Prophylactic Technique Research Articles

Strategy for prophylactic application of peripheral va-ecmo in transplantation involving expected extremely prolonged ischemia time

Heart transplantation (HT) with extremely prolonged (>6 hours) graft ischemia is associated with severe cardiac graft dysfunction. The high efficiency of prophylactic (preoperative initiation) veno-arterial extracorporeal membrane oxygenation (VA-ECMO) to prevent severe hemodynamic disorders during cardiac surgery has been demonstrated. Objective: to determine the effect of prophylactic VA-ECMO on the perioperative period in HT with an expected graft ischemia >6 hours. Materials and methods. Thirty-eight recipients (33 (86.8%) males and 5 (13.2%) females), age 11–66 (44.7 ± 12.0) years (median 48.0 years) were examined. Pre-transplant mechanical circulatory support (MCS) using peripheral VA-ECMO was applied in 15 (39.5%) recipients, in 6 of whom by prophylactic technique. The recipients (n = 38) were divided into 3 groups: 1) «no pre-HT VA-ECMO» (n = 23); 2) «pre-HT VA-ECMO» (n = 9) – pre-transplant VA-ECMO as a bridge to HT; 3) «prophylactic VA-ECMO» (n = 6). Results. In «prophylactic VA-ECMO» group, extracorporeal circulation (ECC) (94.0 [85.5; 102.8] min) and reperfusion time (20.0 [18.3; 27.6] min) were shorter (p < 0.05) compared to «no pre-HT VA-ECMO» (161.0 [122; 191.5] and 60.0 [55.3; 70.5] min) and «pre-HT VA-ECMO» (127.0 [117; 150.3] and 35.0 [27.8; 48.8] min) groups. The vasoactive-inotropic score was lower (p < 0.05) in «pre-HT VA-ECMO» and «prophylactic VAECMO» groups compared to recipients in «no pre-HT VA-ECMO» group, 12.1 [11.2; 14.0] and 12.5 [11.7; 14.8] vs. 16.0 [15.0; 18.5], respectively. The groups did not differ in terms of incidence of severe primary dysfunction. The «pre-HT VA-ECMO» and «prophylactic VA-ECMO» groups were characterized by shorter duration of mechanical ventilation (MV) compared with «no pre-HT VA-ECMO» group (11.7 [10.0; 16.5] and 12.7 [11.3; 18.4], respectively, vs. 14.5 [13.0; 19.3]). The «no pre-HT VA-ECMO» and «prophylactic VA-ECMO» groups did not differ in the need for postoperative MST, 21.7% and 16.7%, respectively. The groups did not differ in terms of length of stay in the intensive care unit (ICU) and in-hospital mortality – 0% («prophylactic VA-ECMO») and 8.7% («no pre-HT VA-ECMO») and 11.1% («pre-HT VA-ECMO»), respectively. Conclusion. Prophylactic VA-ECMO in HT with extremely prolonged cardiac graft ischemia reduces ECC duration, reperfusion period, postoperative mechanical ventilation period, and the need for inotropic therapy.

COMBATING HEMODIALYSIS CATHETER-RELATED INFECTION USING AN ANTIBIOTIC LOCK, ACASE-CONTROL STUDY, AT KING FAHD HOSPITAL OF THE UNIVERSITY, SAUDI ARABIA

