Arnica montana and blood loss, surgical field bleeding and operative time in endoscopic sinus surgery: A Randomized-controlled trial

@#<p><strong>OBJECTIVE:</strong>To determine the association of Arnica montana and blood loss, surgical field bleeding and operative time in endoscopic sinus surgery among adults with chronic rhinosinusitis with nasal polyposis.</p> <p><strong>METHODS:</p></strong> <p><strong>Design:</strong> Single-blinded Randomized Controlled Trial</p> <p><strong>Setting:</strong> Tertiary government hospital</p> <p><strong>Participants:</strong> Forty-one (41) adults aged 19-76 years old with chronic rhinosinusitis with nasal polyposis and meeting inclusion criteria were randomly divided into two groups, Arnica and control. The former took 5 sublingual Boiron® Arnica montana 30C pellets, 12 hours then 1 hour prior to surgery; the latter did not. Both groups had routine oxymetazoline and lidocaine-epinephrine decongestion. Intraoperative blood loss, surgical field bleeding quality and operative time were assessed by blinded surgeons and anesthesiologists. </p> <p><strong>RESULTS:</strong> Mean estimated blood loss was 187ml (SD 100.14) for controls versus 72ml (SD 12.59) for the Arnica group; (p < 0.05). Mean operative time was 3.55 hours (SD 1.25) for controls and 3.44 hours (SD 1.57) for the Arnica group; (p=0.9). Surgical field bleeding was graded slight with 75% needing occasional suctioning (grade 2) and 25% needing frequent suctioning (grade 3) in the Arnica group, versus moderate bleeding with more frequent suctioning (grade 4) in 71% and slight bleeding but needing frequent suctioning (grade 3) in 29% of controls.</p> <p><strong>CONCLUSION:</strong> In this randomized clinical trial, Arnica montana was associated with less blood loss and less surgical field bleeding compared to controls, but there was no difference in mean operative times.  Arnica montana may be effective in reducing blood loss and improving surgical field quality during endoscopic sinus surgery for chronic rhinosinusitis with nasal polyposis.</p> <p> </p>

More expensive surfaces are not always better

To assess efficacy of two support surfaces RIK gel mattress and a power air overlay in preventing and healing pressure ulcers. Retrospective analysis of patient records. An academic affiliated 240-bed long-term care facility in Baltimore, MD, USA. All patients with pressure sores at the start of the study were included. One hundred and twenty-two patient records and weekly wound measurements on 173 pressure ulcers done by a dedicated team of wound nurses and technicians were retrospectively analyzed. The two surfaces studied were assigned by the respective physicians and nurses of each unit. None. The two patient groups were comparable at the start of the study. One third of all patients developed one or more wounds during the study period or 48% of all ulcers studied. Healing rates were similar for both surfaces. New stage II ulcers were most common. There was a trend toward higher risk in patients assigned to the power air overlay mattress. Patients assigned to the gel mattress developed pressure ulcers less frequently than those on the power air overlay; however, the power air overlay tended to heal more ulcers. Controlling for the total amount of time each group spent on the respective mattresses, the efficacy of the gel surface in preventing new ulcers equaled or outweighed the benefit of the power air overlay. Since the gel fluid mattress is less costly we would favor the use of the gel mattress system

Sanctuary or Double-Edged Sword? Challenges Confronting Adolescents Living at Nkosi's Haven in Johannesburg; South Africa

Living in an institution associated with HIV and AIDS is likely to exacerbate difficulties experienced by teenagers who have to cope with the normal stresses of adolescence. The aim of the study was to explore the challenges that adolescents living at Nkosi's Haven encounter and whether they experience any problems when interacting with their peers and other members of the community. The study was located within a qualitative research paradigm and utilised a purposive; non-probability sample of 15 participants recruited from two Nkosi's Havens. A semi-structured interview schedule was employed as the research tool; with in-depth one-on-one interviews adopted as the method of data collection. Thematic content analysis was used to analyse the data collected during the interviews. The main finding that emanated from the study was that Nkosi's Haven is indeed a place of care and nurturing as adolescents are afforded the opportunity to continue with their educational needs while basic and psychosocial needs are also addressed. However; it also emerged that rejection; discrimination; social exclusion and stigmatisation associated with the setting make it difficult for resident adolescents to integrate freely with their peers at school and in the community. The conclusion drawn is that Nkosi's Haven can be regarded as a double-edged sword as it presents both positive and negative factors that impact on its resident adolescents. Results are discussed in terms of their implications for community awareness programmes; policies and practice changes regarding employment and training of staff; and visiting of parents as well as future research

Tumor miofibroblastico inflamatorio: presentación de dos casos pediátricos / Inflammatory myofibroblastic tumor: presentatiom of two pediatric cases

