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[Physical bases of blister formation. II. A study of the total osmotic pressure in the blister fluid of suction blisters and of "naturally" occurring blisters as well as in the serum].

Total osmotic pressure does not differ significantly in suction blister fluid or in serum of healthy persons from blister fluid, suction blister fluid or serum of patients with dermatitis herpetiformis, bullous contact dermatitis and pemphigus vulgaris. The average values reach about 293 mOsmol/kg. This results from direct measurement of total osmolality with an electronic semimicroosmometer based on the principle of freezing point reduction. In opposite to colloid osmotic pressure the total osmotic pressure does not take part in blister formation of human skin in spite of the different concentrations of the single electrolytes in the fluids of various blisters.

Biophysical Phenomena↗

Minitracheostomy: an alternative to "blind" endotracheal suctioning.

The critical care nurse is frequently challenged to clear respiratory secretions for patients with thick, copious mucous and a weak cough. The traditional interventions nurses use are chest physiotherapy, incentive spirometry, and "blind" endotracheal suctioning to facilitate the removal of secretions, but these are sometimes ineffective and cause complications. Nurses who identify patients needing a more effective way to remove secretions can request consideration of a new method, suctioning through a minitracheostomy.

Critical Care↗

The clinical significance of suction drainage cultures.

A prospective study of 72 operations in which one or more suction drains were inserted, showed that cultures of the drains did not have any predictive value for the development of signs of infection. Protracted suction drainage could, however, increase the risk of postoperative infection.

Cefonicid↗

Prolonged suction drainage prevents serous wound discharge after cardiac surgery.

A series of 180 patients was randomised to two groups after median sternotomy performed for cardiac surgery in order to evaluate the effect of suction drainage on serous wound discharge. In group A all wounds were drained using two conventional mediastinal drains, while in group B one suction drain and one conventional mediastinal drain were employed. Five patients developed serous wound discharge in group B compared with 14 in group A (chi 2, P < 0.02). There were no significant differences between the rates of major wound infection (group A, n = 1; group B, n = 1) or the incidence of postoperative pericardial effusion assessed by echocardiography (group A, n = 10; group B, n = 5).

Adult↗

[Two cases of tension pneumothorax caused by tracheal suction during the operation of pectus excavatum].

Rehbein's method is one of the surgical procedures for pediatric pectus excavatum, which constructs thorax by lifting and fixating the sternum using metal strut inserted into bone marrow of bilateral ribs. We experienced two pediatric cases of tension pneumothorax caused by tracheal suctioning during the operation by this method. The etiology of tension pneumothorax was thought to be as follows. A small pleural hole was made during separation of ribs from surrounding tissues and a large amount of air entered into the pleural space and check valve mechanism worked at the pleural hole when the lung was collapsed on tracheal suctioning. In anesthetic management of pectus excavatum by Rehbein's method, we should always be cautious of the possible occurrence of tension pneumothorax.

Child↗

Suction tip contamination in the ultraclean-air operating theatre.

The surgical suction tip forms a reservoir for microorganisms during total hip replacement in conventional operating theatres. We assessed the colonisation of the tip in an ultraclean-air operating theatre in 39 patients, and found that 41% of them had evidence of bacterial colonisation with one or more bacteria. To avoid contamination we suggest that the suction tip is changed before preparation of the femoral canal and insertion of cement and prosthesis.

Air Microbiology↗

Nurses' ability to achieve hyperinflation and hyperoxygenation with a manual resuscitation bag during endotracheal suctioning.

OBJECTIVE: To examine nurses' ability to deliver 1.5 times the ventilated tidal volume at 100% FIO2 with a manual resuscitation bag during endotracheal suctioning. DESIGN: Prospective, descriptive. SETTING: Six adult critical care units in a large university-affiliated medical center. SUBJECTS: One hundred nurses randomly selected from the six adult intensive care units. OUTCOME MEASURES: Nurses' manual resuscitation bag delivery of tidal volume and oxygen, as well as bagging rate, number of breaths delivered, and number of suction catheter passes performed. Patients' heart rate, mean arterial pressure, and arterial oxygen saturation. RESULTS: The mean FIO2 delivered was 0.71 (range 0.24 to 0.97). Oxygen liter flow and nurses' delivered minute ventilation predicted 24% of the variance in FIO2 delivered. Mean bagging rate was 31 compressions per minute. The mean volume per breath delivered was 626 cc, which resulted in achievement of 57% of the standard (1128 cc). Volume achieved was related to patient lung compliance, but not related to nurses' experience, unit of employment, hand strength, or size. CONCLUSIONS: Nurses observed were unable to meet the standard for volume or oxygen delivery. However this did not affect the patient's heart rate, mean arterial pressure, or SaO2.

