7th Postoperative Day Research Articles

Perforated Subhepatic Appendix Presenting as a Gas under Diaphragm: Clinical Diagnostic Challenges for Surgical Residents: A Case Report

This study addresses the rarity of the subhepatic location of the appendix, found in only 0.08% of cases, and the infrequent occurrence of perforated appendicitis presenting with gas under the diaphragm. When these two uncommon conditions coincide in the context of one of the common causes of acute abdomen, namely acute appendicitis, it poses a diagnostic challenge for surgical residents in training. The case presented involves a patient with generalized abdominal pain, soft abdomen, and tenderness over all quadrants, particularly the right upper quadrant. Her chest x-ray findings indicated free gas under the right hemi-dome of the diaphragm and an inconclusive ultrasound for acute appendicitis, computed tomography confirmed the subhepatic appendix and pneumoperitoneum. Operative intervention revealed a perforated subhepatic appendix, and the patient recovered well, being discharged on the 4th postoperative day. The clinical discussion emphasizes the ability of surgical residents to safely perform appendectomies but highlights the crucial role of experienced surgeons in managing cases with atypical presentations. The conclusion underscores the diagnostic challenges posed by atypical presentations of acute appendicitis in a clinical setting.

Conservative management of chylous fistula following laparoscopic partial nephrectomy for renal cell carcinoma: A case report and literature review

Chylous fistula is a rare complication following renal surgery, especially partial nephrectomy due to renal cell cancer. A unified treatment guideline for this complication is currently unavailable. We report a clinical case of chylous fistula after laparoscopic partial nephrectomy due to renal cell cancer, seen on the 4th postoperative day (POD), which was successfully treated conservatively by octreotide and diet adjustments. We take this opportunity to review similar cases mentioned in the literature in order to contribute to the knowledge of symptoms, management and treatment of this complication.

Use Of Apitherapy: A Sweet Approach To Bony Healing Of Extracted Tooth Socket

Objective: To determine the effect of honey in enhancing the height of bony socket healing after tooth extraction. Methods: This Quasi-experimental study includes 100 patients had were selected through convenience sampling and divided into two groups, i.e. 50 each. A tooth radiograph was taken both preoperatively and postoperatively followed by nonsurgical extraction of tooth. The experimental group was provided with honey and instructed to apply it 3 times daily for the next 10 days using an I/V syringe so that honey reached up to the depth of the socket during the initial healing phase. On the 90th postoperative day, patients were repeated with the periapical radiograph. The bony outline of the extracted tooth socket was traced on a tracing paper on the preoperative radiograph and the 90th postoperative day of the radiograph and compared for wound healing by overlapping and measuring the height through a ruler. Hence, the post-operative height of the socket was evaluated in both groups. Data were analyzed using SPSS version 17.0. Results: The mean age was 30.76 ± 6.57 and 31.02 ± 5.97 years in the non-honey and honey group respectively. A total of 24 (48%) subjects were male in the honey group compared with the non-honey group 19 (38%). Females were 26 (52%) and 31 (62%) in the honey group and non-honey group. Statistically significant (p-value 0.001) was observed between the radiological Height of the socket on 90 days in honey and non-honey groups. Conclusion: It has been determined that honey is significantly efficient honey in enhancing the height of bony socket healing after tooth extraction. To encourage adequate socket repair after tooth extraction, it may be given as a postoperative treatment.

Randomized controlled trial comparing the effectiveness of tamsulosin, tamsulosin with tolterodine and double J stent position in controlling stent related symptoms after ureteroscopic lithotripsy

