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Postoperative Setting (postoperative + setting)

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Medical Sciences	100%

Selected Abstracts

Prevalence of Methicillin-Resistant Staphylococcus aureus in the Setting of Dermatologic Surgery

DERMATOLOGIC SURGERY, Issue 3 2009
ROGER S. SICA DO
BACKGROUND The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in the postoperative setting of dermatologic surgery is unknown. Such data could influence the empirical treatment of suspected infections. OBJECTIVE To examine the period prevalence of MRSA infections in the postoperative setting of dermatologic surgery. METHODS We performed chart reviews of 70 patients who had bacterial cultures taken from January 2007 to December 2007. In the 21 postsurgical cases, we analyzed age, risk factors, sites of predilection, method of repair, and pathogen of growth. RESULTS The mean age of the overall study population was 57, with the mean age of postsurgical MRSA-positive cases being 75.5. Of the 21 postsurgical cultures taken, 16 cultures grew pathogen, and two of the 16 (13%) pathogen-positive cultures grew MRSA. LIMITATIONS This is a retrospective chart review of a relatively small sample size in one geographic location. Our patient population is known to contain a large number of retirees. CONCLUSION The increasing prevalence of MRSA skin and soft tissue infections and recommendation to modify empirical antibiotic therapy have been well documented in particular patient populations, but we caution against the empirical use of MRSA-sensitive antibiotics in the postoperative setting of dermatologic surgery. We advocate culturing all infectious lesions upon presentation and reserve empirical use of MRSA-sensitive antibiotics for high-risk patients or locations. [source]

Mild haemophilia: a disease with many faces and many unexpected pitfalls

HAEMOPHILIA, Issue 2010
K. PEERLINCK
Summary., Despite major advances in diagnosis and treatment, the management of patients with mild haemophilia (MH) remains a major challenge. Mild haemophilia is defined by factor levels between 0.05 and 0.40 IU mL,1. The bleeding associated with mild haemophilia is most frequently episodic, occurring during surgery or following trauma. Spontaneous bleeding is rare. Diagnosis is sometimes delayed because of insensitivity of screening clotting assays or discrepancies in factor VIII activity as measured by different assays. The treatment of choice in mild haemophilia A is desmopressin, which typically induces a 2,6-fold increase of factor VIII over baseline. However, desmopressin has its limitations in this setting such as the occurrence of tachyphylaxis and failure to respond in an undetermined proportion of patients. Factors underlying poor biological response or magnitude of response to desmopressin are incompletely understood. Inhibitor development in mild haemophilia is particularly distressing. This complication arises at an older age in this patient group because of infrequent need for factor VIII replacement. Inhibitors in mild haemophilia patients often cross-react with endogenous factor VIII resulting in severe spontaneous bleeding frequently in a postoperative setting. Intensive perioperative use of factor VIII and some specific mutations induce a particularly high risk for inhibitor development, but risk factors are incompletely understood. For reasons of the older age of the patients, treatment of bleeding with bypassing agents may cause major thrombotic complications. Data on therapeutic options for inhibitor eradication in patients with mild haemophilia are particularly scarce. With increased life-expectancy for all haemophilia patients, the group of elderly patients with mild haemophilia requiring major surgery will further increase. Prevention of inhibitors, particularly in this patient group, should be a major topic of interest in both clinic and research. [source]

Chordoma: 6 Years' experience at a tertiary centre

JOURNAL OF MEDICAL IMAGING AND RADIATION ONCOLOGY, Issue 3 2006
PP Agrawal
Summary Nine patients with a histologically proven diagnosis of chordoma seen at the Department of Radiation Oncology, Maulana Azad Medical College and Lok Nayak Hospital between January 1999 and December 2004 were retrospectively reviewed with respect to age, sex, presentation, location of tumour, treatment, response, recurrence, metastasis and follow up. Chordoma constituted 0.07% of total cancer cases registered over 6 years. Out of nine patients, eight were males and one was female with median age at time of diagnosis 52 years (range 34,68 years). All had sacrococcygeal lesions except one who had a spheno-occipital lesion. Seven patients had undergone either subtotal or gross total resection whereas only biopsy had been carried out in two of them. All patients received radiation therapy, seven in a postoperative setting and two for palliation. Follow-up period ranged from 2 to 50 months. Four patients died , the first after fourth fraction of radiation, second after 10 days of treatment, third of progressive lesion in sphenoidal region despite resection and radiation and fourth of local recurrence in the sacrococcyx. One patient developed distant metastases in the lungs and subcutaneous tissue over the scalp along with local recurrence; he is still alive. Two patients are locally free of disease whereas the other two were lost to follow up. The present analysis was undertaken to review our institutional experience with an aim to provide a practical approach to these tumours. In this report, these cases are discussed and the published works have been reviewed for the optimal management of patients with chordoma. [source]

Overnight Hospital Stay Is Not Always Necessary after Uvulopalatopharyngoplasty,

THE LARYNGOSCOPE, Issue 1 2005
FACS, Jeffrey H. Spiegel MD
Abstract Objectives: To determine whether patients with obstructive sleep apnea who undergo uvulopalatopharyngoplasty (UPPP) have a significant incidence of postoperative complications that would justify overnight postoperative observation in the hospital. Study Design: Part 1: review of published medical literature to determine incidence of postoperative complications. Part 2: retrospective review of 117 patients undergoing UPPP with or without additional procedures. Methods: A literature search for existing studies describing the postoperative complications after UPPP for obstructive sleep apnea was conducted. After this, the records of 117 patients who had undergone UPPP at a university-based medical center during a 5-year span were reviewed. Results: Respiratory events occur in 2% to 11% of cases. These include airway obstruction (e.g., laryngospasm), postobstructive pulmonary edema (POPE), and desaturation. Airway obstruction occurred in the immediate postoperative setting. POPE was rare and usually occurred within minutes after the conclusion of the surgical procedure. Desaturation could occur at any time, but the severity was usually equivalent to that found on preoperative sleep study. Hemorrhage occurred in 2% to 14% of cases and had a biphasic incidence, occurring either immediately postoperatively or several days after surgery. Depending on definition, hypertension was observed in between 2% and 70% of patients postoperatively. This was most commonly diagnosed and treated in the immediate postoperative setting. In most reports, arrhythmia and angina occurred in less than 1% of cases. Conclusions: The majority of complications after UPPP with or without additional procedures occur within 1 to 2 hours after surgery. Postoperative oxygen desaturation is usually no worse than that that was observed on preoperative polysomnography findings. A 2 to 3 hour observation period may be suitable for patients after UPPP; if a patient experiences no complications and is maintaining adequate oxygenation and analgesia, same-day discharge from recovery room may be considered. [source]