The efficiency of extended postoperative antibiotic prophylaxis in orthognathic surgery: A prospective,randomized, double-blind,placebo-controlled clinical trial

Postoperative antibiotics are commonly administered in orthognathic surgery, despite the fact that there is no consensus regarding their efficacy. The objective of this study was to investigate the effectiveness of postoperative antibiotics in orthognathic surgery by conducting a prospective, randomized, double-blind, placebo-controlled trial.Patients were randomly allocated into one of two study groups: the intervention group (treated with 1 g of intravenous (IV) amoxicillin-clavulanate TID) or the placebo group (treated with 50 mL of IV 0.9% NaCl TID). The infection rate was assessed using clinical and laboratory parameters.The intervention group included 38 patients, with 40 patients in the placebo group. Baseline and surgical characteristics were comparable between both groups. Mean postoperative C-reactive protein (CRP) and temperature were similar for both groups. Serous discharge was observed in two patients (both in the placebo group), and one of them required surgical intervention. Overall, infection rate was similar in both groups (p-value > 0.1).To conclude, administration of postoperative antibiotics in healthy, young patients undergoing orthognathic surgery did not show a significant advantage in reducing surgical infection rate.     

Providing patient progress feedback and clinical support tools to therapists: Is the therapeutic process of patients on-track to recovery enhanced in psychosomatic in-patient therapy under the conditions of routine practice?

Objectives

In previous studies of patients on-track to recovery (OT) involving therapists receiving only patient progress feedback without clinical support tools (CST) inconsistent results were found. Possible effects of combining patient progress feedback with CST on OT patients remain unclear.

Methods

At intake (t1), 252 patients of two in-patient psychosomatic clinics were randomized either into the experimental group (EG) or the treatment-as-usual control group (CG). Both groups were monitored weekly using the self-report instruments “Outcome Questionnaire” (OQ-45) and “Assessment of Signal Cases” (ASC). Therapists received weekly patient progress feedback (OQ-45) and CST feedback (ASC) only for EG patients starting at the week following intake (t2). Patients who did not deviate negatively from expected recovery curves by at least one standard deviation were considered OT patients (N = 209; N_EG = 111; N_CG = 98). Since therapists received feedback at t2 for the first time, different patterns of change (OQ-45 scales) between the groups from t1 to t2, t2 to t3 (intake + two weeks), t2 to t4 (intake + three weeks), and t2 to t5 (last available OQ-45 score) were evaluated by multilevel models.

Results

Merely from t2 to t3, the EG improved significantly more on the OQ-45 symptom distress scale than the CG (p < 0.05; g = 0.12).

Conclusion

Providing patient progress feedback and CST to therapists did not substantially surpass treatment-as-usual for OT patients in this explorative study except for a very small time-limited enhancement of symptom change.     

Deliberate Hypotensive Anesthesia With the Rapidly Acting,Vascular-Selective,L-Type Calcium Channel Antagonist—Clevidipine: A Case Report

Deliberate hypotension is an important technique for use in select anesthetics for procedures such as orthognathic surgery, specifically LeFort I maxillary osteotomy. We present a case report of an anesthetic involving deliberate hypotension for a 17-year-old female patient who presented for a LeFort I osteotomy, bilateral sagittal split of the mandible, and a genioplasty in order to correct a skeletal class III malocclusion. After reaching a steady-state general anesthetic, deliberate hypotension was induced solely with a bolus and subsequent continuous infusion of the ultrashort acting calcium channel blocker, clevidipine. The preoperative, intraoperative, and postoperative course and anesthetic management are discussed.Key Words: Deliberate hypotension, Bolus infusion, Dental anesthesiology, Calcium channel antagonist, Orthognathic surgery, General anesthesia, Narcotics, Hemodynamics, IV agents, Hemostasis, Pain control, Post-operative pain management, PONV, Nasotracheal intubation, Anti-emetic prophylaxis, Maxillomandibular fixation     

Contextual functions of antigen-presenting cells in the gastrointestinal tract

The immune system of the gastrointestinal tract must be tightly regulated to limit pathologic responses toward innocuous antigens while simultaneously allowing for rapid development of effector responses against invading pathogens. Highly specialized antigen-presenting cell (APC) subsets present in the gut play a dominant role in balancing these seemingly disparate functions. In this review, we discuss new findings associated with the function of gut APCs and particularly the contextual role of these cells in both establishing tolerance to orally acquired antigens in the steady state and regulating acute inflammation during infection.     

Unexpected formation of root-like structures subsequent to the avulsion of immature permanent teeth: Case report

This report describes the unexpected formation of root-like structures following the avulsion of immature permanent teeth without replantation. A 6-year-old female patient had avulsed the four permanent mandibular incisors and the two deciduous mandibular canines. The patient was seen in an emergency healthcare unit but did not receive specialized treatment for tooth replantation. As follow-up treatment, she received a removable prosthesis. After 4 years of follow-up, an image obtained by panoramic radiography showed formations similar to four root structures in the alveolus of the previously avulsed permanent teeth. This finding was confirmed by periapical radiography and computed tomography. This case report demonstrates that in teeth with incomplete root development, even after avulsion without replantation, cells from the pulp stump may have the capacity to form mineralized structures that appear radiographically comparable to root dentin.     

Blunt Abdominal Trauma Requiring Laparotomy: an Analysis of 342 Polytraumatized Patients

Abstract Introduction: Hemorrhage due to abdominal trauma is one of the most frequent causes of early mortality in polytraumatized patients. Therefore, the initial management of abdominal trauma is an important factor in determining the outcome. The aim of this study was to evaluate the clinical course in multiple trauma patients who sustained abdominal trauma requiring operative intervention. Patients and Methods: In this retrospective analysis, a database containing prospectively collected data on polytraumatized patients from a European level I trauma center was used. The following inclusion criteria were applied: (1) operative intervention for blunt abdominal injuries with positive intraoperative findings, (2) injury severity score (ISS) > 18, and (3) age 16–65 years. Results: The inclusion criteria were met by 342 patients (229 male and 113 female patients, mean ISS 39.9±8.9). The most frequently observed intra-abdominal injuries were to the spleen (62.1%) and the liver (47.7%). The most common extra-abdominal injury observed in combination with abdominal trauma was trauma to the chest (71.9%). One hundred forty-three patients (41%) died during their hospital stay. The most frequent reasons for death were hemorrhagic shock (26.7%), ARDS (27.6%) and head trauma (23.2%). The severity of liver injury correlated positively with mortality. In contrast, no correlation between splenic injuries and mortality was observed. Significantly more deaths were attributed to primarily extra-abdominal injuries (111 patients, 77.6%) and then to intra-abdominal injuries (12 patients, 8.4%). In 20 patients (14%), a combination of intra- and extra-abdominal injuries caused posttraumatic death. Conclusion: Mortality was significantly higher for extra-abdominal injuries and their associated complications compared to intra-abdominal injuries. These findings should be considered in the development of treatment algorithms for blunt trauma.     

Diagnostic pitfall: Optic neuritis mimicking optic nerve glioma

We report a case of optic neuritis with enlargement of the optic nerve on MRI. This neuroradiological finding is most commonly seen in tumours of the optic nerve and led together with an inconclusive intraoperative frozen section to an incorrect tentative diagnosis of optic nerve glioma which fatally resulted in the resection of the optic nerve.     

Eine Vision

Ohne Zusammenfassung