scholarly journals 927 Epistaxis Management in COVID-19

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
B Chandrasekar ◽  
B Oremule ◽  
J de Carpentier
Keyword(s):  
Close Contact ◽  
Admission Rate ◽  
Endoscopic Examination ◽  
Traditional Management ◽  
Patient Admissions ◽  
Pdsa Cycle ◽  
Patient Stay ◽  
Hospital Visits ◽  
Group 2 ◽  
Group 1

Abstract Aim Traditional management of epistaxis include endoscopic examination of the nasal cavity and/or cautery requiring close contact between doctor and patient. We aimed to reduce the length of in-patient stay for patients with epistaxis whilst maintaining patient safety during the COVID-19 pandemic. Method A retrospective and prospective audit was performed to assess the management of patients and their outcomes prior to and after new COVID-19 epistaxis guidelines were introduced in our unit. A PDSA cycle was undertaken. Results 27 patients presented to our ENT department in each 3-month audit cycle. 20 patients in each group were packed. More patients were packed bilaterally in group 2. The admission rate reduced from 100% to 25%. Packing duration increased from 1.8 (in group 1) to 3 days in group 2. 1 patient in each group required surgical management. The 30-day re-bleed rate increased from 11% to 30% All re-bleeds in group 1 were admitted. Only 1 patient (3.7%) with a re-bleed in group 2 required admission. The mortality rate was unchanged. The length of time during the initial visit decreased. Hospital visits per patient (for removal of pack, pain, and re-bleeding) increased from 1.1 in group 1 to 2.7 in group 2. Conclusions Our COVID-19 epistaxis guidelines reduced close contact, in-patient admissions, and length of stay. However, there is an increase number of visits per patient and increase re-bleed rate (suggesting that cautery plays an important role). The next cycle plans to introduce a patient leaflet and a virtual clinic.

Microvascular Transplantation of Tracheal Allografts in the Canine Model

2003 ◽  
Vol 112 (4) ◽  
pp. 307-313 ◽  
Author(s):  
Eric M. Genden ◽  
Patrick J. Gannon ◽  
Maria Deftereos ◽  
Shane Smith ◽  
Mark L. Urken
Keyword(s):  
Ex Vivo ◽  
Failure To Thrive ◽  
Canine Model ◽  
Endoscopic Examination ◽  
Survival Times ◽  
Group 3 ◽  
Group 5 ◽  
Group 2 ◽  
Clinical Dilemma ◽  
Group 1

The inability to reconstruct extensive and often life-threatening tracheal defects is a clinical dilemma. The objective of this study was to achieve microvascular revascularization and transplantation of long-segment circumferential tracheal allografts in a canine model. Fifteen mongrel dogs were randomly assigned to 5 treatment groups. Twelve dogs underwent an excision of an 8-cm tracheal segment followed by transplantation and microvascular revascularization of an 8-cm cervical trachea allograft. Group 1 (n = 4) was treated with 10 mg/kg per day of cyclosporin A (CsA) and 7.5 mg/kg per day of mycophenolate mofetil (MM). Group 2 (n = 4) was treated with 5 mg/kg per day of CsA and 7.5 mg/kg per day of MM. Group 3 (n = 4) was treated with 2.5 mg/kg per day of CsA and 7.5 mg/kg per day of MM. Group 4 (n = 2) underwent an autograft tracheal transplant and received postoperative 2.5 mg/kg per day of CsA and 7.5 mg/kg per day of MM. Group 5 (n = 1) did not undergo surgery, but received postoperative 2.5 mg/kg per day of CsA and 7.5 mg/kg per day of MM. The animals were maintained for a duration of 30 days, during which time the graft was assessed by routine endoscopic examination and tracheal biopsies. Ex vivo, tracheal autografts were examined grossly for graft healing and microscopically for histologic architecture. The mean survival times were 13.25 days (group 1), 16 days (group 2), and 20 days (group 3). There was 1 early allograft failure secondary to microvascular thrombosis, and there were 4 delayed failures secondary to postoperative wound infections. Five dogs were euthanized before the end of the 30-day observation period because of failure to thrive or hypocalcemic tetany. None of the dogs in the study demonstrated endoscopic or histologic evidence of rejection before euthanasia. Postmortem examination of the surviving dogs demonstrated normal histologic architecture without evidence of rejection. For the first time, we have achieved allotransplantation of long tracheal segments based on the cranial thyroid artery and internal jugular vein. Minimal systemic immunosuppression appears to be associated with a higher survival rate and a lower complication rate.

