Probability-based choice of antibiotherapy

Surgery of colorectal cancer is suited for assurance of surgical quality. The R0-resection rate in 1927 operations for colorectal cancer was 74.4%. The postoperative mortality was 7.1%. Wound suppuration occurred after surgery of the colon in 6.5%, after surgery of rectal cancer in 9.9% of the cases. In 68.6% of pT4-tumors we found lymphoid metastasis, in 19.3% around the trunk of the inferior mesenteric artery. For compilation of comparative data the quality assurance in colorectal surgery should be realised every 3 to 5 years.     

Oral anticoagulation in dental surgery

STUDY OBJECTIVES: To evaluate whether pediatric or emergency medicine residents exhibit a bias when they select patients from triage based on the chief complaint, ie, medical versus surgical in the pediatric emergency department (PED). DESIGN: A retrospective chart review of a convenience sample of consecutive patients, excluding those seen during times when both pediatric and emergency medicine residents were not simultaneously present. SETTING: Urban Municipal PED with 25,000 visits annually. TYPE OF PARTICIPANTS: Pediatric residents, emergency medicine residents, and medical students rotating through the PED and their supervising attending physicians. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Five hundred and ninety-nine charts were included in the study. On the basis of the triage complaint the initial diagnosis was classified as either surgical or medical. Surgical diagnoses were assigned to those patients who required a surgical procedure, involved a surgical subspecialty or were victims of trauma and represented 151 (25.2%) of the patients seen. Medical diagnoses were assigned to the nonsurgical patients and represented 448 (74.8%) of the patients seen. There are roughly three pediatric residents to each emergency resident working in our PED. Of the 367 patients seen by the pediatric residents, 73 (19.9%) had surgical diagnoses, and 294 (80.1%) had medical diagnoses. Of the 158 patients seen by the emergency residents, 59 (37.3%) had surgical diagnoses and 99 (62.7%) had medical diagnoses. chi2 analysis was used to compare categorical variables. The P value was considered significant at <0.05. DISCUSSION: Residents, both pediatric and emergency medicine, were instructed to see patients based upon the severity of the patient illness as judged by the triage nurse unless the patients' illnesses were of equal severity, in which case they were to be seen in the order in which they presented. The null hypothesis was that in the absence of physician bias, both pediatric and emergency medicine residents would see the same proportion of surgical and medical patients. The results showed that a bias exists. Emergency medicine residents saw a greater proportion of surgical patients, and pediatric residents saw a greater proportion of general medical patients. A limitation of this study may be the that the supervising attending physician selected residents to see certain patients to expedite PED flow. CONCLUSIONS: Recognizing that bias in the selection of patients seen exists is important in ensuring a balanced education experience.     

Use of the laryngeal mask in oral and dental surgery

Adduction between acrylamide and cysteine residues is a post-translational modification associated with proteins separated by gel electrophoresis. In the present article, three model peptides containing 2-4 cysteine residues were reduced with dithiothreitol, incubated with acrylamide monomers and examined by on-line liquid chromatography coupled to electrospray tandem mass spectrometry. Each of the solutions examined in this work revealed the presence of four distinct components: the free peptide, two different peptide-acrylamide 1:1 adducts involving two cysteine residues at different positions within the same sequence, and the peptide-acrylamide 1:2 adducts. The use of liquid chromatography allowed the separation of components which differed only by the site of complexation of acrylamide, while the application of tandem mass spectrometry furnished reliable sequencing information permitting the identification of most cysteine residues involved in such complexation.     

Professional attitudes to specialisation and minor oral surgery in general dental practice

The elucidation of the chemical structure of lpriflavone was carried out by ultraviolet absorption spectrophotometric, infrared spectroscopic, 1H and 13C nuclear magnetic resonance spectroscopic, low and high resolution EI mass spectrometric, thermoanalytical, elemental analytical and X-ray diffraction methods. The results unambigously verify the structure of Ipriflavone.     

