Intubation and other experiences in cardiac surgery: the consumer's views.

Recently publications have advocated earlier weaning and early extubation of the trachea in patients after cardiac surgery. Greater comfort of the patients is one of the advantages claimed for this policy. One hundred consecutive adult patients were questioned on the fifth postoperative day to assess the relative comfort or discomfort of the patients during tracheal intubation and ventilation. Overnight tracheal intubation and ventilation were easily tolerated by over 90 per cent of patients who had received morphine and diazepam. There was a high incidence of amnesia. Some of the other claimed advantages appear inconclusive and further study is desirable to elucidate the effect of early removal of the tracheal tube upon the indicence of pulmonary complications.     

Watch out for the K-wire: painful experiences in two cases.

According to reviews in the literature, only a few case reports have mentioned the unusual migration of K-wires during orthopaedic surgery since 1991. This report emphasises the potential migration of the K-wire during plastic surgery in order to avoid the possible catastrophic complications.     

Surgical experiences in Nepal.

Some examples of surgical problems presenting to the authors during a 2-year attachment to the British Military Hospital, Dharan, Nepal, are described.     

Laparoscopic adrenalectomy. New experiences

Authors have performed 23 laparoscopic adrenalectomies between 03.04.1997 and 02.04.1999. They have removed 16 cortical adenomas, 2 nodular hyperplasias, 2 cysts, 1 carcinoma, 1 pheochromocytoma and 1 myolipoma. The operation time was 90-260 minutes that gradually has been decreased by using "Ultracision" ultrasonic shear. They have made simultaneously two cholecystectomies and one liver wedge biopsy. During removing pheochromocytoma they have not detected extremely high blood pressure data. They had one intraoperative complication, the perforation of the diaphragm which required a temporary thoracic suction drainage. All operations were completed laparoscopically. Patients have been released on the 2nd-3rd postoperative day. Their experiences confirm the literary data that the laparoscopic approach to adrenalectomy is the method of choice today.     

Promoting effective preceptorship experiences.

Preceptors and students alike want and need a positive preceptorship experience. There are some factors, however, that must be considered when arranging such experiences, including sufficient time, workload management, use of space, monetary payment for preceptorship, preparation for the role, the one-to-one relationship, and the learning environment. This article concludes with specific strategies that address these factors. The first uses a theoretical model, one advocated by the authors, the Preceptor Enabling Model. This model delineates the roles and responsibilities of students, preceptors, staff, and faculty. Preceptors, too, need preparatory workshops, paid time for orientation to the role, evaluation of preceptors, and finally, support.     

Adult acute epiglottitis: experiences in a Taiwanese setting.

OBJECTIVE: Acute epiglottitis is a potentially disastrous disease seen occasionally in otolaryngology emergency service. This study reports our experiences in managing adult patients with acute epiglottitis in a Taiwanese setting. STUDY DESIGN: Admission medical records from 46 adult patients with acute epiglottitis over a period of 8 years in a tertiary referral otolaryngology service were retrospectively reviewed. RESULTS: No mortality was reported; 4 (8.7%) patients were supported by artificial airway. A total of 16 (34.8%) patients had comorbid conditions; hypertension and diabetes mellitus were the most common systemic diseases. Patients who needed artificial airway support tended to have more systemic comorbidities ( P = 0.001) and a higher level of hyperglycemia ( P = 0.004) than those who did not need airway support. The incidences of drooling, stridor/dyspnea, and muffled voice were significantly higher in the airway-supported group ( P < 0.05). Stridor/dyspnea is a reliable clinical predictor of airway compromise (odds ratio 2.94; P = 0.0277). CONCLUSION: Dyspnea is a warning sign of impending airway collapse during an episode of acute epiglottitis. Adult patients with more systemic comorbidities might bear higher risk of airway compromise; the role of diabetes mellitus can't be overlooked.     

The congenital refluxing megaureter: experiences with surgical reconstruction.

A series of 17 children with congenital refluxing megaureters underwent ureteric tailoring and reimplantation. The results obtained suggest that such surgery should be restricted to those cases in which an obstructive element is introduced as a result of the reflux or in which ascending infection is further damaging the already prenatally defective kidney parenchyma.     

Dynamic knee stability: current theory and implications for clinicians and scientists

We will discuss the mechanisms by which dynamic knee stability may be achieved and relate this to issues that interest clinicians and scientists concerned with dynamic knee stability. Emphasis is placed on the neurophysiologic evidence and theory related to neuromuscular control. Specific topics discussed include the ensemble firing of peripheral mechanoreceptors, the potential for muscle stiffness modulation via force and length feedback, postural control synergies, motor programs, and the neural control of gait. Factors related to answering the difficult question of whether or not knee ligament injuries can be prevented during athletic activities are discussed. Prevention programs that train athletes to perform their sport skills in a safe fashion are put forth as the most promising prospect for injury prevention. Methods of assessing neuromuscular function are reviewed critically and the need for future research in this area is emphasized. We conclude with a brief review of the literature regarding neuromuscular training programs.