Restructuring emergency eye services during COVID-19 in a tertiary referral centre

2020 ◽  
Vol 81 (12) ◽  
pp. 1-8
Author(s):  
George Moussa ◽  
Fizza Mushtaq ◽  
Priyanka Mandal ◽  
Namita Mathews ◽  
Ben Royal ◽  
...  
Keyword(s):  
Digital Imaging ◽  
Healthcare Providers ◽  
Tertiary Referral Centre ◽  
Telephone Consultation ◽  
Face To Face ◽  
Discharge Rates ◽  
Audit Cycle ◽  
Hospital Visits ◽  
Group 2 ◽  
Group 1

Background/aims Maintaining emergency eye services is crucial during the COVID-19 pandemic. This article describes the introduction of a new restructured referral pathway to reduce the burden on healthcare providers and create a safe environment. Methods During January and February 2020 (group 1), all appointments were face-to-face with a walk-in eye casualty. The first audit cycle comprised all patients in group 1. The primary audit criteria were discharge rates, referral to subspeciality and reattendance. In April 2020, a remodelled system was implemented in which walk-in attendance ceased and was replaced with telephone triage coupled with digital imaging via NHS email for remote clinical review. Patients requiring further assessment following this triage were invited in for face-to-face appointments. A reaudit was conducted during April–July 2020 (group 2) following implementation of these COVID-19 protocol changes. Results In group 1, 2868 appointments (100.0%) were face-to-face and in group 2 4870 (100.0%) appointments were telephone consults that resulted in 2639 (54.2%) face-to-face appointments. The rate of discharge in the first cycle and second cycle were 55.3% and 76.9% respectively (P<0.0001). Furthermore 2298 (47.2%) patients were able to be discharged following telephone consultation in group 2. Conclusions Using this telephone and digital imaging review triage system, the authors have demonstrated a significant reduction in the need for face-to-face reviews. The reduction in avoidable patient face-to-face reviews allows the system to move from saturated to sustainable while increasing accessibility to services for patients who may not be able to present for face-to-face review. This complete audit cycle successfully charts interventions that maximise accessibility, reduce unnecessary hospital visits and deliver safe and prompt management during the pandemic.

scholarly journals TREATMENT OF PATIENTS WITH THE CYCLE OF THE SUPERMONTAL ARM OF THE ONTOGENIC GENESIS

2019 ◽  
pp. 18-24
Author(s):  
Mohammed Rezmak ◽  
Liliya Krynychko ◽  
Alexander Naumenko
Keyword(s):  
Maxillary Sinus ◽  
Pathological Process ◽  
Endoscopic Examination ◽  
Nasal Passage ◽  
Filling Material ◽  
Oroantral Fistula ◽  
Sinus Wall ◽  
Subsequent Revision ◽  
Group 2 ◽  
Group 1

