Drain Site Research Articles

Herniation and incarceration of the gallbladder through the abdominal drain site: A case report

Herniation and incarceration of the gallbladder through the abdominal drain site: A case report

Recurrent Adenocarcinoma from the Drain Site

A 42 year old gentleman who had a recto-sigmoid carcinoma and was operated six months ago presented with a fungating lesion at the right iliac fossa region. The fungating lesion was about 5x5 cm in size with contact bleeding. The patient defaulted his chemotherapy regime and claimed that the lesion grew in size progressively over the time. Onfuther examination we noted that the lesion was originating from the previous blake drain site that was inserted during the first operation. Biopsy of the lesion done and it confirms that it is adenocarcinoma from the colon. The patient was subjected to CT scan for re-staging and was referred to the oncology team for further management. This is a rare occasion where the tumor recur from the drain site probably due to tumor seeding from the previous operation.

A different approach in primary spontaneous pneumothorax surgery: Lateral pleurectomy technique and results

Background: Primary Spontaneous Pneumothorax is a disease with a frequent recurrence rate. The uniportal videothoracoscopic surgery approach is the standard treatment for air leak and recurrence prevention. In common practice, apical pleurectomy is used after apical wedge resection. Our study aims to examine the results, especially the recurrence rate, of the lateral pleurectomy and apical pleural abrasion combination technique applied as an alternative to this technique.Methods: A total of 50 patients who underwent uniportal videothoracoscopic surgery for primary spontaneous pneumothorax between November 2018 and May 2021 were included in the study. The follow-up period for recurrence of the patients was 12-42 months. Age, gender, pneumothorax side, operation indication, Body Mass Index, smoking history, incision length and location, air leakage and tube thoracostomy duration, Verbal Numeric Pain Scores, post-operative length of hospital stay, complications, and recurrence data were recorded.Results: Of the 50 patients, 44 (88%) were male, and 6 (12%) were female, with a mean age of 22.3±5.9 years. Surgery was performed from the existing drain site in 32 (64%) cases and the former drain scar in 11 (22%) cases. The mean duration of tube thoracostomy was 2.7±0.97 days, and the mean length of hospital stay was 3.6±0.89 days. Complications developed in 2 (4%) cases, and recurrence was observed in 2 (4%) cases.Conclusions: Lateral pleurectomy with the apical pleural abrasion technique is easy to apply and reduces the possibility of undesired hemorrhagic drainage. We believe that the lateral pleurectomy technique is safe, easily applicable, and less risky in terms of hemorrhage.

Does the clamping method in local and systemic TXA applications in total knee arthroplasty change the game?: A retrospective comparative cohort study.

Many different methods and drain clamping periods have been described in systemic and local tranexamic acid (TXA) applications, and the superiority of the methods to each other has not been clearly demonstrated. The method of local infusion in combined TXA applications may not alter the Hb drop or total or hidden blood loss. We aim to compare two different combined TXA application methods. We retrospectively analyzed 182 patients who underwent total knee arthroplasty between 2018 and 2021. Patients over 40 years of age who underwent TKA for degenerative knee arthritis were included in the study. Unicondylar, revision, or bilateral arthroplasties and patients with the cardiovascular or cerebrovascular disease were excluded from the study. All patients in the study received 1 g TXA intravenously half an hour before the incision. For the first group, 1 g TXA was given intra-articularly at the drain site after closure, and the clamp was kept closed for 1 hour. In the second group, the drain was clamped for an additional 6 hours, and a 1 g intravenous dose was administered at the 5th hour postoperatively. No local applications were used in the control group. Total, hidden, and visible blood loss (total blood loss, hidden blood loss, visible blood loss), postoperative decreases in hemoglobin and hematocrit level (ΔHgb, ΔHtc), blood transfusion rates, and hospital stay durations were evaluated. There were 72 patients in the first group, 52 in the second, and 58 in control. A total of 37 patients received one or more blood transfusions postoperatively, and there was no statistical difference in the need for blood transfusions between the groups (P = .255). Although a statistically significant difference (P = .001) in total blood loss, hidden blood loss, visible blood loss and ΔHgb values was observed between the groups, the difference between the first and second groups was insignificant (P = .512). The duration of hospital stay was observed to be less in the first and second groups (P = .024). Local and systemic TXA applications were observed to be more effective than only systemic applications in reducing blood loss after total knee arthroplasty, regardless of the local method.