Background: Objective of the study was to determine the effect of stent position and medications in preventing stent-related symptoms. Methods: This was a prospective study conducted at Meenakshi Mission Hospital and Research Centre Madurai, Tamil Nadu, India. 150 patients who underwent ureteroscopic lithotripsy with indwelling stent were distributed into three groups. On demand analgesics were given to group 1 (n=50), Tamsulosin 0.4 mg daily for group 2 (n=50) and tamsulosin 0.4 mg and tolterodine 4 mg daily for group 3 (n=50). The patients were also subclassified into appropriate or inappropriate group according to stent position. All patients completed various domains of Ureteral stent symptom questionnaire (USSQ) on 1st and 7th postoperative days. Appropriate tests statistics were performed using EPI-Info statistical software package. Results: In control group, patients with appropriate stent position had significantly lower symptom scores than those with inappropriate stent position (p value~0.0001) in all domains of USSQ except global quality of life score (p value=0.08). Addition of tamsulosin 0.4 mg (group 2) had superadded beneficial effect in appropriate position group, but not in patients with inappropriately positioned stents. Patients taking both tamsulosin 0.4 mg and tolterodine 4 mg (group 3) had no significant improvement in symptom scores in appropriate position group (all domains of USSQ) and inappropriate position group (most domains). Conclusions: Appropriate stent position is the most important independent factor than medications in preventing stent related symptoms; tamsulosin has superadded benefit in patients with correctly positioned stents.

Outcome of laparoscopic vs open appendectomy in the management of acute appendicitis

The worldwide trend of appendectomy is shifting from conventional open to the laparoscopic technique. The study’s objective was to compare laparoscopic and open appendectomy in terms of various operative and postoperative parameters to find the best operative technique. A prospective comparative study was conducted on 142 patients undergoing laparoscopic (n=43) or open appendectomy (n=99) from 1st February 2022 to 30th January 2023 under the Department of Surgery of Kathmandu Medical College Teaching Hospital (KMCTH). In five patients, laparoscopic appendectomy was later converted to open and excluded from the study. The mean operating time for the open appendectomy group was 44.1±13.1 minutes while for the laparoscopic appendectomy group, it was 48.4±14.0 minutes (p=0.047). Visual analogue score taken on 1st, 7th and 30th post-operative day for open and laparoscopic appendectomy were 4.0±2.2 vs 3.6±1.9 (p=0.160); 1.4±1.3 vs 0.6±0.9 (p<0.001) and 0.2±0.5 vs 0.02±0.15 (p=0.107) respectively. The total days of postoperative hospital stay were 1.57±0.96 for open appendectomy and 1.58±1.07 for laparoscopic appendectomy (p=0.843). However, laparoscopic appendectomy group had an earlier return to normal activity (7.30±1.15 days) when compared to the open appendectomy group (8.05±2.42 days) (p=0.023). The laparoscopic appendectomy group also had fewer postoperative complications than the open appendectomy group (18.6% vs 24.2%) (p=0.411). Thus, laparoscopy is a safe and effective method of removal of appendix for acute appendicitis.

A comparative study of endoscopic myringoplasty versus microscopic myringoplasty at tertiary care center

Background and objectivesMyringoplasty is a surgical procedure performed to repair tympanic membrane perforation which can be performed either using a microscope or an endoscope. The aim of this study is to compare the graft uptake, hearing outcome and operative time of endoscopic myringoplasty (EM) versus microscopic myringoplasty (MM) by underlay cartilage island graft technique. Subjects and methodsIn this prospective comparative study of sixty patients divided into two equal groups with small to medium sized tympanic membrane perforation were included. Tragal cartilage was used as graft material. Both the groups underwent myringoplasty by underlay cartilage island graft using endoscope (n = 30) and microscope (n = 30). The study was conducted between February 2022 to May 2023 after taking ethical approval from IRC of Nepalese Army Institute of Health Sciences. All patients were followed up on 7th postoperative day (POD), 1 and 3 months after surgery. ResultsGraft uptake in was 90 % (27/30) in MM group and 93.33 % (28/30) in EM group. Mean operating time was more in MM group (66.46 ± 6.78min) than EM group (64.53 ± 6.6 min). The improvement in Air Bone Gap (ABG) was better in EM group (12.46 ± 6.58 dB) compared to MM group (10.9 ± 9.01 dB). The differences in graft uptake, operating time and improvement in ABG were not statistically significant. ConclusionThe study concludes that it does not matter which approach is used, good results are predictable and choice of the tool used is up to the individual surgeon.

