Reduce Hospitalization Time Research Articles

Ultrasonography on the Early Postoperative Control of Severe Odontogenic Infections

The management of odontogenic infections remains an important segment of the oral-maxillofacial surgical practice. The implementation of ultrasonography (US) imaging for the diagnosis of head and neck infections increases the possibility of visualizing the abscess collections in the deep neck spaces of lateral pharyngeal, masticator, and submandibular areas. The US imaging can detect the presence of fluid collections and edema, which may indicate local inflammation. Signs of deeper infections, such as subcutaneous emphysema and perifascial fluid, may also be apparent via US imaging. We present a new technique that uses US imaging to evaluate the deep neck infections after drainage from the early postoperative time to determine the locations of the drains inside the collection area and the edema of adjacent tissues. This technique is less costly than computed tomography or magnetic resonance imaging and allows for early assessment of adjacent tissues, leading to an earlier extubation and reduced hospitalization time and costs.

Palliative MRI-guided transurethral ultrasound ablation for symptomatic locally advanced prostate cancer

Purpose Locally advanced prostate cancer can cause bladder outlet obstruction, gross hematuria and frequent hospitalization. While these complications are commonly treated by palliative transurethral resection of the prostate, the improvement is often insufficient. The purpose of this study was to evaluate the safety and feasibility of MRI-guided transurethral ultrasound ablation as an alternative palliative treatment option (pTULSA) for men suffering from symptomatic locally advanced prostate cancer. Methods This prospective, phase one study included 10 men in need of palliative surgical intervention due to urinary retention and gross hematuria caused by locally advanced prostate cancer. Patients were followed for 1 year at 3-month intervals. Time without catheter, time without hematuria, reduction in hospitalization time, and adverse events were measured. Results Ten patients with locally advanced prostate cancer were enrolled, all having continuous catheterization due to urinary retention and nine had gross hematuria before treatment. At 1 week post-pTULSA five patients were catheter-free. At last follow-up catheter-free and gross hematuria-free rates were 70% and 100%, respectively. Average hospitalization time from local complications reduced from 7.3 to 1.4 days in the 6 months before and after pTULSA. No > Grade 2 treatment related adverse events were reported, with all five being urinary tract infections. Conclusions pTULSA appears safe and feasible for palliative ablation of locally advanced prostate cancer. The therapy seems to accomplish long-term hematuria control, can relieve bladder outlet obstruction in selected patients, and seems to reduce the burden of hospitalization due to local complications. Trial Registration Number: NCT03350529

Impact of an orthogeriatrician on length of stay of elderly patient with hip fracture.

Hip fractures are a major health issue in elderly and frail patient. The integration of orthogeriatric care within the orthopaedic team could be useful to optimize the clinical conditions of these patients in perioperative phases and stabilize them after surgery, reducing hospital length of stay. The present study evaluates the role of an orthogeriatrician in the management of patients with a hip fracture. Data about patients admitted and operated from February to September 2018 and from February to September 2019 were collected from the San Giovanni di Dio e Ruggi d'Aragona Hospital of Salerno database. A total of 352 patients were identified and divided in two groups according to the year in which the orthogeriatrician was working in Orthopaedic Department. Records regarding age, sex, side and type of fracture, time of admission, day of surgery and discharge were collected and length of stay, days from the admission to surgery and days from surgery to discharge were calculated. There were no statistically significant differences in the pre-surgery phases of both groups, and all patients were operated at a mean of 2.1days ± 1.8 SD from admission (p > 0.05). No statistically significant difference between demographic data in both groups (p > 0.01) was observed. There was, however, statistically significant reduction of hospitalization time after surgery and total LOS from 2018 to 2019 (p < 0.01). An Orthogeriatric doctor in an Orthopaedic and Traumatology Department may lead a multidisciplinary approach to manage elderly patients with hip fractures, ensuring that the time to surgery from admission is less than 48h, and reducing hospitalization time after surgery and total length of stay.

Utilization of Hydroxyl-Methyl Butyrate, Leucine, Glutamine and Arginine Supplementation in Nutritional Management of Sarcopenia-Implications and Clinical Considerations for Type 2 Diabetes Mellitus Risk Modulation.

