Subcutaneous drain insertion in patients with post-operative extensive subcutaneous surgical emphysema: a single centre experience

Objective

Extensive surgical subcutaneous emphysema (ESE) albeit a benign condition could cause patients distress and in many cases temporary vision impairment. We describe the role and value of early subcutaneous drain insertion (SCD) in the management of ESE and patients’ experience in this cohort study.

Methods

Extensive surgical subcutaneous emphysema is that which extends to the neck and/or the peri-orbital region. A cohort study of a prospectively collected data was conducted between December 2009 and January 2012. All patients with extensive post-operative surgical emphysema who had SCD (size ≥24 French gauge) were included.

Results

1069 thoracic procedures were performed. 21 patients (1.96 %) were diagnosed with extensive surgical emphysema, there were 16 males, median age was 65 (54–82 years). There were 16 VATS and 5 open procedures. All patients had chest surgical emphysema, 16 patients had peri-orbital and neck swelling and 5 had neck swelling. Surgical emphysema occurred within a median of 3 days post-operatively. 14 (67 %) patients had 1 subcutaneous drain inserted, and 7 (33 %) had bilateral SCD insertion (1 drain each side). 19 (90 %) patients experienced improvement of their symptoms with resolution of neck and peri-orbital swelling within 1 day of SCD insertion, 2 patients had their symptoms improved within 2 days. All patients were satisfied with the outcome following insertion of SCD.

Conclusions

ESE should always be investigated and treated promptly. Early SCD insertion has a valuable role in the management of ESE with improvement of patients’ experience.     

Use of mobile telephone short message service as a reminder: the effect on patient attendance

Background: Nonattendance for hospital outpatient appointments is a major burden on healthcare systems and the estimated financial loss can be high. Various reasons for patients not attending have been reported, including the patient/carer forgetting the appointment and confusion over the date and time of the appointment. Various reminder systems have been trialled across a variety of clinical settings. More recently, short message service (SMS) text messaging has emerged as a viable approach for delivering reminders to outpatients at a relatively low cost. Aims and objectives: To evaluate the effect of appointment reminders, sent as SMS text messages to patients’ mobile telephones, on attendance at outpatient clinics at the ITS Centre for Dental Studies and Research (ITS‐CDSR), Muradnagar, Ghaziabad, Uttar Pradesh, India. Materials and methods: The study was conducted at ITS‐CDSR in the Departments of Prosthodontics, Endodontics, Orthodontics and Paedodontics. Patients attending these departments for a period of 4 months and those who had provided a contact mobile number were sent an SMS reminder. Results: In this study, 206 subjects (male, 124; female, 82) participated, 96 (male, 57; female, 39) of whom were in the test group and 110 (male, 67; female, 43) of whom were in the control group. The rate of attendance on time was found to be significantly higher in the test group (79.2%) than in the control group (35.5%). Conclusion: The study results indicate that sending appointment reminders as text messages to patients is an effective strategy to reduce nonattendance rates.     

Exaggerated object affordance and absent automatic inhibition in alien hand syndrome

Patients with alien hand syndrome (AHS) experience making apparently deliberate and purposeful movements with their hand against their will. However, the mechanisms contributing to these involuntary actions remain poorly understood. Here, we describe two experimental investigations in a patient with corticobasal syndrome (CBS) with alien hand behaviour in her right hand. First, we show that responses with the alien hand are made significantly more quickly to images of objects which afford an action with that hand compared to objects which afford an action with the unaffected hand. This finding suggests that involuntary grasping behaviours in AHS might be due to exaggerated, automatic motor activation evoked by objects which afford actions with that limb. Second, using a backwards masked priming task, we found normal automatic inhibition of primed responses in the patient's unaffected hand, but importantly there was no evidence of such suppression in the alien limb. Taken together, these findings suggest that grasping behaviours in AHS may result from exaggerated object affordance effects, which might potentially arise from disrupted inhibition of automatically evoked responses.     

Comparison of smear cytology with histopathology of the CT guided stereotactic brain biopsy

The study was undertaken to determine the accuracy of cytological diagnosis of CNS lesions by comparing it with the final histopathological diagnosis of CT guided stereotactic brain biopsy. Squash preparations were prepared from 25 cases of CNS lesions operated in two years. These included 18 astrocytomas, 1 metastatic deposits, 1 epidermoid cyst, 1 Toxoplasmosis, 1 granulomatous inflammation and 3 cases showing normal brain parenchyma. The cytological diagnosis was available to the neurosurgeon within 10 minutes. The cytohistological correlation with paraffin block sections worked out to be 92%. Thus, this proved to be a fairly reliable and rapid method for immediate intra-operative diagnosis.     

Ultrasound biomicroscopic appearances of eyelid lesions at 50 MHz

PURPOSE: To correlate the ultrasound biomicroscopy (UBM) appearance of eyelid lesions with the results of histopathologic examination. METHODS: Fifty-two patients with eyelid lesions were evaluated using 50-MHz UBM, and the UBM scans were compared with the histopathologic findings. The obscuration of the normal lid sonographic layers and invasion into adjacent tissues were criteria suggesting malignancy. RESULTS: UBM characteristics of different eyelid lesions are presented. The sensitivity of UBM in detecting malignancy ranged from 78% to 86%, whereas the specificity ranged from 37% to 69%. CONCLUSION: This study of eyelid lesions shows that UBM can help differentiate between various benign and malignant lid lesions.     

ASO Research Letter: Trends in Location of Death for Individuals with Pancreatic Cancer in the United States

Annals of Surgical Oncology -     

Primary vs delayed primary closure in patients undergoing lower limb amputation following trauma: A randomised control study

Lower limb crush injury is a major source of mortality and morbidity in trauma patients. Complications, especially surgical site infections (SSIs) are a major source of financial burden to the institute and to the patient as it delays rehabilitation. As such, every possible attempt should be made to reduce any complications. We, thus, aimed to compare the outcomes in early vs delayed closure of lower extremity stumps in cases of lower limb crush injury requiring amputation, so as to achieve best possible outcome. A randomised controlled study was conducted in the Division of Trauma Surgery & Critical Care at Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi from 1 September 2018 to 30 June 2019 and included patients undergoing lower limb amputation below hip joint. Patients were randomised in two groups, in one group amputation stump was closed primarily, while in the second group delayed primary closure of stump was performed. We compared rate of SSI, length of hospital stay, and number of surgeries in both the groups. Fifty‐six patients with 63 amputation stumps were recruited in the study. Mean age of patients in the study was 34 years, of which about 95% patients were males. The most common mechanism of injury was road traffic injury in 66% of patients. Mean injury severity score was 12.28 and four patients had diabetes preoperatively. Total 63 extremities were randomised with 30 cases in group I and 33 cases in group II as per computer‐generated random number. Above knee amputations was commonest (57.14%) followed by below knee amputations (33.3%). Two patients died in the current study. In group I, In‐hospital infection was detected in 7 cases (23.3%) and in group II 9 cases (27.3%) had SSI during hospital admission (P > .05). Mean hospital stay in group I was 10.32 ± 7.68 days and in group II was 11 ± 8.17 days (P > .05). Road traffic injuries and train‐associated injuries are a major cause of lower limb crush injuries, leading to limb loss. Delayed primary closure of such wounds requires extra number of surgical interventions than primary closure. There is no difference in extra number of surgical interventions required in both the groups. Thus, primary closure can be safely performed in patients undergoing lower limb amputations following trauma, provided that a good lavage and wound debridement is performed.