Background: Catheter-related infections (CRI) in hemodialysis patients are very common complications with devastating consequences if not managed appropriately, as most of the morbidity and mortality among these patients are caused by bacteremia related to hemodialysis. Hence, safety issues exist to restrict the spread of infections among this group of patients. A prophylactic technique that is worth of much discussion is the use of antimicrobial lock solutions (ALS). Several studies have been conducted in this area. Yet, there is no consensus recommendation in this regarding. Hence, the purpose of our study is to examine the efficacy of ALS for prevention of CRI in patients undergoing HD. Methodology: Methods:A total of 86 TCC in 69 HD patients were enrolled at the time of catheter insertion for delivering HD. Patients were randomized into two groups: Group I (36 patients-39 insertions) included TCC with antibiotic-lock therapy and Group II (33 patients-47 insertions) with routine TCC management. Infection-free catheter survi­val of both groups was evaluated and compared at the end of the 7-month study period. Results:A total of 67 TCC-related infections were detected, with an incidence rate of 8.79/1000 dialysis sessions (ds). Out of these infections, 50 belonged to patients in group II with an incidence rate of 12.88/1000 ds, and 17 in patients of group I with an incidence rate of 4.51/1000 ds (p<0.001) (Table 3). The bacteremia rate was 5.14/1000 ds in patients of group II and only 0.63/1000 ds in patients of group I (p<0.001). Clinical sepsis occurred in 19 (28.4%) of the 67 TCC infections. Clinical sepsis rate was significantly lower in patients of group I (0.61/1000ds) compared with 4.12/1000 ds in group II patients (p<0.005). Conclusion: TCC lock with vancomycin and gentamycin appears to be highly effective strategy for the reduction of morbidity, and potentially mortality and costs, associated with TCC-related bacterial infections in HD patients. In this study, this protocol was free of side effects.

Metabolomics based biomarker identification of anti-diabetes and anti-obesity properties of Malaysian herbs.

Today, obesity affects over one-third of the global population and is hugely considered the Industrial Revolution's side effect. This multi-factorial disease is continuously spreading across developing countries, including the Middle East and SoutheastAsiaregion, where Malaysia and Darussalam Brunei are the most affected. The sedentary lifestyle and availability of surplus foods have dramatically increased the number of individuals with type 2 diabetes in these countries. Thus, an adequate medical strategy must be developed urgently to address and remedy these diseases. Natural sources have been attracting attention, especially in Malaysia, where most land areas are under plant cover. Metabolomics, as a prophylactic technique, has been used extensively in Malaysia to investigate the potential use and benefits of herbs to combat obesity and diabetes. This review aims to explain the application of the metabolomics approach in the study of anti-diabetes and anti-obesity activity of Malaysian herbs to identify the stand-up point for future advancement in using these herbs as a primary source for drug exploration. This review provides an overview of using metabolomics technique in studying the anti-diabetes and anti-obesity activity of Malaysian herbs. Specific emphasis is given to the changed metabolites in both in vivo and in vitro treatment of Malaysia herbs that might be future drugs for treating diabetes and obesity.

Clinical and hemodynamic insights into the use of internal iliac artery balloon occlusion as a prophylactic technique for treating postpartum hemorrhage

Recently, the effectiveness of internal iliac artery balloon occlusion (IIABO) for treating postpartum hemorrhage caused by pernicious placenta previa (PPP) has been questioned. We conducted a retrospective analysis and hemodynamic simulation to assess the IIABO’s effectiveness. The retrospective analysis involved 480 patients with PPP, among which 288 underwent IIABO treatment and the remaining 192 were used as controls. Blood loss and preoperative indicators were recorded, and multiple regression analysis was applied to test the effect of preoperative indicators on blood loss. Hemorrhage mechanisms were simulated using a numerical model. Results suggested that no significant difference in blood loss (1836 ± 1440 ml vs. 1784 ± 1647 ml, p = 0.22) was observed between the two groups. In addition, preoperative indicators, including age, weight, gestational age, gravidity, parity, blood type, anemia, or diabetes, were not associated with blood loss. In the simulation, after the intra-iliac artery was blocked, blood loss was caused by a reversed flow in the intrapelvic arteries, uterine veins, and uterine venules. The ratio of the time-averaged hemorrhage velocity (TAHV) in the balloon group to that in the control group was lower than that obtained in a clinical study (13.0% vs. 88.9%); in the presence of collateral circulation, blood loss occurred from collateral circulation and uterine venules after IIABO intervention, and the TAHV was 60%–90% that of the control group, which was closer to the clinical results (88.9%). These results suggest that IIABO cannot effectively treat postpartum hemorrhage because of the collateral circulation and reversed flow in the uterine venules.