While onset characteristics may vary, sarcopenia gradually develops over time as a result of the aging process, leading to muscle loss, disturbance of the muscle to fat ratio, and a variety of negative symptoms undermining the wellbeing, quality of life, and lifespan in the aging population globally. There is evidence that sarcopenia may be a cause and consequence of type 2 diabetes mellitus (T2DM) in the aging population. The importance of nutritional management in the prevention and/or deceleration of sarcopenia is critical, with the main focus placed on the amount and quality of protein intake. Significant efforts are being made towards the development of medical nutrition therapies involving certain amino acids and amino compounds, as well as their combinations, for the improvement in muscle strength, muscle function and protein synthesis. This may reduce hospitalization times and hasten the recovery of patients with sarcopenia. The administration of protocols with varying dose and frequencies, as well as their efficacy, is being investigated. In the work herein, we present and evaluate data derived from human trials regarding the utilization of hydroxyl-methyl butyrate (HMB), L-leucine (Leu), L-glutamine (Gln) and L-arginine (Arg) supplementation for optimal management of sarcopenia in geriatric patients, a topic of significant clinical nutrition interest which may have important implications in T2DM status.

Pharmacogenetic Testing in Depressed Patients and Interdisciplinary Exchange between a Pharmacist and Psychiatrists Results in Reduced Hospitalization Times.

Pharmacogenetics (PGx) is a well-researched tool to improve pharmacotherapy. So far, it has not been implemented into daily practice in Germany. In psychopharmacology, substantial benefit can be expected by using PGx due to the excessive CYP metabolism of the psychotropic drugs as well as already discovered target polymorphisms (e. g., serotonin receptor). An evaluation of a naturalistic pharmacist-led pilot implementation of PGx testing in a psychiatric hospital in patients undergoing inpatient treatment for major depressive disorder was conducted. Length of stay, number of antidepressant switches, and rehospitalization rates were analyzed. A PGx-tested intervention cohort of n=49 was retrospectively compared to a control cohort of n=94 patients. The intervention cohort showed significantly shorter stays than the control, after correction of the length of hospital stay and the time to genotyping results (mean intervention: 36.3 d (SD: ±19.3 d); control: 46.6 d (±19.1 d); p=0.003). Antidepressant- naïve patients had the largest benefit from the PGx testing (intervention: 24.7 d (±13.5 d); control: 50.2 d (±22.5 d); p < 0.001. The number of antidepressant switches during the entire stay did not differ between the groups: 0.41 (0.64) vs. 0.21 (0.46); p=0.063 [95% CI -0.01-0.40]). Depressed patients, especially treatment-naïve, seem to benefit from PGx testing prior to treatment. Although the results of this retrospective evaluation are promising, more systematic prospective studies are needed to assess the effect of PGx testing on the treatment of major depressive disorder.

El papel de la enfermería en la aplicación de terapia al vacío en heridas sobre infectadas.

El presente estudio tuvo por objetivo determinar el papel de la enfermería en la aplicación de la terapia al vacío con presión negativa, la cual es ampliamente conocida en la actualidad para mejorar heridas complejas sobre infectadas y reducir el tiempo de hospitalización. Se pretendió conocer la técnica de aplicación de la terapia al vacío y los cuidados inmediatos de enfermería en dicha técnica, requiriéndose que constantemente se actualicen conocimientos.

Minimally invasive surgery during the COVID-19 pandemic. The approach to laparoscopic surgery in endometriosis and oncology

