Pack Removal Research Articles

A novel inflatable device for perihepatic packing and hepatic hemorrhage control: A proof-of-concept study

IntroductionUncontrolled bleeding is the primary cause of death in complex liver trauma and perihepatic packing is regularly utilized for hemorrhage control. The purpose of this study was to investigate the effectiveness of a novel inflatable device (the airbag) for perihepatic packing using a validated liver injury damage control model in swine. Material and methodsThe image of the human liver was digitally isolated within an abdominal computerized tomography scan to produce a silicone model of the liver to mold the airbag. Two medical grade polyurethane sheets were thermal bonded to the configuration of the liver avoiding compression of the hepatic pedicle, hepatic veins, and the suprahepatic vena cava after inflation. Yorkshire pigs (n = 22) underwent controlled hemorrhagic shock (35% of the total blood volume), hypothermia, and fluid resuscitation to reproduce the indications for damage control surgery (coagulopathy, hypothermia, and acidosis) prior to a liver injury. A 3 × 10 cm rectangular segment of the left middle lobe of the liver was removed to create the injury. Subsequently, the animals were randomized into 4 groups for liver damage control (240 min), Sponge Pack (n = 6), Pressurized Airbag (n = 6), Vacuum Airbag (n = 6), and Uncontrolled (n = 4). Animals were monitored throughout the experiment and blood samples obtained. ResultsPerihepatic packing with the pressurized airbag led to significantly higher mean arterial pressure during the liver damage control phase compared to sponge pack and vacuum airbag 52 mmHg (SD 2.3), 44.9 mmHg (SD 2.1), and 32 mmHg (SD 2.3), respectively (p < 0.0001), ejection fraction was also higher in that group. Hepatic hemorrhage was significantly lower in the pressurized airbag group compared to sponge pack, vacuum airbag, and uncontrolled groups; respectively 225 ml (SD 160), 611 ml (SD 123), 991 ml (SD 385), 1162 ml (SD 137) (p < 0001). Rebleeding after perihepatic packing removal was also significantly lower in the pressurized airbag group; respectively 32 ml (SD 47), 630 ml (SD 185), 513 ml (SD 303), (p = 0.0004). Intra-abdominal pressure remained similar to baseline, 1.9 mmHg (SD 1), (p = 0.297). Histopathology showed less necrosis at the border of the liver injury site with the pressurized airbag. ConclusionThe pressurized airbag was significantly more effective at controlling hepatic hemorrhage and improving hemodynamics than the traditional sponge pack technique. Rebleeding after perihepatic packing removal was negligible with the pressurized airbag and it did not provoke hepatic injury.

Endoscopic septoplasty without nasal packing: our technique and outcomes

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; Septoplasty is one of the common procedures performed in otorhinolaryngology practice for treatment of nasal obstruction caused by deviated nasal septum. Septoplasty is traditionally performed using a headlight and nasal speculum. However Endoscopic technique using rigid endoscopes has gained widespread popularity in recent years. Traditionally after correction of septal deviation the mucosal flaps are opposed and held together by some kind of nasal packing to prevent bleeding and septal hematoma. But the nasal pack causes significant morbidity in the post-operative period and also bleeding and pain while pack removal. In the present study we describe our technique of endoscopic septoplasty without nasal packing, in terms of patient comfort and complications.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;It was a descriptive study, conducted at Subbaiah institute of medical sciences, Shimoga from January 2017 to December 2020 on 50 subjects and the results were analyzed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;All 50 patients included in the study had reduced NOSE scores on the 2&lt;sup&gt;nd&lt;/sup&gt; post-operative day itself. None of the patients had septal hematoma, reduced oxygen saturation or post-op sinusitis. 3 out of 50 patients had minimal bleeding in the post-operative period. 12 out of 50 patients had crusting post operatively on 2&lt;sup&gt;nd&lt;/sup&gt; day but none had at 2 weeks. One patient had synechiae and one patient had residual septal deviation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Endoscopic septoplasty is preferred over conventional septoplasty. Trans septal quilting sutures has less complication rate, good quality of life and can be practiced easily and hence a valid alternative to intranasal packing following septal surgery.&lt;/p&gt;

Characterization of outcomes and practices utilized in the management of internal carotid artery injury not requiring definitive endovascular management.