32372 Eosinophilic cellulitis secondary to trimethoprim-sulfamethoxazole

A 51-year-old female presented with 3 weeks of multiple itchy plaques on her left leg and right forearm. Her medical history was significant for recent bilateral mastectomy with lymphatic drain placement for treatment of invasive ductal carcinoma. Several days after drain placement, she was started on trimethoprim-sulfamethoxazole for concern of cellulitis at the drain site. Nine days later, she developed this eruption without systemic symptoms. Physical examination revealed multiple erythematous edematous plaques located on the left buttock, left thigh, and right forearm.

Institutional Management of Abdominal Lymphatic Malformations: Evolution of Treatment Over a Decade

IntroductionAbdominal lymphatic malformations (LM) have been historically managed with surgical resection; however, sclerotherapy and sirolimus have emerged as effective therapies. The purpose of our study is to evaluate our institutional change in management and outcomes for abdominal LM over the past decade. MethodsA retrospective cohort study was performed for all children with an abdominal LM managed at our multidisciplinary Vascular Anomalies Center from 2011 to 2020. Patient demographics, symptoms, treatment, treatment response, and complications were analyzed with descriptive statistics. ResultsTwenty-nine patients with abdominal LM were identified with a median age at treatment of 6 y (interquartile range 3-14). A majority of lesions were identified as macrocystic (n = 18, 62%). The most common intervention was surgery alone (n = 14, 48%) followed by sirolimus alone (n = 4, 14%), and sclerotherapy + sirolimus (n = 4, 14%). Five patients were observed due to lack of symptoms at presentation. Prior to 2017, 91% (10/11) of LM were treated with surgery alone. Following 2017, only 31% (4/13) were treated with surgery alone. Sixty-seven percent (16/24) of treated patients had >95% reduction in LM maximum diameter. A majority of patients (23/24) who received treatment had improvement or resolution of symptoms at median 9-mo follow-up. Only three patients had post-treatment complications, including a drain site infection, small bowel obstruction, and an aspiration event. Complications only occurred after sclerotherapy sessions. ConclusionsOver the study period, our institution has transitioned to initial management of symptomatic abdominal LM with sclerotherapy and/or sirolimus with almost all treated patients having excellent or satisfactory treatment response. Post-treatment complications were rare.

Retained appendicolith: Some things work themselves out

Management of perforated appendicitis has been debated for decades, remaining controversial today. Data is scarce regarding the approach to retained appendicolith after appendectomy. A 14-year-old girl presented with perforated appendicitis and an extraluminal appendicolith. IV antibiotics were initiated and drain placed until resolution of intraabdominal abscess. The drain was removed, and she was discharged on oral antibiotics. Ten days later she developed pain and purulent drainage from the drain site and was found to have a reaccumulated collection, so antibiotics were restarted, and she improved. Weeks later interval laparoscopic appendectomy ensued; the appendix was inflamed, and purulent fluid was noted in the pelvis. She initially recovered until multiple abscess recurrences, first temporized by percutaneous drainage, and subsequently by 6 weeks of antibiotics. Finally, workup of progressive right hip pain and swelling revealed a subcutaneous collection containing a shadowing echogenic lesion, consistent with the appendicolith from initial CT. Incision and drainage yielded pus and a 12 mm brown calcified mass; packing was placed. She was discharged on amoxicillin and continued wound care. Pathologic evaluation described a mass of calcified degenerated vegetable matter and food particles consistent with an appendicolith. Two years later she is without recurrent symptoms.