The global coronavirus pandemic has a major impact on the healthcare services and professionals. It brings challenges to the gynecologists’ work in optimizing the care of their patients. In an effort to restrain the transmission of the virus and prioritize the treatment of patients with COVID-19, the elective surgeries were limited during the pandemic. Nevertheless, the urgent procedures must be performed. In this paper, we reviewed the articles regarding the advantages and risks of minimally invasive surgery and the methods to perform a safe surgery during the COVID-19 pandemic. At this time, there is limited evidence that laparoscopy represents a high risk of infection, because there is limited data on the presence of the virus in the surgical smoke. However, it is thought that the best option for all the surgeons would be to use certain strategies to minimize any theoretical risk of viral transmission during laparoscopic surgery. Recommendations and guidelines have been made by authorities, by the Ministry of Health from Romania and by professional societies on how to operate under extreme circumstances within a system where the priority is, first and foremost, the patients who need immediate care under safe circumstances. The laparoscopy advantages regarding the reduced hospitalization time, the smoke and fluids that can be restrained and evacuated in a safer way and the less traumatic surgical maneuvers are very helpful during this pandemic. Recommendations were made regarding the protection during emergency surgery in COVID-19 patients that specifically include the use of N95 masks for anesthesia and surgical teams. The patient should also wear a fluid-resistant surgical face mask. A checklist that can be considered both a new standard for hospitals and a tool that helps healthcare personnel and patients to feel safe during their hospital stay was developed in order to decrease the risk of viral spread.

A Randomized Longitudinal Double-Blind Clinical Trial on Long-Term Neuropathic Symptomatology Relief &amp;amp; Pain Analgesia

Diabetic neuropathic pain is one of the most difficult to treat with high levels of reoccurrence and a substantial increase with aging. It involves expensive hospitalizations, often resulting in an amputated lower limb. We explored a variety of methods treating neuropathic pain such as low-level laser, monochromatic near-infrared treatment, TENS, acupuncture and pulsed electromagnetic fields that demonstrated inconclusive, limited or temporary pain relief with minor or short-term improvements in mobility. Research conducted by ultra-low energy technologies reports pain relief and reduction of inflammation as a result of anti-oxidant electron donation transforming free radicals into stable molecules. We report the results of a randomized double blind one-year-long longitudinal clinical study on 10 diabetic mellitus (DM) subjects with chronic neuropathy, treated with ultra-low energy nanotechnology who experienced substantial long-term neuropathic pain relief. Importantly, pain analgesia and improvement in neuropathic symptomatology were not age-contingent. This contradicts past research postulating that age-accumulated inflammation and endothelial dysfunction can further exacerbate diabetic neuropathy. Importantly, a method offering age-independent, cost-effective, long-term neuropathic pain relief and increased mobility has major implications in reducing hospitalization time and overall expenses by offering a solution that enhances quality of life.

ANTIBIOTICS FOR APPENDICECTOMY IN CHILDREN AND ADOLESCENTS DURING THE PERIOPERATIVE PERIOD: AN INTEGRATIVE REVIEW.

ABSTRACTObjective: To analyze the preoperative use of antibiotics in children and adolescents requiring appendectomy.Data source: Integrative review was performed in the MEDLINE, Latin American and Caribbean Health Sciences (LILACS) and Cochrane databases and the PubMed portal, with no time limit. The keywords used were: appendicitis, child, adolescent and antibacterial with Boolean AND. The articles included were published in Portuguese, English or Spanish and whose participants were under 18 years of age. Review articles and guidelines were excluded. The studies were classified according to their level of evidence and 24 papers were selected.Data collection and analysis: Seven randomized clinical trial studies (level of evidence II), eight cohorts (level III), seven retrospective observational studies (level V) and two historical documentary analysis (level IV) were selected. The studies addressed antibiotics used in acute appendicitis in both uncomplicated and complicated cases. Antibiotics initiated in the preoperative period showed a decrease in the rates of surgical wound infections. First-line (empiric) regimens were tested for sensitivity to microorganisms in peritoneal material cultures, however the results were controversial. Broad-spectrum antibiotics have been suggested in some studies because they have good coverage, but in others they have not been recommended because of the risk of developing bacterial resistance. Shorter administration time and earlier change to the oral route reduced hospitalization time.Conclusions: There are several clinical protocols with different antibiotics. However, there is no standardization concerning the type of antibiotic drug, time of use, or route.