Adult↗

[Using a rotating suction debridement instrument with power generator in endonasal paranasal sinus surgery].

Endonasal nasal and sinus surgery using an endoscope for visual control has minimized the risks of surgery. A new technique is presented in which a suction-irrigation endoscope is used for visual control during surgery. The instrument is combined with a suction-rotation microdebrider with different tips and a power generator. The handling of this instrument is easy and atraumatic and it achieves a relatively bloodless field to reduce further the risk of inadvertent penetration of the skull base and lamina papyracea during endoscopic surgery.

Debridement↗

Suction dressings: a new surgical dressing technique.

A new technique in surgical dressing is described which is a combination of a semi-permeable dressing and suction drainage. This dressing has been used successfully in 20 orthopaedic patients without any wound complication and with satisfactory comfort to the patient. This form of post-operative wound management appears to retain the nursing and hygiene advantages of suction drainage, whilst avoiding the patient discomfort and the possibilities of wound infection, associated with deep internal drainage.

Adult↗

Suction-assisted lipectomy in the management of obstructive sleep apnea.

Suction-assisted lipectomy is a valuable method of aesthetic recontouring of the neck. We report the successful use of suction-assisted lipectomy as an adjunctive procedure at the time of tracheostomy in the treatment of obese patients with severe obstructive sleep apnea. This functional procedure helps to maintain tracheostomy patency during sleep.

Adolescent↗

Can the human right ventricle create a negative diastolic pressure suggestive of suction?

Pressure in the right ventricle (RV) as well as the right atrium (RA) and pulmonary artery (PA) were measured in 80 patients with catheter-tip micromanometers and evaluated to determine if the pressures are compatible with the concept of RV diastolic suction. In 40 patients with normal PA pressure, minimal RV diastolic pressure that occurred during early filling, was negative (-2 +/- 0.3 mm Hg) (mean +/- SEM). In 29 patients with PA hypertension, minimal RV diastolic pressure during expiration also was negative (-2 +/- 0.7 mm Hg). In 11 patients with right ventricular failure, however, minimal RV diastolic pressure was positive (9 +/- 2 mm Hg). These results indicate that the human right ventricle, in the absence of failure, has a negative early diastolic pressure, which may reflect RV diastolic suction.

Adolescent↗

To drain or not to drain: a retrospective study of closed-suction drainage following radical hysterectomy with pelvic lymphadenectomy.

The records of 115 patients were reviewed following radical hysterectomy with pelvic lymphadenectomy for early stage (IA2 to IIB) cervical cancer to determine the effectiveness of closed-suction drainage in decreasing postoperative morbidity. In Group 1 (n = 67), closed-suction (Jackson-Pratt) drains were placed bilaterally in the pelvic lymphadenectomy sites, whereas in Group 2 (n = 48), no drains were utilized. The groups were similar for mean age, tumor histology, disease stage, and preoperative serum albumin and total protein. There was no difference in the mean operative time, mean estimated blood loss, or transfusion rate. Likewise, febrile morbidity rates, incidence of pelvic cellulitis, length of postoperative ileus, and total hospital stay were similar. Group 1 had an increased rate of rehospitalization and morbidity directly related to the presence of the drains. The data suggest that prophylactic surgical drainage may not be necessary to prevent postoperative morbidity following radical hysterectomy with pelvic lymphadenectomy and on occasion contributes to postoperative complications.

Adult↗

A new safe and aesthetic approach to suction abdominoplasty.

Suction abdominoplasties are associated with a number of surgical complications, mainly in obese people and diabetic patients. The aesthetic result is often spoiled by poor balance caused by improper distance between the "guide points" of an harmonious abdomen (e.g., minimum of 10 cm between the pubic scar and the umbilicus). Almost all surgical complications are caused by extensive undermining and can be avoided by an en bloc resection without any undermining (the suction lipectomy of the upper flat creates a "mesh undermining" which is almost as efficient). A new neo-umbilicoplasty, described here, can be situated in the "right position" with good aesthetic results.