Spinal Drain Complications for Advanced Aortic Surgery at a University Hospital Center in Montreal, Canada

Spinal drains (SD) are an important component of spinal cord protection for patients undergoing complex aortic surgery. However, SDs are not benign and can lead to important complications such as intracranial hemorrhage and spinal hematomas. We sought to evaluate the outcomes of SD placement, including drain-related complications and spinal cord ischemia at a university hospital center in Montreal, Canada. Patients who underwent SD placement between 2014 and 2020 were identified using procedure codes. A retrospective chart review was then performed to identify patient demographics, comorbidities, characteristics of the index surgery, postoperative outcomes, and SD-related complications. Seventy-nine patients underwent preoperative SD placement. Sixty-six percent of patients were male and the mean age at the time of procedure was 66 years. Fifty-seven percent of patients presented with isolated thoracic aortic aneurysms and 43% presented with thoracoabdominal aortic aneurysms. Thirty-eight patients (48.1%) underwent advanced endovascular repair. Intraoperative drain placement was obtained with an average of 1.3 attempts, however this increased to 1.8 attempts in patients who experienced SD-related events (P = .032). Multiple attempts at placement was associated with an increase in SD events (P = .004). Ten patients (12.7%) experienced intraoperative SD events, including 6 patients (7.6%) who reported transient paresthesia requiring drain removal and new drain placement, 3 patients (3.8%) who had a bloody spinal tap, causing 1 drain placement to be aborted, and 1 patient who developed a hematoma at the drain insertion site and subsequently had their drain removed. Of the patients who experienced intraoperative SD events, three (3.8%) developed postoperative SD complications in addition to seven patients (8.9%) who developed new drain-related complications. Four patients (5.1%) had bloody drain output, two patients (2.5%) had a cerebrospinal fluid leak, two patients (2.5%) experienced intracerebral hemorrhages without long-term sequelae, one of the placed drains malfunctioned, and one patient had prolonged bleeding around the drain site. Spinal cord ischemia occurred in five patients (6.3%) total, two of whom experienced permanent disability. Of the five cases of SCI, three (3.8%) occurred in patients who had experienced SD complications. Postoperative SD-related complications occurred in 12.7% of patients undergoing aortic surgery, were more likely to occur when multiple attempts at SD placement occurred, and were associated with an increased risk of spinal cord ischemia. Lack of vascular-specialized anesthesiologists, participation of residents in SD placement and difficult patient anatomy may all have contributed to increasing the number of attempts required for SD placement.

Resection for Chronic Hepatic Abscess due to Infected Embolization Coils After Liver Injury.

Liver injuries after blunt abdominal trauma are very common. Non-operative approaches to management are now the standard of care for many patients with up to and including grade V liver injuries. However, the long-term complications associated with coil embolization can be challenging to manage. We present the case of a 29-year-old male who presented with a chronic liver abscess which contained the coils following embolization of a grade IV liver injury and the subsequent transhepatic embolization of the pseudoaneurysm. In addition, the patient developed a fistula draining the abscess through the previously placed drain site that traversed the diaphragm. A multidisciplinary discussion was held between trauma surgery, hepatobiliary surgery, thoracic surgery, and interventional radiology to discuss the best treatment plan. The patient subsequently underwent liver resection, fistula tract resection, and diaphragm repair. This case presents a definitive management strategy for these complex patients.

A Comparative Study of Soft Tissue Sarcomas of the Extremities; Brachytherapy versus Radiotherapy

Background: Soft tissue sarcoma (STS) is a wide group of solid tumors with specific features originating from mesenchymal tissue. Radiotherapy (RT) and chemotherapy have been widely applied in the treatment of these tumors to enhance surgical outcomes. This study was performed aiming to compare the results of postoperative brachytherapy (BRT) versus RT in patients who underwent surgical resection of extremity STSs. Methods: In a prospective study from 2011 to 2015, 166 patients with extremity STS who underwent surgical resection were included. All visible tumors, scars, and drain sites, if present during the surgery, were resected. A number of 79 patients received adjuvant RT, and 87 patients underwent BRT after surgical resection. Results: In patients who were treated through RT, the two-year local control was 90% in comparison with 87% for those treated through BRT (P > 0.050). The total radiation dose was 3869 ± 370 and 3048 ± 465 in the patients who underwent RT and in the BRT group (P < 0.001), respectively. The number of radiation sessions in the RT group and BRT group was respectively 27.3 ± 4.5 and 5.8 ± 2.0 (P = 0.001). Conclusion: Not only BRT can lead to similar local control and survival in comparison with the conventional adjuvant RT, but it can also decrease the total dose and number of radiation sessions in patients with STS of the extremity, which is a high grade, in individuals who underwent surgical resection.

