Seventh Postoperative Day Research Articles

Comparison Between Closed and Open Methods for Creating Pneumoperitoneum in Laparoscopic Cholecystectomy.

Background: To study the efficacy of closed and open methods for creating pneumoperitoneum in laparoscopic cholecystectomy by comparing the two in terms of their outcome and complication. Study Design: Single-centre, prospective, observational study. Materials and study: Purposive sampling method where the inclusion criteria were all patients with cholelithiasis who were advised and consented to laparoscopic cholecystectomy of age 18-70 years were included in the study group. Exclusion criteria include patients with a paraumbilical hernia, a history of upper abdominal surgery, uncontrolled systemic illness, and local skin infection. Sixty cases of cholelithiasis satisfying exclusion and inclusion criteria who underwent elective cholecystectomy during the study period were included. Thirty-one of these cases underwent the closed method, while in the remaining 29 patients open method was adopted. Cases in which pneumoperitoneum created by closed technique were grouped as group A and those by open technique as group B. Parameters comparing the safety and efficacy of the two methods were studied. The parameters were access time, gas leak, visceral injury, vascular injury, need for conversion, umbilical port site hematoma, umbilical port site infection, and hernia. Patients were assessed on the first postoperative day, the seventh postoperative day, and then two months after surgery. Some follow-ups were done telephonically. Results: Out of 60 patients, 31 underwent the closed method, while 29 underwent the open method. Minor complications like gas leak during the procedure was observed more in the open method. The mean access time in the open-method group was less than in the closed-method group. Other complications like visceral injury, vascular injury, need for conversion, umbilical port site hematoma, umbilical port site infection, and hernia were not observed in either group during the allocated follow-up period in the study. Conclusion: Open technique for pneumoperitoneum is as safe and effective as the closed technique.

Delayed-onset contact dermatitis caused by olanexidine gluconate antiseptic solution: effect of wiping off the remaining drug solution in two cases

BackgroundOlanexidine glucuronide (Olanedine®), an antiseptic solution may cause skin dermatitis around one week after disinfection. Although removal after the procedure is recommended to avoid skin dermatitis, whether it is effective for preventing skin dermatitis has not been documented in detail in the literature.Case presentationWe encountered two cases of delayed-onset contact dermatitis by Olanedine®. In both cases, the patient’s back was disinfected with Olanedine® and was covered with a surgical drape for epidural catheterization. After catheterization and removal of the surgical drape, the insertion site of the catheter was covered with a film dressing, then the epidural catheter was taped to the back. On the third postoperative day, the epidural catheter was removed. On the seventh postoperative day, the patients reported pruritus on the back, where an erythematous papule rash was observed. However, it was not observed at the site covered by the tape to secure the epidural catheter or by the tape of the surgical drape. Symptoms were relieved with oral or topical steroids by the time of discharge.ConclusionWiping off the remaining Olanedine® even a few days after disinfection may be helpful not only for reducing symptoms but also for preventing the development of contact dermatitis.

Evaluation of colonic anastomosis healing using hybrid nanosheets containing molybdenum disulfide (MOS2) scaffold of human placental amniotic membrane and polycaprolactone (PCL) in rat animal model.

Anastomosis is a standard technique following different conditions such as obstruction, tumor, and trauma. Obstruction, adhesion, or anastomosis leakage can be some of its complications. To improve healing and prevent postoperative complications, we design a hybrid scaffold containing acellular human amniotic membranes and polycaprolactone-molybdenum disulfide nanosheets for colon anastomosis. The animal model of colocolonic anastomosis was performed on two groups of rats: control and scaffold. The hybrid scaffold was warped around the anastomosis site in the scaffold group. Samples from the anastomosis site were resected on the third and seventh postoperative days for histopathological and molecular assessments. Histopathologic score and burst pressure had shown significant improvement in the scaffold group. No mortality and anastomosis leakage was reported in the scaffold group. In addition, inflammatory markers were significantly decreased, while anti-inflammatory cytokines were increased in the scaffold group. The result indicates that our hybrid scaffold is a proper choice for colorectal anastomosis repair by declining postoperative complications and accelerating healing.

