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PubMed1981

Blood components for oral surgery.

World-wide blood demands are increasing at 18% per year. Around 50% of collected blood is used whole -- for surgery, accident victims, anaemias, malignancies, and haemoglobinopathies. Blood component therapy is placing extraordinary demands upon Blood Collection Services. This therapy uses multiple or single cell types, and a variety of plasma-derived components. Malignant over-growth depresses marrow function; and, active treatment, temporarily, similarly depresses cell production. Specific transfusion cells are available for the patient's protective mechanism. Platelets are required, fairly fresh, for depletion and for their primary clotting ability. Similarly, infused platelets are used to counter local or systemic drug sensitive platelet depression. From plasma components, specific coagulation products are available for health and during surgery for haemophilia, Christmas, and Von Willebrand's diseases. Prior to oral surgery, all possible coagulation abnormality problems need investigation and specific factors. Anti-coagulation therapy must be reduced or stopped as indicated by the need for therapy and the availability of the appropriate, previously depressed, Vitamin K dependent-clotting factors (II, VII, IX, X). Local measures, formerly the only treatment, are now of less importance. Some countries do not have these blood factors available.

Anticoagulants↗
PubMed2005

Changes in mortalities and hospital admissions associated with holidays and respiratory illness: implications for medical services.

RATIONALE AND OBJECTIVES: To see whether net mortalities increase during and after reductions in medical services, either at average weekends, or at Christmas when pressure from illness is unusually high. METHODS: (1) Paired t-tests to compare mean daily deaths and hospital admissions during and after weekends (Saturday-Tuesday) with means for the week, in south-east England; (2) Linear regressions to see whether trends of daily deaths change when admissions are reduced at Christmas. RESULTS: Neither mean daily all-cause, respiratory or ischaemic heart deaths exceeded weekly averages during weekends, or during Saturday-Monday or Saturday-Tuesday, despite falls in daily elective and daily emergency hospital admissions at weekends that averaged 61-72% and 14-22%, respectively. During 19-24 December, daily deaths were above annual means, respiratory deaths by 49% (29, 1-58), but elective admissions fell and although emergency admissions tended to rise, total admissions rose only for respiratory disease, and only by 33% (376, -47 to 799). On Christmas Day (25 December), even emergency admissions fell sharply below previous trends, respiratory emergency admissions by 18% (P<0.01). Respiratory deaths alone then immediately increased (P<0.01) above trend, by 5.9% (5.8 deaths/day) on 26 December and by 12.9% (12.9) on 27 December. CONCLUSIONS: No adverse effect on mortality was apparent within 2 days from reduction in medical services at weekends. However, respiratory deaths accelerated sharply after reduction in elective and emergency admissions at Christmas, when rates of infection and mortality from respiratory disease were high. Implications for medical services during respiratory epidemics are discussed.

Cause of Death↗
PubMed1989

Has the increasing use of grommets influenced the frequency of surgery for cholesteatoma?

The number of operations for cholesteatoma, together with the number of cases undergoing insertion of ventilation tubes in the Tayside region of Scotland between 1966 and 1986 have been studied. During this period there has been a sixty fold increase in the use of ventilation tubes, but the incidence of cholesteatoma surgery has only varied between 0.94 and 1.88 operations per 10,000 of population per year. The mean annual incidence of cholesteatoma during this period was 1.32 cases per 10,000 of population. The results indicate that there has been neither a rise nor a fall in the incidence of cholesteatoma in Tayside despite a considerable increase in the use of ventilation tubes.

Child↗
PubMed2000

Prophylactic antibiotics in surgery and surgical wound infections.

Wound infection remains a considerable cause of morbidity and mortality among surgical patients, despite the relative success of prophylactic antibiotics. In modern efforts to control healthcare costs while improving the quality of patient care, we must not overlook the basic principles of wound infections and their appropriate treatment. Predisposing factors for the development of surgical wound infection include the creation of a surgical wound, the presence of bacteria, and a susceptible host. The selection of an appropriate antimicrobial drug depends on the identification of the most likely pathogens associated with a given procedure, as well as the expected antibiotic susceptibility of those pathogens. Ideally, a prophylactic antibiotic should achieve high peak tissue concentration at the site of the wound before the first incision and should be maintained until the time of closure. Currently, the administration of prophylactic antibiotics is indicated for contaminated and clean-contaminated wounds. Despite the proven effectiveness of antibiotic prophylaxis, many researchers would argue that contemporary dosing regimens should be reevaluated. The debates concerning the dosage and timing of ideal prophylactic administration are likely to continue.