Outcome of Childhood Cerebellar Pilocytic Astrocytoma: A Series With 20 Years of Follow Up.

Background: Cerebellar pilocytic astrocytoma (PCA) is one of the few CNS tumors that can be cured with gross-total removal (GTR). In this series, we had 39 patients diagnosed with cerebellar PCA, 27 patients (70%) had GTR, and mean follow-up period was 62 months with no tumor recurrence.Objective: To assess the long-term outcome of childhood cerebellar PCA treated at our institute during the period 2000-2020 and to highlight our surgical protocol.Methodology: Retrospective review of all patients under 18 years of age who were diagnosed with cerebellar PCA and had surgical excision between 2000 and 2020 at the Medical City of King Saud University.Results: The study included 39 patients: 17 males and 22 females, the mean age was 8.4 years. Radiologically, the tumor was solid in eight patients, cystic in 15 patients, and mixed components were found in 16 patients. The lesion was located in the right cerebellar hemisphere in 12 patients, left cerebellar hemisphere in five patients, and midline 22 patients. The tumor size ranged from 2 to 7 cm in its greatest diameter, it was <5 cm in 13 patients and >5 cm in 26 patients. Thirty-one patients had preoperative hydrocephalus. GTR of the tumor was achieved in 27 patients and subtotal resection (STR) was done in 12 patients, 18 patients required permanent ventriculoperitoneal (V-P) shunt, and five patients had postoperative radiotherapy. Postoperative complications included infection in two patients, cerebellar mutism in two patients, and significant neurologic disability in four patients. The duration of follow-up ranged from 0 to 240 months (mean follow-up period: 62.0 months). The outcome at 10 years was good in 30 patients, fair in four patients, poor in four patients, and one patient died. Recurrence was documented in nine patients, seven of them had GTR and two had STR.Conclusion: GTR, if achievable, is curative for childhood cerebellar PCA. Many posterior fossa surgical complications could be avoided with watertight dural closure. Although new dural substitutes are available we prefer using autologous grafts (pericranium). It is easy to harvest pericranial graft from the external ventricular drain (EVD) site. The insertion of EVD synchronously with GTR of the tumor and gradual weaning of EVD could avoid the insertion of V-P shunt.

803. The Impact of Bundled Interventions to Decrease Transmission of Drug-Resistant Pseudomonas aeruginosa from Wastewater Drain Sites on a Hematologic Malignancy/Hematopoietic Stem Cell Transplant Unit