Abdomen↗

Suction blister device with regulation of temperature: demonstration of histamine release and temperature change in cold urticaria.

A suction blister device with a sensitive thermometer and with a temperature regulator was constructed. Utilizing this device, it was demonstrated that the cold challenge induces an increase in the skin temperature in cold urticaria patients during the cold challenge and a simultaneous release of histamine into the suction blisters. The skin temperature increases faster after the cold challenge period in cold urticaria patients than in normal control persons. This could be explained by vasodilatation and increased circulation in the skin, following the release of histamine in the cold urticaria reaction.

Cold Temperature↗

Suction blister fluid as a model for interstitial fluid in rats.

1. Suction blisters on the skin of rats, obtained with a negative pressure of 150 mm Hg, show a close similarity to human suction blisters, based on histological, electrolyte and protein findings. 2. Pharmacokinetic experiments with inulin and antipyrine have proved that the movement of these low protein binding drugs between blister fluid and serum follows the laws of diffusion. 3. The investigations suggest that blister fluid resembles interstitial fluid and can therefore serve as a model for the estimation of drug concentrations in interstitial fluid.

Animals↗

Viability of fat obtained by syringe suction lipectomy: effects of local anesthesia with lidocaine.

The results of transplantation of free autologous fat obtained by blunt syringe suction lipectomy are unpredictable. We examined if adipose tissue viability is compromised by using syringe suction lipectomy and by infiltration of the tissue with local anesthetics. As reference, we used adipose tissue samples excised during elective surgery. Fat obtained intraoperatively and by lipectomy was digested with collagenase to isolate adipocytes. The mechanical damage associated with sample handling and cell isolation in both procedures was similar and did not exceed 6% of the total cell mass. In addition, cells isolated from intraoperative and lipectomy samples did not differ functionally, responded similarly to insulin stimulation of glucose transport and epinephrine-stimulated lipolysis, and retained the same growth pattern in culture. Since during fat transplantation the graft is exposed to local anesthetics at both the donor and the recipient sites, we reexamined adipocyte function in the presence of lidocaine. Lidocaine potently inhibited glucose transport and lipolysis in adipocytes and their growth in culture. That effect, however, persisted only as long as lidocaine was present; after washing, the cells were able to fully regain their function and growth regardless of whether the exposure was as short as 30 minutes or as long as 10 days. These results indicate that adipose tissue obtained by syringe lipectomy consists of fully viable and functional adipocytes, but local anesthetics may halt their metabolism and growth.

Adipocytes↗

Toxic shock syndrome associated with suction-assisted lipectomy.

Toxic shock syndrome (TSS) is a serious, potentially life-threatening condition resulting from an exotoxin of Staphylococcus aureus. Presenting symptoms include high fever, diarrhea, nausea, and vomiting progressing to hypotension, oliguria, conjunctival hyperemia, and an erythematous rash over the trunk, abdomen, and extremities. TSS has been associated both with and without the use of tampons during menstruation, postsurgical infections, and stab wounds, and can occur in postrhinoplasty patients with and without nasal packing. There has been one case reported in the literature of TSS associated with suction-assisted lipectomy (SAL). This article discusses the diagnosis and treatment of two cases in which the patients developed TSS after outpatient use of SAL. In the first case, an abdominoplasty and SAL were performed in a healthy young female. The second case involved the harvesting of abdominal fat via syringe suction and subsequent facial fat injection in a female with systemic lupus erythematosus and severe facial atrophy.

Adult↗

Suction lipectomy: the gold triangle at the neck.

Cervical suction lipectomy is a simple procedure that poses no technical problems. Evaluation of the amount of fat to remove is easy since the deposit is superficial and the skin considerably more supple than over the body. Although postoperative changes may be slow to develop, the skin usually exhibits outstanding adaptability in this area and this adaptability improves over time. On the basis of these favorable features occurring in the same location, a cervical gold triangle can be defined. In this area, where excellent results can be expected, indications of suction-assisted lipectomy can be very broad.

Aged↗