, and reticulocytes <6.5 g Hb/L. Results Postoperatively, severe aplasia was seen in 40 of the 83 patients (48%). There was no difference in the characteristics of patients with and without aplasia, other than the extent of surgery. The incidence of severe aplasia was only related to the duration of surgery (537 min in the aplastic group versus 444 min in the non aplastic group) (P,=,0.002), and to the extent of the peritoneal disease (peritoneal index of 19.5 in the aplastic group, vs. 15.3 in the nonaplastic group) (P,=,0.02). Conclusion We report for the first time that the duration of surgery may increase the incidence of hematological toxicity following intraperitoneal chemotherapy. We also hypothesized that intra- and postoperative transient biochemical disorders, such as hypoalbuminemia, hemodilution, liver, and renal insufficiency and stress can be involved in this process. These hypotheses may allow improved postoperative care. J. Surg. Oncol. 2005;90:220,225. © 2005 Wiley-Liss, Inc. [source] An acute pain service improves postoperative pain management for children undergoing selective dorsal rhizotomyPEDIATRIC ANESTHESIA, Issue 12 2009CHANTAL FRIGON MSC MD Summary Background:, A continuous epidural infusion of morphine is the pain treatment modality for children undergoing selective dorsal rhizotomy (SDR) in our institution. The aim of the study was to evaluate the impact of having an organized acute pain service (APS) on postoperative pain management of these children. Methods:, We conducted a retrospective cohort study using anesthetic records and the APS database to compare the postoperative pain management of children undergoing SDR before and after the introduction of the APS at the Montreal Children's Hospital in April 2001. Ninety-two consecutive children who had their surgery between January 1997 and July 2006 were included. We collected data regarding postoperative pain, opioid-induced side effects, complications (sedation, desaturations < 92%), and hospital length of stay. Results:, Pain scores were documented more frequently after the implementation of the APS (61% vs 48.5%). Sedation scores were documented only after the implementation of the APS. Postoperative desaturation was significantly more frequent in the pre-APS group compared to the APS group (45.5% vs 6.8%, P < 0.001). Despite the fact that the epidural catheter was in place for the same duration for both groups [median of 3 days (3,3 25,75%ile)], the duration of hospitalization was 1 day shorter in the APS group compared to the pre-APS group [median of 5 (5,5 25,75%ile) vs 6 (5,6 25,75%ile) days, P < 0.001]. Conclusions:, Although we recognize that it is possible that there were changes in care not related specifically to the introduction of a dedicated APS that occurred in our institution that resulted in improvements in general postoperative care and in length of stay, our study did show that having an organized APS allowed to significantly decrease the incidence of postoperative oxygen desaturation and to decrease the hospital length of stay by 1 day. [source] EMLA® Cream coated on the rigid bronchoscope for tracheobronchial foreign body removal in childrenTHE LARYNGOSCOPE, Issue 1 2009Hai Yu MD Abstract Objectives: Removal of a tracheal or bronchial foreign body is a common emergent surgical procedure in children. The anesthetic management can be challenging. EMLA® Cream (EC) has been widely used to provide topical anesthesia. In the present study, we evaluate the efficacy and safety of EC coated on the rigid bronchoscope for tracheobronchial foreign body removal in children undergoing intravenous anesthesia with spontaneous ventilation. Study Design: The authors conducted a randomized, double-blind, placebo-controlled clinical trial. Methods: Thirty patients were randomized to receive either EC or placebo (lubricant ointment) coated on the rigid bronchoscope. Intravenous anesthesia and spontaneous ventilation were performed in all patients. Heart rate, blood pressure, pulse oxygen saturation (SpO2) and frequency and degree of breath holding were recorded. After surgery, the bronchoscopist rated overall surgical manipulation as excellent, fair, and poor. The durations of postoperative care were also recorded. Results: Episodes of oxygen desaturation (SpO2 < 90%) occurred in 3/15 (20%) patients in the EC group and in 9/15 (60%) patients in the control group (P < .05). Occurrences and degrees of breath holding were less in the EC group than that in the control group (P < .05). Ranks of surgical manipulation were excellent in 80% of patients in the EC group versus 13% of patients in the control group (P < .05). The durations of postoperative care were shorter in the EC group than that in the control group (P < .05). Conclusions: EC coated on the rigid bronchoscope combined with intravenous anesthesia could provide more efficacious and safer anesthesia for tracheobronchial foreign body removal in children under spontaneous ventilation. Laryngoscope, 119:158,161, 2009 [source] Practice Patterns, Safety, and Rationale for Tracheostomy Tube Changes: A Survey of Otolaryngology