BackgroundWastewater drain (WWD) sites are an important reservoir for amplification, propagation and transmission of multidrug resistant organisms. We observed an increase in the incidence of carbapenem and fluoroquinolone non-susceptible (CP-NS and FQ-NS) P. aeruginosa bloodstream infections (BSI) among patients on our hematologic malignancies (HM) and hematopoietic cell transplant (HCT) unit. The incidence of CP-NS/FQ-NS P. aeruginosa BSI from 2012 through May 2021 is represented in Figure 1. We sought to determine the impact of low-cost, low-barrier interventions targeting WWD sites on the prevalence of patient and environmental P. aeruginosa colonization and incidence of BSI.Figure 1. Incidence of P. aeruginosa BSI, 2012 through May 2021 MethodsBehavioral and structural interventions to limit acquisition from WWD sites were informed by an environmental analysis and rolled out in staged fashion beginning in September 2019. Pre- and post-intervention colonization surveys were performed on the unit to assess for patient and WWD site P. aeruginosa colonization. Whole genome sequencing (WGS) was performed on select isolates. A sensitivity analysis performed accounted for the unconfirmed patient isolates. BSI data was collected retrospectively. ResultsCharacteristics of the pre- and post-intervention groups are presented in Table 1. Five of 27 (18.5%) and 1 of 26 (3.8%) patients in the pre- and post-intervention point prevalence survey, respectively, were confirmed to be colonized with P. aeruginosa (Figure 2), corresponding to a prevalence rate ratio of 0.21 (0.03,1.66). If the two indeterminate samples in the pre-intervention period were positive, the prevalence rate ratio would instead be 0.15 (0.02,1.12). The most frequent P. aeruginosa strains identified by WGS from the patients and environment were 111, 308 and 446. At least 87% of rooms were colonized with P. aeruginosa from at least one WWD site, from pre- and post-intervention periods (Table 2). Table 1. Demographic and clinical characteristics of patients in each epoch. Results are given as percent (frequency) unless otherwise noted. Chi square test was used unless otherwise noted. Figure 2. Proportion of patients colonized with P. aeruginosa Positive: Colonized with P. aeruginosa, confirmed by WGS; Unknown: Phenotype of isolate suggestive of P. aeruginosa, WGS not performed; Negative: No growth on selective agar or non-P aeruginosa identification on WGS Table 2. WWD site colonization, by phenotypic and WGS determination. Fisher’s exact test was used unless otherwise noted. Conclusion P. aeruginosa WWD colonization on our HM/HCT unit may predispose patients to colonization and BSI. The prevalence of patient colonization decreased following implementation of the interventions, despite persistent environmental colonization. We will follow the incidence of P. aeruginosa BSI to determine the long-term impact of these interventions. Disclosures All Authors: No reported disclosures

DRAIN VERSUS NO DRAIN AFTER LAPAROSCOPIC CHOLECYSTECTOMY-A COMPARATIVE STUDY.

INTRODUCTION Gallstones are the most common conditions encountered in surgical OPD. The prevalence rose with age, except in women of 40-49 years, so that at 60-69 years, 22.4% of women and 11.5% of men had gall stones or had undergone cholecystectomy. With the help of this study, best treatment option for cholecystectomy patient (whether to insert drain or not), was ensured in terms of post lap cholecystectomy collections of bile or blood, drain site pain. The study was provide knowledge whether drain insertion was benecial or harmful to patient. MATERIALS AND METHODS This comparative study was presented to the surgery OPD and emergency department with cholelithiasis within a period of 1 year from the approval of Research committee and Ethics Committee, Adesh institute of medical sciences and research, Bathinda. The primary outcome variable used to calculate sample size is amount of collection on post-operative day 3(Quantitative Variable) in both groups. Total 100 patients were present in this study. RESULT In this present study VAS median grade in patients with drain was G4 (48%), followed by G3(47%) then G2(5%). VAS median grade in without drain group was G2 (48%), followed by G3(31%) and G1(16%). CONCLUSION There is no signicant difference as far as post operative wound infection in laparoscopic Cholecystectomy with drain or without drain. Therefore in patients undergoing laparoscopic cholecystectomy keeping drain can be avoided as it does not provide any additional benet.

MUNICIPAL SOLID WASTE MANAGEMENT IN BANGLADESH: A STUDY OF X MUNICIPALITY

Proper solid waste disposal is very important for the nature itself and its’ inhabitants. However, a study covering various aspects of solid waste management including management practices, prevailing problems and possible solutions are scarce in the literature. Accordingly, this study investigates a municipality of Bangladesh to understand the practices, problems and probable solutions of solid waste management. The dwellers of the surveyed municipality throw solid waste in various places like dustbin, drain, roadside and other crude dumping sites. Only about one-fourth of the respondents throw wastes to designated dustbins. More than half of the respondents don’t have knowledge about proper disposal of solid wastes. The study findings indicate that the survey respondents throw waste throughout the whole day. More than 80 percent of the respondents are either dissatisfied or highly dissatisfied with the existing solid waste management services of the municipality. The data indicate that about two-third of the respondents are willing to pay for improving the waste disposal system. The respondents informed that they are affected by various diseases such as diarrhea, pneumonia, asthma, and bronchitis during the last one year which they perceive as the outcome of improper solid waste management. Therefore, this study suggests for awareness development, time management of waste disposal, establishment of more disposal and collection points, employment of more manpower and vehicles, introduction of the ‘door to door’ waste collection mechanism, segregation of industrial and clinical wastes for ensuring a better managed solid waste disposal system in the municipality.