BackgroundAfter internal carotid artery (ICA) injury during endoscopic skull base surgery, the majority of patients undergo ICA embolization or stenting to treat active extravasation or pseudoaneurysm development. However, management practices when embolization or stenting is not required have not been well described. The objective of this study was to determine how patients with ICA injury but no embolization, stenting, or ligation do long‐term and ascertain the reconstruction methods utilized.MethodsTwenty‐nine cases of ICA injury were identified in an international multi‐institutional retrospective review. Of these, we identified six cases that were not treated with embolization, stenting, or ICA sacrifice. Information was available for five cases.ResultsA muscle patch was used in the immediate repair of each case. A nasoseptal flap was used in one case. Prefabricated nasal tampons were used in all cases. Nasal packing was initially left in for a median of 7 days prior to removal. The initial muscle patch was reinforced with a second muscle graft in one case. One case demonstrated ICA bleeding at the time of packing removal and was repacked an additional week. Follow‐up for each of these cases was at least 2 years. No cases of subsequent carotid rupture were found and none of these cases ultimately underwent endovascular stenting. Radiation or proton therapy has not been subsequently used in any of these patients.ConclusionsThis study details the reconstruction, lessons learned, and long‐term follow‐up for five cases of ICA injury not treated with embolization, stenting, or ligation.

Elimination of nasal obstruction improves pulmonary functions and oxygenation

BackgroundNasal obstruction is a significant medical problem. This study aimed to examine the effect of nasal obstruction and nasal packing on arterial blood gases and pulmonary function indices, and the impact of the elimination of nasal obstruction on preoperative values.ResultsThe mean age of the study population was 26.6 ± 10.1 years, males represented 50.8%. Spirometric indices showed statistically significant improvement (preoperative forced expiratory volume in 1st second 66.9 ± 13.9 vs 79.6 ± 14.9 postoperative and preoperative forced vital capacity 65.5 ± 12.7 vs 80.4 ± 13.8 postoperative). Oxygen saturation was significantly lower during nasal packing (95.6 ± 1.6 preoperative vs 94.7 ± 2.8 with nasal pack), and significant improvement (97.2 ± 1.4) was observed after removal of the nasal pack. Nasal obstruction scores significantly improved.ConclusionThe results of this study indicate that either simple nasal obstruction or nasal packing may cause hypoxemia and abnormalities in lung function tests. Hypoxemia was more evident with nasal packing.

Depacked patients who underwent a shortened perihepatic packing for severe blunt liver trauma have a high survival rate: 20 years of experience in a level I trauma center

IntroductionNon-operative management is currently the preferred approach in blunt liver trauma, including high grade liver lesions. However, hemodynamic instability imposes the need for an emergency laparotomy, with a perihepatic packing (PHP) to control liver bleeding in most cases. Our retrospective study aimed to assess the outcomes of liver trauma patients who underwent a shortened PHP. MethodsAll consecutive patients who underwent PHP for blunt liver trauma from 1998 to 2019 in our Level I trauma center were included in the study. Unstable patients with severe liver trauma were transferred to the operating room without any delay, and a collective decision was made to perform abbreviated laparotomy to pack the liver. Demographics, perioperative data, postoperative outcomes, and mortality were retrospectively collected, and survivors and deceased patients were compared with a paired t-test. ResultsFifty-nine patients of 206 patients admitted with severe liver injuries were treated with shortened PHP. Thirty-four (57.6%) patients died, including 26 (76.5%) within the first 24 h. Twelve (20.3%) patients had a selective hepatic embolization and eight (13.6%) had an extrahepatic embolization. Forty-eight patients had an extra abdominal associated injury. This was not a predictive factor of mortality. The removal of packing was performed in 24 patients within 72 h after laparotomy, with an 80% survival rate in these patients. ConclusionShortened PHP is an effective strategy for controlling liver bleeding in severe hepatic trauma. The mortality rate of these patients is high, but after the removal of packing, the survival is good.

Fault-Tolerant Battery Power Network Architecture of Networked Swappable Battery Packs in Parallel

To improve the reliability and energy efficiency of battery swapping, we constructed a battery power network system with active redundancies and with multiple battery management controllers (one in each newly developed smart redundant battery pack). Each pack is getting ready to assume the role of the major to coordinate direct safe mounting of the packs onto the power bus for load sharing or charging without the need for a direct current to direct current converter. This fault-tolerant architecture provides multiple backups in both management control and power supply. To verify this design, the mounting, insertion, and removal of the battery packs were executed during charging and discharging. Battery packs can be swapped on and off safely at any time regardless of their charging states. Battery packs can be direct safe mounted onto the power bus by a threshold algorithm. With each mount on event, the equivalent output energy conversion efficiency ranges from 98.3% to 99.2% throughout the transient. Moreover, when the major battery pack fails or gets removed, other battery packs can indeed assume the role of major safely. The reliability, energy efficiency, and safety of our system were verified.

