Role of lymphatic vessel function in atherosclerosis and research progress of drug intervention / 中国药理学通报

Atherosclerosis (AS) is a chronic vascular disease characterized by excessive accumulation of plaques formed by fat, cholesterol and inflammatory immune cells. Lymphatic vessels, as channels for the drainage of lipids, inflammatory substances and tissue fluids, are involved in multiple pathological processes such as lipid accumulation in the intima of AS arteries, vascular inflammation and intimal hyperplasia, and have become a new target for AS research. This article mainly discusses the role of lymphatic vessels in each pathological link of AS and related Chinese and western medicine interventions, aiming to provide feasible ideas for preventing and treating AS with Chinese and western medicines from the view of lymphatic vessels.

Efetividade do uso de drenos em procedimentos cirúrgicos no trauma hepático / Effectiveness of the use of drains in surgical procedures for liver trauma

O cenário de violência urbana e a alta tecnologia automobilística culminaram no aumento de incidência de lesões penetrantes e contusas. Como o fígado ocupa a maior parte do quadrante superior do abdome, qualquer trauma na parte inferior do tórax ou no abdome superior o coloca em risco de lesão que pode acarretar vazamento biliar, sangue ou seroma. Portanto, a drenagem é indicada para evitar complicações causadas pelo acúmulo desses líquidos. Este estudo visou avaliar a efetividade da drenagem em procedimentos cirúrgicos de trauma hepático. Estudo observacional, com análise retrospectiva de prontuários onde foi avaliado um total de 60 prontuários. Em conclusão, os pacientes com lesões mais graves tiveram maior número de drenagem; o tempo de permanência em UTI foi semelhante àqueles que não utilizaram drenos; reoperações utilizaram o dreno com maior frequência; o uso ou não de drenagem não evidenciou diferenças quanto a necessidade de hemoderivados ou em relação ao número de óbitos

The urban violence scenario and the high automobile technology culminated in an increase in the incidence of penetrating and blunt injuries. Since the liver occupies most of the upper quadrant of the abdomen, any trauma to the lower chest or upper abdomen is risky for injury that can lead to bile leakage, blood, or seroma; therefore, drainage is indicated to avoid complications caused by the accumulation of these liquids. This study aimed to evaluate the effectiveness of drainage in surgical procedures for liver trauma. It is observational, with retrospective analysis of medical records. A total of 60 records were evaluated. In conclusion, patients with more severe injuries had a greater number of drainages; the length of stay in the ICU was similar to those who did not use drains; reoperations used the drain more frequently; the use or not of drainage did not show differences in terms of the need for blood products or in relation to the number of deaths

Investigation and analysis of staff turnover in health institutions / 中华医院管理杂志

Objective:To investigate and analyze the loss of personnel in health institutions, and put forward the suggestions.Methods:The staff turnover in various health institutions was analyzed based on a continuous monitoring data from 2012 to 2019.Results:In 2012-2019, the turnover rate of health institutions had generally remained at about 1.5%-2.0%. In 2015-2019, the natural attrition rate was 0.44%-0.70% and the job-changing rate was 0.06%-0.12%. Among all kinds of institutions, the loss of staff in township health centers and Centers for Disease Control and Prevention were the most serious.Conclusions:Some new characteristics have emerged in the flow of health personnel, which have gradually adapted to the demand for health services, and the role of market mechanisms in the allocation of health human resources has gradually emerged.For the institutions with serious attrition, it is suggested to strengthen policy integration, guide the rational flow of health personnel.

Review of stentless, tubeless, apposed renal (STAR) transplant wound management programme