Mesh abdominoplasty for rectus diastasis in women and men

PurposeMeshes clearly have improved outcomes for tissue approximation over suture repairs for incisional hernias. A knowledge gap exists as to the surgical complication rate and post-operative outcomes of a mesh rectus diastasis repair with a narrow well-fixed mesh that simultaneously narrows the rectus muscles and closes the widened linea alba.MethodsInclusion criteria for mesh abdominoplasty were patients who (1) underwent a retrorectus planar mesh for repair of rectus diastasis (2) did not have a concurrent incisional hernia and (3) underwent skin tailoring as part of a cosmetic aspect of their care. The primary endpoint was surgical site occurrence (SSO) at any time after surgery as determined with review of their office and hospital medical records. Secondary endpoints included the length and complexity of the return to the operating room for any reason, non-surgical complications, readmission, post-operative recovery, surgical site infection, recurrence/persistence of abdominal wall laxity, and soft tissue revision rates.ResultsSSO rate was 0% for the 56 patients who underwent this procedure. There were 40 women and 16 men. Superficial infections requiring oral antibiotics were required in three patients. One was a drain site erythema, one was for a superficial stitch abscess, and the third was for a mesh strip knot infection 6 months after the procedure. One patient underwent further tightening of the abdominal wall. Rates of soft tissue revision in the office for improved cosmesis were 23% in women and 6% in men.ConclusionRepair of rectus diastasis with a narrow well-fixed mesh and concurrent skin abdominoplasty is a well-tolerated and reliable procedure with low recurrence and low SSO in the manner described. It is a procedure that works for both female and male pattern rectus diastasis, and has become our procedure of choice for moderate and severe rectus diastasis.

Tension Pneumocephalus: A Rare Complication Following Skull Base Surgery

Tension pneumocephalus (TP) is a rare complication following skull base surgery with potentially deadly consequences if not recognized and treated quickly. Characterized by the presence of air with a pressure gradient inside of the intracranial vault capable of causing mass effect, TP can result in altered mental status, seizures, or even death. We present the case of a 52-year-old male with recurrent hemangiopericytoma who underwent tumor resection and reconstruction complicated by tension pneumocephalus. It was determined to be caused by a failure of the drain site closure in the setting of a lumbar drain, thus resulting in an “inverted soda bottle” effect leading to TP. We review the reported cases of TP in skull base surgery and highlight the importance of ensuring drain site closure in order to prevent the development of tension pneumocephalus after skull base surgery.

Chronology and stratigraphy of the Imlay Channel in Lapeer County, Michigan, USA

The Imlay Channel in Lapeer County, Michigan, was one of two outlets for the glacial Lake Maumee phase of ancestral Lake Erie. Fifteen new radiocarbon and optical ages from within and adjacent to the Imlay Channel constrain sedimentation rates within the channel and the timing of regional deglaciation. For nearly 50 years, the deglaciation of this region of Michigan has been based on a single age from the Weaver Drain site located near the Imlay Channel, and a new radiocarbon age of 16.7–17.0 cal ka BP from 3 km east of the Imlay Channel supports this long-standing deglacial age. On average, there is a 14 m thick sediment fill within the channel. Radiocarbon and optically stimulated luminescence ages reveal that much of the alluvial fill was deposited by 14.9 ka, and alluvial fans building into the channel stabilized in the early Holocene. Cross-sections along and perpendicular to the Imlay Channel, built from geotechnical borings and water-well records, reveal a current-day bedrock sill elevation at 235 m a.s.l. that would have permitted drainage of all stages of glacial Lake Maumee in the past.