Effect of prophylactic balloon occlusion of internal iliac artery in pregnancies complicated by placenta previa and accreta

BackgroundPlacenta previa and accreta are serious obstetric conditions that are associated with a high risk of intraoperative massive hemorrhage, the prophylactic intravascular balloon occlusion technique is increasingly used in managing uncontrolled hemorrhage in cesarean section (CS). We aim to examine the clinical effectiveness of prophylactic balloon occlusion of the internal iliac artery (PBOIIA) during CS in improving maternal outcomes for patients with placenta previa and accreta.MethodsA total of 420 women with placenta previa and accreta who underwent CS from January 2014 to December 2018 were included retrospectively. Patients were divided into balloon group in which patients had PBOIIA (n = 248) and the control group in which patients did not have PBOIIA (n = 172). Meanwhile, we performed a subgroup analysis in whether taking parallel transverse uterine incision (PTUI) surgery. Information on conditions of patients and newborns, perioperative blood indicators, surgical outcomes were collected.ResultsMedian estimated blood loss (mEBL) was 2200 mL in the balloon group and 2150 mL in the control group respectively, there was no significant difference between two-groups comparison (P > 0.05), and the rate of patients with hysterectomy was also has no difference between the two groups (36.3% verus 35.5%, P > 0.05), while there is a significant difference between two groups in the amount of PRBCs transfused [3 (0–31.5) verus 3 (0–39), P <0.05], moreover, the proportion of PRBCS> 8 units in the balloon group is significantly lower than that in control group (11.29% verus 23.26%, P <0.05).. However, the total hospitalization costs (45,624.4 ± 11,061.9 verus 37,523.1 ± 14,662.2, CYN) and surgery costs (19,910.6 ± 2622.6 verus 11,850.5 ± 3146.1, CYN) in balloon group were significantly higher than those in control group (P < 0.05). Subgroup analysis showed PTUI surgery had no significant differences in EBL (P >0.05), but it could significantly decrease hysterectomy rates (P <0.05).ConclusionsPBOIIA has no significant effect on reducing intraoperative EBL and hysterectomy rate in patients with placenta previa and accreta. and although it could reduce the intraoperative PRBCs in patients with massive hemorrhage, it significantly increases the financial cost for patients. Therefore, PBOIIA should not be routinely recommended to patients with placenta previa and accreta.

An Update on the Posterior Earlobe/Concha Mastoid Suspension Suture to Correct "Pixie Ear" Following Facelift: Review of 40 Cases.

Auricular displacement (AD) and earlobe distortion, such as "pixie ear," are commonly seen deformities after rhytidectomies. In 2018, the authors of this article published a prophylactic technique (posterior earlobe rotation flap [PERF] and concha-mastoid suspension suture [CMSS]) to prevent such cosmetic-related complications in primary facelift surgery. Here, the authors review the utilization of this technique to correct such deformities in patients receiving revision facelift surgeries. The authors sought to demonstrate the usefulness of this technique in reconstructive cases suffering from such aesthetic deformities. A total 25 secondary and 15 tertiary rhytidectomies were operated between 2015 and 2018. A combination PERF/CMSS technique was performed bilaterally during each revision facelift surgery (n = 80). A retrospective data analysis (preoperatively; 1 year postoperatively) was conducted to detect any deformities. No "pixie ear" deformities were seen in any of our patients postoperatively. AD was detected twice and unilateral hypertrophic scarring once. The postoperative photometric analysis showed a natural ptosis grade I/II in all our patients. The total rate of aesthetic-related complications in our patient cohort was 3.75% (AD: 2.5%; hypertrophic scarring: 1.25%). After demonstrating the effectiveness of the PERF and CMSS techniques in primary facelifts, the authors reviewed the technique's effectiveness for restoring earlobe distortion and AD in secondary or tertiary rhytidectomy cases. In addition to its prophylactic utilization, this method also possesses strong reconstructive power to change tension vectors applied on the face (CMSS) and/or to correct pre-existing aesthetic complications, such as "pixie ear" formation (PERF).

