Same day/next day discharge of burn patients treated with skin grafts

In the past, many patients were admitted for a minimum of 72 h for split-thickness skin grafting (STSG). Several factors have caused us to discharge burn patients on the same day or within 24 h following STSG. We have reviewed outcomes of such patients to determine whether early discharge has an adverse effect on graft outcome and to determine patient acceptance of this new procedure. We retrospectively reviewed charts of patients consecutively treated at our hospital. Two hundred patients were identified. All patients were found to have successful grafts. From our results, we can conclude that patient discharge in less than 24 h following STSG does not predispose patients to poor graft take or other adverse outcomes.

Laparoscopic management of complications following laparoscopic Roux-en-Y gastric bypass for morbid obesity

BACKGROUND

We reviewed our experience with complications following laparoscopic Roux-en-Y gastric bypass (LRYGB) that were managed laparoscopically.

METHODS

A total of 246 consecutive morbidly obese patients (mean body mass index, 50.9 kg/m2) underwent LRYGB by three surgeons at two institutions. All patients met National Institutes of Health criteria for surgical treatment of morbid obesity. Patients were followed prospectively.

RESULTS

A total of 62 patients (25.2%) developed 64 complications, 34 of which (13.8%) required a surgical intervention. Twenty-seven of the 34 procedures were performed laparoscopically. Gastrojejunostomy stricture was the most common complication (8.9%), followed by intestinal obstruction (7.3%) and gastrointestinal bleeding (4%). The intestinal obstruction was secondary to adhesions (n = 6), internal hernia at the level of the transverse mesocolon (n = 3), jejunojejunostomy stricture (n = 3), and cicatrix around the Roux limb at the level of the transverse mesocolon (n = 3). Other complications included gastrojejunostomy leak (1.6%), symptomatic gallstone disease (2.8%), and gastric remnant perforation (0.8%). One patient underwent a negative laparoscopy to rule out anastomotic leak. There were 3 deaths in this series of patients, 2 attributable to anastomotic leak.

CONCLUSIONS

A variety of complications can present after LRYGB. Laparoscopy is an excellent technique to treat these complications.

Laparoscopic revision of failed open bariatric procedures

BACKGROUND

Roux-en-Y gastric bypass (RYGB) is considered the surgical procedure of choice for morbid obesity. Patients who fail to meet weight loss goals after restrictive or malabsorptive surgery can be offered revision. We present five cases in which prior open bariatric procedures were revised laparoscopically.

PATIENTS

Five patients presented for laparoscopic revision having regained weight after initial success with prior bariatric surgery.

RESULTS

Preoperative body mass index averaged 46 kg/m2. Average operative time was significantly longer (344 min) than we had experienced with 56 primary RYGB during the same 4-month period (206 min). In one patient, a stricture had developed at the gastrojejunostomy requiring endoscopic dilation. There were no other complications and no deaths. All the patients had lost weight at the 6-month follow-up assessment.

CONCLUSIONS

Laparoscopic revision of failed open bariatric procedures, although requiring longer operative times than primary RYGB, can be performed safely in the hands of an experienced minimally invasive surgeon.

Effect of diagnosis and treatment of sinusitis in critically ill burn victims

The purpose of this study was to assess the incidence of diagnosed sinusitis and the effect of diagnosis and treatment on the outcome in critically ill burn victims. Chart analysis of 84 consecutive burn victims requiring mechanical ventilation for greater than 7 days was performed. Sinusitis was diagnosed in 13/84 patients (15%). There was no difference in age or total body surface area burned, or the incidence of inhalation injury, ARDS, pneumonia and sepsis (P>0.05). Co-morbid disease was similar in both the groups. The number of ventilator-dependent days and hospital length of stay were higher in the sinusitis group (P<0.05). The hospital mortality in those diagnosed and treated for sinusitis was 23% (3/13) as opposed to 48% (34/71) in those not diagnosed with sinusitis (P<0.05). Increased number of ventilator-dependent days and longer hospital stay are associated with the diagnosis of sinusitis. Our findings suggest an improved survival in those diagnosed and treated for sinusitis.