Robotik radikal prostatektomi sonrası üretrovezikal anastomoz kaçağının erken postoperatif kontinans üzerine etkisi

Objective: This study aimed to assess the urethrovesical anastomotic leakage (UAL) and associated factors in patients who underwent robot-assisted radical prostatectomy (RARP) and its effect on early continence. Material and Methods: The data of 81 patients who underwent RARP between February 2017 and June 2022 were evaluated in this retrospective analysis. On the seventh postoperative day, we performed a cystography to determine whether the patients had UAL. Uni- and multivariate analyses were done to investigate the factors that could lead to UAL. Continence rates were recorded in patients at 6-12 weeks after surgery. Results: Overall 25 patients (31%) had UAL; of them 12 (15%) were mild, eight (10%) were moderate, and five (6%) were extensive. A drain/ serum creatinine ratio >1.5 and a prostate volume >53 cm3 were determined to be significant in predicting UAL in both the uni- and multivariate analyses (p=0.017 and p=0.046, respectively). On the postoperative second or third day, of the 36 patients who had drain output greater than 100 ml, eight (22%) had a high drain/serum creatinine ratio (>1.5), seven (88%) of which had UAL. According to the early period follow-up data, incontinence was prevalent in 9 (36%) of the patients with UAL and 20 (%37) of the patients without UAL (p=0.959). Conclusion: Cystography is an effective method for detecting leakage after RARP. A large prostate volume (>53 cm3) and a high postoperative drain/serum creatinine ratio (>1.5) were found to be associated with UAL. UAL had no effect on early continence. Keywords: anastomotic leak, cystography, prostatectomy, robot-assisted, urinary incontinence

Fresh arterial allograft as a replacement for an infected common femoral prosthetic graft and recurrent false aneurysm.

Replacing an infected vascular prosthetic conduit with an allograft is a possible solution of this complication given the low recurrence of infection. It is most commonly utilized for cases where the use of autologous tissue is not an option. We present the case of a 70-year-old patient who had undergone repeated vascular reconstructions in the right lower limb. He was admitted to our department due to a progressively growing mass in the right groin and subsequently placed on the waiting list for a fresh allograft. The patient had the infected false aneurysm and prosthetic material of the femoral bifurcation replaced with an arterial allograft. The previous femoral popliteal autovenous bypass graft was reimplanted into the allograft. There were signs of sepsis during the operation; however, the blood culture was negative. Cultures from neither the wound nor the drain revealed the presence of any bacteria. The patient was discharged on the seventh post-operative day with prophylactic antibiotics. An early followup confirmed that there were no signs of recurrent infection and that the reconstruction remained patent. Seven and half months after the surgery, the femoral popliteal bypass graft became occluded and a conservative approach was chosen. A small thrombosed false aneurysm of the graft was revealed two years after the surgery due to transient non-compliance of the patient to immunosuppression therapy. It was treated conservatively. Two and a half years after the surgery, the allograft still remains open and the limb is preserved.

Sternum Defektlerinin Rekonstrüksiyonunda Güvenilir Bir Yöntem: Pektoralis Major Kas Flebi ile Negatif Basınçlı Yara Bakım Kombinasyonu

Objective: Sternotomy defects may present mildly as isolated skin separation or severely as mediastinitis. A combination of treatment options can support treatment. Methods: Patients who were treated with pectoralis major flap with the combination of negative pressure wound therapy (NPWT) between 2016-2020, were retrospectively reviewed. Demographic features, microorganisms causing wound infection, flap reconstruction preference, time of hospitalization, remission, recurrence and associated morbidity and mortality data were evaluated. Results: Thirteen patients were included with a mean age of 65.4 years. All patients previously underwent coronary artery bypass graft surgery. Wound cultures from patients were positive in nine (69%). Isolated microorganisms were Staphylococcus spp. (n=4), Klebsiella pneumoniae (n=3) and Acinetobacter baumannii complex (n=2). The most common comorbidities were hypertension (76%) and diabetes mellitus(46%). The average hospital stay was 23.4 days. One patient died on the seventh postoperative day, two had seromas at the flap donor site, and one had hematoma. Conclusion: Pectoralis major muscle flap and NPWT after complete removal of dead tissues is an effective method to repair and treat sternum defects.