INTRODUCTION@#We aimed to review the necessity of conventional interventions in renal transplant for preventing complications arising out of the use of wound drains, ureteral stents and stapled skin closures.@*METHODS@#We reviewed a series of 33 patients who received stentless, tubeless/drainless and suture-apposed living donor renal transplants (STAR group) and compared the results to a control non-STAR group of 36 patients in whom all three interventions of drains, stents and skin staples were used.@*RESULTS@#No significant differences in demographics and clinical characteristics were observed between the two groups. With regard to the overall surgical complications, no significant differences in terms of wound infection, seroma, perinephric collections, urinoma, bacteriuria or vascular complications were observed between the groups. When analysed according to the interventions specific for preventing complications, although slightly more asymptomatic perinephric collections were observed and two lymphoceles required treatment in the STAR group, these differences were not statistically significant. Similarly, no significant differences in ureteric or skin-related complications were observed between the groups. Both groups had comparable good outcomes for renal function, graft survival and patient survival.@*CONCLUSION@#The routine use of ureteric stents, drains or skin staples may not be necessary for uncomplicated renal transplants. Potential complications associated with the placement of these interventions can be avoided without compromising on the safety of patients and/or the outcome of transplants.

Are routine post drain removal chest x-rays necessary after oesophagectomy?

Background: Routine chest X-rays (CXR) are often performed following the removal of chest drains placed during oesophagectomy. CXRs are costly and inconvenient for the patient, often being performed out of working hours. The aim of this study was to evaluate whether routine CXR is necessary following drain removal or if CXRs should only be performed when indicated by the clinical status of the patient.Methods: This was a retrospective study of oesophagectomies performed at a single high volume centre. Routine post chest drain removal CXRs were analyzed and compared to baseline post-operative CXRs. The clinical status of the patient before and after chest drain removal was recorded.Results: 188 patients were identified. 111/188 (59%) had a pleural effusion or pneumothorax on their baseline post-operative CXR. Abnormal findings on post drain removal CXR were common with 72/188 (38.3%) patients having a new or worse pleural effusion or pneumothorax. Only, 5.6% (11/188) of these patients actually developed clinical signs after chest drain removal. Of these, only 2.1% (4/188) required chest drain re-insertion. No patients underwent intervention without showing clinical deterioration. No re-intervention was prompted by CXR finding alone.Conclusions: Routine CXR following chest drain removal is unnecessary. It is safe to only perform CXRs on patients who develop clinical signs.

A rare case of bilateral drain site abdominal hernia: a case report and review of literature

Use of abdominal drain is a tradition used since a long time. These is generally done to prevent or drain any post-operative intra-abdominal collection aiming to reduce morbidity and mortality and early recovery of patient. But drain has its own complication such as drain site infection, drain site hernia. We encountered a case of bilateral drain site hernia in a 55 year old female who was previously operated for perforation peritonitis. Both herniae were repaired successfully with onlay meshplasty. Drain placement has various complications like drain site infection, adhesion's, intestinal erosion, bleeding, anastamotic rupture and drain site hernia. There is greater risk of hernia in patient with poor nutritional status, obesity, ascitis, severe abdominal infection or with persistent cough. It is better to avoid unnecessary placement of drain. If a drain is placed, its removal should be done as early as possible. It is better to close the defect after removal of drain.

Safety of drainless excision of the submandibular gland / Segurança na excisão da glândula submandibular sem o uso de drenos

Abstract Introduction: Percutaneous drains can be associated with several complications, including infection, fistula formation, discomfort and prolonged hospitalization. Objective: The aim of this study was to evaluate the safety of submandibular gland excision without the use of surgical drains. Methods: We analyzed the surgery time, postoperative complications such as bleeding, facial palsy, seroma, and repeat exploration of wounds and duration of the hospital stay. Excision of the submandibular gland via a transcervical approach was undertaken by two surgeons. Prior to wound closure, the skin flap and wound bed were approximated using hemostatic fibrin glue (Greenplast-Q PFS KIT®, GC Greencross, Youngin, Korea). Neither saline irrigation nor insertion of a percutaneous drain were included. Results: A total of 23 patients underwent submandibular gland excision. The study group consisted of 14 men (60.8%) and 9 women (39.2%) (mean age, 47.6 years; range, 24-70 years). There were two patients who had minor complications. One patient showed minor bleeding on the skin incision line immediately postoperatively, and one developed a seroma at 7 days postoperatively. There were no major surgical complications. Total duration of the surgery from skin incision to closure averaged 44.86 minutes. Mean duration of the hospital stay was 3.17 days. Patients were discharged on average at 1.17 days after surgery. Conclusion: The submandibular gland can be safely excised without the use of a surgical drain, therefore allowing early patient discharge.

