Incidence of postoperative tonsillectomy bleeding: coblation versus noncoblation

Tonsillectomy and adenoidectomy continue to be the most frequent surgical procedures performed by otolaryngologists for the resolution of upper airway obstruction or recurrent or chronic throat infections and for management of recurrent childhood ear disease. It accounts for around 30% of the operations they perform, with haemorrhage being the most common and serious complication following tonsillectomy and represents about 78% of readmissions within 28 days of surgery. The reported incidence of post-tonsillectomy secondary haemorrhage varies remarkably, from 0.8 per cent to 18 per cent, depending largely on the size and age of the population measured and the definition of 'bleeding' employed. The operating principle of coblation or electrodissociation is similar to bipolar diathermy or electrosurgery. By coblation the medium is dissociated into free sodium ions, which are responsible for the destruction of intercellular bonds, resulting in tissue dissociation. This reaction is achieved at temperatures between 60 °C and 70°C with minimal collateral thermal tissue damage. Also, the presence of cool, irrigating isotonic saline helps to limit the amount of heat delivered to the surrounding structures. It is the duty of the surgeon to ensure that optimal methods are being used and to assess the utility and safety of any new technology in his field. So, the next logical step in the evaluation of coblation tonsillectomy is to determine the postoperative complication rate. The aim of the present study was to compare the rates of reactionary and delayed hemorrhage between coblation tonsillectomy and the standard dissection technique, this study was also designed to attempt to determine whether a learning curve exists with regards to postoperative bleeding when using this new coblation technique. The present study reviewed tonsillectomies performed from August 2002 to end of 2005 in the International Hospital of Bahrain. The new technique using tissue coblation for tonsil dissection offers significant advantages in the postoperative period compared with dissection tonsillectomy with bipolar diathermy hemostasis. Coblation is associated with a lesser incidence of delayed hemorrhage that is more significant in the children population. Comparing the skill of an operator using a well-practiced technique and a new technology must surely introduce a bias in favor of the established technique. As with all new technology, there is a learning curve after which the technique is mastered and morbidity reduced to a minimum

Role of some specific training program on elderly subjects

This work was conducted to detect the cardiopulmonary and metabolic effects of 12 weeks of aerobic exercises on 20 male elderly, they were selected from geriatric housing with age ranged from 65 to 75 years old. The aerobic program included walking and jogging for 15 minutes three times/ week, with intensity of 60% to 80% of maximum heart rate and 50% to 75% of VO2max The parameters studied were: 1. Cardiopulmonary parameters [blood pressure, heart rate and respiratory rate]. 2. Biochemical analysis [serum cholesterol triglyceride HDL, LDL, blood glucose level]. All parameters were measured before and after the 12 weeks program. The data were statistically treated and showed a significant improvement in cardiopulmonary systems efficiency and reduction in serum cholesterol, triglyceride, LDL, and post prandial blood glucose while HDL showed a significant increase but non-significant change was reported in fasting blood glucose level. 1 To detect quantitatively the value of the therapeutic training program [aerobic type] in rehabilitation of the elderly people. 2. To clarify the effects of the aerobic training program on the blood pressure, heart rate, respiratory rate, blood lipids and glucose profile.-3. To investigate finding a training program, which may help those elderly individuals in order to offer additional method for improving their physical fitness

Efficacy of IV propafenone in the management of atrial fibrillation after open heart surgery

The aim of this study was to evaluate the efficacy and safety of propafenone in patients with AF after OHS. Twenty patients who underwent OHS [CABG two patients and valve replacement 18 patients] and had AF in the first 48 hours of the study [heart rate >110 b/min., FS >/25%, with fair liver, renal and respiratory functions] received i.v. Propafenone 2 mg/kg. Another group of the patients received placebo as a control. Patients had continuous electrocardiographic, BP and CVP monitoring 0, 15, 30 and 60 minutes from beginning of the infusion. Ten patients reverted to sinus rhythm [all were in sinus rhythm preoperatively] with a mean time of 24 +/- 11 minutes. These patients had significant decrease in CVP. Ten patients did not revert but showed significant decrease in HR [146 +/- 17 b/min. To 104 +/- 17 b/min.] and CVP did not change. No side effects of propafenone were recorded. Control group showed no reversion in sinus rhythm with no change in HR or CVP. It is concluded that i.v. Propafenone is a valuable drug for treatment of AF post OHS. It reverts patients to sinus rhythm and even when ineffective it significantly slowed the heart rate with no detrimental hemodynamic effects