Efficacy of Topical High Volume Budesonide Nasal Irrigation in Post FESS Patients of Chronic Rhinosinusitis With or Without Nasal Polyposis.

Chronic rhinosinusitis (CRS) is a chronic inflammatory process of nasal mucosa and paranasal sinuses, lasting more than 12weeks, without complete resolution of symptoms. CRS is treated medically, followed by Endoscopic sinus surgery (ESS) if necessary, and supplemented by post-operative topical treatment with highly variable clinical outcomes. However, till date there is no consensus on the composition and duration of maximal medical treatment. Despite proven role of topical steroids, the mode of delivery, dose and duration of topical intranasal corticosteroids still remains debatable. Studies found that high volume sinonasal irrigation (> 50ml) using budesonide is most efficient method but still there is not sufficient data to prove this and results are variable with multiple modifiable factors therefore, this study has been conducted. (1) To determine the difference in mean decrease in Lund-Kennedy endoscopic scores and SNOT-22 scores among post ESS patients with high volume budesonide nasal irrigation nasal cavity and control nasal cavity of chronic rhinosinusitis patients. (2) To determine safety by measuring serum cortisol levels and intra ocular pressure. This is hospital based interventional, randomised, double blind, control trial study. A total of 66 patients of CRS with previous failed medical therapy were included. Same patients nasal cavities were divided into control and case nasal cavities, to avoid demographic bias. All subjects had a baseline SNOT-22 scores (Sino Nasal Outcome Test scores), Lund Kennedy endoscopy score, NCCT PNS score. All patients were undergone ESS procedure. After nasal pack removal, nasal cavities were randomly assigned 1:1 to receive normal saline irrigation (control group) or 1mg of budesonide irrigation (case group) for transnasal irrigation twice daily for 12weeks. A total of 66 patients with 132 nasal cavities were included in the study. Out of which 16 were female and 50 were male with mean age 33year and mean duration of symptoms was 38.19months. Mean duration of follow up was for 3months. Mean decrement in SNOT-22 score in control nasal cavity from 52.54(16.309) to 30.06 (18.16) and in endoscopic score from 6.53 (1.33) to 3.93 (1.6) which is statically significant (p value < 0.05) in both scores. Mean decrement in SNOT-22 score in case nasal cavity from 53.73 (15.75) to 21.15 (13.52) and in endoscopic score from 6.74 (1.8) to 2.77 (1.4) which is statically significant (p value < 0.05) in both scores. Decrement in SNOT-22 scores and endoscopy scores in case nasal cavity in comparision to control nasal cavity were compared by student 't' test and found to be statically significant (p value equals to 0.0001). In subjective outcomes 57.57% shows total improvement in control nasal cavities while 72.73% case nasal cavities shows total improvement. Our study shows high volume budesonide irrigation is safe and superior over normal saline irrigation and results were statistically comparable. Still further studies with larger sample size and longer duration of irrigation needed.Based on available evidence, high volume budesonide irrigation is statically safe and superior over normal saline irrigation.

Survey of throat pack use: An oral surgery perspective

AbstractAimPrevious national surveys highlighted variation in throat pack use, lack of team‐approach and poor adherence to safety processes. A recent review found no evidence supporting anaesthetist‐inserted throat packs. A survey of oral surgeons was undertaken to establish current practice.Materials and methodsAnonymous online questionnaire publicised via BAOS.ResultsFewer oral surgeons are placing throat packs routinely. There is a trend towards surgeons placing throat packs rather than anaesthetists. Four‐fifths of surgeons are following best safety processes: radio‐opaque material, throat pack from swab count, WHO ‘sign out’ check for removal. The increase in surgeons’ view that they have responsibility for throat pack removal is consistent with more surgeons placing throat packs. Increase in surgeons’ awareness of throat pack incidents. A quarter of surgeons cognisant of recent recommendations.ConclusionsContinued variation found in oral surgeons’ use of throat packs. The decrease in routine throat pack use suggests increased decision‐making by surgeons. A change in practice from anaesthetists to surgeons inserting throat packs noted. It appears this change is driven by anaesthetists, given the lack of knowledge of recent recommendations by oral surgeons. A striking improvement in adherence to safety processes observed. No adoption of team‐approach to throat pack use. It is vital now to establish an evidence‐base for throat pack use during oral surgical procedures.