Evaluation of inner ear damage by mastoid drilling with measurement of serum prestin (SLC26A5) levels

ObjectiveThe objective of this study is to demonstrate any inner ear injury caused by drilling in mastoid surgery with prestin, outer hair cell motor protein specific to the cochlea. MethodsThe patients with chronic otitis media requiring mastoidectomy (n = 21) and myringoplasty (n = 21) were included. Serum prestin level obtained from blood samples was measured before surgery and on postoperative days 0, 3, and 7 using Human Prestin (SLC26A5) ELISA Kit. All patients underwent the Pure Tone Audiometry (PTA) test before surgery and on the postoperative 7th day. The drilling time was also recorded for all patients who underwent mastoidectomy. ResultsIn both mastoidectomy and myringoplasty groups, the postoperative serum prestin levels increased on days 0 and 7 (pday-0 = 0.002, pday-7 = 0.001 and pday-0 = 0.005, pday-7 = 0.001, respectively). There was no significant difference in the serum prestin levels between the two groups, postoperatively. The PTA thresholds at day 7 did not change in either group. A significant decline at 2000 Hz of bone conduction hearing threshold in both groups and a decline at 4000 Hz in the myringoplasty group were found. There was no correlation between the drilling time and the increase of prestin levels in the postoperative day 0, 3, and 7. ConclusionOur results showed that mastoid drilling is not related to a significant inner ear injury. Although the myringoplasty group was not exposed to drill trauma, there was a similar increase in serum prestin levels as the mastoidectomy group. Also, a significant decline at 2000 Hz of bone conduction hearing threshold in both groups and a decline at 4000 Hz in the myringoplasty group were found. These findings suggest that suction and ossicular manipulation trauma can lead to an increase in serum prestin levels and postoperative temporary or permanent SNHL at 2000 and 4000 Hz. Level of evidenceLevel-4.

Clinical significance of tumor suppressor genes methylation in circulating tumor DNA of patients with pancreatic cancer

BackgroundCirculating tumor DNA (ctDNA) has emerged as a potential diagnostic and prognostic biomarker in various tumors. However, the role of tumor suppressor genes (TSGs) methylation in ctDNA of patients with pancreatic cancer (PC) remains largely unclear. MethodsPatients with PC (n = 43), pancreatic benign diseases (n = 39), and healthy controls (n = 20) were enrolled in the study. Quantitative analysis of methylation pattern of five candidate TSGs including NPTX2, RASSF1A, EYA2, p16, and ppENK in ctDNA was performed by next generation sequencing (NGS). The diagnostic performances of these 5-TSGs methylation were assessed by the operating characteristic (ROC) curve and clinicopathological features correlation analysis. Meanwhile, the changes in methylation levels of these 5-TSGs on the 7th postoperative day were evaluated in 23 PC patients who underwent radical resection. ResultsThe methylation levels of RASSF1A, EYA2, ppENK and p16 genes in patients with PC were significantly higher than those in healthy controls. EYA2, p16 and ppENK genes showed significantly hypermethylation in PC than those in pancreatic benign diseases. NPTX2, RASSF1A, EYA2, p16 and ppENK genes showed significantly hypermethylation in pancreatic benign diseases than those in healthy controls (P < 0.05). The methylation levels of these 5 candidate TSGs were not correlated with the tumor size, nerve invasion, lymph node metastasis and TNM stage of PC. The AUC of these biomarkers for diagnosis of PC ranged from 0.65 to 0.96. The AUC values of these methylated genes and CpG sites for differentiating malignant and benign pancreatic diseases were ranging from 0.68 to 0.92. Combined the hypermethylated genes improved the detective ability of PC than single gene. The methylation levels of NPTX2, EYA2 and ppENK genes were significantly decreased after radical resection of PC. ConclusionQuantitative analysis of methylation pattern of NPTX2, RASSF1A, EYA2, p16 and ppENK in ctDNA by NGS could be a valuable non-invasive tool for detection and monitoring of PC.

