Comprehensive Nursing Intervention Can Reduce Postoperative Complications and Shorten Hospital Stay of Children with Cleft Lip and Palate Repair Surgery

This research aims to probe into the impact of people-oriented comprehensive nursing intervention on children with cleft lip and palate repair surgery. Totally 112 lip cleft children who underwent surgical treatment in our hospital from June 2017 to March 2019 were randomized into routine and intervention groups. Among them, 55 in the former underwent routine nursing intervention, and 57 in the latter obtained comprehensive nursing intervention additionally. The hospital stay and complications of the two groups were observed. The hospital stay and complications in the latter were less than those in the former. Comprehensive nursing intervention can reduce postoperative complications and shorten hospital stay in children with cleft lip and palate repair surgery.

Gastric Pneumatosis: An Atypical Presentation of Desmoid Tumor

Case presentation: A middle-aged woman presented to the emergency department with a chief complaint of abdominal pain, fever, vomiting, and diarrhea. Abdominal computed tomography revealed gastric pneumatosis and air in the portal system. The patient had an unfavorable clinical course with pneumoperitoneum and septic shock due to secondary peritonitis. She underwent emergency laparotomy where neoformation of the mesentery root was found with infiltration of the small intestine and jejunal perforation. The anatomopathological study of the tumor revealed that it was a desmoid tumor. Discussion: To our knowledge this is the first report in the literature of gastric pneumatosis as the initial presentation of a mesenteric desmoid tumor. Although it usually has a benign clinical course, its locally invasive characteristics can lead to critical illness. Physicians shouldn’t overlook these types of complications, as early identification and surgical intervention can modify the prognosis and shorten hospital stay.

Exposure-Based Methadone and Lorazepam Weaning Protocol Reduces Wean Length in Children

OBJECTIVE Determine if a standardized methadone and lorazepam weaning protocol that is based on dose and duration of exposure can reduce the length of opioid and benzodiazepine weaning and shorten hospital stay. METHODS Retrospective cohort study performed in a 24-bed medical/surgical PICU. A total of 177 patients on opioid and/or benzodiazepine infusions for >3 days were included; 75 patients pre protocol (June 2012– June 2013) were compared with 102 patients post implementation of a standardized weaning protocol of methadone and lorazepam (March 2014–March 2015). The recommended wean was based on duration of infusions of >3 days up to 5 days (no wean), 5 to 13 days (short wean), and ≥14 days (long wean). RESULTS Median number of days on methadone for patients on opioid infusions for 5 to 13 days was reduced from 8.5 to 5.7 days (p = 0.001; n = 45 [pre], n = 68 [post]) and for patients on opioid infusions for ≥14 days, from 29.7 to 11.5 days (p = 0.003; n = 9 [pre], n = 9 [post]) after protocol implementation. The median number of days on lorazepam for patients on benzodiazepine infusions for 5 to 13 days was reduced from 8.1 to 5.2 days (p = 0.020; n = 43 [pre], n = 55 [post]) and for patients on benzodiazepine infusions for ≥14 days, from 27.4 to 9.3 days (p = 0.011; n = 9 [pre], n = 8 [post]). There was no difference in methadone or lorazepam wean length for patients on 3 to 5 days of infusions. There was no difference in adverse events or hospital length of stay. CONCLUSIONS A methadone and lorazepam weaning protocol based on patient's exposure to opioids and benzodiazepines (dose and duration) reduces weaning length.

Hypertonic saline and adrenaline nebulization in the treatment of bronchiolitis: a retrospective study

Background: Bronchiolitis is the leading cause of acute illness and hospitalization in young children. There is limited role for diagnostic laboratory or radiographic tests in typical cases of bronchiolitis. Several large recent trials have revealed lack of efficacy of either bronchodilators or corticosteroids. Novel treatment like hypertonic saline and adrenaline nebulizations need to be evaluated for their efficacy.Methods: In this retrospective case control study, we included children aged between 6 months to 2 years admitted for bronchiolitis between August 2017 till July 2018. Each of the 45 children treated with adrenaline nebulisation was assigned a child who was given hypertonic saline nebulization only matched for age and duration of symptoms.Results: 45 children given adrenaline nebulization and 45 children given only hypertonic saline nebulization were compared. Mean duration of stay for children treated with adrenaline nebulization was 5.3 days and those given hypertonic saline was 4.8 days. p value of 0.29.Conclusions: Adrenaline nebulization did not shorten hospital stay in children admitted for bronchiolitis as compared to children given hypertonic saline.