Effect of luting media on the compressive strengths of two types of all-ceramic crown

This study evaluated the effect of selected luting media on the compressive strength of two types of all-ceramic crown. Tooth preparation was standardized; each preparation had a shoulder width of approximately 1.2 mm, and all internal preparation angles were rounded. Hi-Ceram and Dicor all-ceramic crowns were fabricated and cemented into the preparations with zinc phosphate, glass-ionomer, or composite resin cement. Coronal compressive fracture strengths were determined, using a set of unrestored teeth as a control. There were no statistically significant differences among the mean compressive strengths of the three luting media, and there was no statistically significant difference between the mean compressive strength of Dicor and that of the natural tooth control.

Wettability of elastomeric impression materials: effect of selected surfactants

This study evaluated seven classes of 65 impression materials for the effect of selected surfactants on contact angle values for high-strength stone. Uniform surfaces of the materials were treated with a surfactant, and stone samples were poured on each impression material surface. The samples were sectioned and photographed for measurement of the advancing contact angles. Statistical analysis supported four conclusions: No significant difference was found between the two surfactants. Both surfactants were significantly better than the control (water). Polyether impression materials were superior in wettability to the other elastomeric impression materials tested. With respect to contact angle, two distinct groups of impression materials emerged. Reversible hydrocolloid (47.7 +/- 1.5), irreversible hydrocolloid (36.8 +/- 8.8), and polyether (45.8 +/- 7.6) formed a hydrophilic group. A hydrophobic group consisted of the polysulfide (62.6 +/- 10.1), poly(vinyl siloxane) (71.1 +/- 12.3), condensation-reaction silicone (74.1 +/- 11.0), and polyethene (75.9 +/- 14.6) materials.

Noninvasive blood flow measurement in expanded polytetrafluoroethylene grafts for hemodialysis access

Volume flow rates were measured in 31 expanded polytetrafluoroethylene grafts (6 mm) of 26 patients undergoing hemodialysis. Flow was calculated from the known access graft diameter and by measurement of the mean Doppler shift frequency waveform. Overall flow rates were 750 +/- 383 ml/min (range, 0 to 1921 ml/min). There was no difference in flow between grafts anastomosed to either antecubital or upper arm veins but there was a significant difference in flow rate between straight and loop grafts (652 and 914 ml/min) and between grafts anastomosed to the radial, distal brachial, and proximal brachial arteries (648, 876, and 1169 ml/min, respectively). Flow rates measured during a preocclusive 14-day period in five grafts were significantly lower than flow rates in grafts that remained patent for at least 2 weeks following examination (307 +/- 172 vs. 849 +/- 346 ml/min). This is a safe, repeatable noninvasive measure of access graft hemodynamics, which may be useful as a functional monitor and a warning of impending failure.

Changes in plasma kininogen levels induced by cellulose sulphate during pregnancy in the rat

1 Cellulose sulphate (1 mg/kg) produced a 30-40% depletion of plasma kininogen in rats.2 The time course of repletion of kininogen in the plasma was compared in rats in the oestrous and dioestrous stages of the cycle and in 22 day pregnant animals. A partial repletion occurred, 3 h after the cellulose sulphate injection, which was followed by a secondary fall in plasma kininogen. Plasma kininogen values were back to control levels 10 h after the treatment in all groups.3 Treatment of rats from days 19-22 of pregnancy with cellulose sulphate resulted in 40% depletion of plasma kininogen and in prolongation of pre-parturition behaviour.4 It is suggested that the increase which normally occurs in plasma kininogen levels towards the end of pregnancy in the rat may play a role in the process of parturition.

Plasma kinin and kininogen levels in the female rat during the oestrous cycle, pregnancy, parturition and the puerperium

1 Plasma kininogen concentration of the female rat did not change during the oestrous cycle but increased two-fold during gestation. Plasma kininogen did not change during parturition, rose in the first puerperal day and then rapidly declined to non-pregnant levels.2 Free kinin levels in the blood of non-pregnant female rats were low and inconstant. Free kinin was undetectable in the blood of pregnant rats, but was found in four out of ten parturient rats.3 After administration of the kininase inhibitor dimercaprol (30 mg/kg i.p.), free kinin was present in the blood of six parturient rats. Dimercaprol caused appearance of free kinin in the blood of only one out of six non-pregnant rats.4 It appears that the plasma kinin system is activated to a small degree during parturition.