Plasmodium ovale infection in Sri Lanka: distant exposure and incidental detection of hyperparasitemia: a case report

BackgroundPlasmodium ovale malaria, which was previously endemic to tropical Africa and the Southwest Pacific islands is now being reported from parts of Asia. In Sri Lanka, the indigenous transmission of malaria has not been documented since October 2012. Since then, there have been several imported cases of malaria, including P.ovale, which have been detected sporadically. The reporting case of P. ovale was imported and detected incidentally in 2021, with several atypical presentations.Case presentationA 40-year-old Sri Lankan medical doctor developed continuous fever with chills, rigors, and dysuria a day following removal of a large lipoma at the root of the neck under general anaesthesia. When the fever has been responding to antibiotics, on the 4th postoperative day a mild thrombocytopenia on complete blood count was detected. A blood smear which was done on the 5th postoperative day incidentally found a malaria parasite and confirmed as Plasmodium ovale with a density of 6535 parasites/microliter on the same day. He never had malaria in the past, but he had worked in South Sudan 1 year ago and visited India six months ago. On the 6th postoperative day, he was treated with chloroquine, and hyperparasitemia reduced rapidly by the next day. As the fever recurred with clinical deterioration, he was treated with different antibiotics. During the course of the illness, he did not develop pallor, or icterus except for a palpable soft spleen. The parasite count was zero on the 9th postoperative day and his fever subsided on the next day. Further, he was treated with primaquine to prevent future relapse and transmission.ConclusionA long incubation period, incidental detection of P ovale in a blood smear, and hyperparasitaemia are the atypical presentations of this case. Postoperative bacterial infection and stress may have reactivated the dormant malaria (hyponozoites) in this patient with an unusual picture. Coinfection of malaria with bacterial sepsis is a challenge in the management of the patient. As the Anopheles mosquito vector exists in Sri Lanka, the risk of indigenous transmission is high from such imported cases of P. ovale.

Does surgery affect systemic immune response? a perioperative analysis of TGF-β, IL-8 and CD45RO.

The options of (neo-)adjuvant immunotherapy in addition to surgery in the treatment of oral squamous cell carcinoma (OSCC) are steadily increasing, but patients do not always respond to therapy as intended. The objectives of this study were to investigate the systemic perioperative course of the biomarkers CD45RO, TGF-β, and IL-8 in non-tumor-related minor and tumor-related major maxillofacial surgery and to perform association analyses with demographic and histomorphologic parameters. A deeper understanding of surgery-related changes in various of different immune biomarkers could help to better understand the immunologic consequences of surgery which could influence immunotherapeutic protocols. Peripheral whole blood from 38 patients was analyzed by real-time quantitative polymerase chain reaction (RT-qPCR) at five different timepoints before and after maxillofacial surgery to detect changes in mRNA expression of the biomarkers TGF-β, IL-8 and CD45RO. All patients underwent general anesthesia to undergo either resection and free flap reconstruction for OSCC or minor maxillofacial surgery (controls). Statistical analysis was done using Mann-Whitney-U test, Wilcoxon test, and Spearman's correlation. Compared to the preoperative expression, there was a significant postoperative downregulation of CD45RO, TGF-β and IL-8 until the 4th postoperative day (p ≤ 0.003) in OSCC patients. For TGF-β and IL-8, the reduction in expression was significant (p ≤ 0.004) compared to controls. By postoperative day 10, all analyzed parameters converged to baseline levels. Only CD45RO still showed a significant downregulation (p=0.024). Spearman analysis revealed a significant correlation between increased duration of surgery and perioperative reduction in peripheral blood expression of CD45RO, TGF-β and IL-8 (p ≤ 0.004). Perioperative changes in TGF-β and PD-L1 expression were shown to be not correlated. Preoperative TGF-β expression was significantly lower in patients with lymph node metastases (p=0.014). With regard to the analyzed parameters, major oncologic head-and-neck surgery does not seem to have long-lasting systemic immunologic effects. Reduced CD45RO might be an expression of transient systemic immunosuppression in response to major surgery. The association of duration of surgery with expression changes of immunologic markers supports efforts to keep the duration of surgery as short as possible. As perioperative TGF-β and PD-L1 expression changes are not associated, these results support further investigation of a combined perioperative anti-PD-1 and anti-TGF-β immunotherapy.