Reconstruction of Pilonidal Sinus by Rhomboid Flap : Our Experience

Background: Pilonidal sinus is a common disease of young adult usually caused by insertion of fallen hair into skin (Gluteal cleft). Wide excision surgery is a common practice but due to high recurrence and long duration of healing there are more simple alternatives. Our experience with transposition of Rhomboid flap in the treatment of pilonidal sinus are described. The conventional way of treatment of pilonidal sinus is block excision and lay open of the sinus result in 5-14 days hospital stay healing time of 6-10 weeks. In our study all patients hospital stay was 2-3 days, healing time was less than two weeks with minimum complication. The aim of the study is to do rhomboid flap for the treatment of pilonidal sinus, so to avoid complications and recurrence, to shorten hospital stay and to give better outcome.Methods: Total 6 patients of 18-40 years of age after doing all investigations and clinical examinations, excision of pilonidal sinus was done and repaired by rhomboid transposition flap in the same setting. All the patients were followed up post operatively for 3 months to see any discharging sinus.Results: All 6 patients were discharged on 3rd post operative day and stitches were removed on 8th post operative day and approximate time to resume their work is 14 days.Conclusion: Pilonidal sinus surgery is a challenging operation for the surgeon because of recurrence and complication. Rhomboid flap technique has become familial because of its advantage of early healing, less hospital stay and very low recurrence rate.Chatt Maa Shi Hosp Med Coll J; Vol.16 (2); July 2017; Page 17-19

Surgical approach for Siewert type II adenocarcinoma of the esophagogastric junction: transthoracic or transabdominal? A retrospective analysis in a single center

Background: Adenocarcinoma of the esophagogastric junction (AEG) is a special type of challenging carcinoma between esophageal and gastric cancer with controversy in the diagnosis, treatment and prognosis. The Siewert classification is widely accepted by the majority of scholars at home and abroad, in which, type I and type III AEG are usually treated based on the guidelines for esophageal cancer and gastric cancer, respectively. However, the surgical approach topatients with type II AEG still remains controversial. In this study, we intended to realize the different surgical approach for Siewert type II AEG treatment by analyzing the data retrospectively. Methods: Patients with Siewert type II AEG were collected in Guangdong General Hospital from 2004 to 2014. We compared the clinicopathological outcome and prognosis in transthoracic(TT) and transabdominal(TA) approach. Results: A total of 158 patients with Siewert type II AEG were enrolled. Overall medium survival was 52 months and the 5-year survival rate was 39.1%. The 5-year survival rate was comparable between TT and TA group (35.1% vs 43.2%,p>0.05), while more lymph nodes were dissected in TA group (23.7±0.2 vs 18.1±0.3, p<0.05), with less postoperative complications (14.3%vs28.4%,p<0.05) and shorten hospital stay(12±4 d vs 15±7 d, p<0.05). Conclusion: For Siewert type II AEG patients, there is no significant difference in survival outcome as treated with TT or TA approach. However, fewer lymph nodes dissection number was conducted in transthoracic group, with a higher incidence of postoperative complication. Therefore, we consider that transabdominal approach is more suitable for patients with Siewert type II AEG to achieve an optimal extent of lymph node dissection, and reduce the incidence of complication, shorten hospital stay and promote the recovery. But our study is only a single-center, retrospective, small sample clinical study that represents our previous clinical treatment experience and we need more multi-center, prospective, and a large sample of clinical studies to be validated.

Randomized clinical trial of the effect of simo decoction plus acupuncture and chewing gum on postoperative ileus in patients with hepatocellular carcinoma after hepatic resection.

307 Background: Postoperative ileus (POI) is a common complication following hepatic resection that delays recovery of bowel function and increases length of hospital stay. Simo decoction (SMD) and acupuncture tsusanli acupoint are used to enhance bowel hypomotility in China. Chewing gum reducing POI is reported. The aim of study is to evaluate the effect of SMD plus acupuncture tsusanli acupoint and chewing gum alone on POI and length of hospital stay in patients with hepatocellular carcinoma (HCC) after hepatic resection. Methods: Primary HCC patients undergoing hepatic resection were randomized to SMD plus acupuncture, chewing gum, or empty control group. Interventions were started on postoperative day 1 for six consecutive days or until flatus. Primary endpoints were POI and length of hospital stay. Secondary endpoints were surgical complications. Results: Between March 2015 and August 2015, 162 patients were randomized to SMD plus acupuncture (55), chewing gum (53), or empty control (54). SMD plus acupuncture or chewing gum group have significantly shorter first peristalsis, flatus, and defaecation time than empty control group (all P< 0.05). The mean (s.d.) length of hospital stay of the three groups was 14.0 (4.9), 14.7 (6.2), and 16.5 (6.8) days. The difference between SMD plus acupuncture and empty control group was significant (P = 0.014). However, chewing gum cannot significantly shorten hospital stay than empty control (P = 0.147). Interventions groups had less grade I and II complications. Conclusions: SMD plus acupuncture or chewing gum is a safe treatment to reduce POI and shorten hospital stay. Registration number: NCT02438436 (https://clinicaltrials.gov). Clinical trial information: NCT02438436.