Training Programs,THE LARYNGOSCOPE, Issue 4 2007Abtin Tabaee MD Abstract Introduction: Tracheotomy for long-term ventilation is a common surgical procedure in the hospital setting. Although the postoperative care is often perceived as routine, complications associated with tracheostomy changes may result in loss of airway and death. In addition, the practice patterns, rationale, and complications related to tube changes have been poorly described. Study Design and Methods: A survey of chief residents in accredited otolaryngology training programs was performed to determine the management strategies, rationale, and complications associated with postoperative tracheostomy tube changes. Results: The first tube change was performed after a mean of 5.3 (range, 3,7) days after the procedure, most frequently by junior residents. The first change was performed in a variety of locations including the intensive care unit (88%), step down unit (80%), and regular floor (78%). Twenty-five percent performed these changes at night or on weekends. The most frequently reported rationale for performing routine tracheotomy changes was examination of the stoma for maturity (46%), prevention of stomal infection (46%), and confirmation of stability for transport to a less monitored setting (41%). Twenty-five (42%) respondents reported awareness of a loss of airway, and nine (15%) respondents reported awareness of a death as a result of the first tube change at their institution during their residency. A statistically significant higher incidence of airway loss was reported by respondents who reported performing the first tube change on the floor (96.1% vs. 63.6%). Conclusion: There is significant variability in the approach to postoperative tracheostomy tube management. The occurrence of major complications including deaths from routine tube changes requires an examination of the rationale and safety of this practice. [source] Carbon Dioxide Laser Endoscopic Diverticulotomy Versus Open Diverticulectomy for Zenker's Diverticulum ,THE LARYNGOSCOPE, Issue 3 2004C. W. David Chang MD Abstract Objectives/Hypothesis To compare open and CO2 laser,assisted endoscopic surgical management of Zenker's diverticulum. Study Design A retrospective review of 49 consecutive surgically treated patients with Zenker's diverticulum was conducted. Methods Patients' records were reviewed and analyzed for patient age and sex, size of diverticulum, incision time (time recorded from start of incision to surgical completion of case), length of hospital stay, complications, and follow-up management. A postoperative questionnaire inquiring about swallow function was conducted by mail or telephone. Swallow function was assessed on a four-point scale. Results Various procedures performed included endoscopic CO2 laser,assisted diverticulotomy (n = 24) and open diverticulectomy with cricopharyngeal myotomy (n = 28). The average incision time of laser endoscopic cases (47 min) was significantly shorter (P < .001) than that of open diverticulectomy cases (170 min). Length of hospital stay did not significantly vary between the two groups. Five patients (21%) initially treated with laser endoscopic diverticulotomy demonstrated symptomatic persistent Zenker's diverticulum; three underwent repeat operation. No open cases required repeat operation. One endoscopic case was aborted secondary to esophageal injury from placement of the endoscope. Postoperative fever was seen in two (8%) endoscopic cases and four (14%) open approach cases. No major complications (recurrent laryngeal nerve paralysis, mediastinitis, or death) were encountered. More than 90% of respondents in each treatment group reported normal or near-normal swallow function. Conclusion Laser endoscopic management is a reasonable and safe method for surgical treatment of Zenker's diverticulum in comparison with the open technique. Employment of the endoscopic approach reduces operative time and the complexity of postoperative care. Practitioners should be aware that the endoscopic approach may result in a higher failure rate. [source] The System of Health Insurance for Living Donors Is a Disincentive for Live DonationAMERICAN JOURNAL OF TRANSPLANTATION, Issue 4 2010E. S. Ommen The health insurance system for living donors is derived from insurance policies designed to cover accidental death or dismemberment. The system covers only the direct consequences of organ removal, and recoups the costs of related medical services from the transplant recipient's health insurance provider. The system forces transplant programs to differentiate between health services that are, or are not directly attributable to donation and may compromise the pretransplant evaluation, postoperative care and long-term care of living donors. The system is particularly problematic in the United States, where a significant proportion of donors do not have medical insurance. The requirement to assign donor costs to a particular recipient is poorly suited to facilitate advances in living donation such as the use of nondirected donors and living-donor paired exchange programs. We argue that given