The Impact of Hematological Indices on the Occurrence of Delayed Graft Function (DGF) of Transplanted Kidney.

to analyse the effect of haematological indices on the occurrence of Delayed Graft Function (DGF) in patients undergoing kidney transplantation and on the function of the transplanted kidney on the 7th postoperative day. 365 recipients who underwent kidney transplantation from a donor with known brain death between 2010 and 2017 were included in this retrospective study. Information from patient medical records, donor medical records, and donation and transplantation protocols was used for analysis. Statistica 13 was used for statistical analysis. In the study group, DGF occurred in 144 recipients (39.45%), and Non-Graft Function (NGF) occurred in 12 recipients (3.29%). Recipients who developed DGF had a significantly higher Neutrophil/Monocyte Ratio (NMR) before renal transplantation (p = 0.048), a lower NMR value on postoperative day 1 (p < 0.001), and a difference between the values on day 1 and before surgery (p < 0.001). In addition, they had a significantly lower Lymphocyte/Monocyte Ratio (LMR) on postoperative day 1 LMR 1 (p < 0.001). It was shown that the value of the indices based on the ROC curve-NMR1 > 29.29, NMR1-0 > 22.71, and LMR1 > 1.74 (respectively: AUC = 0.624; 95% CI 0.566-0.682; and p < 0.001/AUC = 0.622; 95% CI 0.563-0.680; and p < 0.001/AUC = 0.610; 95% CI 0.550-0.670; and p < 0.001)-can be used to identify recipients with a significant probability of DGF. the NMR and LMR parameters on the first postoperative day and the difference between the NMR values on the first post-transplant day and the first pre-transplant day are predictive factors associated with the risk of DGF.

Case of triple extradural hematoma in a single patient: A rare case report

Epidural hematoma (EDH) is found in 1–4% of traumatic brain injury cases. Acute triple extradural hematoma is a rare presentation of head trauma injury. In sporadic cases, they represent 0.5–1% of all extradural hematomas. Here is a case report of a 36-year-old female patient who presented to us with a head injury due to fall from a bike due to collision with a stray animal. The patient had a Glasgow Coma Scale of 9 (E2V2M5) with bilateral sluggishly reacting pupil to light. Computed tomography showed asymmetric bilateral posterior fossa EDHs along with an extradural hematoma in the right frontal region with multiple small contusions with mass effect. The surgical evacuation was performed first of the posterior fossa in the prone position and then right frontal hematoma evacuation in the supine position in the same sitting. The patient recovered well and was discharged on the 10th post-operative day with no neurological deficit. Early drainage of hematomas has been demonstrated to be an effective technique that soon decreases the intracranial pressure and promotes an efficient resolution to the neurological damage.

Comparison of Antibiotic Coated Vicryl Vs Non-Coated Vicryl in Abdominal Fascial Closure After Laparotomy in Children

Objective: To compare the outcome of antibiotic-coated vicryl versus non-coated vicryl in abdominal fascial closure after laparotomy in children regarding surgical site infections in contaminated wounds. Material and Method: This randomized control study (NCT06129773) was conducted for one year at The Children's Hospital and University of Child Health Sciences, Lahore. According to the operational criteria, 100 patients were included in the research and randomly divided into two groups (50 patients in each Group). All patients were assessed for surgical site infection on the 3rd, 7th, and 30th postoperative days using the Southampton wound grading system. The student's t-test and Chi-square tests were applied in SPSS version 24 to interpret the associations between different variables. A P-value of &lt;0.05 was considered significant. Results: Both groups have similar demographic parameters like age and weight distribution. The mean age of the children in abdominal fascial closure with antibiotic-coated vicryl was 64.09±50.14 months, while in non-coated vicryl was 64.26± 53.45 months (p-value of 0.164). There was a male predominance in the study population, with 70 % males and 30 % females. The total surgical site infection (SSI) incidence following laparotomy was 37%. Surgical site infections occurred in 22% of patients in abdominal fascial closure with antibiotic-coated vicryl and 52% in the non-coated vicryl Group (p-value: 0.002). The hospital stay in the antibiotic-coated vicryl Group was significantly shorter than non-coated group. (4.20 versus 8.24 days. P- value: 0.001). Conclusions: The results of our study concluded that antibiotic-coated vicryl is superior to uncoated vicryl for abdominal fascial closure after laparotomy in contaminated wounds in children