Dexmedetomidine-soaked nasal packing can reduce pain and improve sleep quality after nasal endoscopic surgery: a double-blind, randomized, controlled clinical trial.

Bilateral endoscopic nasal surgery is usually associated with pain and sleep disturbance. The aim of this study was to evaluate the effects of dexmedetomidine-soaked nasal packing on analgesia and improvement of sleep quality in patients undergoing this surgery. Eighty patients were enrolled and randomly allocated into 4 groups. At the end of surgery, dexmedetomidine-soaked nasal packings were applied to three groups with a dosage of 1 μg kg-1 (D1), 2μg kg-1 (D2), 4 μg kg-1 (D4) and normal saline-soaked nasal packing (NS) was applied to a fourth group. The primary outcome was postoperative pain scores using a visual analog scale (VAS)recorded at six time points: before the surgery (T1); 2 h (T2), 8 h (T3), 24 h (T4), 48 h (T5) after surgery; and at the moment of nasal packing removal (T6). Secondary outcomes were postoperative sleep status evaluated by the Pittsburgh sleep quality index (PSQI) and subjective sleep quality value (SSQV). Factors affecting sleep, hemodynamic changes, and adverse events were also recorded. Compared with the NS group, dexmedetomidine-soaked nasal packing significantly relieved postoperative pain and improved sleep quality. The effect was similar between D2 and D4, which was greater than in D1. However, D2 was associated with fewer adverse events. Dexmedetomidine-soaked nasal packing not only offers effective analgesia but also improves postoperative sleep quality in patients undergoing bilateral endoscopic nasal surgery. Taking effect and adverse events into consideration, a dosage of 2μg kg-1 may be optimal. www.chictr.org.cn/index.aspx (ChiCTR1900025692) Retrospectively registered 5 September 2019.

Rectoneovaginal fistula after sex reassignment surgery. Description of our experience and literature review

Male-to-female reassignment surgery or vaginoplasty includes those surgical procedures that aim to recreate a functional and cosmetically acceptable female perineum with minimal scarring. The technique of choice at our center is penile inversion vaginoplasty with or without scrotal skin grafts. We present 4 cases diagnosed with rectoneovaginal fistulas (RnVF) treated at our center with favorable evolution. The first patient was diagnosed in the late postoperative period during dilation. She underwent two failed vaginal repair attempts. Finally, a temporary colostomy and a rectal flap were performed. The second patient was diagnosed two weeks after the initial surgery due to aggressive dilation and was treated with a temporary colostomy and secondary wound closure. The third patient was diagnosed on the fifth post-operative day after removal of the vaginal packing. Dietary restriction was indicated, and a rectal flap was performed. A fourth patient was diagnosed within the late postoperative period; she was submitted to surgical exploration and a rectal wall flap was created. RnVF after sex reassignment surgery has an incidence of about 2%–17%; RnVF is the most common type of fistula after this procedure. In most cases, it is secondary to rectal injury during the initial surgery. The management of these fistulas ranges from primary closure, diverting colostomies, conservative management, or the performance of flaps. A multidisciplinary team approach is recommended for the diagnosis and treatment of this complication.

Effects of Cryotherapy on Temperature Change in Caudal Thigh Muscles of Dogs.

The aim of the study reported here was to determine the effect of cryotherapy on the caudal thigh muscles of dogs. We hypothesized that temperature changes would be greatest in superficial tissues and decrease with tissue depth. Eight mixed-breed dogs (mean weight 21.2 kg, mean age 3.3 years) were studied. Temperature was measured at the skin surface and at depths of 1.0 and 3.0 cm below the skin using needle thermistor probes that were inserted beneath the site of cold pack application. Treatment consisted of a standard 1.0°C cold pack applied for 20 minutes. Temperature was recorded every minute for the 20 minute cold pack treatment, and for 80 minutes following treatment. Cutaneous temperatures significantly decreased (p < 0.01), with rapid rewarming of the skin following cold pack removal. Tissue cooling was less profound with increasing tissue depths, but was still significant (p < 0.05). There was no significant difference in muscle temperature between haired and clipped limbs. A single application of a cold pack to the caudal thigh muscles of dogs for 20 minutes resulted in significant temperature reduction at all tissue depths (p < 0.05). This decrease persisted for ∼60 minutes. The presence of hair did not have a significant effect on muscle cooling (p > 0.05).