Effect of incentive spirometry after cardiac surgery: protocol for a systematic review

Introduction: Patients receiving cardiac surgeries present high risk of developing postoperative complications. Incentive spirometry (IS) is used for the prevention and treatment of postoperative pulmonary complications in patients undergoing cardiac surgeries. Publications have suggested that IS is ineffective. In contrast, some studies have shown that when IS is adequately used, it may lead to beneficial outcomes. Objectives: To assess the effect of IS in patients undergoing cardiac surgeries. Methods/design: Systematic Reviews with randomised and quasi-randomised trials with adult patients undergoing cardiac surgeries, evaluating the effect of flow or volume-oriented IS. Outcome measures: postoperative pulmonary complications; adverse events; mortality; length of hospital stay; length of intensive care unit stay; reintubation rate; pulmonary function; antibiotic use; oxygenation; and respiratory muscle strength. Search: MEDLINE, EMBASE, CENTRAL, PEDro, CINAHL, LILACS, SCIELO, Allied, AMED, Scopus, Open Grey database, the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP), ClinicalTrials.gov, clinicaltrialsregister.eu, and ReBec. Two authors will independently extract data. PEDro scale will be used to evaluate the methodological quality of the studies. Meta-analysis will be performed using the inverse variance method and the random effects model in RevMan 5.3. We will use the I2 statistic to estimate the amount of heterogeneity across studies in each meta-analysis. Ethics and dissemination: The approval of an ethical committee is not required. Only clinical trials that have complied with ethical guidelines and followed the Declaration of Helsinki, will be included in this systematic review. The findings of this study will help clarify uncertainties about the effects of incentive spirometry in the postoperative period of cardiac surgery and may be disseminated to clinicians, assisting in decision making and including the best evidence in the treatment of their patients. Discussion: This review will clarify the uncertainty over whether IS is a useful technique for patients undergoing cardiac surgeries. While good quality studies have shown IS is an effective prophylactic technique, other studies have suggested that there is no evidence to support IS utilization.Keywords: incentive spirometry, cardiac surgery, postoperative.

Defoliation of the vines before or after berry set: Physiological consequences and qualitative factors

Defoliation of the vines consists of eliminating the leaves in the grape bunch zone in a more or less intensive manner. It is a long-proven prophylactic technique that has seen a renewed interest in the current context of the reduction of phytosanitary inputs. However, several questions remain. Which is the optimal period? What is the ideal intensity? What are the risks? Is the mechanization of this process a feasible option? Agroscope has been undertaking defoliation trials in Switzerland since 2010 in order to shed light on these questions.

Biomechanics of Prophylactic Tethering for Proximal Junctional Kyphosis: Comparison of Posterior Tether Looping Techniques

Study DesignBiomechanical study. ObjectivesCompare effects of four spinous process (SP) tether looping methods on segmental flexion range of motion (ROM), intervertebral disc (IVD) pressures, and peak tether forces. Summary of Background DataSP tethering has been gaining interest as a prophylactic technique to prevent PJK caused by ligamentous laxity in ASD corrective surgery. Several SP tether looping methods have been proposed; however, there is no consensus on appropriate technique. No study has investigated the effect of the tether looping method on segmental biomechanics. MethodsNine T1–T4 cadaveric motion segments were tested to 5 Nm of flexion-extension. The uppermost instrumented vertebra (UIV) was located at T3 using standard pedicle screws and fusion rods. A crosslink (CL) was placed inferior to the pedicle screws. A 5-mm polyester tether was looped under the CL at UIV and through holes drilled at the base of UIV + 1 and UIV + 2 SPs. Biomechanical measurements included flexion ROM, IVD pressure, and peak tether forces at UIV/UIV + 1 and UIV + 1/UIV + 2. An untethered test was used for baseline values. Tethered tests included one single-level (SL) method and three double-level (DL) methods: common (CM), chained (CH), and figure-8 (F8). ResultsSL yielded significant reductions in flexion ROM at UIV/UIV + 1 (p = .001) and in IVD pressure at UIV/UIV + 1 (p = .007). Choice of DL method had a significant effect on flexion ROM at UIV/UIV + 1 (p = .004) but not at UIV + 1/UIV + 2 (p = .14). Choice of DL method also had a significant effect on IVD pressure at UIV/UIV + 1 (p < .001) but not at UIV + 1/UIV + 2 (p = .311). CM produced the greatest reductions in flexion ROM and IVD pressure, with the lowest peak tether forces among the DL methods. ConclusionTether looping method significantly alters segmental biomechanics. Tethering with the CM method to UIV + 2 allows for reductions in loads acting on the UIV + 1 SP and posterior ligaments. Level of EvidenceLevel V, biomechanical study.