Antibiotic Prophylaxis↗
PubMed1991

Avoiding Christmas cholesterol.

Judging from your response to our September feature on cholesterol testing providing dietary advice has become of paramount importance to OHNs. The Flora Project for Heart Disease Prevention offers information on the risk factors of high cholesterol and has become a major noninstitutional authority on coronary heart disease. With Yuletide in sight The Flora Project offers advice on a cholesterol-clear Christmas.

Holidays↗
PubMed1969

Coagulation factors in chronic liver disease.

Coagulation studies were carried out on 30 patients with chronic liver disease. The clotting defect was complex and involved factors V, VII, IX (Christmas factor), and prothrombin. Some patients showed a significant depression of factor IX in the presence of a normal one-stage prothrombin time. Thrombotest was found to be a good indicator of factor IX deficiency in this group of patients and may be of use as an additional liver function test. The screening of patients with liver disease for surgery or liver biopsy should assess the coagulation factors involved in both intrinsic and extrinsic thromboplastin generation.

Adult↗
PubMed2005

Surgical excision of isolated renal-bed recurrence after radical nephrectomy for renal cell carcinoma.

OBJECTIVE: To present our results on managing loco-regional recurrence of renal cell carcinoma (RCC) with surgical excision, as local recurrence at the site of a previous nephrectomy is resistant to both systemic therapy and radiotherapy. PATIENTS AND METHODS: In all, 16 patients were operated on between 1994 and 2003 for local recurrence of RCC. The median (mean, range) age at the time of local recurrence was 57.9 (57.4, 28.9-71.7) years, and the median interval from primary surgery 2.22 (3.88, 0.27-14.46) years. Before surgery eight patients had been given systemic immunotherapy, with no response of their local recurrence. RESULTS: Two patients were deemed inoperable because of direct invasion of the great vessels and the liver by tumour. The remaining 14 patients had recurrence in residual adrenal tissue (two), para-aortic nodes (three), para-caval nodes (two), retrocaval nodes (one), renal bed (six), liver, spleen and stomach (one each), and diaphragm (two). Although complete macroscopic en-bloc clearance was achieved in these patients, only eight had tumour-free margins on histological examination. The histology was consistent with RCC recurrence in all cases. All of the patients were followed with computed tomography at regular intervals. At a median follow-up of 1.0 (1.65, 0.25-6.5) years, five patients remain disease-free, four have local and distant relapse, and five developed distant metastasis only. The presence of tumour at the resection margin was a significant factor in predicting local and distant disease-free survival (P < 0.05). CONCLUSIONS: En bloc excision of isolated locally recurrent RCC is possible, and complete surgical extirpation can lead to prolonged disease-free survival.

Adult↗
PubMed2000

Undetectable ultrasensitive PSA after radical prostatectomy for prostate cancer predicts relapse-free survival.

Radical retropubic prostatectomy is considered by many centres to be the treatment of choice for men aged less than 70 years with localized prostate cancer. A rise in serum prostate-specific antigen after radical prostatectomy occurs in 10-40% of cases. This study evaluates the usefulness of novel ultrasensitive PSA assays in the early detection of biochemical relapse. 200 patients of mean age 61. 2 years underwent radical retropubic prostatectomy. Levels < or = 0.01 ng ml-1 were considered undetectable. Mean pre-operative prostate-specific antigen was 13.3 ng ml-1. Biochemical relapse was defined as 3 consecutive rises. The 2-year biochemical disease-free survival for the 134 patients with evaluable prostate-specific antigen nadir data was 61.1% (95% CI: 51.6-70.6%). Only 2 patients with an undetectable prostate-specific antigen after radical retropubic prostatectomy biochemically relapsed (3%), compared to 47 relapses out of 61 patients (75%) who did not reach this level. Cox multivariate analysis confirms prostate-specific antigen nadir < or = 0.01 ng ml-1 to be a superb independent variable predicting a favourable biochemical disease-free survival (P < 0.0001). Early diagnosis of biochemical relapse is feasible with sensitive prostate-specific antigen assays. These assays more accurately measure the prostate-specific antigen nadir, which is an excellent predictor of biochemical disease-free survival. Thus, sensitive prostate-specific antigen assays offer accurate prognostic information and expedite decision-making regarding the use of salvage prostate-bed radiotherapy or hormone therapy.

Adult↗