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Complications of elective cesarean delivery necessitating postpartum hysterectomy.

A 34-year-old primiparous woman underwent an elective primary cesarean delivery. Five days later a hysterectomy had to be performed to save the patient's life because of generalized peritonitis. Although risks have decreased dramatically with modern obstetric care, awareness of the potential for severe complications is mandatory even in cases of elective cesarean delivery.

Abscess↗

Using OASIS data to improve skin care.

Using the FOCUS-PDCA process, this article outlines an early intervention project focusing on improving patient interventions for skin care using OASIS data.

Aged↗

In situ tunneled bowel flap tubes: 2 new techniques of a continent outlet for Mainz pouch cutaneous diversion.

In Mainz pouch continent cutaneous urinary diversion, introduction of the in situ tunneled appendix as the continent outlet in 1990 has simplified the surgical technique and greatly increased the acceptance of the procedure. Based on the results of long-term animal studies, 2 new techniques of a continent outlet were randomly used with a Mainz pouch 1 procedure (ileocecal pouch) in 17 patients in whom the appendix was not available or usable for construction of a continent outlet. According to the flap valve principle of the tunneled appendix, in 17 patients a small caliber conduit was created from large bowel wall at the lower pole of the cecum and was tunneled in situ under the mucosa. In technique 1 (seromuscular bowel flap tube), a tube lined by serosa was created from a pedicled island flap of large bowel wall in 11 patients. In technique 2 (full thickness bowel flap tube), a tube lined by mucosa was created from a pedicled flap of large bowel wall in 6 patients. After a mean followup of 8 months (range 2 to 17) 16 of 17 patients catheterize the reservoir at intervals of 4 to more than 6 hours using 14 to 16F catheters and are continent day and night without leakage. The only major complication in this series was incontinence in 1 patient with a seromuscular bowel flap tube who died of metastatic tumor 6 months postoperatively.

Dermatologic Surgical Procedures↗

Effect of sinus surgery on pulmonary function in patients with cystic fibrosis.

The impact of sinus surgery on the pulmonary status of cystic fibrosis patients is unknown. This retrospective study reviewed the charts of the cystic fibrosis patients presenting to our institution's cystic fibrosis center with nasal obstruction, recurrent sinusitis, and nasal polyposis. This group subsequently underwent endoscopic ethmoidectomy and antrostomy. Fourteen of the 15 patients, ages 5-24 years, received preoperative and postoperative pulmonary function testing obtained by spirometry. The data were compiled and analyzed statistically. Our results suggested no significant improvement in the pulmonary function of cystic fibrosis patients after sinus surgery.

Adolescent↗

Needle revision of failed filtering blebs using 5-Fluorouracil and a combined ab-externo and ab-interno approach.

PURPOSE: To evaluate a surgical technique to revise a failed filtering bleb using subconjunctival 5-Fluorouracil with a combined ab-externo and ab-interno approach. PATIENTS AND METHODS: This study is a retrospective review of the outcome of 77 consecutive bleb revisions, with greater than 6-month follow-up, performed by a single glaucoma surgeon (MW). All eyes had previously functioning filtering blebs with currently inadequately controlled intraocular pressures (IOP) prior to the bleb revisions. All surgery was performed in the operating room, using a retrobulbar injection and a microscope. Visco-elastic was injected into the anterior chamber. 5-Fluorouracil (0.1 mL; 50 mg/ml) was infiltrated around the bleb. A 30-gauge needle was used to lyse subconjunctival fibrosis and episcleral scar tissue binding down the scleral flap, and elevate the scleral flap. Through an inferior paracentesis, a cyclodialysis spatula was used to confirm and enlarge the communication with the subconjunctival space. The main outcome measurements were IOP and number of glaucoma medications. A successful outcome was defined as a 20% reduction from baseline IOP and a maximum IOP of 18 mm Hg, with or without medications, and a minimal follow-up of 6 months. RESULTS: 52% of patients achieved success after one revision with an average follow-up of 29.6 +/- 14.4 months. In successful cases, the mean IOP decreased from 22.7 +/- 4.5 mm Hg to 11.3 +/- 3.5 mm Hg and medications were reduced from an average of 2.2 +/- 1.1 to 0.4 +/- 0.7. Kaplan-Meier survival analysis calculated a success of 77% at 1 year, 68% at 2 years, and 58% at 3 years. CONCLUSIONS: In failed filtering blebs, needle revision with 5-Fluorouracil and a combined ab-externo and ab-interno approach results in high success and low complication rates. The outcome of this procedure compares favorably with previously reported revision techniques.

Aged↗

Prospective evaluation of preoperative factors associated with successful mitomycin C needling of failed filtration blebs.

PURPOSE: To study the long-term effectiveness and factors involved in successful needling of failed filtration blebs with mitomycin C (MMC). MATERIALS AND METHODS: We conducted a prospective, nonrandomized comparative trial that included 34 consecutive patients (34 eyes) who underwent mitomycin C needling of a failed filtering bleb after trabeculectomy followed by a 0.01 mL injection of mitomycin C (0.2 mg/ml). The success of the needling revision was defined as absolute if the intraocular pressure (IOP) was < 21 mm Hg without antiglaucoma medications and qualified if the IOP was < 21 mm Hg with antiglaucoma medications. Preoperative and perioperative factors were evaluated for an association with postoperative success using Kaplan-Meier survival analysis. RESULTS: The mean follow-up was 14.2 +/- 9.8 months. The mean preoperative IOP was 25.5 +/- 4.4 mm Hg, which decreased to 11.1, 13.4, 15.8, 16.7, 14.9, 14.1, 13.9, and 13 on postoperative day 1, postoperative week 1, and after 1, 3, 6, 9, 12, and 24 months, respectively (P = 0.001 for each comparison). At the final visit, success was absolute in 15 eyes (44.1%) and qualified in 14 eyes (41.2%). The success rates were 90% and 75% at 1 and 2 years, respectively. The success of the needling procedure was highly correlated with glaucoma filtration surgery performed less than 4 months previously (Kaplan-Meier analysis, log-rank test P = 0.006). CONCLUSIONS: Mitomycin C needling revision appears to have a high long-term success rate. Surgery performed less than 4 months previously contributes to the success of the initial mitomycin C needling procedure.

Adult↗

More on gloving.

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Acquired Immunodeficiency Syndrome↗