Wednesday, September 26, 2018 7:35 AM–9:00 AM ePosters: P13. Changes in spinous process tether looping method significantly alters segmental biomechanics for proximal junctional kyphosis prophylaxis

BACKGROUND CONTEXT Spinous process (SP) tethering is gaining interest as a prophylactic technique to alleviate load concentrations and reinforce the posterior ligament complex (PLC) at the uppermost instrumented vertebra (UIV) to reduce the risk of developing proximal junctional kyphosis (PJK) in adult spinal deformity (ASD) surgeries. Consensus has yet to be established on appropriate technique and there is a lack of biomechanical data to provide initial guidance. While multiple SP looping methods have recently been proposed, no study has evaluated the effect of tether looping method on segmental biomechanics. PURPOSE We sought to evaluate the effects of four tether looping methods on segmental biomechanics at UIV, UIV+1, and UIV+2. We hypothesized that the different looping methods would result in significant differences in flexion range-of-motion (ROM), intervertebral disc (IVD) pressures, and peak tether loop tensions. STUDY DESIGN/SETTING Biomechanical study. OUTCOME MEASURES Flexion ROM, IVD pressure, peak tether tension. METHODS Nine T1–T4 cadaveric motion segments were tested in flexion–extension bending to 5 Nm using a pure-moment testing machine. UIV was located at T3 using standard pedicle screws and rods. A rod crosslink (CL) was placed inferior to the pedicle screws. Motion of UIV, UIV+1, and UIV+2 was recorded using a motion capture system. IVD pressure was measured at UIV/UIV+1 and UIV+1/UIV+2 using custom pressure probes. A 5 mm braided polyester suture was used for tethering. The tether was looped under the CL at UIV, and through holes drilled at the base of UIV+1 and UIV+2 SPs. Tether tension was measured using custom in-line tension sensors for each independent loop. An untethered test was used for baseline values. Tethered tests included one single level (SL) and three double level (DL) tests: (1) SL, a single tether from CL at UIV to UIV+1 SP, (2) DL Common (CM), a tether from CL at UIV to UIV+1 SP and another tether from CL at UIV to UIV+2 SP, (3) DL Chained (CH), a tether from CL at UIV to UIV+1 SP and another tether from UIV+1 SP to UIV+2 SP, and (4) DL Figure-Eight (F8), a single tether from CL at UIV to UIV+1 SP and UIV+2 SP in a woven figure-eight loop. Loops were pretensioned to 22N before each test. RESULTS The SL method resulted in significant reductions in flexion ROM at UIV/UIV+1 (p=.001) but not at UIV+1/UIV+2 (p=.052). SL also yielded significant reductions in IVD pressure at both UIV/UIV+1 (p=.007) and UIV+1/UIV+2 (0.002). The choice of DL method had a significant univariate effect on flexion ROM reduction at UIV/UIV+1 (p=.004) but not at UIV+1/UIV+2 (0.14). The choice of DL method also had a significant univariate effect on IVD pressure reduction at UIV/UIV+1 (p CONCLUSIONS The use of different tether looping methods significantly alters the tether's effect on segmental biomechanics. double level techniques provide greater reductions in flexion ROM and IVD pressures; however, they yield greater tether tensions at the uppermost tethered level compared to SL. CM produced the best results for improved segmental stability. The transfer of peak SP loading to superjacent levels may provide benefits in protecting the UIV+1 SP and the PLC. New understanding in the effect of looping methods may provide improved ability to reduce PJK caused by ligamentous laxity.

Клінічна ефективність профілактики акушерських та перинатальних ускладнень у вагітних із первинною артеріальною гіпертензією на тлі йододефіциту