Sphenopalatine ganglion block for headache after accidental dural puncture in a child: a case report

Background: PDPH is a well-recognized complication of anesthesia in the neuraxial. Few cases have been reported in children. EBP is more difficult in children, as it requires sedation or even general anesthesia. The SPG block is an effective, low-risk treatment option for PDPH refractory to conservative management. We will report a case of unnoticed accidental perforation of the dura mater, with the appearance of PHPD 48 hours after anesthesia, treated with SPG block. Case report: Female patient, aged 3 years and 9 months, weighing 20 kg, ASA I. Coagulogram and complete blood tests were normal. Abbreviation of fasting with orally 10 ml/kg of 12.5% maltodextrin between 2-4 hours before umbilical hernia correction. Monitoring, venoclysis (#22G), inhalation anesthesia with sevoflurane under the Baraka method. Asepsis and antisepsis, lumbar puncture with pediatric epidural needle (22G), injection 10 ml 0.25% levobupivacaine. The surgery duration is 40 minutes. PACU without motor blockage of the lower limbs. After 48 hours, she sought emergency care at the hospital with a typical PDPH after accidental puncture of the dura mater, without the anesthesiologist's perception. On the 5th postoperative day, the child presented refractoriness, leading to limitations in daily activities, SPG block with 1% lidocaine was performed with immediate success. Discharged home without a headache. Conclusion: Occurrence of PDPH after lumbar puncture in children is rare. SPG block has been an alternative for the use of EBP. The novel approach described in this report has minimal risks of discomfort or injury to the nasal mucosa. We believe that SPG block is a feasible, easy, safe, inexpensive, and well-tolerated treatment, being an option for the treatment of PDPH in children. Using five publishing sites this is the 1st SGP block in children.

Presence of Dengue Antibody in a Newborn with Maternal Peripartum Dengue Fever

In Bangladesh, the incidence of dengue infection continues to rise, and it has been related to severe maternal and infant morbidity during pregnancy. After presenting with an initial onset of fever at 37 weeks’ gestation, an 18-year-old pregnant woman ended up being diagnosed with dengue fever. The rapidly declining platelet count, 18,000/mm3 on the third day, necessitated a blood transfusion. On day six of her illness, while her platelet count was 23,000/mm3, she developed pre-labor rupture of membranes with labor pain. The labor became prolonged, with signs of obstruction. A prompt caesarian section was carried out under general anesthesia. She was discharged from the hospital on the 4th post-operative day without any negative sequelae. After birth, the newborn was diagnosed with dengue IgG by potential vertical transmission. Early detection and treatment are necessary for dengue during pregnancy. However, physicians must exercise extra caution when treating a pregnant dengue-infected patient by maintaining their physiological state, preventing shock, and, at the same time, taking care of the fetus, which may develop distress. J Bangladesh Coll Phys Surg 2023; 41: 120-122

Subacute postoperative atrial fibrillation after heart surgery: Incidence and predictive factors in cardiac rehabilitation.