Resumo Introdução: Os drenos percutâneos apresentam várias complicações associadas, inclusive infecção, formação de fístulas, desconforto e permanência hospitalar prolongada. Objetivo: Avaliar a segurança da excisão da glândula submandibular sem o uso de drenos cirúrgicos. Método: Analisamos o tempo de cirurgia, as complicações pós-operatórias tais como sangramento, paralisia facial, seroma e necessidade de reexploração de ferida operatória, e a duração da internação hospitalar. A excisão da glândula submandibular por via transcervical foi realizada por dois cirurgiões. Antes do fechamento da incisão, o retalho cutâneo e o leito da ferida operatória foram aproximados utilizando cola hemostática de fibrina (Greenplast-Q PFS KIT®, GC Greencross, Youngin, República da Coréia). Não houve irrigação salina nem uso de dreno percutâneo. Resultados: Foram submetidos 23 pacientes à excisão da glândula submandibular. O grupo de estudo consistiu em 14 homens (60,8%) e 9 mulheres (39,2%) (média de 47,6 anos; variação de 24 a 70). Dois pacientes apresentaram complicações menores. Um paciente apresentou pequeno sangramento na incisão da pele no pós-operatório imediato e um deles teve seroma aos 7 dias de pós-operatório. Não houve complicações cirúrgicas importantes. A duração total da cirurgia, desde a incisão na pele até o fechamento, foi de 44,86 minutos. A duração média da internação hospitalar foi de 3,17 dias. Os pacientes receberam alta em média 1,17 dia após a cirurgia. Conclusão: A glândula submandibular pode ser excisada com segurança sem o uso de dreno cirúrgico, permitindo que o paciente tenha alta hospitalar mais precocemente.

Outcome of thyroid lobectomies undergone with and without drains

Background: Thyroid lobectomy is a common operative technique of management of benign solitary thyroid nodules in which drains are used routinely. Objective of this study to compare the outcome of thyroid lobectomies undergone with and without drains in patients of benign solitary thyroid nodules.Methods: A comparative cross-sectional research was completed on 98 patients of benign solitary thyroid nodules at surgery department of Liaquat University Hospital Jamshoro. Patients having age of 18-60 years underwent thyroid lobectomies were included and distributed in two groups A and B. Group A includes thyroid lobectomies with drain and Group B without drain. Postoperative outcomes including pain score assessed via visual analog score (VAS), hospital stay and complications including wound infection, seroma and hematoma.Results: Out of 98 cases, 49 underwent thyroid lobectomy with drain and 49 without a drain. Females patients were in majority in group A 42 (85.7%) and also in group B 47 (95.9%). No significant difference (p-value=0.674) was in mean age of group A 30.8±10.2 years and group B 31.8±12.2 years. Higher mean with significant difference (p-value=0.001) was in pain score of group A 5.61±1.25 as compared to group B 3.55±0.70. No significant difference was in complications; seroma 1 (2.04%) vs 5 (10.20%), hematoma 1 (2.04%) vs 1 (2.04%) and infection 3 (6.12%) vs 0 (0.0%) in group A and B respectively. Higher mean with significant difference (p-value=0.001) was in hospital stay of group A 2.40±1.57 days as compared to group B 1.42±0.54 days. No significant difference (p-value=0.748) was in overall rate of complications in group A 5 (10.20%) and B 6 (12.24%).Conclusions: Thyroid lobectomy with drain is not effective in lowering the postoperative complications whereas enhanced the risk of postoperative pain, wound infection and duration of hospital stay as compared to thyroid lobectomy without a drain.

