The Use of Color Duplex Ultrasound for Local Perforator Flaps in the Extremity

Background The local flaps, especially perforator and keystone flaps, are used as first-line treatment option in reconstruction of small tomoderate-sized defect of the extremity. However, the high complication rate associated with these flaps may hinder this usage. Methods This article reviews the technical and clinical aspect of using color duplex ultrasound )CDU) in the preoperative, intraoperative, and postoperative period for propeller and keystone flaps. Results CDU allows the surgeon to understand the anatomical aspect of the perforator such as the location, point of penetration on the deep fascia, subcutaneous pathway )axiality) and physiological aspect such as velocity and flow volume. Understanding and utilizing this information will allow accurate preoperative design, intraoperative decision making, and postoperative monitoring, leading to better outcome. Conclusion Carefully designed local perforator flaps based on anatomy and physiology using CDU will be a powerful armamentarium for reconstruction of the lower extremity.

Das frühe Diabetische Makulaödem: Ein Indikator für schlechte postoperative Ergebnisse nach Katarakt Chirurgie bei Diabetikern. Die DICAT-II-Studie

<b>Background:</b> The prospective DIabetes and CATaract Study II (DICAT II) was performed to characterise the risks of cataract surgery to the retinae of patients with early diabetic macular oedema (E-DMO). <b>Methods:</b> DICAT II was a prospective, comparative, multicentre, observational study involving six Italian clinics. Patients were aged ≥55 years, had type 1 or 2 diabetes with spectral-domain optical coherence tomography evidence of ESASO classification Early DMO. Group 1 eyes (78 eyes, 78 patients) underwent phacoemulsification-based cataract surgery. Group 2 eyes (65 eyes, 65 patients) had E-DMO and either clear media or had undergone uncomplicated cataract surgery ≥1 year previously. Central subfield thickness (CST) and best-corrected visual acuity (BCVA) were assessed in both groups. <b>Results:</b> The negative impact of surgery on CST was evident after the first postoperative week; CST peaked during the first month, then rapidly decreased. CST worsening ≥10 µm was observed in 63/78 eyes (80.7%) and 29/65 eyes (44.6%) in Groups 1 and 2, respectively (<i>p</i> &#x3c; 0.0001). CST worsening of ≥50 µm was observed in 51 eyes (65.4%) and 10 eyes (15.4%) in Groups 1 and 2, respectively (<i>p</i> &#x3c; 0.0001). Mean CST worsening was lower in Group 2 than in Group 1 (38.6 ± 30.4 µm vs 85.5 ± 55.3 µm, <i>p</i> &#x3c; 0.0001) with a lower BCVA loss (−2.6 ± 3.5 letters vs −8.2 ± 6.2 letters, <i>p</i> &#x3c; 0.0001). Higher glycaemic levels and HBA1c levels were significantly associated with the risk of &#x3e;50 μm CST worsening in eyes from both groups. <b>Conclusion:</b> Early DMO is associated with poorer outcomes after cataract surgery and requires close pre- and postoperative monitoring.

Study of incidence of hypocalcaemia in patients undergoing total thyroidectomy for papillary carcinoma: a retrospective study

Background: Hypocalcaemia following total thyroidectomy is a fairly common complication. Occurrence of acute hypocalcaemia can be predicted in patients undergoing thyroid surgery for malignancy, based on serial calcium measurement and this helps in early prediction of hypocalcaemia. The aim of the study was to assess the incidence of post thyroidectomy hypocalcaemia and methods to treat hypocalcaemia and prevention of its complication at the earliest.Methods: The incidence of hypocalcemia was analysed with serial calcium estimation in immediate post-operative period, 4 hours and 24 hours after surgery and on 5th post-operative day. The factors analysed included pre-operative and post-operative serum calcium levels, clinical features, the disease type and factors related to surgery and histopathologically diagnosis as malignant papillary thyroid carcinoma is confirmed.Results: In this study 30 patients underwent total thyroidectomy for papillary carcinoma were studied. Incidence of 22% of hypocalcemia, with transient hypocalcemia in 20% and permanent hypocalcemia in 2% of cases were noted. Conclusions: Patients underwent thyroid surgery for malignant conditions showed higher incidence and severity hypocalcaemia. This complication can be prevented with meticulous peroperative dissection, prompt identification of parathyroid gland. Avoiding injury or spasm of the blood vessels supplying them and frequent postoperative monitoring of serum calcium levels.

Clinical accuracy of non-contact forehead infrared thermometer and infrared tympanic thermometer in postoperative adult patients: A comparative study.

Core temperature monitoring is important for the assessment and prevention of possible postoperative complications. The aim of the present study was to examine the agreement between the core temperature values and the forehead, tympanic membrane and axillary values in postoperative adult patients in clinical practice. The study measured the core temperature of 65 patients undergoing scheduled abdominal surgery using SpotOn™ and compared these with those obtained using non-contact forehead infrared, infrared tympanic and axillary thermometers. Correlation and Bland–Altman analyses were conducted for these comparisons. All temperatures were recorded at 4h intervals after postoperative arrival to the ward. Forehead temperature recordings showed a good correlation with the core temperature with excellent accuracy and was comparable to the tympanic temperature. Both forehead and tympanic thermometers can rapidly and effectively measure the core temperature during early postoperative period. Considering patients’ safety, non-contact forehead infrared thermometers may be useful for postoperative monitoring.

Development of an algorithm for selecting the required frequency of injected current for multi-frequency electrical impedance tomography for tasksrelated to preoperative monitoring of human lung function

This paper proposes an algorithm for selecting the required frequency of injected current for problems of personalized multi-frequency electricalimpedance tomography. The essence of the algorithm is to calculate the rate of change in the recorded difference of potentials for the assigned range of frequencies of injected current, followed by determining the frequency after which the rate of a change in potentials is minimal. Subsequently, the injection parameters are readjusted to the chosen frequency and the complete process of electricalimpedance tomography is started. The proposed solutions were studied on four subjects with different fat mass, defined by bioimpedance analysis. Thus, it seems possible to track the dynamics of a change in the lungs of a certain patient by visualizing the reconstructed conductivity field, taking into consideration its internal features. It was established that in the course of studying lungsby using the method of electricalimpedance tomography, it is necessary to take into account the frequency of injected current at an increase in percentage of fat mass. The results of the studies showing a change in the quality of imaging the breathing process at different frequencies of injected current (from 50 kHz to 400 kHz, with a pitch of 50 kHz) are presented. For the test participants with a fat weight of 7.6 kg, 23.3 kg, 15.2 kg and 37.3 kg, the injection frequency was determined as 150 kHz, 200 kHz, 200 kHz, and 350 kHz, respectively. The proposed algorithm enables visual monitoring of lung function and can be used in the problems of pre- and postoperative monitoring of respiratory function of patients. Its use is particularly relevant for patients connected to an apparatus of artificial lung ventilation.