A COMPARATIVE STUDY BETWEEN LAPAROSCOPIC VERSUS OPEN REPAIR OF INCISIONAL HERNIA AT A TERTIARY CARE INSTITUTE.

Introduction Incisional hernia is a bulge or protrusion near or directly along a prior abdominal surgical incision.Repair of ventral hernias has always been challenging because of the distorted anatomy due to previous surgery. With the advancement in technology as well as surgical techniques, laparoscopic incisional hernia repair (LVHR) is more commonly being performed as compared to open repair in various centers throughout the World. Our study aimed to compare the short-term operative outcomes between laproscopic and open repair. Materials and methods Fifty patients diagnosed with non-complicated incisional hernias were included in this prospective study and were randomly divided into the laparoscopic group and the open group. The two groups were compared to evaluate operative time, postoperative pain, length of hospital stay and time taken to return to normal activity. A p-value of less than 0.05 was considered to be statistically signicant. Mean operative time Results was longer in Laproscopic repair (100 min) as compared to open repair (76 min)(p<0.01). Patients experienced more pain on the rst and seventh postoperative days in the open group (p<0.01) and they also had a longer duration of hospital stay as compared to the laparoscopic group . Conclusion Laparoscopic repair carries a signicant advantage over open hernia repair, especially in terms of reduced postoperative pain, duration of hospital stay, and early resumption of normal activity

EUSTACHIAN TUBE DYSFUNCTION FOLLOWING ANTERIOR NASAL PACKING

Background: Eustachian tube maintains middle ear pressure equal to that of atmosphere and helps in ventilation of middle ear. Its function may be deranged due to adenoids, cleft palate, nasogastric tubes, allergy and by nasal packing. Objectives:To evaluate the effect of anterior nasal packing on Eustachian tube function. Methods: A cross-sectional study including 50 patients with deviated nasal septum with or without external nasal deformity and nasal polyposis. Tympanometry was performed prior to surgery, second post-operative day before pack removal and on seventh post-operative day ve days after pack removal. Results: Out of 50 patients (100 ears) who had anterior nasal packing after nasal surgeries, 40 ears had abnormal middle ear pressure after 48 hours of anterior nasal packing just before the pack removal. Middle ear pressure 5 days after the pack removal was found abnormal in 4 ears. Conclusion: This study shows that anterior nasal packing result in Eustachian tube dysfunction and negative middle ear pressure which is reversible in nature.

Retinal Pigment Epithelium Tear After Nonpenetrating Deep Sclerectomy.

Retinal pigment epithelium (RPE) tear is a common complication in the context of neovascular age-related macular degeneration treated by intravitreal injections of antivascular endothelial growth factor drugs. There are some reports of such complications after trabeculectomy but none after nonpenetrating deep sclerectomy (NPDS). A 57-year-old man presented to our hospital with uncontrolled advanced glaucoma of his left eye. NPDS with adjunctive use of mitomycin C was performed with no intraoperative complication. On the seventh postoperative day clinical examination and multimodal imaging revealed a macular RPE tear in the operated eye. Subretinal fluid induced by the tear resolved within 2 months with an increase in intraocular pressure. To the best of our knowledge, this article discusses the first reported case of RPE tear occurring just after NPDS.

The Impact of Surgery on Circulating Malignant Tumour Cells in Oral Squamous Cell Carcinoma.

