BAL for pneumonia prevention in tracheostomy patients: aclinical trial study

To evaluate the role of flexible bronchoscopy [FB] and bronchoalveolar lavage [BAL] on pneumonia prevention of tracheostomy patients in intensive care unit. This clinical trial was conducted on 67 head-injury patients who needed tracheostomy. The eligible patients were divided into two groups of different methods for removing the airway secretions. In intervention group, FB and BAL was added to routine conventional methods for airway clearance. Patients were followed for signs and symptoms of pneumonia. The risk of nosocomial pneumonia decreased from 35% to 14% in intervention group. The days of hospital stay were significantly reduced with bronchoscopic method. Flexible Bronchoscopy is recommended to all ICU admitted patients that have tracheostomy tube and high volume of secretion in their airways. It can not only prevent the pneumonia formation decrease the morbidity and mortality rate but it can even shorten the ICU stay time and consequently reduce the costs of treatment

[Laparoscopic evaluation for chronic post operative abdominal pain]

Approximately 20% of patients undergoing laporotomy experience chronic postprandial abdominal pain for months after operation. Most surgeons are wary of re-operation in this condition, and opt for conservative treatment with analgesics and sedatives. This study was performed to determine the cause of this chronic abdominal pain by means of laparoscopy. Elective laparoscopic surgery was performed on 76 patients suffering from chronic post-operative abdominal pain. They did not have any signs and/or symptoms of acute intestinal obstruction; the most common complaints were: abdominal pain in 100%, nausea in 30%, vomiting in 10%. Diagnostic laparoscopy was performed and cases with positive findings were treated by laporoscopic surgery. In 81% of patients the cause of pain was obvious intestinal adhesions, 10% had adhesions without any correlation to patient's symptoms and the remaining 9% did not have any positive finding on diagnostic laparoscopy. Adhesiolysis, [sharp release with scissors] is the treatment of choice. 95% of those patients who underwent Adhesiolysis became pain free for a mean average of 11 months follow up [pre-operative average of pain episode was 4 time per week]. Laparoscopic diagnosis and treatment of chronic post-laparotomy pain is the gold standard method, it is minimally invasive and has good results