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Pre-admission clinics are becoming increasingly popular for surgical specialties with a quick turnover as they aid waiting list management and reduce non-attender rates for surgery. As paediatric patients have a high rate of non-attendance, we performed a retrospective audit of otolaryngology paediatric pre-admission assessment clinic notes for June to October 1998 (n = 363). The attendance rate for the clinic was 97 per cent. Of the children who attended the clinic, 90 per cent had their operation as planned, complications occurred in 2.9 per cent. The operation date was delayed in 20 patients, in 11 patients no cause for the delay was given in the case notes. As a result of this audit, the Senior House Officer sees the patient on the day of admission rather than in the pre-admission clinic, which is staffed by nurses.
The surgical closure of septal perforations remains a distinctive challenge to the otorhinolaryngologist. This is demonstrated by the modest success in most techniques. An alternative method, involving surgical enlargement of the perforation with posterior edge repair, is described and the outcome is investigated. Thirteen patients with perforations of up to 50.mm in size underwent this technique. A questionnaire interview was conducted and symptom scores were obtained. The length of hospitalization, follow-up period and post-operative complications were evaluated as were measures of morbidity.
The results showed a significant improvement in the symptom scores for nasal crusting, epistaxis and overall discomfort. This technique is straightforward and is especially suitable for larger perforations. The successful improvement in symptoms and an associated low morbidity makes it a complement to alternative surgical closure techniques.
A 76-year-old patient had an elective percutaneous dilatational tracheostomy (PDT) under endoscopic control in the intensive care unit. Twelve days later when her general condition improved, two attempts at decannulation failed due to upper airway obstruction above the tracheostomy site.
Bronchoscopy showed herniation of the anterior tracheal wall above the tracheostomy tube occluding 80 per cent of the lumen. The herniated anterior segment was elevated and partially resected under endoscopic guidance. The patient made a full recovery and was decannulated on the first post-operative day. Pitfalls and possible complications of PDT are discussed.
A stochastic epidemic model was applied to meningococcal disease outbreaks in defined small
populations such as military garrisons and schools. Meningococci are spread primarily by
asymptomatic carriers and only a small proportion of those infected develop invasive disease.
Bayesian predictions of numbers of invasive cases were developed, based on observed data
using a stochastic epidemic model. We used additional data sets to model both disease
probability and duration of carriage. Markov chain Monte Carlo sampling techniques were
used to compute the full posterior distribution which summarized all information drawn
together from multiple sources.
The anti-emetic efficacy of prophylactic ondansetron and tropisetron in combination with a low dose of droperidol in patients with high probability for post-operative nausea and vomiting undergoing gynaecological laparoscopy was compared. Patients were randomly allocated in a double-blind manner to receive either ondansetron 8 mg (n=45) or tropisetron 5 mg (n=43) at the end of surgery. A standardized general anaesthetic technique was used, including droperidol 0.75 mg. The incidence of nausea was 36% and 49% (P=0.28), and vomiting occurred in 13% and 14% of the patients in the ondansetron and tropisetron groups, respectively. The onset time for rescue medication was significantly sooner after tropisetron than ondansetron (3 h 18min vs. 6 h 25min; P=0.007). There were no statistically significant differences in efficacy between prophylactic ondansetron and tropisetron combined with droperidol in a high-risk population. However, ondansetron appeared to be more effective in preventing post-operative nausea and vomiting in the early hours after surgery compared with tropisetron.
We monitored eclosion patterns of adult Coquillettidia perturbons (Walker) in the Minneapolis – St. Paul region of Minnesota directly using emergence traps (1983, 1984, and 1992), and indirectly using CO2-baited adult traps (1987–1992) and larval sampling (1988 and 1989). Most mosquitoes eclosed in a unimodal pulse during June although peak eclosion periods varied among years and sites. It required 26.6 ± 1.5 days for 90% of individual populations to eclose. Temporal abundances of host-seeking females also suggested unimodal eclosion with peaks typically occurring in June and July. Most larvae overwintered in the fourth instar and pupated in early summer, as expected from adult data. However, many larvae overwintered in the third instar and did not molt into the fourth until July, which was after most eclosion was completed. These individuals may eclose in autumn or may spend a second winter as larvae.
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