The maxillary sinus cysts are a fairly common pathology of the paranasal sinus system, which has a multifactorial etiology that continues to be actively investigated. In recent years, particular attention of researchers has focused on the role of chronic inflammation of the root of the teeth, which are directly adjacent to the lower wall of the maxillary sinus, and accordingly involve the surrounding structures in the pathological process. One of the objective indicators of the severity of inflammation is the level of matrix metalloproteinases, in particular matrix metalloproteinase 9 (MMP-9). Аs follows, the purpose of the study is to study of efficiency of treatment of patients with cystic sinus cysts of odontogenic origin in the long term. Materials and methods. The study included 150 patients. Group 1 - 125 people (age 20-69 years, men - 58, women - 67), group 2 - 25 patients (age 21-59 years, 11 men and 14 women). All patients from the examined groups underwent surgical treatment - removal of the cyst of the maxillary sinus through the lower nasal passage, with subsequent conservative treatment; patients of the first group in the postoperative period were audited channels of the teeth of the upper jaw with replacement of the filling material, and patients of the second group this intervention was not carried out. The inclusion criterion is an increase in the level of ММП-9 in saliva. The exclusion criteria were the presence of acute disease 3 months before surgery, treatment with the dentist 3 months before surgery, normal level of MMP-9 in saliva. In the course of preoperative preparation, all patients underwent CT scan of the paranasal sinuses, endoscopic examination of the nasal cavity and nasopharynx, rhinopneumometry, determination of the index of mucociliary clearance, activity of MMP-9 in saliva. The study of MMP-9 activity in saliva was performed using ELISA kit. Statistical data processing was performed using IBM SPSS Statistics 22. Conclusion. The level of ММР-9 in the saliva of patients of the first group was 1347 (± 328) ng / ml, the second - 1410 (± 220) ng / ml. The number of recurrences of sinus cyst in group 1 was 8, accounting for 6.4% of the total. Other complications include sinus mycetoma - 4 oroantral fistula - 1, hoonal polyp - 2.. The number of relapses of the sinus cyst in group 2 was 9 cases (36%), mycetoma of the sinus cyst - 3 cases, oroantral fistula - 1, hoonal polyp - 1. Conclusion. The results obtained indicate a higher likelihood of recurrence of the maxillary sinus cyst in the absence of a subsequent revision of the root of the teeth and around the root areas immediately adjacent to the lower sinus wall.

scholarly journals Effects of Change in 6-Minute Walking Distance on Hospital Readmissions and Emergency Department Visits in Patients with Pulmonary Arterial Hypertension

2021 ◽  
Author(s):  
Yong-Gon Seo ◽  
SuKi Oh ◽  
MiJa Jang ◽  
Ho-Young Kim ◽  
Sung-A Chang ◽  
...  
Keyword(s):  
Hospital Readmission ◽  
Hospital Readmissions ◽  
Walking Distance ◽  
Change Rate ◽  
Significant Difference ◽  
Pulmonary Arterial ◽  
Ed Visits ◽  
Hospital Visits ◽  
Group 2 ◽  
Group 1

Abstract Pulmonary arterial hypertension (PAH) is a rare disease and its prognostic factor includes reduction of 6-min walking distance (6MWD). Thus, the study aimed to confirm the correlation between different change rate of 6MWD and hospital readmission and emergency department (ED) visits in patients with PAH. 139 patients were divided into three groups according to change rate of 6MWD; group 1 (≥15%, n = 54), group 2 (15%<change≥0%, n = 47)), group 3 (<0%, n = 38). The hospital readmission, ED visits, and hospital visits were compared between the three groups. A significant difference in hospital readmission was observed between the groups (P = 0.0113), with group 1 showing higher frequency of hospital readmissions than group 2 (P = 0.0261). A significant difference in the hospital visits was observed between the three groups (P = 0.0024). A positive correlation was observed between hospital readmission (r = 0.21861, P = 0.0097) and hospital visit (r = 0.35877, P < 0.0001). A weak negative correlation was observed between the ED visit and change rate in 6MWD (r = −0.25299, P = 0.0027).This study showed that the positive change rate in 6MWD may relate to the reduction in the ED visits in patients with PAH.

scholarly journals 749 Unexpected benefits of pandemic guidelines for the management of epistaxis

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
J A Empey ◽  
E Gogo ◽  
A Zuccarelli ◽  
C Diver
Keyword(s):  
Patient Safety ◽  
Royal Victoria Hospital ◽  
Treatment Cost ◽  
Admission Rate ◽  
Key Factors ◽  
Rigid Endoscopy ◽  
Patient Admissions ◽  
Patient Stay ◽  
Invasive Intervention