Evaluation of a pregnancy-testing protocol in adolescents undergoing surgery

A 14-year-old boy presented acutely with occipital headache, nausea and vomiting. MRI showed obstructive hydrocephalus and marked bilateral cerebellar swelling with increased signal on T2-weighted imaging. Following treatment with oral corticosteroids, the clinical and radiological signs resolved. The clinical course and radiological appearances were consistent with cerebellitis associated with a significant mass effect and hydrocephalus.     

The effect of hexetidine spray on dental plaque following periodontal surgery

The aim of the present study was to determine the effects of a 0.2% hexetidine spray, used as a supplement to regular oral hygiene measures, on dental plaque and gingival condition following periodontal surgery. This study was carried out on 38 patients who required 2 episodes of periodontal surgery. Examinations regarding dental plaque were performed at 0, 7, 14, 21 and 28 days, while the condition of the gingiva were examined at 0 and 28 days. Dental plaque was assessed by the Turesky modification of Quigley-Hein index; the gingival condition was evaluated using the gingival index of L?e-Silness and the papilla bleeding index. In a double-blind cross-over study of 28 days duration, significant reduction in plaque accumulation and an improvement in wound healing were demonstrated for the test spray compared to the placebo.     

Evaluation of Guamanian dental caries preventive programs after 13 years

The authors followed the collection of 77 eyes with glaucoma (54 eyes with POAG, 16 eyes with PACG and 7 eyes with CG) after ECCE or phacoemulsification with implantation of IOL. The patients were operated in 1990-1991 at the Ophthalmological Clinic FNKV and 3rd Medical Faculty in Prague. The authors evaluated IOP, therapy and visual acuity 6 weeks and 6 months after operation. After 6 months period IOP was decreased in average about 3 mmHg; in POAG the reduction was 1.9 mmHg and in PACG the reduction was 4.7 mmHg. In this time the authors also registered decreasing antiglaucomatous therapy at 38 eyes (i.e. 49.3% operated eyes). The reducing therapy represents 50% eyes with POAG and 69% eyes with PACG. The visual acuity is in 70% 6/6-6/12. Patients with PACG have more expressive postoperative effect. The authors draw the attention to late diagnosis CG, after successful operation the visual acuity is reduced on account of advanced changes of the optic disc.     

The asthmatic dental and oral surgery patient. A review of management considerations

Asthmatic dental patients are common and require special care. Management strategies are becoming less empirical as our understanding of the disease increases. Prevention, early detection and treatment of acute asthmatic exacerbations are the cornerstones of safe treatment.     

Advances in osseointegrated implants for dental and facial rehabilitation following major head and neck surgery

Osseointegrated implants can be used to facilitate retention stability and support for facial and intraoral prostheses used to restore head and neck defects. Preliminary studies indicate that in nonirradiated maxillectomy patients the success rates are about 75%. In the reconstructed mandible the results appear to be more favorable--over 90% for implants placed in free nonvascularized bone grafts and over 90% for free revascularized bone grafts. Similar high success rates have been observed for most sites used to support facial prostheses. Success rates for auricular sites exceed 95% and for floor of nose sites success rates exceed 90%. Success rates have been lower (77%) for implants placed in the frontal bone for retention of orbital prostheses. Success rates for irradiated bone sites have been lower and range from 60.4% in the maxilla to 68.6% in facial bone sites. Of greater concern is that most implants placed in irradiated sites are beginning to show signs of impending failure.     

A plastic surgery literature review to assist in the management of patients seeking elective esthetic dental treatments

This article reviews plastic surgery literature to help identify and manage the risk presented by patients interested in elective esthetic dentistry whose physiologic profile would compromise the success of the procedure. A questionnaire, designed to help identify patients with problematic physiologic profiles, is presented. In addition, risk management techniques adapted from the plastic surgery literature are reviewed.     