The extent to which surgical management of oral squamous cell carcinoma (OSCC) disseminates cancer is currently unknown. To determine changes in numbers of malignant cells released into systemic circulation immediately following tumour removal and over the first seven post-operative days. An observational study from March 2019 to February 2021. This study was undertaken at Queen Mary University Hospital, Hong Kong. Patients with biopsy-proven oral SCC were considered for eligibility. Patients under 18 years of age, pregnant or lactating women and those unable to understand the study details or unable to sign the consent form were excluded. Twenty-two patients were enrolled (12 male and 10 female) with mean age of 65.5 years. Primary tumour management was performed in accord with multi-disciplinary team agreement. Anaesthesia and post-operative care were unaltered and provided in accord with accepted clinical practice. Three types of malignant cells detected in peripheral blood samples were enumerated and sub-typed based on the presence of chromosomal aneuploidy and immunohistochemical characteristics. To test the hypothesis that malignant cells are released by surgery, the numbers of single circulating tumour cells (CTCs), circulating tumour microemboli (CTM) and circulating endothelial cells (CTECs) were recorded pre-operatively, upon tumour removal and the second and seventh post-operative days. Of a potential 88 data collection points, specimens were not obtainable in 12 instances. Tumour removal resulted in a statistically significant increase in CTCs and a non-statistically significant rise in CTMs. CTCs, CTMs and CTECs were detected in the majority of patients up to the seventh post-operative day. Individual patients demonstrated striking increases in post-operative CTCs and CTECs numbers. Surgical management of OSCC has a significant impact on the systemic distribution of cancer cells. Malignant cells persisted post-operatively in a manner independent of recognised staging methods suggesting differences in tumour biology between individuals. Further investigation is warranted to determine whether circulating malignant cell enumeration can be used to refine risk stratification for patients with OSCC.

Individualized Care and Follow-Up in Outpatient Surgery: A Pilot Study.

Introduction In outpatient surgery, post-discharge follow-up calls are essential for identifying complications and are considered a cost-effective intervention. Currently, there is a lack of scientific evidence to support the development and validation of standardized protocols adjusted to patients' specificities. Our aim is to develop a personalized model for our outpatient surgery unit (OSU) to create an individualized follow-up strategy in the future. Material and methods We performed a retrospective, cohort, single-center study, including patients undergoing surgery at an OSU of a tertiary hospital in Portugal, for three months. Follow-up calls were performed on the seventhand fourteenth days after discharge. The variables analyzed included: sex, age, surgical specialty, anesthetic technique, American Society of Anesthesiologists (ASA) physical status classification, surgery duration, and complications. A binary logistic regression was adjusted for the complications detected in each call. Results Nine-hundred eighty-four (984) patients were included, of which 79.8% (n=785) and 75.3% (n=741) answered the follow-up calls on the seventh and fourteenth days after discharge, respectively. Complications were reported in 47.1% (n=370) and 29.8% (n=221) of these calls, respectively, with pain having the highest incidence rate (44.7% in the first call; 26.6% in the second). The type of anesthesia and surgical specialty were independent risk factors for complications (p<0.001). Each minute increase in surgery duration increased by 1.1% the odds of complications (95% confidence interval 1.003-1.018) in the first call. Compared with no anesthesiology involvement, general anesthesia, regional anesthesia, and monitored anesthetic care are 2.52, 2.04, and 1.75 times more likely to have complications detected in the first call and 3.21, 2.36, and 3.11 times more likely to have complications on the second (p<0.05 for all). A model that predicts the detection of complications in each call was created. Discussion Outpatient surgery may allowprocedures to be carried out safely, efficiently, and cost-effectively. To optimize the outcomes, it is important to quantify results as a tool for honing our strategies. The present study recognized the influence of several variables in the incidence of post-discharge complications. Also, considering the complications reported, pain was the most frequent among the reports and should not be neglected. In our reality, no follow-up calls are routinely performed after the seventh day, and complications were reported in that period, meaning some patients probably should be accompanied for a longer period. Conclusions To ensure the quality of care and patient safety and satisfaction, it is essential to identify and manage postoperative complications. Despite not being a routine contact, the incidence rate of complications on the seventh and fourteenth postoperative days is noted. According to our investigation, the type of anesthesia, surgical specialty, and duration of surgery should be carefully considered when establishing individualized follow-up plans. These plans, using tools adjusted to the population of each OSU, such as the calculator presented, may allow the available resources to be used with the greatest potential benefit for both patients and healthcare systems.

Attached Oral Mucosal Wound Closure using Blue Glue - A Prospective Clinical Study.