Role of subcutaneous vacuum suction drain in prevention of abdominal wound complication in emergency laparotomy

Background: Some of the most common wound complications following laparotomy include hematoma formation, seroma formation, wound infection, burst abdomen and wound dehiscence. Closed-suction drains (CSDs) help to drain any wound collection and also reduce any dead space in the wound thereby promoting healing and preventing complication.Methods: We conducted a prospective study and included patients presenting with acute abdomen in emergency department. Patients were selected as per inclusion and exclusion criteria. Two groups (group A and B) with equal number of patients were created based on closed envelope technique. CSD was placed in the wound of patients in group A. Wound healing and complications were compared between the two groups.Results: 50 patients were included in the study with 25 in each group. Hematoma formation was found to be significantly more among group B (24.0%) compared to group A (4.0%). Seroma formation (p value =0.03917), SSI rate (p value =0.039) and wound dehiscence/burst abdomen (p value =0.0415) was more in group B than group A. The mean wound healing time (days) and mean hospital stay (days) was significantly more in group B.Conclusions: Placing a subcutaneous vacuum suction drain at the time of abdominal wall closure during emergency laparotomy results in better wound healing and reduces postoperative wound complication, hospital stay time, morbidity and also decreases overall healthcare cost.

An analysis of factors determining the requirement of ventriculoperitoneal shunt surgery in the children suffering from posterior fossa tumour: a single centre retrospective review

Background: Hydrocephalus is a relatively common occurrence in a children suffering from the posterior fossa tumour (PFTm). However, there is a divided opinion regarding the ventriculoperitoneal shunt (VPS) surgery before the posterior fossa tumour resection in a child. For the better clinical outcome, we should be able to predict which patient will require VPS following the resection of PFTm. Purpose of our retrospective analysis is to analyse various factors that predicts the necessity of VPS following PFTm resection.Methods: A consecutive series of twenty-six patients who underwent PFTm resection without undergoing VPS preoperatively are analysed in our series.Results: In our series, we found that the younger age at presentation, incomplete tumour resection, longer period of artificial ventilatory support, insertion of external ventricular drain (EVD) and its duration during the postoperative period correlate the necessity of VPS following PFTm resection. However, the severity of hydrocephalus prior to tumor surgery, tumour size, anatomical location of the tumour, tumour dissemination, use of Dural grafts during closure and histopathological type do not predict the requirement of the VPS following PFTm.Conclusions: Patients who are younger at diagnosis should be treated with utmost importance. Gross total resection should be the goal. Factors which predict the likelihood of the EVD which parallels the likelihood of postresection hydrocephalus must be prevented for the better clinical outcome.

Central Line Induced Pneumothorax: A Case Report

Central venous catheter insertion is a commonly performed procedure. We report a case of central venous catheterization induced pneumothorax in a 45 years old male patient who underwent a surgery for sub-arachnoid hemorrhage and post-surgery, developed tension pneumothorax during internal jugular vein catheterization.

Role of drains in cases of peptic ulcer perforations: comparison between single drain versus no drain

Background: Peptic ulcer perforation is one of the commonest causes of peritonitis and needs immediate surgical intervention after prompt resuscitation if mortality and morbidity are to be contained. Aims and objectives of the study was to compare role of Intra-abdominal drains prophylactically after plugging of these perforations single drain or no drain.Methods: In this study, we compared the relative safety and efficacy of putting single drain prophylactically near operation site or in natural abdominal fossae (hepato-renal pouch or sub hepatic) and no drain in cases of peritonitis due to peptic ulcer perforation. Study was done on 60 patients (one drain put in 30 patients Group A and no drain was put in other 30 patients of Group B). We handle the perforation after thorough peritoneal lavage with warm saline and metrogyl. All the perforation was closed by Grahm’s Patch.Results: No significant difference between drain and non-drain group as far age and sex concerned. Significant difference was seen in operative duration, hospital stay, wound dehiscence and post-operative fever, intraperitoneal collection or abscess formation. So use of drains are not effective in preventing post-operative infection rather there are chances of its blockage due to debris, intestine or omentum and tubes itself are source of infection as foreign body and there are chances of migration of bacteria from exterior to peritoneal cavity via these drains.Conclusions: Non drainage of peritoneal cavity after peptic ulcer perforation surgery is an effective method to reduce operative duration, hospital stay and wound dehiscence and post-operative pyrexia.