El tumor miofibroblástico inflamatorio tiene un comportamiento predominantemente benigno pero en ocasiones puede mostrar grados variables de agresividad. Se localiza en diferentes órganos, el pulmón es el sitio más frecuente, seguido por la cavidad abdominal. Se presentan 2 casos con tumor miofibroblástico inflamatorio. Caso N° 1 femenino de 5 años con palidez cutáneo mucosa, hiporexia, dolor abdominal, fiebre, soplo cardíaco y hepatoesplenomegalia. Ultrasonido, tomografía y estudio radiológico contrastado: tumor en cuerpo gástrico con engrosamiento de sus paredes sugestivo de enfermedad linfoproliferativa. Estudio endoscópico: lesión verrugosa, en curvatura mayor y cuerpo alto. Biopsia: no concluyente. Caso N° 2 femenino de 14 años con estreñimiento agudo, dolor abdominal, masa palpable en mesogastrio e hipogastrio. Ultrasonido y tomografía: lesión ocupante de espacio en mesenterio, quística. Las dos pacientes presentaron anemia severa, leucocitosis y trombocitosis. Se realizó laparotomía exploradora en ambas, caso N° 1: tumor sólido en curvatura mayor gástrica, se hizo resección completa mediante gastrectomía parcial. Caso N° 2: tumor que surge del mesocolon transverso, quístico, ocupando todo el abdomen, 90% fue resecado. Diagnosticó histopatológico: tumor miofibroblástico inflamatorio. Evolución satisfactoria en ambos casos. Esta neoplasia debe sospecharse en niños para evitar terapias radicales, la cirugía conservadora es suficiente como tratamiento en la mayoría de los casos

The inflammatory myofibroblastic tumor behaves predominantly benign but can sometimes show varying degrees of aggressiveness. It is located in different organs, the lung is the most frequent, followed by the abdominal cavity. We present 2 cases of inflammatory myofibroblastic tumor. Case No. 1 female 5 years old with pale skin mucosa, anorexia, abdominal pain, fever, heart murmur, and hepatosplenomegaly. Ultrasound, CT and contrast radiological study: tumor in the stomach with thickening of their walls suggestive of lymphoproliferative disease. Endoscopic Study: warty lesion on greater curvature and high body. Biopsy inconclusive. Case No. 2 female 14 years with severe constipation, dominal pain, palpable mass in mesogastrium and hypogastric. Ultrasound and CT: space-occupying lesion in the mesentery, cystic. The two patients had severe anemia, leukocytosis and thrombocytosis. Laparotomy was performed in both Case No. 1: solid tumor greater curvature gastric resection was completed by partial gastrectomy. Case No. 2: tumor that arises from the transverse mesocolon, cystic, occupying the entire abdomen, 90% were resected. Pathological diagnosis: inflammatory myofibroblastic tumor. Satisfactory in both cases. This neoplasm should be suspected in children to prevent radical therapies, surgery, conservative treatment is sufficient in most cases

Enfermedad de rosai-dorfman o histiocitosis sinusal con linfadenopatía masiva: caso clínico con adenopatía unilateral / Disease of rosai-dorfman or histiocytosis sinusal with lymphadenopathy massive: case clinic with adenopathy unilateral

La Histiocitosis Sinusal con Linfadenopatía Masiva (HSLM) descrita por primera vez, en 1969, por Rosai y Dorfman, se presenta en las dos primeras décadas de la vida, con linfadenopatías cervicales bilaterales y otras localizaciones; etiología desconocida. Diagnóstico principalmente Histopatológico. Preescolar masculino de 3 años de edad quien ingresa con plastrón ganglionar latero-cervical derecho, doloroso, de 8 x 6 cm de diámtero, de dos meses de evolución, asociado a pérdida de peso, sudoración nocturna y fiebre inminente. Leucocitos/ neutrifilia, Anemia, Trombosis, VSG y PCR aumentedas; hipergammaglobulinemia, serología positiva para EBV, descartándose etiologías infecciosas y autoinmunes, con diagnóstico presuntivo de Linfoma de Hodkings; realizando biopsia ganglionar y Citometría de flujo que reportan celulas histocitarias S-100 positivas en "Emperipolesis", combatibles con HSLM. Prednisona evolución favorable. Las características clinico-laboratoriales conjuntamente con hallazgos histológicos, permitieron orientar el diagnóstico de esta entidad poco común

Via venosa central por punción yugular interna por via perpendicular retroesternocleidomastoidea con método de Seldinger / Central venous route by internal yugular punction by retrosternocleidomastoideal way with Seldinger method

La técnica empleada para la cateterización de la vena yugular interna, es más compleja que la usada para la cateterización de la vena subclasiva, pero está prácticamente libre de complicaciones graves, aun en manos inespertas. Se evita con dicha técnica la posibilidad de neumotórax. Se se falla a un lado puede intentarse al lado contralateral sin control radiológico previo. No tiene diferencias de confort para el enfermo con la punción de la vena subclavia por vía infraclavicular