Traditionally, sutures have been widely used to close intraoral wounds. Various alternatives have been developed amongst which newer tissue adhesives such as N-butyl-2-cyanoacrylate having accepted clinical properties are gaining popularity. The primary purpose of the present study is to evaluate the efficacy of N-butyl-2-cyanoacrylate for intraoral attached mucosal wound closure following alveoloplasty. In this prospective split-mouth study, 25 patients requiring alveoloplasty in either maxillary or mandibular arch bilaterally with a total of 50 sites were divided into two equal groups, namely silk suture (Group 1) and cyanoacrylate (Group 2). Each patient was evaluated on the first, third, seventh, 14th and 21st post-operative days. Parameters evaluated were time taken to close incision and to achieve haemostasis, pain, oedema, post-operative wound healing, patient discomfort and possible complications. Time taken to close incision, time taken to achieve haemostasis, post-operative pain and oedema were found to be less in Group 2. Wound healing too was found to be better in Group 2. There was one case of adhesive peel off on the first post-operative day which was managed by reapplying the tissue adhesive. The incidence of wound dehiscence and wound infection was observed more in Group 1 on the third post-operative day. Suture breakage (16%) and adhesive dislodgement (8%) were reported on the seventh post-operative day. The use of cyanoacrylates' inherent benefits, such as improved wound seal off in attached mucosa, quick polymerisation and bacteriostatic characteristics can be beneficial when performing minor oral surgical procedures on elderly, young and mentally challenged patients.

Evaluation of Efficacy of Low-Intensity Pulsed Ultrasound on Comorbidities Following Mandibular Impacted Third Molar Surgery: A Prospective Study.

Despite several in vitro and in vivo applications of low-intensity pulsed ultrasound (LIPUS), it remains an under-studied feature of the oral and maxillofacial region. The goal of this in vivo study was to objectively investigate the efficacy of low-intensity pulsed ultrasound on wound healing and related morbidities following surgical removal of an impacted third molar. The following in vivo prospective, comparative, randomised controlled clinical study was carried out amongst 56 patients who reported to the Department of Oral and Maxillofacial Surgery fulfilling the inclusion criteria. Group A received sham ultrasound, whereas Group B received LIPUS therapy. Based on the group allocated LIPUS 1 MHz, pulsed 20% and dose 1.0 watts/square centimetre (W/cm2)/sham, ultrasound therapy was given on 1st, 2nd and 3rd post-operative days. The assessment of post-operative pain, oedema, trismus and wound healing on preoperative, first, third and seventh postoperative days. The quantitative variables of the study were assessed using independent sample t-test, and qualitative variables were assessed using the Chi-square test. The P < 0.05 on third and seventh post-op days for pain, trismus and wound healing in the LIPUS group compared to control group making it statistically significant. There was no statistically significant difference in the reduction of oedema amongst the two groups. Post-LIPUS application in the patients, postoperative pain was significantly reduced, trismus was noticeably improved and wound healing was satisfactory and can be employed as a complementary technique.

An Unusual Case Report of Adult Cervical Cystic Hygroma

Cystic Lymphangioma (CL) is a rare condition that is typically observed as a congenital malformation in the head and neck. These congenital lesions usually appear before the age of two. Adult occurrences are extremely unusual, and only a few cases have been mentioned in the literature. CL is characterised by the collection of an epithelial lining of lymphatic fluid, which can be caused by lymphatic abnormalities, trauma, or surgery. In the present case report, the authors present the findings of a 49-year-old adult female who had painless, gradually increasing left-sided neck swelling for three years, with no other relevant medical history. The initial ultrasound revealed a large cystic lesion extending from the left sternocleidomastoid muscle to the left submandibular gland. The lesion measured 8×7×3 cm and exhibited narrow septae and loculation at the periphery. Avascularity was noted within the cyst wall and interlobular septae. The diagnosis favoured macrocytic lymphangioma/Congenital Lymphangioma (CH). During the surgical procedure, the cyst was dissected, and it was found to be located over the internal jugular vein, carotid artery, and spinal accessory nerve. The cyst was completely removed, and a surgical drain was left in place. The wound was sutured in two layers, and a sterile dressing was applied. The drain was removed on the third postoperative day, and the dressing with sutures was removed on the seventh postoperative day, revealing a healthy wound. The diagnosis was confirmed by histopathological examination {Haematoxylin and Eosin (H&amp;E)} of the tissue specimen, which showed flattened epithelium lining the inside of the cyst. The cyst contained dilated gaps in a fibrocollagenous stroma infiltrated by lymphocytes. Therefore, CH can be considered as a differential diagnosis for head and neck masses in adults.