The objective: reduction in the incidence of obstetric and perinatal complications in pregnant women with primary hypertension in conditions of endemic iodine deficiency based on the study of pregnancy and childbirth course, fetal and newborn conditions after the introduction of the developed complex of preventive and therapeutic measures. Materials and methods. A clinical analysis of 100 pregnant women has been conducted: – control group (KG) – 30 healthy pregnant women living in conditions of endemic iodine deficiency, give birth to the first time, without somatic pathology, had vaginal delivery; – And the group – 30 pregnant women with primary hypertension, who live in conditions of endemic iodine deficiency and received the usual medical and preventive measures; – II group – 40 pregnant women with primary hypertension who live in conditions of endemic iodine deficiency and received the method of prevention of obstetric and perinatal complications developed by us. Clinical and statistical analysis of the course of pregnancy, childbirth and condition of the fetus and the newborn after the introduction of the developed complex of treatment and preventive measures has been carried out. The obtained data are processed by the statistical method using the Microsoft Excel computer program. Results. Due to the use of proposed by us method, we managed to reliably reduce the frequency of gestational anemia (I group – 43.3% vs. 22.5% in group II, p&lt;0.05), development of gestational diabetes (I group – 13.3% vs. 5.0% in the 2nd group, p&lt;0.05), the threat of preterm labor (I group – 16.6% vs. 7.5% in the second group, p&lt;0.05), placental dysfunction (group I – 63.3% vs. 22.5% in the second group, p&lt;0.05); violation of microbiocenosis of the genital tract (group I – 53.3% vs. 17.5% in group ІІ, p&lt;0.05). In addition, a significant reduction in the level of combined preeclampsia (group I – 40.0% vs. 20.0% in group II, p&lt;0.05) and change in the incidence of FGR syndrome (group I – 40.0% vs. 22.5% in the second group, p &lt;0.05). Significant decline in the incidence of developmental delivery complications: premature rupture of fetal membranes (I group – 26.7% vs. 15.0% in group II, p&lt;0.05); preterm labor (group I – 13.3% vs. 5.0% in group II, p&lt;0.05); Fetal distress (group I – 36.6% versus 15.0% in group II, p&lt;0.05). It should be noted that the absence of PDNLP in pregnant group II versus 6.7% incidence of pregnant in group I. Reduction in the level of various forms of newborn asphyxiation: from 26.7% in group I to 15.0% in group II, p&lt;0.05 against the background of the use of the proposed method, severe asphyxia was absent in newborns from pregnancy group II versus 3.3% cases in group І. The total incidence of newborns in the early neonatal period has significantly decreased by 1.7 times (60.0% in group I versus 35.0% in group II, p&lt;0.05). There is no perinatal loss in group II, which also confirms the effectiveness of our proposed method. Conclusions. The proposed therapeutic and prophylactic technique for the prevention of obstetric and perinatal complications in pregnant women with primary hypertension in the background of natural iodine deficiency has made it possible to reliably reduce the frequency of obstetric and perinatal complications. This makes it possible for the proposed method to be recommended for use in therapeutic practice. Key words: course of pregnancy, childbirth, condition of newborn, obstetric and perinatal complications, primary arterial hypertension, iodine deficiency.

Is dural hitching necessary to prevent post-operative extradural haemorrhage in craniotomies and craniectomies

Object The goal of this study was to determine the necessity of dural tenting sutures in preventing post-op extra-dural haematomas (EDH) in craniotomies and craniectomies at a premier Neurosurgical unit in Sri Lanka. Methods Data was collected prospectively from 785 cranial operations of patients between the ages of 12 to 75 years. Dural hitching was considered as the control according to current Sri Lankan practices and not performing the dural hitch was considered the intervention. Sample allocation into each group was done alternatively with dura hitching being carried out on the first patient. Data was collected from 403 patients in the control group and 382 patients from the intervention group. The main outcome measure was the indication of significant post- operative EDH with evidence of neurological deficit or a post- operative CT scan with evidence of >30ml collection or midline shift >5mm. Results Dural hitching as a prophylactic technique proved no benefit in decreasing the occurrence of post-operative surgically significant extradural collections even in the context of an Asian hospital environment. It however remains as an important neurosurgical technique invaluable in other circumstances.

Does periosteal scraping of the third metacarpal bone reduce the incidence of ‘bucked shins’ in young Thoroughbred racehorses?