ANTERIOR NASAL PACKING POST SUBMUCOUS RESECTION (SMR): A COMPARISON BETWEEN REMOVAL ON 1ST VERSUS 2ND POST OPERATIVE DAY

Objective: To evaluate the effect of removal of nasal packs after sub mucous resection (SMR) on the first postoperative day versus second post operative day in terms of bleeding control and prevention of septal hematoma formation.&#x0D; Study Design: Comparative cross sectional study.&#x0D; Place and Duration of Study: ENT department, Combined Military Hospital Jhelum Pakistan, from Oct 2017 toOct 2018.&#x0D; Methodology: Total 100 patients of both genders, ages from 16 to 35 years with a deviated nasal septum wereincluded. Written informed consent was taken and hospital ethical committee approval was obtained. Patientswere randomly divided into two groups of 50 patients each by simple random sampling. Patients in both groupsunderwent submucous resection. Patients in whom sub mucous resection was combined with other procedureslike rhinoplasty, turbinectomy, polypectomy were excluded. In group A the nasal packs were removed on thefirst post operative day. In group B the nasal packs were removed on the second post operative day. Nasal packing in all patients was done with vaseline gauze rolls. The groups were compared for bleeding at the time of nasal pack removal and septal hematoma formation in the follow up period.&#x0D; Results: There was no statistically significant difference between the two groups in terms of bleeding (p-value0.40) and septal hematoma formation (p-value 0.49).&#x0D; Conclusion: After sub mucous resection, removal of nasal packs on 1st versus 2nd post operative day is notassociated with any significant difference in bleeding and septal hematoma formation.

Placenta percreta after Strassman metroplasty of complete bicornuate uterus: a case report

BackgroundA bicornuate uterus often results in infertility. While reconstructive procedures may facilitate pregnancy, spontaneous abortion or serious pregnancy complications may occur. We present a case of a bicornuate uterus with spontaneous conception after Strassman metroplasty; however, life-threatening complications during pregnancy occurred.Case presentation: A 38-year-old woman with a history of infertility presented for prenatal care at 6 weeks of gestation. She had conceived spontaneously after four failed in vitro fertilization and embryo transfer (IVF-ET) procedures, Strassman metroplasty for a complete bicornuate uterus, and two postoperative IVF-ET pregnancies that ended in embryo arrest. This pregnancy was uneventful until the patient presented with massive vaginal bleeding at 28 weeks of gestation and was diagnosed with placenta previa and placenta percreta. Bleeding was controlled after emergency Caesarean section and delivery of a healthy neonate. However, severe adhesions were noted as well as a rupture along the metroplasty scar. Two days later, on removal of the intrauterine gauze packing, severe hemorrhage resumed, and the uterus did not respond to oxytocin, hemabate, or carbetocin. Emergency hysterectomy was required.ConclusionsReconstructive surgical procedures for complete bicornuate uterus may allow patients to achieve spontaneous pregnancies. However, potential intrapartum complications include placenta implantation and postpartum hemorrhage, and the latter may be exacerbated as the uterus does not contract or respond to oxytocin or prostaglandin drugs. Patients should be counseled on the risks associated with pregnancy after Strassman metroplasty, and clinicians must be aware of potential severe complications.

Maternal and fetal outcomes of patients referred from primary health-care facilities to a tertiary hospital: A cross-sectional study