A Rare Case of Posterior Spinal Cord Syndrome Following Commando Surgery

A 60-year-old male who underwent commando surgery for oral cancer in a supine position and 20-degree neck extension developed sensory ataxia with a loss of proprioception in bilateral lower limbs and hands in the immediate postoperative period. The magnetic resonance imaging (MRI) of brain and screening of spine done within 6 h of surgery indicated a degenerative cervical canal stenosis from C3 to C7 level. A final diagnosis of posterior spinal cord syndrome (PCS) was made after excluding other causes clinically and radiologically. Emergency surgical decompression in the form of C3–C7 laminectomy and intravenous methylprednisolone were administered within 12 h of index surgery. An early diagnosis and treatment resulted in a good neurological recovery by the seventh postoperative day and he was ambulatory with minimal support at 3-month follow-up.

A case study on how nasal high-flow treatment helps prevent the recurrence of surgical atelectasis by providing respiratory support

Background: Preventing postoperative atelectasis in surgical patients with impaired pulmonary function is preferable. This study presented a case in which the use of nasal high flow treatment to assist the respiratory system prevented the recurrence of postoperative atelectasis. Case Presentation: An urgent laparoscopic procedure was performed on a 68-year-old man who had a perforation in his upper digestive tract. The patient appeared undernourished because of his severe, uncontrolled diabetes mellitus. The scheduled surgery was completed without incident. On the fifth postoperative day, the patient exhibited acute atelectasis of the left lower lobe, with an oxygen saturation of 89%. When tracheal suction and postural draining restored normal oxygenation, positive-pressure ventilation at 8 cm H2O airway pressure was employed to stop recurring atelectasis. On the seventh postoperative day, 15 hours after positive pressure breathing ended, the patient suffered a relapse of acute atelectasis. Once bronchoscopy was utilized to remove a mucous plaque from the tracheobronchial tree, nasal high flow treatment at a rate of 40 l/minute was employed to deliver a modest dose of continuous positive airway pressure rather than positive pressure breathing. The respiratory rehabilitation continued without a hitch, and his health was more stable with nasal high flow therapy&amp;apos;s breathing support than it was with positive pressure ventilation. The nasal high flow therapy also provided gas that was sufficiently humidified, which improved the bronchial secretion. There was no new atelectasis throughout the remainder of the patient&amp;apos;s stay in the intensive care unit. Conclusion: Respiratory support with nasal high flow treatment might help to prevent postoperative atelectasis by providing continuous positive airway pressure in conjunction with progressive respiratory rehabilitation.

Congenital Pulmonary Airway Malformation in a Two-Month Old Infant: A Case Report

Congenital Pulmonary Airway Malformations (CPAM) are rare clinical conditions that affect the lungs. They are characterised by the formation of large, multiloculated, cystic structures due to the overgrowth of the terminal bronchioles. This report presents the case of a two-month-old female infant who was referred to the pediatric emergency ward with a diagnosis of aspiration with collapse of the left lung. The patient exhibited progressively worsening respiratory distress accompanied by fever. The infant had a history of breast milk aspiration and had been admitted to the hospital multiple times due to respiratory distress since birth. Even after discharge, she required moist oxygen therapy at home. Upon presentation, a chest X-ray showed left lung collapse, and her respiratory rate was measured at 70 breaths/min. Other vital parameters and laboratory examinations were within normal limits. A high-resolution Computed Tomography (CT) scan of the thorax confirmed the diagnosis of CPAM. The patient was placed on ventilator support and received antibiotic treatment. Once stabilised, she underwent right postero-lateral thoracotomy with right middle and lower lobectomy under general anesthesia. Following surgery, she was discharged in stable condition on the seventh postoperative day, with her respiratory distress resolved. The child continues to receive regular follow-up care, including immunisations and appropriate nutritional support.