Clinical application of nose ring drain in severe diabetic foot infection / 中国修复重建外科杂志

Objective: To evaluate the effectiveness of the nose ring drain (NRD) in treatment of severe diabetic foot infection. Methods: The clinical data of 35 patients with severe diabetic foot infection who were treated with NRD between June 2017 and June 2019 were analyzed retrospectively. There were 24 males and 11 females with an average age of 54.5 years (range, 28-82 years). All of them were type 2 diabetic patients. The diabetes duration was 3-20 years, with an average of 9.4 years. The diabetic foot duration was 4 months to 2 years, with an average of 1.16 years. There were 16 cases of left foot and 19 cases of right foot. According to Wagner's grading, there were 11 cases of grade 2, 20 cases of grade 3, and 4 cases of grade 4, all of which were moderate and severe infection of diabetic foot wound. Postoperative wounds were treated with "nibble-like" debridement until the patient's epidermis regenerated and healed. During the treatment process, the indexes of bacterial culture type of wound secretions, duration of antibiotic therapy, wound healing method, healing time, amputation rate, and other indicators were analyzed and summarized. Results: All 35 patients were followed up 3-6 months, with an average of 4.5 months. Postoperative bacterial culture of wounds showed that 5 cases of Staphylococcus aureus, 4 cases of Pseudomonas aeruginosa, 5 cases of Escherichia coli, 3 cases of Enterobacter cloacae, 3 cases of coagulase-negative Staphylococcus, and 15 cases of other types were detected. The duration of antibiotic therapy ranged from 3 to 15 days, with an average of 9.1 days. The wound was autolytically healed without skin grafting, and the healing time was 62-82 days, with an average of 72.3 days. During the follow-up, 3 cases (8.6%) had amputation due to the patient's poor blood glucose control, which led to a large spread of infection. In addition, among the other patients with wound healing, there was no recurrence of wound infection or new ulcer on the original surface. Conclusion: The NRD is a simple operation for treatment of severe diabetic foot infection, which can effectively control wound infections and promote wound healing and regeneration without skin grafting.

Incidência de seroma em abdominoplastia com e sem uso de drenos e pontos de adesão: revisão sistemática e metanálise / Incidence of seroma in abdominoplasty with versus without the use of drains and quilting sutures: a systematic review and meta-analysis

Introdução: A abdominoplastia é um procedimento para a melhoria do contorno corporal e a técnica tem sido aprimorada pela associação da dissecção limitada do retalho cutâneo e pontos de adesão no mesmo ato operatório, evitando-se a formação de seroma pós-abdominoplastia, complicação que incomoda tanto o paciente quanto o cirurgião. Portanto, o objetivo é avaliar se o uso de pontos de adesão está associado a menor incidência de seroma após abdominoplastia quando comparado ao uso de drenos. Métodos: Revisão sistemática da literatura com metanálise, envolvendo as seguintes bases de dados: Science Direct, Scielo, Pubmed, Lilacs, CINAHL e Scopus. Para analisar os dados foi utilizado o programa Stata 12.0 e a estatística I² proposta por Higgins, com intervalo de confiança de 95% para o risco relativo para seroma, segundo o tipo de intervenção (dreno, ponto de adesão, dreno com ponto de adesão). Sendo registrado no PROSPERO sob o número CRD42019120399. Resultados: Cinco estudos preencheram os critérios de inclusão e foram incluídos na metanálise. Ao comparar o uso de dreno de sucção com pontos de adesão, os pontos de adesão mostraram um fator de proteção na prevenção do seroma (RR: 0,13; IC 95%: 0,02-0,66). Conclusão: Os achados sugerem que o uso de pontos de adesão em abdominoplastia em detrimento do uso de drenos pode ser uma técnica eficaz para prevenção da formação de seromas.

Introduction: Abdominoplasty, which aims to improve body contour, has been upgraded by its association with limited dissection of the cutaneous flap and quilting sutures in the same surgery to avoid the formation of postabdominoplasty seroma, a complication that troubles both patient and surgeon. Therefore, this study aimed to assess whether the use of quilting sutures is associated with a lower incidence of seroma after abdominoplasty than the use of drains. Methods: A systematic review of the literature and a meta-analysis were performed of the Science Direct, Scielo, Pubmed, Lilacs, CINAHL, and Scopus databases. The data analysis was performed using the Stata 12.0 program and the I² statistic proposed by Higgins, with a 95% confidence interval for the relative risk for seroma by intervention type (drain, quilting sutures, drain with quilting sutures). The study was registered in PROSPERO (CRD42019120399). Results: Five studies met the inclusion criteria and were included in the meta-analysis. Quilting sutures showed a protective effect (versus use of drain with quilting sutures) in the prevention of seroma (relative risk, 0.13; 95% confidence interval, 0.02­0.66). Conclusion: These findings suggest that the use of quilting sutures instead of drains in abdominoplasty can effectively prevent seroma formation.