Abstract Aim The Royal Victoria Hospital adopted ENT UK’s pandemic guidelines for the management of epistaxis. We aimed to reduce ENT referrals, in-patient admissions and staff exposure to COVID-19 whilst maintaining patient safety. This involved collaboration with ED to promote the use of absorbable packs and pharmacological alternatives over rhinoscopy & rigid endoscopy with cautery +/- non-absorbable packs. Method Data was collected on patients presenting with epistaxis over a six-week period beginning March 2020 and the same period in 2019. Key factors recorded were number of presentations, ENT referrals, admissions, and their durations, along with management and outcomes. ENT provided training to ED staff and produced video resources for the "My ED" app. Feedback from ED and patient data was gathered to improve training and assess effectiveness. Results Pre-pandemic, 48% of ED epistaxis presentations were referred to ENT vs. 28% following the guidelines introduction. In 2019 49% of referrals were admitted vs. 42% in 2020. The average in-patient stay was reduced from four nights to one. Re-admission rate remained similar from 22% in 2019 to 20% in 2020. These results were achieved following repeated improvements to the training sessions. Conclusions The ENT UK guidelines, when supplemented with ED collaboration, are effective at reducing ENT referrals and admissions. In addition to reducing COVID-19 exposure, the guidelines offered an improved patient experience (less invasive intervention, reduced/removed in-patient stay) with no loss of efficacy. This, combined with a reduced treatment cost of ∼£2,000 per in-patient, suggests the guidelines have long-term value out-with a pandemic setting.

scholarly journals Prevention of scarring of a dacryorhinostomy

2020 ◽  
Vol 19 (3) ◽  
pp. 37-40
Author(s):  
L. V. Fileva ◽  
Keyword(s):  
New Technologies ◽  
Vertical Section ◽  
Endoscopic Examination ◽  
Lacrimal Duct ◽  
Endoscopic Endonasal ◽  
Prophylactic Measures ◽  
Vertical Division ◽  
Group 2 ◽  
Conservative And Surgical Treatment ◽  
Group 1

Pathology of the vertical section of the lacrimal duct continues to attract the interest of otorhinolaryngologists and ophthalmologists. With the development of new technologies, an active search began for effective and safe methods of conservative and surgical treatment of the disease of the lacrimal organs. Measures aimed at preventing scarring: various drains, differing in shape, material, method of conduction, and duration of stay in the lacrimal ducts, medical methods can not only contribute to recovery, but also extend the time and negatively affect the outcome of treatment. The problem of scarring formed dacryorrhinostomy remains unresolved to this point. The article presents the results of the examination of patients with pathology of the vertical division of the lacrimal duct after video endoscopic endonasal dacryocystorhinostomy performed in the ENT department of the Clinics of Samara State Medical University. In all patients, the stoma of 0,7–0,8 сm is formed endonasally. The data of the video endoscopic examination of the nasal cavity and lacrimal ducts after the use of stents and the preparation Antiadgesin were analyzed. Patients are divided into 2 groups. Group 1 – 17 people who, after the formation of dacryorhinostomy, used bicanalicular silicone stents that were in the lumen of the lacrimal duct for 2 to 4 weeks, group 2 – 12 people who after the formation of the dacryorrhinostomy injected the drug „Antiadhesin“ into the lacrimal duct through the upper and lower tear points with blunt cannula in the amount of 1 ml. The effectiveness of prophylactic measures aimed at eliminating stenosis of the dacryorhinostomy was evaluated. Data on the greater efficiency of surgical intervention in patients in group 2 with the use of the drug Antiadgesin compared with group 1 using stents.

In-vivo evaluation of the effect of cyanoacrylate on prosthetic vascular graft infection – does cyanoacrylate increase the severity of infection?