Postoperative atrial fibrillation (POAF) is the most common arrhythmia following cardiac surgery (CS). It may occur between the 1st and the 4th postoperative day as acute POAF or between the 5th and the 30th as subacute (sPOAF). sPOAF is associated with higher thromboembolic risk, which consistently increase patients' morbidity. Neutrophil-to-lymphocyte ratio (NLR) is a low-cost inflammatory index proposed as possible POAF predictor. Identification of patients' risk categories might lead to improved postoperative outcomes. The aim was to assess the incidence of sPOAF and to identify possible predictors in patients performing cardiovascular rehabilitation (CR) after CS. A single-center cohort study was performed on 737 post-surgical patients admitted to CR on sinus rhythm. Continuous monitoring with 12-lead ECG telemetry was performed. We evaluated the predictive role of anamnestic, clinical, and laboratory data, including baseline NLR. Subacute POAF was documented in 170 cases (23.1%). At the multivariate analysis, age (OR 1.03; p = .001), mitral valve surgery (OR 1.77; p = .012), acute POAF (OR 2.97; p < .001), and NLR at baseline (OR 1.13; p = .042) were found to be independent predictive factors of sPOAF following heart surgery. sPOAF is common after CS. Age, mitral valve procedures, acute POAF, and preoperative NLR were proved to increase sPOAF occurrence in CR. NLR is an affordable and reliable parameter which might be used to qualify the risk of arrhythmias at CR admission. Identification of new predictors of postoperative atrial fibrillation may allow to improve patients' prognosis.

Associations of neutrophil to lymphocyte ratio and red cell distribution width on different days with the prognosis of aneurysmal subarachnoid hemorrhage patients.

The associations of neutrophil to lymphocyte ratio (NLR) and red cell distribution width (RDW) with the prognosis of aneurysmal subarachnoid hemorrhage (aSAH) patients were confirmed in a few studies. But NLR and RDW levels in most of these studies were on admission. Here we carried 1 retrospective study including 150 patients with aSAH who underwent surgeries in the First Affiliated Hospital of Yangtze University from January 2020 to February 2023 to explore the associations on the preoperative day, the first (1st), third (3rd), and seventh (7th) postoperative days. The level of RDW on the 3rd postoperative day and level of NLR on the 7th postoperative day in patients with poor prognosis were significantly higher than patients with good prognosis. The results of multivariate logistic analysis also confirmed the associations of RDW on the 3rd postoperative day (OR = 16.785, 95% CI: 4.077-69.107, P < .001) and NLR on the 7th postoperative day (OR = 8.399, 95% CI: 2.167-32.544, P = .002) with prognosis of aSAH patients. The results of receiver operating characteristic curve showed that cutoff values of RDW and NLR for predicting the prognosis in aSAH patients were 13.05% and 6.97, respectively. Higher RDW on the 3rd postoperative day and NLR on the 7th postoperative day were possibly associated with poor prognosis of aSAH patients. We should pay attention to the RDW and NLR levels during different hospitalization periods, especially in the short postoperative period. Moreover, the cutoff values for predicting prognosis need to be validated in larger-sample studies.

Primary Free Flaps for Coverage and Reconstruction in Acute Facial Trauma.

Background Acute facial trauma in motor vehicle accident defects may be associated with skeletal, neuromuscular, or mucosal losses. Simultaneous repair of the critical structures in these defects mandates the use of flap cover; paucity of local tissues necessitates the use of free skin flaps. Materials and Methods Six free flap reconstructions for acute facial trauma defects over a 10-year period were reviewed. The defect location, associated injuries, flap choice, additional reconstructive procedures, and flap outcomes were analyzed. Results There were four males and two females with ages between 18 and 63 years. Four defects were located in the lateral face and scalp, and two in the lower central face. Defect size ranged between 96 and 346 cm 2 . There were fractures in three, facial nerve injuries in two, and loss of facial muscles in one. Five free flaps were anterolateral thigh flap; simple and composite, one was a radial artery forearm flap. Recipient pedicles were the superficial temporal vessels in two and facial vessels in four cases. There were no re-explorations but one flap necrosed on 7th postoperative day on account of invasive aspergillosis. Discussion Use of free flaps for ballistic wounds is common. In uncommon nonballistic traumatic facial defects, the location, nature of the defect, and type of associated injuries and need for simultaneous reconstructions may dictate the use of free flaps and permit a one stage debridement, flap coverage, and a simultaneous reconstruction of lost functional units. Conclusion Free flap coverage in high velocity acute facial trauma defects offers a better possibility for primary reconstruction of associated facial injuries and helps in achieving better functional outcomes.