Role of Closed Suction Drain in the Prevention of SSI in Elective Surgery

Presence of haematoma, serous fluid, and dead space in a wound increase the risk of infection as they act as a culture media. Multiple options had been mentioned to reduce these risks. We tried to assess the incidence of SSI following placement of closed suction drains following elective surgeries. Methods: A prospective observational study was conducted in the Department of General Surgery, IPGMER & SSKM Hospital, Kolkata from January 2016 to June 2017. Patients who were given a subcutaneous suction drain after an elective general surgical procedure were included in the study. Patients unwilling to take part in the study, patients from paediatric age group, on steroids, with Class 4 wounds and those underwent Laparoscopic Surgery were excluded. Outcome was measured in the form of presence or absence of SSI and data was analysed. Results: No statistically significant decrease of incidence of SSI was found in terms of different age, sex, socio-economic status, duration of hospital stays, smoking or alcoholism. Increased incidence of SSI was detected among Diabetics even after using closed suction drainage. Conclusion: Placement of closed suction drain did not significantly reduce incidence of SSI following elective general surgical procedures.

Effect of duration of pre-operative admission on surgical site infection in major abdominal surgeries: an observational study

Background: Surgical site infection (SSI) are second most common cause of mortality in surgical patient, situation has been further complicated by emergence of drug resistant strains. The importance of preventing surgical site infections is well recognized since they lead to increased morbidity, prolonged hospital stays, need for readmission, high end antibiotic treatment and re-surgery. The study was done to see if   incidence of SSI is decreased with decreased pre-operative admission time. Others factors associated with SSI were analysed including the microbiological spectrum.Methods: The study was an analytical, observational, case control study. Sixty (60) cases each of gynaecology and obstetrical post-operative patients who developed SSI within 30 days were taken as cases and who did not develop SSI were taken as controls and preoperative admission time was analysed in both cases and controls to observe if risk of surgical site infections decreases due to decreased exposure to nosocomial pathogens when the pre-operative admission time was less than 48 hours.Results: Author found that there was statistically significant difference in the time between surgery and admission in the gynaecological surgeries with p value 0.023, as compared to the obstetrics surgeries where there was no statistically significant difference. Common organism isolated was E. coli sensitive to gentamicin.Conclusions: From this study, it seems to be a good policy to evaluate the patient on OPD basis and admit them about 24 to 48 hours prior to the surgery rather them keeping them admitted for prolonged duration in wards for diagnostic evaluation. This prevents nosocomial contamination in the patient’s skin flora thereby preventing SSI. This practice not only conserves the hospital resources but also makes the patient turn over faster. Further this might in the long run reduce the antibiotic resistant hospital flora.

Seasonal Study of Cu, Zn and Pb Accumulation and Distribution in Sediments and PhragmitesAustralisplanted in A Constructed Wetland "Lake Manzala Engineered Wetland Project", (LMEWP), Egypt

Lake Manzala Engineered Wetland project (LMEWP) is a constructed wetland that has been designed for treating drainagewater coming from Bahr El-Baqar drain. In this study, the concentration of heavy metals (Cu, Zn and Pb) in water, sedimentand different organs of Phragmitesaustralis collected from LMEWP seasonally. The aim of this study was to determine thedynamics of distribution of metals in different parts of phragmitesaustralis, and to determined the bioaccumulation factor(BCF) in different organs of plant phragmitesaustralis and Translocation Factor (TA), particularly to determine the time ofmaximum accumulation in the above-ground tissues and to assess removal capacity of phragmitesaustralis in LMEWP.Results revealed a high significant correlation between heavy metals concentrations in phragmitesaustralis with its locationin LMEWP vegetation cell; start cell> end cell. The highest concentration of metals is mostly found in phragmitesaustralisroot. All metals were accumulated in root over time until the end of the growing season after eight months. On the otherside, metal concentrations in stem and leaves increased even after the growing season of the plant. Overall, the resultssuggest to harvestphragmitesaustralis before six months IN the growing season in order to improve the accumulativeefficiency of phragmitesaustralis in LMEWP project.