Clinical value of non-invasive ventilator in the treatment of bronchial asthma with pneumonia

Objective To explore the clinical value of non-invasive ventilator in the treatment of bronchial asthma with pneumonia. Methods From June 2016 to June 2018, a total of 90 patients with bronchial asthma complicated with pneumonia admitted to the Second People's Hospital of Yiwu were enrolled in this study.The patients were randomly divided into observation group and control group according to the digital table, with 45 cases in each group.The control group received routine treatment and nursing.The observation group was given non-invasive ventilator-assisted treatment based on the control group, and both two groups were treated for 7 days.Blood gas indicators[pH value, partial pressure of oxygen (PaO2), partial pressure of carbon dioxide (PaCO2), arterial oxygen saturation (SaO2)], pulmonary function indicators[ACT score, FEV1 occupational vital capacity percentage (FEV1/FVC), exhalation peak flow rate (PEF), lung volume (VC)], airway function indicators[peak volume ratio (PFV), expiratory flow rate/tidal expiratory peak flow rate (25/PF) when exhaled 75% tidal volume, tidal volume (VT), tidal exhalation medium flow rate/tidal inhalation medium flow rate (ME/MI)], complications during treatment and length of hospital stay were compared before and after treatment. Results After treatment, PaO2 [(9.12±0.76)kPa], SaO2 [(93.72±7.59)%], ACT score [(23.67±2.13)points], FEV1/FVC[(73.47±5.29)%], PEF[(3.68±0.58)L/s], PFV(50.36±5.27)%, 25/PF(81.36±5.34)%, VT(9.31±1.56)mL/mg, ME/MI(89.12±4.63)% in the observation group were higher than those in the control group [PaO2(7.31±0.43)kPa, SaO2 (86.51±5.51)%, ACT score (17.45±1.89)points, FEV1/FVC (65.24±5.62)%, PEF (2.98±0.42)L/s, PFV (41.31±4.52)%, 25/PF (72.39±5.16)%, VT (7.69±1.65)mL/mg, ME/MI (77.96±3.71)%], the differences were statistically significant (t=13.905, 5.157, 14.653, 7.153, 6.557, 8.744, 8.103, 4.786, 10.357, all P<0.05). The incidence of complications (28.89%) and hospitalization time [(11.36±2.31)d] in the observation group were lower than those in the control group [55.56%, (15.46±2.68)d], the differences were statistically significant (t=6.559, 7.773, allP<0.05). Conclusion Non-invasive ventilator can effectively improve the blood gas index of patients with bronchial asthma complicated with pneumonia, improve lung function and airway function, reduce the incidence of complications, reduce hospitalization time, and promote the early recovery of patients.It is worthy of promoting. Key words: Asthma; Pneumonia; Ventilators, mechanical; Blood gas analysis; Lung function; Airway function

Inhospital exercise benefits in childhood cancer: A prospective cohort study.

Childhood cancer patients are at risk of developing important adverse effects, mortality and disease relapse after treatments, which has a substantial economic impact on healthcare systems. The objective of this study was to determine the effects of supervised inhospital exercise on clinical endpoints during childhood cancer treatment. 169 children with a new diagnosis of cancer were divided into an exercise intervention (n=68, 11±4years) or a control group (n=101, 11±3years). The cohort was followed up from the start of treatment for up to five years. Supervised inhospital exercise intervention was performed during the neoadjuvant (for solid tumors) or intensive chemotherapy treatment period (for leukemias). The median duration of the intervention was 22 (interquartile range, 14-28)weeks. We assessed survival, risk of disease relapse or metastasis, and days of hospitalization (primary outcomes), and cardiovascular function, anthropometry and blood variables (secondary outcomes). No exercise-related adverse events were noted. The exercise group had significantly less days of hospitalization than the control group (P=.031), resulting in a lower (~-17%) mean total economic cost of hospitalization in the former. Moreover, echocardiography-determined left ventricular function (ejection fraction and fractional shortening) was significantly impaired in the control group after treatment compared with baseline, whereas it was maintained in the exercise group (P=.024 and .021 for the between-group differences, respectively). In conclusion, supervised inhospital exercise intervention is safe and plays a cardioprotective role, at least in the short term, in children with cancer, also reducing hospitalization time, and therefore alleviating the economic burden.