the current understanding regarding the long-term risks of living donation, the provision of basic medical insurance is a necessity for living donation and that the system of attributing donor costs to the recipient's insurance is inefficient, has the potential to undermine the care of living donors and is a disincentive to the expansion of living donation. [source] RISK FACTORS IN SURGICAL MANAGEMENT OF THORACIC EMPYEMA IN ELDERLY PATIENTSANZ JOURNAL OF SURGERY, Issue 6 2008Ming-Ju Hsieh Background: Although elderly patients with thoracic disease were considered to be poor candidates for thoracotomy before, recent advances in preoperative and postoperative care as well as surgical techniques have improved outcomes of thoracotomies in this patient group. The aim of this study was to investigate surgical risk factors and results in elderly patients (aged ,70 years) with thoracic empyema. Methods: Seventy-one elderly patients with empyema thoracis were enrolled and evaluated from July 2000 to April 2003. The following characteristics and clinical data were analysed: age, sex, aetiology of empyema, comorbid diseases, preoperative conditions, postoperative days of intubation, length of hospital stay after surgery, complications and mortality. Results: Surgical intervention, including total pneumonolysis and evacuation of the pleura empyema cavity, was carried out in all patients. Possible influent risk factors on the outcome were analysed. The sample group included 54 men and 17 women with an average age of 76.8 years. The causes of empyema included parapneumonic effusion (n = 43), lung abscess (n = 8), necrotizing pneumonitis (n = 8), malignancy (n = 5), cirrhosis (n = 2), oesophageal perforation (n = 2), post-traumatic empyema (n = 2) and post-thoracotomy complication (n = 1). The 30-day mortality rate was 11.3% and the in-hospital mortality rate was 18.3% (13 of 71). Mean follow up was 9.4 months and mean duration of postoperative hospitalization was 35.8 days. Analysis of risk factors showed that patients with necrotizing pneumonitis or abscess had the highest mortality rate (10 of 18, 62.6%). The second highest risk factor was preoperative intubation or ventilator-dependency (8 of 18, 44.4%). Conclusion: This study presents the clinical features and outcomes of 71 elderly patients with empyema thoracis who underwent surgical treatment. The 30-day surgical mortality rate was 11.3%. Significant risk factors in elderly patients with empyema thoracis were necrotizing pneumonitis, abscess and preoperative intubation/ventilation. This study also suggested that surgical treatment of empyema thoracic in elderly patients is recommended after failed conservative treatment because of the acceptably postoperative complication and mortality rate. [source] AL01 PACIFIC ISLANDS PROJECT , PAST PRESENT AND FUTUREANZ JOURNAL OF SURGERY, Issue 2007D. A. K. Watters The Pacific Islands Project began in 1995 and in its early years had a focus on providing specialist services that were not available in the 10 island nations visited. In 2002 Nauru was added and PIP Phase III will end its 9 month bridging/extension phase in September 2007. During the last 12 years Fiji School of Medicine has commenced a postgraduate medical training program in surgery similar to that has been in existence in PNG since 1975. There are now a growing number of Pacific-trained surgeons who can select suitable cases, do some of the surgery, and supervise the postoperative care. Increasingly visiting teams have focused on transferring skills and building local capabilities (capacity building). The RACS, the Project Director and the speciality coordinators have managed the first three phases of the project in Australia. Phase III had on-going evaluation by an internal RACS committee under the chairmanship of Professor Hamish Ewing. AusAid also externally reviewed the project late in 2006. That review was generally complimentary as to what has been achieved but also points to some new goals for the future. At the time of writing this abstract the future direction of PIP is yet to be decided and designed. This will be done mid 2007. However, it is to be hoped there will be a new program, focused on capacity building, that is managed in the Pacific and employs the skills of Pacific Island Specialists wherever possible. RACS is likely to continue to play an important role in sourcing visiting specialists, organising training positions, arranging courses. We have much expertise to offer but there is no longer any need for us to set the agendas. [source] Sarah Bernhardt's ,Doctor God': Jean-Samuel Pozzi (1846,1918)AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 5 2007Caroline DE COSTA Abstract Samuel Pozzi was a major figure in the early development of modern gynaecological surgery. His textbook, A Treatise on Gynaecology, published in French in 1890 and rapidly translated into five other languages, was the first internationally acclaimed text integrating modern principles of anaesthesia, antisepsis, diagnosis, surgical technique and postoperative care, and in later editions remained a standard reference