Postoperative fluid management

Postoperative care units are run by an anesthesiologist or a surgeon, or a team formed of both. Management of postoperative fluid therapy should be done considering both patients' status and intraoperative events. Types of the fluids, amount of the fluid given and timing of the administration are the main topics that determine the fluid management strategy. The main goal of fluid resuscitation is to provide adequate tissue perfusion without harming the patient. The endothelial glycocalyx dysfunction and fluid shift to extracellular compartment should be considered wisely. Fluid management must be done based on patient's body fluid status. Patients who are responsive to fluids can benefit from fluid resuscitation, whereas patients who are not fluid responsive are more likely to suffer complications of overhydration. Therefore, common use of central venous pressure measurement, which is proved to be inefficient to predict fluid responsiveness, should be avoided. Goal directed strategy is the most rational approach to assess the patient and maintain optimum fluid balance. However, accessible and applicable monitoring tools for determining patient's actual fluid need should be further studied and universalized. The debate around colloids and crystalloids should also be considered with goal directed therapies. Advantages and disadvantages of each solution must be evaluated with the patient's specific condition.     

Feasibility and Acceptability of Photographic Food Record,Food Diary and Weighed Food Record in People with Serious Mental Illness

People with serious mental illness (SMI) experience challenges that may make typical dietary assessment methods less feasible and accurate. This study aims to determine the feasibility, acceptability and preliminary validity of a 3-day photographic food record (PR), a 1-day food diary (FD) and a 1-day weighed food protocol (WR) in people with SMI. Participants completed measures at two timepoints, with a 4-week interval. Feasibility and acceptability for each method were measured through four outcomes: percent of completers, quality assessment, number of participants requiring technical devices and satisfaction questionnaire. Relative validity was measured by agreement in estimated energy intake between methods, using Bland–Altman analysis and WR as the benchmark, and prevalence of misreporting, using the Goldberg cut-off method, updated by Black. In total, 63 participants were recruited, with a dropout rate of 19.0% prior to timepoint 1 and additional 6.4% prior to timepoint 2. Quality deficits were identified for all methods. The FD was most acceptable to participants, followed by the PR. The difference in estimated energy intake between assessment methods was not statistically significant, though there was considerable individual variability. Underreporting was considerable across all methods but appeared highest in the PR. A FD and PR present as feasible and acceptable methods for assessing dietary intake in people with SMI. Further validity testing is required. In addition, clear guidance for completion and removal of potential barriers is required for participants.     

The close association between dental and periodontal treatments and oral ulcer course in behcet's disease: a prospective clinical study

Objective:  The aim of the study was to evaluate the influence of dental and periodontal treatments to the course of oral ulcers in patients with Behcet's disease (BD).
Methods:  Fifty-eight consecutive BD patients with oral ulcers were studied. Twenty-nine patients were in the intervention group (F/M: 15/14, mean age: 39.6 ± 6.9 years) and 29 (F/M: 15/14, 39.4 ± 10.6 years) were followed with a conventional treatment approach. In addition to oral hygiene education, dental and periodontal treatments were carried out in the intervention group, whereas the control group was only given oral hygiene education. Patients were evaluated in the pre-treatment observation period (1 month), treatment period (1 month) and 6 months after treatment.
Results:  An increase in the number of new oral ulcers (4.1 ± 3.5) was observed within 2 days during the treatment compared with 3–30 days during treatment month (2.3 ± 1.2) ( P  = 0.002). However, 6 months after the treatment, the number of oral ulcers (1.9 ± 1.5) was significantly lower compared with the pre-treatment observation (4.8 ± 3.2) ( P  = 0.000) and treatment periods (6.4 ± 2.3) in the intervention group ( P  = 0.05), whereas a similar oral ulcer presence was observed in the control group (2.8 ± 2.4, 3.7 ± 2.3 and 4.8 ± 4.3, respectively) ( P  > 0.05). Dental and periodontal indices were also better in the intervention group during the 6-month follow-up.
Conclusion:  Our results suggest that, in BD patients, dental and periodontal therapies could be associated with a flare-up of oral ulcers in the short term, but may decrease their number in longer follow-up. They also lead to a better oral health.     