Recuperación de pacientes en postoperatorio de drenaje de hematoma subdural crónico asociado al uso de ácido tranexámico

Con el objetivo de evaluar la recuperación de pacientes que recibieron ácido tranexámico luego del drenaje de hematoma subdural crónico (HSC), se seleccionan al azar 22 pacientes de ambos sexos en edades comprendidas de 32 a 87 años. A un grupo de 11 paciente intervenidos, se les continuó el tratamiento con la colocación de un sistema de drenaje externo tipo Jackson-Pratt (grupo A) y un segundo grupo de pacientes, se les continuó tratamiento con Ácido Tranexámico (grupo B). Ambos grupos fueron evaluados en aspectos clínicos y tomográficos una semana después de la intervención. La distribución obtenida por género representó 99,5% masculino. Del total de pacientes, la mitad presentó HSC en el lado derecho y los casos bilaterales representaron 31,8%. Los resultados funcionales postoperatorio fueron satisfactorios en el 59,1% comparado con los obtenidos en la escala Glasgow preoperatorio donde más del 50% de los casos no superaban el valor 13 de la escala. El síntoma más común fue hemiparesia izquierda (45,5%), seguido de hemiparesia derecha (22,7%). El tratamiento con Ácido Tranexámico obtuvo resultados satisfactorios en el 63,6% de los casos de manera inmediata y en el 27,3% a las 24 horas; caso contrario a los resultados obtenidos con el sistema de Jackson-Pratt, donde el 54,5% obtuvo mejoría a las 24 horas. De igual manera la relación entre días de hospitalización y tratamiento fue significativa. Estos resultados permiten concluir queel tratamiento con Ácido Tranexámico ofrece una excelente tasa de recuperación, con menor número de complicaciones, mortalidad y secuelas, permitiendo también disminuir el tiempo de permanencia hospitalaria.

Comparison between Results of Microdiscectomy and Open Discectomy in Management of High-Level Lumbar Disc Prolapse.

AIM:This work aims to compare between results of microdiscectomy and open discectomy in management of high-level lumbar disc prolapse.METHODS:This is a controlled randomised study, where patients having upper lumbar disc herniations were evaluated preoperatively both clinically and radiologically, randomisation was planned to perform open discectomy in odd number patients and to perform microdiscectomy in even number patients, patients were evaluated and followed up for deficits and outcomes.RESULTS:We operated ten patients in this study, five cases were operated upon with microdiscectomy, and five cases were operated upon with open discectomy, the median age of presentation in this study was 44 years, there were five males and five females, postoperative pain improvement was better in microdiscectomy. Hospital stay, blood loss, bone loss and postoperative complications were less in microdiscectomy.CONCLUSION:Microdiscectomy allows good surgical visualisation and is less traumatic to the involved tissues. The results of this study indicated that microsurgery reduces hospitalisation time, improves the overall surgery-related outcome. The main differences between the two procedures were the length of the incision and blood loss. We found that lumbar microdiscectomy allows patients earlier return to work and normal life with less reliance on postoperative narcotic analgesic agents.

Radical prostatectomy and simultaneous penile prosthesis implantation: a narrative review.

Radical prostatectomy (RP) represents one of the most commonly used first-line treatment modalities in men with localized prostate cancer (PCa). Despite efforts to preserve the neurovascular bundles with nerve sparing (NS) surgery, erectile dysfunction (ED) remains common after RP and this may significantly affect patients' quality of life (QoL). The aim of this paper is to evaluate the outcome of simultaneous placement of penile prosthesis and RP. The ideal candidates for simultaneous penile prosthesis implantation are those who report pre-existent refractory ED and patients in whom there is a high risk of extracapsular disease, such as any cT2c or cT3, and undergo non-nerve sparing RP. If the patient chooses to undergo PPI to treat his refractory ED it is clear that this procedure will be associated with higher patients' satisfaction rates, if carried out simultaneously with RP rather than at a later stage. A simultaneous procedure would avoid two admissions, reduce hospitalization time and guarantee a faster recovery of sexual function, preventing the otherwise unavoidable loss of penile length. Since the urologist does not need to preserve the neurovascular bundles, as the penile implant will take care of postoperative rigidity, RP can be performed more radically from an oncological point of view, thus reducing the risk of recurrence and metastasis, especially in patients with high risk of locally advanced disease. In conclusion, simultaneous PPI with RP provides early sexual rehabilitation, improving patients' quality of life, without compromising surgical outcomes. However, larger series will be necessary, to better identify the patients who are more likely to benefit from nerve sparing surgery and postoperative penile rehabilitation from those who would are more likely to develop refractory ED post RP and would therefore benefit from simultaneous implantation of a penile prosthesis.