The occurrence of bucked shins in young Thoroughbred racehorses in North America is high. Although an altered training regime has demonstrated a significant decrease in this condition, trainers can be opposed to altering something as fundamental as their training routine. Periosteal scraping of the third metacarpal bone (McIII) is a putative prophylactic technique used to prevent bucked shins; therefore, a study to investigate the validity of the procedure is warranted. To investigate whether prophylactic McIII scraping: 1) reduces the incidence of bucked shins in juvenile Thoroughbred horses at race speeds (breeze); and 2) allows increased cumulative breeze miles before the onset of disease. Nonrandomised prospective clinical study. One hundred and seventy yearling Thoroughbreds from one farm, under one trainer, were enrolled in this study over one training season; 85 horses were treated and 85 horses were control animals. Horses were observed for bucked shins over 5 cumulative breeze miles. The objectives were evaluated by comparing incidence rates and Kaplan-Meier plots. The incidence rate for bucked shins was 0.059 cases per breezed mile in the treatment group, compared with 0.103 cases per breezed mile in the control group. Comparison of Kaplan-Meier plots of breeze miles for the 2 groups demonstrated a significant difference between groups (P = 0.035). Horses that developed bucked shins following periosteal shin scraping breezed an average of 3.52 miles before the onset of disease, compared to 2.50 miles for horses not prophylactically treated (P = 0.005). Periosteal McIII scraping reduced the incidence rate of bucked shins. The procedure allowed treated horses to breeze greater cumulative distances before an incident but failed to prevent the disease over the long term. Further investigation into this commonly used prophylactic technique is required.

Incentive Spirometry in Postoperative Abdominal/Thoracic Surgery Patients

Background: Postoperative patients have higher incidences of respiratory complications. Patients undergoing abdominal or thoracic surgical procedures are at greater risk of having such complications. Incentive spirometry is an inhalation-based prophylactic technique that encourages patients to mimic a natural deep sigh to periodically increase lung volume. As this technique is the prophylactic method of choice for many hospitals, several studies have tested its efficacy. Methods: Five articles, including 4 systematic reviews and 1 clinical practice guideline, are analyzed and summarized. Each article was reviewed by a multidisciplinary team of health care providers and is discussed herein. A clinical recommendation for practice change is provided on the basis of the results. Summary: Incentive spirometry is only as effective as cough/deep-breathing regimens and other means of postoperative pulmonary prophylaxis. No single prophylactic technique clearly outperforms all others in preventing pulmonary complications. Future research is needed to determine the best method to prevent postoperative pulmonary complications.

Prophylactic Laparoscopic Hiatoplasty Technique with a Bioabsorbable Synthetic Tissue Regenerator in the Surgical Treatment of Gastroesophageal Reflux Disease

Abstract Introduction: Laparoscopic fundoplication has been confirmed as an effective long-term therapy in the treatment of gastroesophageal reflux disease, but has been reported that various facto...

Incentive Spirometry in Postoperative Abdominal/Thoracic Surgery Patients

Postoperative patients have higher incidences of respiratory complications. Patients undergoing abdominal or thoracic surgical procedures are at greater risk of having such complications. Incentive spirometry is an inhalation-based prophylactic technique that encourages patients to mimic a natural deep sigh to periodically increase lung volume. As this technique is the prophylactic method of choice for many hospitals, several studies have tested its efficacy. Five articles, including 4 systematic reviews and 1 clinical practice guideline, are analyzed and summarized. Each article was reviewed by a multidisciplinary team of health care providers and is discussed herein. A clinical recommendation for practice change is provided on the basis of the results. Incentive spirometry is only as effective as cough/deep-breathing regimens and other means of postoperative pulmonary prophylaxis. No single prophylactic technique clearly outperforms all others in preventing pulmonary complications. Future research is needed to determine the best method to prevent postoperative pulmonary complications.

Prophylactic Antipropagation Stitch in Total Knee Arthroplasty Performed via Medial Parapatellar Approach: A Simple and Cost-Effective Technique for Reducing Quadriceps Injury

This article describes a novel, simple, and effective technique for limiting extensor mechanism damage during total knee arthroplasty (TKA) performed via the medial parapatellar (MPP) approach. Immediately on making the quadriceps tendon split in the MPP approach, a figure-of-eight stitch is placed at the apex of the split. The prophylactic stitch technique has been used by one surgeon in 1000 consecutive TKAs over the past 5 years. This technique has eliminated proximal extension of the quadriceps tendon split into the muscle belly and may help to decrease postoperative pain, increase postoperative quadriceps strength, and improve patient satisfaction and outcomes.