VASA ◽  
2020 ◽  
Vol 49 (4) ◽  
pp. 281-284
Author(s):  
Atıf Yolgosteren ◽  
Gencehan Kumtepe ◽  
Melda Payaslioglu ◽  
Cuneyt Ozakin
Keyword(s):  
Vascular Graft ◽  
Graft Infection ◽  
Vascular Graft Infection ◽  
Group 4 ◽  
Significant Difference ◽  
Group 3 ◽  
Group 2 ◽  
Prosthetic Vascular Graft Infection ◽  
Group 1

Summary. Background: Prosthetic vascular graft infection (PVGI) is a complication with high mortality. Cyanoacrylate (CA) is an adhesive which has been used in a number of surgical procedures. In this in-vivo study, we aimed to evaluate the relationship between PVGI and CA. Materials and methods: Thirty-two rats were equally divided into four groups. Pouch was formed on back of rats until deep fascia. In group 1, vascular graft with polyethyleneterephthalate (PET) was placed into pouch. In group 2, MRSA strain with a density of 1 ml 0.5 MacFarland was injected into pouch. In group 3, 1 cm 2 vascular graft with PET piece was placed into pouch and MRSA strain with a density of 1 ml 0.5 MacFarland was injected. In group 4, 1 cm 2 vascular graft with PET piece impregnated with N-butyl cyanoacrylate-based adhesive was placed and MRSA strain with a density of 1 ml 0.5 MacFarland was injected. All rats were scarified in 96th hour, culture samples were taken where intervention was performed and were evaluated microbiologically. Bacteria reproducing in each group were numerically evaluated based on colony-forming unit (CFU/ml) and compared by taking their average. Results: MRSA reproduction of 0 CFU/ml in group 1, of 1410 CFU/ml in group 2, of 180 200 CFU/ml in group 3 and of 625 300 CFU/ml in group 4 was present. A statistically significant difference was present between group 1 and group 4 (p < 0.01), between group 2 and group 4 (p < 0.01), between group 3 and group 4 (p < 0.05). In terms of reproduction, no statistically significant difference was found in group 1, group 2, group 3 in themselves. Conclusions: We observed that the rate of infection increased in the cyanoacyrylate group where cyanoacrylate was used. We think that surgeon should be more careful in using CA in vascular surgery.

The influence of continuous local wound infusion on postoperative pain in patients undergoing transfemoral amputation

VASA ◽  
2015 ◽  
Vol 44 (5) ◽  
pp. 381-386 ◽  
Author(s):  
Christian Uhl ◽  
Thomas Betz ◽  
Andrea Rupp ◽  
Markus Steinbauer ◽  
Ingolf Töpel
Keyword(s):  
Pain Management ◽  
Pilot Study ◽  
Local Anaesthetic ◽  
Phantom Pain ◽  
Transfemoral Amputation ◽  
Postoperative Wound ◽  
Stump Pain ◽  
Management Protocol ◽  
Group 2 ◽  
Group 1

Abstract. Summary: Background: This pilot study was set up to examine the effects of a continuous postoperative wound infusion system with a local anaesthetic on perioperative pain and the consumption of analgesics. Patients and methods: We included 42 patients in this prospective observational pilot study. Patients were divided into two groups. One group was treated in accordance with the WHO standard pain management protocol and in addition to that received a continuous local wound infusion treatment (Group 1). Group 2 was treated with analgesics in accordance with the WHO standard pain management protocol, exclusively. Results: The study demonstrated a significantly reduced postoperative VAS score for stump pain in Group 1 for the first 5 days. Furthermore, the intake of opiates was significantly reduced in Group 1 (day 1, Group 1: 42.1 vs. Group 2: 73.5, p = 0.010; day 2, Group 1: 27.7 vs. Group 2: 52.5, p = 0.012; day 3, Group 1: 23.9 vs. Group 2: 53.5, p = 0.002; day 4, Group 1: 15.7 vs. Group 2: 48.3, p = 0.003; day 5, Group 1 13.3 vs. Group 2: 49.9, p = 0.001). There were no significant differences between the two groups, neither in phantom pain intensity at discharge nor postoperative complications and death. Conclusions: Continuous postoperative wound infusion with a local anaesthetic in combination with a standard pain management protocol can reduce both stump pain and opiate intake in patients who have undergone transfemoral amputation. Phantom pain was not significantly affected.

