Thirty-Day Readmission Rate Using an Outpatient Infusion Pathway after Laparoscopic Roux-en-Y Gastric Bypass

The objective of this study was to determine whether implementing an outpatient infusion pathway (OIP) resulted in a decreased 30-day readmission rate after laparoscopic Roux-en-Y gastric bypass (LRYGB). Data were retrospectively gathered on all patients who underwent LRYGB at our institution between April 1, 2015, and March 31, 2016, after instituting an OIP (postinfusion group). Thirty-day readmission rate, length of stay, and 30-day mortality rate were compared with patients who underwent LRYGB between January 1, 2014, and December 31, 2014, before implementing the OIP (preinfusion group). Patients not able to take 40 ounces of fluid orally at discharge after surgery were enrolled in the OIP. One OIP session would include an antiemetic, 1 liter bolus of 0.9 per cent saline, and intravenous multivitamin, thiamine, and folic acid. A total of 174 patients were included for analysis. Seventy-nine patients were in the pre-infusion group and 95 patients in the postinfusion group. Of the 95 patients in the postinfusion group, 18 patients (18.9%) met inclusion criteria for the OIP. There was a 45 per cent decrease in 30-day readmission rate after the institution of the OIP for patients who underwent LRYGB, however this was not statistically significant (11.39% vs 6.31%; OR 1.907; 95% confidence interval: 0.648–5.613, P = 0.235). There was no difference in postoperative length of hospital stay (1.65 vs 1.41 days, P = 0.114) or mortality (0.7% vs 0%, P = 0.454), in the pre- and postinfusion groups, respectively. Implementation of an OIP decreased 30-day readmission rate after LRYGB by 45 per cent; however, this was not statistically significant.

Lignocaine as a topical analgesia for post-operative nasal pack removal: a prospective, randomized, double-blind, controlled trial

The objective of this study was to assess the efficacy of topical lignocaine in reducing the pain of pack removal after nasal surgery. Fifty-eight patients with Merocel nasal packs in situ after nasal surgery were randomized to receive 10 ml of either 2 per cent lignocaine or 0.9 per cent saline on the packs 10 minutes prior to their removal and thepain experienced on their removal was recorded on a visual analogue scale. The median pain score was 3.4 in the lignocaine group and 2.9 in the saline group with no statistical evidence of adifference between the two groups. There was no statistical evidence of an association between the group and the operation performed, the use of intra-operative Moffat’s solution or the use of post-operative oral analgesia. We conclude that lignocaine used in this way does not reduce the pain of pack removal after nasal surgery.

Temporalis fascia grafts shrink

Temporalis fascia, placed as an underlay graft, is commonly used to repair tympanic membrane perforations. Graft failure, however, is a well recognized complication. Grafts are often allowed to dry out during the procedure and, therefore, are often positioned in a dry or partially dehydrated state and only become fully rehydrated after placement. This study looked at how the size of the temporalis fascia alters with its state of hydration. The size of 20 temporalis fascia grafts was measured when fresh, after flattening and allowing them to dry, and finally after rehydrating the grafts with 0.9 per cent saline solution. Significant shrinkage was demonstrated. It is therefore proposed that a cause of increased failure rates, particularly in anterior myringoplasties, is loss of underlay due to graft rehydration and shrinkage. Thus graft shrinkage should be considered when positioning the graft.

Influence of water salinity on sheep performance while grazing on natural grassland and saltbush pastures

Merino sheep grazing a semi-arid natural grassland were given water containing 0.0, 1.2, 1.6 or 2.0 per cent (w/v) soluble salts and similar sheep grazing on saltbush (Atriplex vesicaria) were given water containing 0.0, 0.8, 1.2 or 1.6 per cent soluble salts. The saline water was made up from sodium chloride and magnesium sulphate to give an ionic concentration similar to that occurring in natural underground waters. On grassland, 1.2 per cent saline water was without effect on the sheep, 1.6 per cent water reduced weight and wool growth in the first year and 2.0 per cent water reduced both wool growth and body weight by a significant amount. The effects were confined to the summer period of November to March. On saltbush, the results for four years were essentially similar to those for sheep on the grassland, although the effects of 1.2 per cent and 1.6 per cent saline waters were more pronounced. However, in the fifth year when drought conditions prevailed, the effects of both these treatments were more severe Water intakes were up to 1 lday-1 higher on the saline water treatments than on the fresh water, except when water intakes of the sheep on saltbush were high (7-11 lday-1) and then water salinity reduced water intakes. It was concluded that water salinities up to 1.2 per cent on grassland and 0.8 per cent on saltbush will not affect sheep productivity. Higher concentration (up to 1.6 per cent on grassland and 1.2 per cent on saltbush) can be used for adult sheep when forage conditions are good.

Anti-mesodermal Activity of a Nitrogen Mustard Derivative

Amongst the numerous derivatives of nitrogen mustard that have been tested for their anti-tumour activity on Walker carcinoma by Danielli and his collaborators (1961), (Cl—CH2—CH2)2: N—C6H4—O—CO—NH—C6H4—COOH, i.e., p-(NN-Di-2-chloroethyloamino)-phenyl- N-(p-carboxyphenyl) - carbamate (later referred to as I.C. 140), has been found to be particularly promising. To check its cytotoxic activity for embryos, and to find out, if possible, whether I.C. 140 has any specific selectivity for particular embryonic tissues, chick and mouse embryos were treated during the early stages of development. Chick embryos were explanted according to the method described by New (1955) at Stage 4 or 5 (Hamburger & Hamilton, 1955), i.e., after a pre-incubation period of 22 hr. As I.C. 140 is difficult to dissolve in water, it was first suspended in an appropriate volume of 0·9 per cent, saline solution. One part of this suspension was then diluted with nine parts of liquid albumen to give the final concentration of 50 or 100 μg. per ml.