up to the 1930s. He was the author of more than 400 papers on gynaecological and general abdominal surgery and his technical expertise drew surgeons from all over the world to his theatre in the Hospital Broca, in one of the poorer parts of Paris. He was equally successful in several professional fields apart from medicine. However, his name is now little known in the English-speaking world. This short biography aims to re-introduce Pozzi to readers of English. [source] 4232: OOKP protocol updateACTA OPHTHALMOLOGICA, Issue 2010FC LAM Purpose The OOKP remains the procedure of choice for restoring sight in patients with corneal blindness caused by end-stage ocular surface disease not amenable to cadaveric keratoplasty. Falcinelli's modifications of Strampelli's technique of OOKP surgery remains the gold standard for its excellent visual and keratoprosthesis-retention results. To maintain good outcomes, aid research and to maintain standards, it is important that benchmarks are maintained in patient selection and preoperative assessment, surgical technique and post-operative care. We therefore present, for discussion, the updated protocol that is currently used in the British National OOKP Referral Centre at the Sussex Eye Hospital, Brighton. Methods Members of the OOKP Study Group met in Rome, Italy in 2001 and Vienna, Austria in 2002 to produce and up-to-date standard and protocol. Since then, we have continued to update our protocol on the basis of our own outcomes and findings. We present our updated protocol for discussion and for use in other OOKP centres. Results Our updated protocol includes a discussion on the indications and contraindications for surgery, criteria for patient selection, surgical technique, routine postoperative care, and the recognition and management of postoperative complications. Conclusion 5 years have passed since the standards for modified OOKP surgery were published. This paper highlights changes to this standard resulting from our practice in our national OOKP centre. [source] Botulinum toxin reduces anal spasm but has no effect on pain after haemorrhoidectomyCOLORECTAL DISEASE, Issue 2 2009B. Singh Abstract Objective, Pain following haemorrhoidectomy is due to a combination of factors including spasm of the internal sphincter, an open wound and local infection. In this study, we investigated the effect of botulinum toxin on postoperative pain following Milligan,Morgan haemorrhoidectomy. Method, A prospective randomized controlled trial was conducted in 32 patients undergoing haemorrhoidectomy. Routine postoperative care included metronidazole and bupivacaine. Patients were also given an inter-sphincteric injection of either placebo or botulinum toxin (150 units). Maximal resting pressure (MRP) and maximal squeeze pressure (MSP) were measured postoperatively. A linear analogue score was used to assess postoperative pain. The sample size calculation was calculated to show one standard deviation difference between groups. The primary endpoint was reduction in postoperative pain. Results, The MRP was significantly lower in the botulinum toxin group (mean 50.5 mmHg; 95% CI 39.77,61.23) compared with the placebo group (mean 64.94 mmHg; 95% CI 55.65,74.22) (P = 0.04) at week 6. At week 12 there was no significant difference in MRP between the two groups. In contrast MSP was significantly lower in the botulinum toxin group at weeks 6 and 12 (mean 87.1 mmHg; 95% CI 66.9,107.1) compared with the placebo group (mean 185.8 mmHg; 95% CI 134.2,237.4) at week 12 (P = 0.0014). There was no significant effect on overall or maximal pain scores. Median time for return to normal activities was not significantly different between groups. Conclusion, Botulinum toxin reduces anal spasm but has no significant effect on postoperative pain. [source] Prophylactic effect of clarithromycin in skin flap complications in cochlear implants surgery,THE LARYNGOSCOPE, Issue 10 2009Juan Garcia-Valdecasas MD Abstract Objectives/Hypothesis: To assess the usefulness of postoperative clarithromycin versus classical postoperative prophylaxis with occlusive dressing to prevent cochlear implant skin flap complications. Study Design: Cohort study. Methods: Surgical site infections were compared in four groups: 1) ceramic/classical postoperative cares (21 patients), 2) titanium-silicon/classical postoperative cares (75), 3) ceramic/clarithromycin (24), and 4) titanium-silicon/clarithromycin (76). Preoperative ceftriaxone was systematically used in all patients in all four groups. Patients were followed up for at least 4 months. Attributable risk and number needed to treat were calculated. Results: All infections appeared in titanium-silicon covered implants, and the risk of surgical site infection was 8.1 times higher in patients treated only with ceftriaxone and classical postoperative prophylaxis compared to those also given clarithromycin. Eleven patients needed to receive clarithromycin to avoid surgical infection. Conclusions: Long-term treatment with low-dose clarithromycin may reduce the incidence of surgical site infections. Laryngoscope, 2009 [source] | ||||||||||