Abnormal Haemostasis and Blood Viscosity in Malignant Hypertension

1984 ◽  
Vol 52 (03) ◽  
pp. 253-255 ◽  
Author(s):  
C Isles ◽  
G D O Lowe ◽  
B M Rankin ◽  
C D Forbes ◽  
N Lucie ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Viscosity ◽  
Renal Damage ◽  
Antithrombin Iii ◽  
Plasma Viscosity ◽  
Malignant Hypertension ◽  
Fibrin Deposition ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

SummaryWe have previously shown abnormalities of haemostasis suggestive of intravascular coagulation in patients with malignant hypertension, a condition associated with retinopathy and renal fibrin deposition. To determine whether such abnormalities are specific to malignant hypertension, we have measured several haemostatic and haemorheological variables in 18 patients with malignant hypertension (Group 1), 18 matched healthy controls (Group 2), and 18 patients with non-malignant hypertension (Group 3) matched for renal pathology, blood pressure and serum creatinine with Group 1. Both Groups 1 and 3 had increased mean levels of fibrinogen, factor VIIIc, beta-thrombo- globulin, plasma viscosity and blood viscosity (corrected for haematocrit); and decreased mean levels of haematocrit, antithrombin III and platelet count. Mean levels of fast antiplasmin and alpha2-macroglobulin were elevated in Group 1 but not in Group 3. We conclude that most blood abnormalities are not specific to malignant hypertension; are also present in patients with non-malignant hypertension who have similar levels of blood pressure and renal damage; and might result from renal damage as well as promoting further renal damage by enhancing fibrin deposition. However increased levels of fibrinolytic inhibitors in malignant hypertension merit further investigation in relation to removal of renal fibrin.

Total Knee Arthroplasty after Previous Ipsilateral Hip Arthroplasty Showed Lower Clinical Outcomes and Higher Leg Length Discrepancy Perception

2020 ◽  
Author(s):  
Han-Jun Lee ◽  
Seong Hwan Kim ◽  
Nicolas Pujol ◽  
Yong-Beom Park
Keyword(s):  
Clinical Outcomes ◽  
Hip Arthroplasty ◽  
Leg Length ◽  
Function Score ◽  
Patient’S Satisfaction ◽  
Length Discrepancy ◽  
Total Knee ◽  
Group 2 ◽  
Ks Function ◽  
Group 1

AbstractThe purpose of this study is to compare perception of leg length discrepancy (LLD) and clinical results of total knee arthroplasties (TKA) in patients with or without previous ipsilateral hip arthroplasty. Between 2008 and 2015, navigation-assisted TKA was performed in 43 patients with previous hip arthroplasty after hip fracture. After 1:3 propensity score matching was performed, 108 patients of primary navigation-assisted TKA (group 1) and 36 patients with hip arthroplasty (group 2) were included. Knee Society (KS) scores, Western Ontario and McMaster Universities Index (WOMAC) scores, and patients' satisfaction including perception of LLD were evaluated. Radiographic evaluation included mechanical axis, component position, and LLD. Logistic regression analysis was performed to find the factors that affect the clinical outcomes. No significant differences in radiologic and clinical evaluations, except for KS function score, patient's satisfaction and LLD (p< 0.001), were detected between the groups. LLD and its perception were significantly higher in group 2 (1.8 ± 3.4 mm in group 1 and 9.7 ± 4.1 mm in group 2, p = 0.000). Risk factors for the low KS function score were found as LLD (odds ratio [OR]: 1.403, p = 0.008) and previous hip arthroplasty itself (OR: 15.755, p = 0.002), but much higher OR was found in previous hip arthroplasty. Although the outcomes of TKA in patients with ipsilateral hip arthroplasty are comparable to those of primary TKA, LLD was high and patient's satisfaction and functional outcomes were low in patients with previous ipsilateral hip arthroplasty. Care should be taken when considering TKA in patients with previous hip arthroplasty. This is a Level III, case control study.

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