INTRODUCTION: There is insufficient local data on the maternal and fetal morbidity and mortality of cases seen initially at the primary health-care facility (PHCF) and subsequently referred to a tertiary hospital for acute management. This study aimed to determine the maternal and fetal outcomes of such patients using the World Health Organization maternal near miss, mortality, and neonatal mortality rates. MATERIALS AND METHODS: A cross-sectional study was done that involved obstetric patients beyond 20-week gestation and in the immediate postpartum who were initially managed at the PHCF then referred to a tertiary hospital for management. RESULTS: There were 485 deliveries (85.5%) with a primary cesarean section rate of 16.6%. One patient underwent exploratory laparotomy for uterine rupture with extraction of a stillborn baby and hysterectomy. Eighteen cases (3.2%) necessitated other forms of surgical interventions including hysterectomy (6), transverse compression suture (3) with bilateral uterine or hypogastric artery ligation, uterine repositioning (1), evacuation of vaginal hematoma (4), balloon pack insertion (2), postpartum curettage (1), and removal of retained suture needle (1). The maternal near-miss rate is 46.7/1000 live births (46.7%). There were three intensive care unit admissions and 5 cases required ventilatory support. The maternal mortality rate is 10.6 maternal deaths per 1000 live births (1.06%). Majority of the babies had good APGAR scores at birth. Twenty-two babies (4.5%) required intensive neonatal management. The neonatal mortality rate is 0.42% or 4.2/1000 live births. CONCLUSIONS: Almost 40% of referred cases were primigravidas and have preexisting medical problems that should not have been seen at the primary care level but directed to secondary or tertiary center at the outset. It cannot be understated that education of the populace, more training, and monitoring the performance of base health facility workers should be done to prevent maternal and fetal catastrophes.

Wedge-shape Merocel Pack After Functional Endoscopic Sinus Surgery: Our Experience With 697 Patients.

Background:Chronic rhinosinusitis (CRS) is a disease characterized by inflammation of the paranasal sinus mucosa for a duration of more than 12 weeks. It is one of the most frequently diagnosed chronic diseases that is encountered in everyday practice with an overall prevalence ranges from 7% to 27%Objective:To evaluate our long-term experience using wedge-shape middle meatal Merocel packing after functional endoscopic sinus surgery (FESS) for chronic rhinosinusitis (CRS).Methods:charts and electronic records of consecutive adult CRS patients who failed to respond to medical treatment and underwent endoscopic sinus surgery using wedge-shaped middle meatal Merocele packing were retrospectively reviewed. Demographic data, presence and absence of nasal polyps and/or asthma, postoperative bleeding, middle meatal adhesions and/or lateralization, and requirement of adhesiolysis were reviewed.Results:697 patients (1394 nasal sides) were included. The mean age was 34 years. CRS with nasal polyps was observed in 224 patients (32%) and 185 (27%) had associated asthma. Postoperative pain and discomfort while the pack in place were tolerable and no patient required pre-scheduled pack removal. All packs were removed in the clinic with tolerable discomfort. No major bleeding that required re-packing was seen, but mild oozing or minor bleeding was encountered in some cases which was controlled by small cotton packs soaked with diluted adrenaline. Thirty-four patients (4.9%) had middle meatal adhesions. Right side adhesions were seen in 13 patients (38.2%), left side adhesions in 12 patients (35.3%), and bilateral in 9 patients (26.4%). Significant severe lateralized middle turbinate was observed in 2 cases. No infectious complications related to the pack have happened.Conclusion:Wedge-shaped Merocel pack is an effective middle meatal pack after FESS. It is easy to shape, widely available, and economical. It can decrease early postoperative bleeding and also it provides support to the middle turbinate preventing lateralization and adhesions.

Video ile Bilgilendirme Yapılmasının Postoperatif Tampon Çıkarılma Anksiyetesine Etkisi

Video ile Bilgilendirme Yapılmasının Postoperatif Tampon Çıkarılma Anksiyetesine Etkisi

Quality-of-life assessment after endoscopic skull base surgeries

Introduction Endoscopic transnasal approaches have been the main treatment option for most of anterior skull base and sellar diseases. Quality-of-life (QOL) assessment after skull base surgeries are now well appreciated and measured to improve medical and surgical care for those patients. Aim To assess QOL after endoscopic transnasal skull base surgery in its six main domains. Patients and methods This study was conducted on 20 patients who had endoscopic skull base surgery for various skull base lesions. QOL was assessed by modified short form health survey questionnaire 1 and 4 weeks postoperatively. A scoring system was adopted, and cases were divided into two group according to their overall score (worse and better groups). Comparison between the two groups was conducted to determine factors that worsen QOL results after endoscopic skull base surgery. Results The overall QOL showed statistical improvement 1 month postoperatively over after 1 week. One week after operation, QOL was statistically affected by age of patient, duration of nasal pack removal, and duration of ICU admission. Postoperative pain domain is worsened by superior turbinate resection or trimming during first week. Conclusion QOL after endoscopic skull base surgeries has been associated with statistically significant improvement after 4 weeks, with significant decrease in the incidence of postoperative complications.