Menagement of post-operative suction pneumothorax after trans-hiatal esophagogastrectomy

Objective: This observational study was done to know the factors responsible and management of suction pneumothorax after trans-hiatal esophagogastrectomy. Materials and Methods: Progressive observational study of 415 patients who underwent trans-hiatal esophagogastrectomy and 35 patients who underwent trans-abdominal esophago-gastrectomy in last five years, for carcinoma esophagus and followed in immediate post-operative period for suction pneumothorax. Results: Ten patients from trans-hiatal group and two patients from trans-abdominal group complicated with suction pneumothorax in immediate post-operative period. It is the corrugated rubber drain site behind the neck incision close to esophago-gastric anastomosis which is responsible for maximum number of cases of suction pneumothorax. Withdrawal of corrugated rubber drain is the first and effective treatment, if diagnosis is made at an earliest point of occurrence of suction pneumothorax. If pneumothorax and air leak is not diagnosed and treated, then other fatal pulmonary complications can occur. Conclusion: Trans-hiatal esophageal dissection is usually associated with mediastinal pleural breach, so bilateral intercostal tube thoracostomy is a rational part of this surgery. Also close observation in immediate post-operative period is necessary to pick-up suction pneumothorax at an earliest point of suspicion. Keywords: Trans- hiatal suction pneumothorax, Esophagogastrectomy suction pneumothorax.

Sustainable removal of Ni(II) from waste water by freshly isolated fungal strains

The release of untreated wastewater containing biotoxic substances in the form of heavy metals is one of the most crucial environmental and health challenges faced by our community. The recent advances in microbes derived removal has propelled bioremediation as a better and effective alternative to conventional techniques. Present study investigates the detoxification mechanisms evolved by the nickel (Ni(II)) resistant fungal strains, isolated from the industrial drain sites. The molecular detailing of the isolated fungal isolates confirms their identity as Neurospora crassa and Aspergillus flavus. Laboratory-scale experiments have established influence of different ranges of dose, pH, time, and metal concentration on the removal and uptake trends. Further, the variations in the carbon and nitrogen sources and agitation conditions has revealed the best substratum for achieving optimum results for the industrial exploitation of these microbes. SEM micrographs and FTIR spectra elucidates the superficial alterations on the mycelium of the fungal isolates and the involvement of active functional groups in the bioremediation of Ni(II) respectively. Biosorption of Ni(II) on living biomass has followed the Langmuir adsorption model. The findings of the study have provided a promising insight in the simultaneous action of different mechanistic removal approaches to explore a large scale removal of Ni(II) from the waste generating industries.

Patient-Directed Home Drain Removal in Head and Neck Surgery.

The purpose of this study was to evaluate the efficacy and safety of at home drain removal in head and neck surgery patients. The study population included patients who underwent head and neck surgery at an academic tertiary care center between February 2020 and November 2020 and were discharged with one to four drains with instructions for home removal. Prior to discharge, patients received thorough drain removal education. Patients were prospectively followed to evaluate for associated outcomes. One hundred patients were evaluated in the study. There was record for ninety-seven patients receiving education at discharge. The most common methods of education were face-to-face education and written instructions with educational video link provided. Of 123 drains upon discharge, 110 drains (89.4%) were removed at home while 13 (10.6%) were removed in office. Most drains were located in the neck (86.4%). There was one seroma, two hematomas, two drain site infections, and five ED visits; however, none of these complications were directly associated with the action of drain removal at home. Calculated cost savings for travel and lost wages was $259.82 per round trip saved. The results demonstrate that home drain removal can provide a safe and efficacious option for patients following head and neck surgery. This approach was safe and associated with patient cost savings and better utilization of provider's time. Furthermore, patients and healthcare providers avoided additional in-person encounters and exposures during the COVID-19 pandemic. Our findings warrant further investigation into cost savings and formal patient satisfaction associated with home drain removal. 4 Laryngoscope, 131:2471-2477, 2021.