The role of subgaleal suction drain in chronic subdural hematoma evacuation – Retrospective study in a tertiary care centre

Background: Chronic subdural hematoma (CSDH) is one of the common problems seen in neurosurgical practice, especially in the elderly. Chronic subdural hematoma is a pseudo-encapsulated collection of old blood between the duramater and subarachnoid caused by tear of bridging veins. Materials and methods: Total of 186 patients have underwent burr hole evacuation for subdural hematoma in the study period according to the medical records. Of which 93 had a subgleal drain and rest 93without the drain. Results: The mean GCS at admission was 14 (+/- 1). Out of total 186 patients, 164 (88%) patients had unilateral CSDH and 22(12%) had bilateral CSDH. Among 164 patients with unilateral CSDH 82 (50%) and out of 22 with bilateral CSDH 11 (50%), subgaleal vacuum drain was placed. In rest of 82 (50%) patients with unilateral and 11 (50%) bilateral CSDH, drain was not used. Conclusions: Chronic sub dural hematoma is a common presentation to the neurosurgeon. The present retrospective, comparative study of evacuation of chronic SDH with subgaleal suction drain, and without drain were compared and found to be an effective and safe method in reducing recurrence.

A Multivariate Analysis on the Effect of No Closed Suction Drain on the Length of Hospital Stay in Total Knee Arthroplasty

PURPOSE: Despite the long history of drain use in total knee arthroplasty (TKA), no drain has been gaining popularity. The purpose of this study was to investigate whether drainage is related to the length of hospital stay. MATERIALS AND METHODS: A total of 166 consecutive unilateral TKAs performed on 135 patients with osteoarthritis were retrospectively reviewed. Closed suction drainage was used in 111 cases (67%). Length of hospital stay after surgery was recorded, and a multivariate linear regression analysis was performed to evaluate various variables (patient factors, surgical factors, and post-surgical factors) and to investigate whether drainage was an independent variable. RESULTS: Hospital stay was shorter in no drain cases (21.7±4.8 days) than in drain cases (24.2±3.7 days, p<0.001). The multivariate analysis showed that older age (β=0.12, p=0.02), drain use (β=2.81, p=0.03), and occurrence of comorbidity (β=1.46, p=0.04) were the independent variables associated with the extended hospital stay. There was no difference in comorbidity between drain cases (39.6%) and no drain cases (27.2%, p=0.13). CONCLUSIONS: The drain use, age, and occurrence of comorbidity were related to the length of hospital stay. TKA without drain is an effective procedure both medically and economically.

Safety of the removal of pericardial and mediastinal drain within a different drainage volume after cardiac valvular replacement surgery: A case control study / 中国胸心血管外科临床杂志

@#Objective To assess the safety of the removal of pericardial and mediastinal drain within different drainage volume after cardiac valvular replacement surgery. Methods Between July 2013 and July 2017, 201 patients with rheumatic heart disease (CHD) were treated with valve replacement in our hospital, including 57 males and 144 females, aged 15 to 72 years. They were divided into two groups according to the amount of 24-h drainage before the drain removal: a group one with 24-h drainage volume≤50 ml (n=127) and a group two with 24-h drainage volume>50 ml (n=74). The postoperative hospital stay and the incidence of severe complications between the two groups were compared. Results There was no difference between the two groups in the baseline information or the incidence of severe pericardial effusion and tamponade, while the group two tended to have a shorter length of hospital stay after surgery (8.0 dvs.7.5 d, P=0.013). Conclusion In CHD patients undergoing valvular surgery, compared with a relatively low amount of drainage before the drain removal, drawing the tube at a greater amount of drainage (24-h drainage volume>50 ml) will shorten the length of hospital stay after cardiac surgery while incidence of severe complications remains the same.