Cryotherapy: an effective modality for decreasing intraarticular temperature after knee arthroscopy.

Cryotherapy is a modality commonly used after arthroscopic procedures. We divided 17 patients into two groups after routine knee arthroscopy: 12 patients were immediately treated with ice and 5 control patients were treated without ice for the first hour. In all patients, thermocouple probes were placed intraarticularly into the lateral gutter of the knee. Ice was placed on the operative knees of the treatment group for 2 hours. The control group had no intervention for the 1st hour and then had ice applied for the 2nd hour. Temperatures were continually recorded every minute for 2 hours. The temperature in the treatment group declined significantly, by 2.2 degrees C (95% confidence interval [-3.6 degrees C, -0.72 degrees C]) over the 1st hour and by 0.79 degrees C (95% CI [-1.8 degrees C, 0.18 degrees C]) over the 2nd hour (P = 0.008). The temperature in the control group increased significantly, by 5.0 degrees C (95% CI [2.4 degrees C, 7.5 degrees C]) over the 1st hour (P = 0.006). After ice was applied, the temperature fell significantly, by 4.0 degrees C (95% CI [-8.3 degrees C, 0.26 degrees C]) (P = 0.06). The difference between the temperature decrease in the treatment group and the increase in the control group at 60 minutes was 7.1 degrees C. This is the first rigorously conducted study in human patients that documents a statistically significant decline in intraarticular knee temperature with the application of ice and compression to the skin. The mechanism by which cryotherapy acts must therefore include the cooling effect on the intraarticular environment and synovium.

Local complications after surgical resection for thyroid carcinoma.

BACKGROUND: One of the issues in the debate surrounding the extent of thyroid excision for localized, well-differentiated thyroid cancer is the low morbidity rate reported after all degrees of thyroid resection. This study was conducted to determine morbidity and mortality after surgical resection for thyroid cancer. MATERIALS AND METHODS: Ninety-one patients with thyroid carcinoma were identified from tumor registries at a university, veterans administration, and private hospital over a 36-year period. Forty-five patients (49%) underwent total thyroidectomy, 28 (31%) subtotal thyroidectomy, and 18 (20%) thyroid lobectomy. RESULTS: Permanent postoperative local complications occurred in 4% of patients. Forty-four patients (48%) experienced temporary local complications: transient hypocalcemia in 38 (42%), airway obstruction in 3 (3%), postoperative bleeding in 2 (2%), and recurrent laryngeal nerve injury in 1 (1%). The local complication rate increased in direct relationship to the extent of thyroid resection. There were no postoperative deaths. CONCLUSION: The most frequent underreported morbidity after thyroid resection is transient hypocalcemia. Compared to other life-threatening or permanent postoperative complications that could occur, transient hypocalcemia is relatively less important, and the significance of its identification is predominantly economic.