Distant metastases of malignant tumors of head and neck

The charts of 176 previously untreated patients with head and neck squamous cell carcinoma who completed treatment during 2006 in Oro-Maxillo-Facial Clinic, UMF "Carol Davila" Bucharest were reviewed. These patients had no evidence of distant metastases when initially evaluated. The overall incidence of distant metastases was 27.84%, varying from 10.52% for buccal mucosa to 63.63% for tongue and floor of the mouth (p < 0.05). 80% of the metastases were detected within two years after treatment. The rate also increased with the T and N classification; however, the N stage had greater influence on the rate of metastases than the T stage.     

An assessment of olfactory function in patients with laryngopharyngeal reflux disease

Conclusions: The results reported here indicate that there was a statistically significant difference in the olfactory functions of laryngopharyngeal reflux patients vs the healthy group. To the best of the authors’ knowledge, this study is the first to evaluate the olfactory function of patients diagnosed with laryngopharyngeal reflux using an objective method, 24-h pH monitoring.

Objectives/Hypothesis: The aim of this study was to investigate olfactory functions in laryngopharyngeal reflux (LPR) patients and compare the results with healthy controls.

Methods: A total of 60 participants; 30 men and women with a diagnosis of laryngopharyngeal reflux and 30 healthy controls, were included in the study. Patients in the laryngopharyngeal reflux group were evaluated by the Reflux Symptom Index (RSI), Reflux Finding Scores (RFS), and finally 24-h pH monitoring to confirm the diagnosis of laryngopharyngeal reflux. The Sniffin’ Sticks olfactory test results of the laryngopharyngeal reflux and control groups were compared, and the relationship between the study findings and the olfactory parameters were evaluated.

Results: The odor threshold, odor discrimination, odor identification, and TDI scores of the laryngopharyngeal reflux group were significantly lower than those of the control group. Also there was a statistically significant negative correlation detected between the olfactory test and some symptom and finding scores.     

Retrieval of prolapsed coils during endovascular treatment of cerebral aneurysms

One of the feared complications during detachable coil embolization of cerebral aneurysms is herniation of a coil loop into the parent artery. Although coil protrusion of one or two loops into the parent vessel may not cause adverse events and in some instances can be ignored, the authors believe that coil retrieval is indicated if a free end is seen pulsating along the blood flow stream to prevent migration of the entire coil mass. In one patient, a microballoon was inflated across the neck of the aneurysm during retrieval of a herniated coil to prevent further coil herniation from the aneurysm sac. We present two cases in which prolapsed coils were successfully retrieved either using a microsnare and balloon combination or a microsnare alone. This report focuses on the efficacy of the Amplatz microsnare for such retrievals and the circumstances in which a herniated coil needs to be retrieved. We report two cases in which embolization coils partially migrated into the parent artery during endovascular treatment of cerebral aneurysm and were retrieved using the Amplatz Nitinol microsnare.     

Giant serpentine aneurysm with acute spontaneous complete thrombosis

We report a case of a giant serpentine aneurysm (GSA) of the middle cerebral artery (MCA) that underwent complete spontaneous thrombosis after angiography. The patient was a 24-year-old man who had an acute headache. CT and MR examinations revealed a large partially thrombosed aneurysm of the MCA with residual flow in the artery. Angiography demonstrated a GSA arising from the left MCA. Thirteen days later, a second angiography showed complete thrombosis of the aneurysm.     

Congenital anterior dislocation of the radial head: a case with radiographic findings identical to traumatic dislocation

Differentiation of congenital unilateral dislocation of the radial head from a traumatic dislocation depends mainly on the radiographic findings. Here, we report a case of congenital unilateral anterior radial head dislocation with radiographic findings identical to traumatic dislocation.