The influence of maxillary sinus augmentation on the success of dental implants through second-stage surgery

OBJECTIVE: To study the familial occurrence of hemangioblastoma of the central nervous system and to search for an effective way to diagnose and manage the disease. METHODS: From 1974 to 1993, six patients with hemangioblastoma with family history underwent surgical treatment at our hospital. Computerized tomography (CT) or magnetic resonance imaging (MRI) technique was used for the diagnoses before operation. RESULTS: Each patient had more than two relatives with hemangioblastoma. Multiple lesions were found in two of the six familial hemangioblastoma cases. All the patients recovered well after operation. So far, no victims have been discovered in the third generation. CONCLUSIONS: The high occurrence rate of familial hemangioblastoma cases suggests an involvement of hereditary factors. We need a long follow-up study on the descendants of familial hemangioblastoma patients. MRI is of diagnostic value in determining the location and nature of hemangioblastoma in both brain and spinal cord. A thorough examination is necessary for hemangioblastoma patients, and microsurgery is important in removing the tumor.     

Evaluation of local anesthesia techniques for small incision cataract surgery

PURPOSE: To evaluate the surgical experiences and patient preference with 3 local anesthesia techniques for small incision cataract surgery. SETTING: Department of Ophthalmology, Hj?rring Hospital, Denmark. METHODS: This prospective, randomized study included 66 patients having simultaneous bilateral cataract surgery. There were 3 test groups, each containing 2 of the following local anesthesia techniques: retro/peribulbar (RBA), sub-Tenon's (STA), or topical (TA). Each patient served as his or her own control. No medical sedation was used. Patient response to each anesthesia technique was evaluated by the surgeon based on surgical difficulties, a nurse using hand-holding tension and verbal interaction, and a visual analog pain score. Patients were also asked which of the 2 techniques they preferred and their reasons. RESULTS: No local anesthesia techniques interfered with surgery. The order of a positive pain/discomfort response during surgery was TA > STA > RBA. Significantly more pain occurred with application of RBA than with STA or TA. No postoperative pain was recorded with any method. Fifty-six percent of patients said they preferred 1 technique over the other; 16% of patients having STA would not do so again, 19% would not have TA again, and 40% would not have RBA again. The main reasons for preferring STA and TA were fear of or pain from a retrobulbar injection. The main reasons for preferring RBA were less awareness, anxiety, and surgical pain. Immediate visual recovery seemed to be of minor importance in patients' choice of an anesthesia technique. CONCLUSION: Although less discomfort/pain occurred during surgery with RBA, patients preferred STA and TA primarily because of the inconvenience or pain of the retrobulbar injection. Although medical sedation was not used in this study, the pain/discomfort ratio from surgery was not greater than in studies using intravenous sedation, indicating that the use of medical sedation should be re-evaluated.     

Pain control after dental surgery: a double-blind, randomised trial of lornoxicam versus morphine

Lornoxicam is a new non-steroidal anti-inflammatory drug of the oxicam class. This randomised, double-blind, placebo controlled trial compared the analgesic efficacy and tolerability of intramuscular (IM) injections of lornoxicam (4, 8, 16 and 20 mg) with morphine (10 and 20 mg) and placebo in 252 patients with mainly moderate to severe pain following surgical removal of an impacted mandibular third molar. Patients treated with lornoxicam or morphine experienced a significantly greater cumulative pain relief over the 4-h post-injection period (TOTPAR0-4) than placebo recipients. This effect appeared to be dose-dependent, with patients in the lornoxicam 4 mg or morphine 10 mg groups recording significantly lower TOTPAR0-4 scores than patients in the higher dosage groups of these drugs. No significant difference was detected between the morphine 20 mg group and the lornoxicam 8, 16 and 20 mg groups. Lornoxicam was well tolerated at all doses and was associated with a significantly lower incidence of adverse events than morphine 10 or 20 mg. Thus, the analgesic efficacy of IM lornoxicam at doses > or = 4 mg is superior to placebo, and doses > or = 8 mg are at least as effective as IM morphine 20 mg. Furthermore, lornoxicam possesses a more favourable tolerability profile than morphine and thus represents an attractive alternative for the treatment of moderate to severe acute pain.