Effectivness of submucosal, oral and intramuscular routs of dexamethasone administration in trismus, swelling, and pain reduction after the third lower molar surgery

Background/Aim. Surgical extraction of impacted lower third molars is inevitably followed by the postoperative occurrence of trismus, swelling, and pain sensations to some degree. Corticosteroids (dexamethasone in particular) are commonly used drugs in the prevention of these complications. The aim of this study was to determine the effectiveness of dexamethasone in the prevention of postoperative complications, edema, trismus, and pain after the surgical extraction of impacted lower third molars, depending on the method of its administration. Methods. This prospective study involved 30 healthy patients, aged 18 years and above, of both sexes, with fully impacted lower third molar ? class I or II and position B or C, according to Pell and Gregory classification system and vertical position according to Winter classification. All patients were divided randomly into three groups de-pending on the way of dexamethasone administration: oral ? dexamethasone administered in the form of oral tablets in a dose of 4 mg one hour before the surgery; submucosal ? dexamethasone solution administered submucosally in a dose of 4 mg in the area of the buccal sulcus, after the inferior alveolar nerve block anesthesia and additional anesthesia for the buccal nerve; intramuscular ? dexamethasone solution administered intramuscularly in a dose of 4mg into the area of the deltoid muscle, right before the intervention. Preoperatively and at every follow-up (on the first, second, and seventh day postoperatively), interincisal distance, the degree of edema, and the level of pain with the use of a visual analog scale (VAS) were measured. On the seventh postoperative day, the total number of analgesics taken by the patients was recorded. Results. In the postoperative period, there was no statistically significant difference be-tween the examined groups in terms of effectiveness in swelling, trismus, and pain reduction (p &gt; 0.05). Conclusion. There is no significant difference in dexamethasone effectiveness in postoperative trismus, swelling, and pain reduction after the third lower molar surgery, regarding the route of administration ? oral, intramuscular, or local submucosal.

Is daycare tonsillectomy a safe outpatient surgery at Pokhara ENT Center, Nepal

Introduction: Tonsillectomy is one of the most common surgical procedure in the world performed by Ear, Nose and Throat surgeon. Over the past decade, there has been progress in surgical techniques for tonsillectomy, yet pain and bleeding after tonsillectomy remain important surgical complications. With the increasing need to reduce healthcare costs in developing countries, there is currently a trend towards performing tonsillectomy on a daycare basis and this study aims at evaluating how efficacious it may be in our setting. Methods: A retrospective review of all the daycare tonsillectomy surgeries performed at the Pokhara ENT Center, Pokhara, Nepal from February 2018 to January 2019. Patients aged 15 years and up of either sex who met the paradise criteria were included while patients who met the same but had a contraindication for tonsillectomy surgery were excluded. Demographic information as well as complications within six hours of surgery before discharge and on follow-up on the seventh post-operative day were evaluated, as were any emergency room visits in the first 24 hours and any complications requiring a visit to a healthcare facility. Results: On day of surgery 17% had worst pain and on seventh post-operative day 75% had no pain, only 2% presented with primary hemorrhage and 3% presented with secondary hemorrhage. None of them required revision surgery. Conclusions: Daycare tonsillectomy is being done in only some of the centers owing to the risk of postoperative complications in our country. In our study, the number of complications was lower and not life-threatening. It can be considered a safe and cost-effective method, though patient selection is crucial.

Single coronary ostium with obstructive hypertrophic cardiomyopathy treated using the Morrow procedure: a case report

BackgroundHypertrophic cardiomyopathy is a commonly inherited heart disease. In addition, single coronary artery (SCA) is a rarecongenital anomaly of the coronary arteries. And SCA concomitant with severehypertrophic obstructive cardiomyopathy (HOCM) has seldombeen reported in the literature. However, such caseshave not been reported to be treated with the Morrow procedure.Case presentationHerein, we presented a case of a 64-year-old female diagnosed with a single left coronary artery with severe HOCM. The HOCM was treated with the Morrow procedure. The patient was discharged on the seventh postoperative day and was asymptomatic during the follow-up.ConclusionTo our knowledge, this is the first study reporting a single left coronary artery with severe HOCM treated with the Morrow procedure. In addition, myocardial protection by cardioplegia antegrade perfusion was safe for the patient with SCA and HOCM.