Stability and survival analysis of elderly patients with osteolytic spinal bone metastases after palliative radiotherapy

PurposeThis retrospective study aimed to evaluate the stability and fracture rates of osteolytic spinal bone metastases (SBM) in elderly patients following palliative radiotherapy (RT) and to derive prognostic factors for stability and survival.MethodsA total of 322 patients aged at least 70 years received palliative RT at two major German academic medical centers or at the German Cancer Research Center. Stability assessment was based on the validated Taneichi score prior to RT and at 3 and 6 months after RT. The survival time following RT was assessed, and prognostic factors for stability and survival were analyzed.ResultsPrior to RT, 183 patients (57%) exhibited unstable SBM and 68 patients (21%) pathological fractures. At 3 and 6 months after RT, significant recalcification and stabilization were evident in 19% (23/118) and 40% (31/78) of surviving patients, respectively. Only 17 patients (5%) experienced new pathological fractures following RT. Tumor histology was found to significantly influence stabilization rates with only breast cancer patients exhibiting increased stabilization compared to patients with other histologies. The median survival time and 6‑month survival rates following RT were 5.4 months (95% confidence interval 4.4–7.2 months) and 48%, respectively. The patients’ performance status was found to be the strongest predictor for survival after RT in this patient cohort; further factors demonstrating a significant association with survival were the application of systemic treatment, the number of SBM and the primary tumor histology. To analyze the influence of age on survival after RT, study patients were stratified into 3 age groups (i.e., 70–74 years, 75–79 years, and ≥80 years). The subgroup of patients aged at least 80 years showed a strong trend towards a worse survival time following RT compared to younger patients (i.e., 6‑month survival rate 39% vs. 51%; p = 0.06, log-rank test).ConclusionsPrognostic factors influencing overall survival such as performance status and histology should guide the choice for palliative RT for SBM. Strongly hypofractionated RT regimes may be advisable for most elderly patients considering the overall poor prognosis in order to reduce hospitalization times.

Experience in Simultaneous Endoscopic Submucosal Dissection Treating Synchronous Multiple Primary Early Esophageal Cancers.

Objective: Synchronous multiple primary early esophageal cancers (SMPEEC) are rare and aggressive. Early detection of esophageal cancer can improve survival rate. Endoscopic submucosal dissection (ESD) is a minimally invasive endoscopic treatment of early esophageal cancers. However, ESD for SMPEEC is little known. We aimed to clarify the clinical outcomes of simultaneous ESD treating SMPEEC. Methods: We retrospectively reviewed the medical data of 34 patients, who underwent ESD for SMPEEC at Endoscopy Center of Zhongshan Hospital, Fudan University, between May 2013 and December 2014. The data of lesion size, histopathology, en bloc resection, curative resection, complication, and tumor local recurrence were analyzed. Results: Among 34 patients, 67 lesions were removed simultaneously in 33 cases; 2 lesions were removed in 2 operations for 1 case. For the simultaneous resection, the en bloc rate was 97.01% (65/67) and the curative resection rate was 92.54% (62/67). Postoperative stricture occurred in two cases and delayed bleeding occurred in one case. There was one local recurrence, no metastasis or procedure-related death. Conclusions: Simultaneous ESD as a treatment for SMPEEC is technically feasible, benefited from reducing hospitalization time and medical expenses. For the cases with risk factors of complications, simultaneous ESD needs to be avoided.