SURGICAL TREATMENT RESULTS OF PATIENTS WITH PHLEGMONS OF THE NECK USING A PORTABLE SYSTEM FOR TREATING WOUNDS UNDER NEGATIVE PRESSURE

Abstract. The failure of high e ffi ciency of treatment of phlegmons in the deep tissue spaces of the head and neck is to some extent explained by the rapid and sometimes fulminant complications development of that threaten the patient’s life, such as thrombosis of the neck veins, sepsis, erosive bleeding, mediastinitis, and others.Research objective: to study the eff ectiveness of portable systems using for the treatment of wounds under negative pressure in the postoperative period in patients with phlegmons of the neck.Material and methods. The results of the treatment of 54 patients undergoing treatment for deep phlegmons of the neck were analyzed.All patients were divided into two groups. The main group included 30 patients with intraoperative installation of a portable system for the treatment of wounds under negative pressure.The comparison group consisted of 24 patients with the classic installation of glove-tube drains in the anatomical locations indicated below.Research results. In all 54 patients, collar Razumovsky V. I. mediastinotomy was applied. The transition to serous discharge from the wound occurred in both groups: in the comparison group, on average, 267.4 hours after the end of surgery, while in the main group, on average, 38.9 hours after the end of surgery. On the 15th postoperative day, an average of 3.6 ml per group – in the main group, 58.7 ml – in the comparison group.In the postoperative period, 4 (7.4 %) patients developed purulent mediastinitis: 1 (3.3 %) patient from the main group, and 3 (12.5 %) patients from the comparison group. All patients underwent identical intensive treatment measures. Two of these patients from the comparison group died due to the development of acute cardiovascular insu ffi ciency, which made the total mortality for the group, respectively, 2.2 %. There were no fatal consequences in the main group. It should be noted that the average length of hospital stay in the main group was 14 days (336.1 hours), while in the comparison group, it was 27 (657.8 hours) days.In the postoperative period, 3 (13.64 %) patients of the comparison group had cicatricial stenosis of the esophageal anastomosis, in connection with which one of them had an esophageal stent installed, and the other two underwent courses of dilation procedures.Conclusions. In general, in the main group, the use of a mobile portable system for the treatment of wounds under negative pressure refl ects a signifi cantly more favorable postoperative course in patients of the main group and contributes to the prevention of infectious complications after surgical interventions and wounds, improves the drainage process by eff ectively emptying wounds and cavities from the accumulated exudate and allows signifi cantly improve the results of surgical treatment of deep phlegmons of the neck.

A Comparative Review of the Efficacy of 24-HourVersus 48-Hour Dose Regimen of Amoxicillin/Clavulanic Acid Prophylaxis forpostoperative infections following elective Caesarean Section at the University College Hospital, Ibadan, Nigeria: A Randomized Clinical Trial

Objectives: To compare the efficacy of 24hour versus 48hour prophylaxis of amoxicillin/clavulanic acid in the prevention of postoperative infections. Study Design: This study was a randomized controlled clinical trial conducted in a tertiary hospital in Ibadan, Nigeria. Two hundred and fifty -two pregnant women scheduled for elective caesarean section were randomly assigned into two groups. After the initial pre-incision antibiotic administration, group A received the Amoxicillin/Clavulanic Acid for 24 hours while group B received the same drug for 48hours. Main Outcomes: Participants were examined on the 3rd, 10th and 17th post-operative days for evidence of infections. All entry and analysis of data was by computer using the Statistical Package for Social Sciences version 22 (IBM, New York). Statistically significant differences were determined at p value of &lt; 0.05. Results: The incidence of postoperative wound infection, postoperative fever and endometritis in this study was 5.2%, 9.1% and 5.6% respectively. There was no significant differences in the incidence of postoperative wound infection, postoperative fever and endometritis between the two regimens of antibiotics. Conclusion: A 24-hour prophylactic regimen of amoxicillin/clavulanic acid is adequate following caesarean section and prolonged use of antibiotics is generally unnecessary, costly and inadvertently increases antibiotics resistance