Intercostal Muscle Flap in Post Tuberculous Pneumonectomy: A New Technique

Objective: There are many risk factors for postoperative bronchopleural fistula (BPF), including extensive resection, diabetes, chronic infection, perioperative steroid therapy, preoperative chemotherapy, and radiotherapy, the risk of bronchopleural fistula increases with resection for inflammatory diseases, especially Mycobacterium tuberculosis (MTB). The aim of this study is to evaluate the efficacy and safety of using double pedicled intercostal muscle flaps with dual blood supply to buttress the bronchial stump after pneumonectomy for tuberculous lesions as a prophylactic new technique from post-pneumonectomy BPF. Methods: Between 2007 and 2011, 47 patients with pneumonectomy for post tuberculous lesions in the department of cardiothoracic surgery, Zagazig University Hospital were divided into two groups. Group A: 28 patients with single pedicled intercostal muscle flap used and applied on the bronchial stump after pneumonectomy. Group B: 19 patients with double pedicled intercostal muscle flaps used and applied on the bronchial stump. The mean age of the patients was 42.9 years (range 27 - 67 years) in Group A, 44.8 years (range 36 - 71 years) in Group B. Results: Bleeding in one patient in Group A (3.5%) and two patients in Group B (10.5%); empyema in two patients (7.1%) in Group A only one of them developed bronchopleural fistula; arrhythmias in one patients (3.5%) in Group A and one patient in Group B (5.2%); chylothorax in one patients (3.5%); Chronic chest pain in one patient in Group A (3.5%) and two patients in Group B (10.5%). The mean follow up period was 32.7 ± 12.9 months (range between 3 and 48 months). All patients remained symptom free with no evidence of late bronchopleural fistula in Group B. Conclusions: Double pedicled intercostal muscle flaps with dual blood supply buttressing the bronchial stump is new prophylactic technique from BPF after pneumonectomy for pulmonary tuberculous lesions in high risk patients.

Application of evidence-based medicine to recurrence of Hansen’s type I intervertebral disc disease in dogs: A justification for continuation of study into percutaneous laser disc ablation?

AbstractTo review and evaluate the literature reporting results of prophylactic surgical procedures for Hansen’s type I intervertebral disc disease.Systematic literature review.Online bibliographic searches of abstracts through PubMed and the Veterinary Information Network (VIN) were performed using the searchable term “canine intervertebral disc disease and recurrence”. The resources were evaluated in regard to the ability of the retrieved references to directly address the clinical question as follows: which prophylactic technique when considered with or without surgery will consistently reduce or eliminate the recurrence of clinical signs associated with Hansen’s type I intervertebral disc disease. All studies were compared and evaluated with regard to study design, technique utilized, short and long-term outcome, and evidence classification.An online bibliographical search was performed in PubMed using the full search term of “canine intervertebral disc disease and recurrence” resulted in 20 total sources, and of those sources 13 contained information pertaining to the clinical question. The same search term when used in the VIN search engine under the classification of journal abstracts resulted in 43 total results with 18 applicable resources. In review of both searches, 13 resources were listed in both searches. Of the 18 obtained by the VIN search 14 were available in the English language. No resources were included in class I level of evidence, and only one was considered as class II level of evidence. As for the remaining studies, three results were classified as class III studies, and the remaining reports were classified as class IV level of evidence.Although direct extrapolation of the evidence provided by the search to the clinical scenario is not possible, this review will hopefully provide the basis for development of a randomized controlled study to provide for a clear need in evidence for prevention of intervertebral disc extrusion in dogs.

15-Year Experience With Soft Tissue Expansion in Total Knee Arthroplasty

Preoperative identification of a knee at risk for wound healing after total knee arthroplasty (TKA) allows the surgeon to apply a soft tissue expansion technique to expand the available tissue for closure and healing after TKA. A consecutive series of 64 soft tissue expansions were performed for 59 cases of conflicting incisions and 5 cases of severe angular deformity, with a mean of 3.5 previous surgeries. An average 2.1 expanders were used for a total volume of 359 mL. Expansion took a mean of 70 days during which 14 minor and 7 major complications occurred. There were 8 post-TKA complications, 5 of which required a return to the operating room. Soft tissue expansion is a safe, prophylactic technique that provides adequate coverage in this complex subset of patients.