MICROBIAL PATTERN OF DIABETIC FOOT ULCER PATIENT IN JEMURSARI ISLAMIC HOSPITAL SURABAYA PERIOD 2012-2016

Diabetic foot ulcers (DFU) are complications in people with diabetes mellitus (DM) in the form of wounds or tissue damage resulting in vascular insufficiency and or neuropathy that can develop into an infection. Early detection of germs of diabetic foot ulcers may be used as a recommendation of empirical therapy before the definitive treatment based on culture results and appropriate antibiotics treatment, which may reduce hospitalization time and amputation events. According to Riskesdas in 2013, state that the number of antibiotic used without prescriptions in Indonesia about 86.1%. The study aims to retrospectively analyze the bacterial culture and drug susceptibility test results for patients with diabetic foot ulcers (DFU) in Jemursari Islamic Hospital Surabaya during 2012–2016 to help clinicians choose a more appropriate empirical antibiotic treatment for DFU. This study used cross–sectional designed with retrospective approaches, which analyzed descriptively and samples were taken by the total sampling of 11 samples. This research was conducted at Islamic Hospital of Jemursari Surabaya in May–September 2017 by using medical record data which are outpatient and inpatients who treatment at Jemursari Islamic Hospital. The result was found 6 types of bacteria consisting of Staphylococcus aureus (18%), Staphylococcus non–haemolytic (18%), Klebsiella pneumonia (27%), Enterobacter aerogenes (18%), Burkholderia cepacia (9%), Escheria coli (9%). The most sensitive antibiotics in the Gram–positive bacteria in this study are Amikacin, Teicoplanin and Oxacillin and the most resistant to Amoxicillin and Ampicillin whereas the most sensitive antibiotics in the Gram–negative bacteria in this study were Meropenem and the most resistant to Ciprofloxacin and Trimethroprim–sulfamethoxazole.

Negative-pressure wound therapy for high-risk surgical incision wounds using an ultra-portable device: 11 cases

Negative-pressure wound therapy (NPWT) involves the application of subatmospheric pressure to a wound to help in the healing process. The objective of this case series was to evaluate the clinical...

Electrochemotherapy as palliative treatment in patients with advanced head and neck tumours: Outcome analysis in 93 patients treated in a single institution

PurposeTo describe outcomes of Electrochemotherapy as palliative treatment in patients with advanced head and neck (H&N) tumours. MethodsNinety-three patients (120 treatment sessions) with H&N recurrent and/or metastatic neoplasm were treated. Treatment response was assessed 4 weeks after ECT with clinical examination and two months after the first evaluation with a CT scan of the H&N for deep lesions evaluation. The grade of bleeding and pain before, at the end of treatment and one week after ECT were evaluated. ResultsFive percent of complete responses, 40% of partial responses were registered. Disease progression was seen in 20% of patients after the first ECT procedure, the remaining 34% of patients experienced stable disease. A good control of pain and bleeding was obtained, especially in patients with moderate symptoms before the treatment. No toxicities related to ECT were seen. ConclusionsECT is an interesting antitumoral therapy in advanced chemo and radio-refractory H&N neoplasms. ECT is able to reduce frequent symptoms, such as pain and bleeding, improving quality of life without damage to healthy tissue and with limited side effects. Moreover, ECT reduces hospitalization time and may contribute to an overall reduction in healthcare costs associated with advanced H&N cancers care.

Primary spontaneous pneumothorax (PSP): the role of VATS and a new paradigm

The therapeutic management of primary spontaneous pneumothorax (PSP) will include many variables, which alone anticipates difficulties of consensus and challenge to paradigms. Even the recent technological advances and the growing number of publications indicating the need for review the definitive surgical approach to PSP were not able to change the classic guideline. However, they have undoubtedly brought into question the need to add new items to the list. The increase availability of minimally invasive surgery to all surgeons is established as a method of choice in surgical treatment of these patients. The reduction in hospitalization time, impact on care costs, less postoperative pain, high therapeutic resolution by the extinction of the cause and prevention of relapse, reduction of the emotional impact considering the chances of recurrence around 30%, after the first episode and the possibility of early return to the usual activities mainly to young population. These variables support the reflection on method indication at the first episode of PSP. Why not?