Fístulas rectoneovaginales en pacientes tras cirugía de reasignación de sexo. Descripción de nuestra experiencia y revisión de la literatura

Male-to-female reassignment surgery or vaginoplasty includes those surgical procedures that aim to recreate a functional and cosmetically acceptable female perineum with minimal scarring. The technique of choice at our center is penile inversion vaginoplasty with or without scrotal skin grafts. We present 4 cases diagnosed with rectoneovaginal fistulas treated at our center with favorable evolution. The first patient was diagnosed in the late postoperative period during dilation. She underwent 2 failed vaginal repair attempts. Finally, a temporary colostomy and a rectal flap were performed. The second patient was diagnosed 2 weeks after the initial surgery due to aggressive dilation and was treated with a temporary colostomy and secondary wound closure. The third patient was diagnosed on the fifth post-operative day after removal of the vaginal packing. Dietary restriction was indicated, and a rectal flap was performed. A fourth patient was diagnosed within the late postoperative period; she was submitted to surgical exploration and a rectal wall flap was created. Rectoneovaginal fistulas after sex reassignment surgery has an incidence of about 2-17% and they are the most common type of fistula after this procedure. In most cases, it is secondary to rectal injury during the initial surgery. The management of these fistulas ranges from primary closure, diverting colostomies, conservative management, or the performance of flaps. A multidisciplinary team approach is recommended for the diagnosis and treatment of this complication.

Comparative study of nasal packs, quilts and splints in septal surgery

&lt;p&gt;&lt;strong&gt;Background&lt;/strong&gt;: Nasal packing, quilting and splinting are utilized in septal surgery to have a patent airway. The effects on the patient have been studied.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and Methods: &lt;/strong&gt;60 subjects with deviated nasal septum requiring septal surgery were selected from the Rhinology division of otorhinolaryngology services of Dayanand Medical College and Hospital, Ludhiana. Comparison between nasal packing, nasal splints and quilt suturing was carried out in a period of one and a half years.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;All the 20 patients (100%) of anterior nasal packing had severe local discomfort but no postoperative hematoma. 1 patient (5%) of quilt stitching showed septal swelling in 1 patient (5%) of anterior nasal packing suffered from moderate degree of fever. There was no such episode in any of the patients in whom quilt stitching and splints were used. 6 patients (30%) of anterior nasal packing had crust formation which was not seen in quilt stitching and splint patients. 7 patients (35%) of nasal packing had ulceration of nasal mucosa on removal of pack, while none had in the quilt stitching or nasal splint group. 2 (10%) patients with anterior nasal packing had postoperative synechiae formation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Quilting and splinting are the ideal tamponade post septal intervention As except for mild discomfort they do not experience the unpleasant sequel of accordion nasal packs. Moreover, it makes the procedure a day care surgery.&lt;/p&gt;

Non-Invasive Analysis of Actinic Keratosis before and after Topical Treatment Using a Cold Stimulation and Near-Infrared Spectroscopy.

Background and objectives: The possible evolution of actinic keratoses (AKs) into invasive squamous cell carcinomas (SCC) makes their treatment and monitoring essential. AKs are typically monitored before and after treatment only through a visual analysis, lacking a quantitative measure to determine treatment effectiveness. Near-infrared spectroscopy (NIRS) is a non-invasive measure of the relative change of oxy-hemoglobin and deoxy-hemoglobin (O2Hb and HHb) in tissues. The aim of our study is to determine if a time and frequency analysis of the NIRS signals acquired from the skin lesion before and after a topical treatment can highlight quantitative differences between the AK skin lesion area. Materials and Methods: The NIRS signals were acquired from the skin lesions of twenty-two patients, with the same acquisition protocol: baseline signals, application of an ice pack near the lesion, removal of ice pack and acquisition of vascular recovery. We calculated 18 features from the NIRS signals, and we applied multivariate analysis of variance (MANOVA) to compare differences between the NIRS signals acquired before and after the therapy. Results: The MANOVA showed that the features computed on the NIRS signals before and after treatment could be considered as two statistically separate groups, after the ice pack removal. Conclusions: Overall, the NIRS technique with the cold stimulation may be useful to support non-invasive and quantitative lesion analysis and regression after a treatment. The results provide a baseline from which to further study skin lesions and the effects of various treatments.