Should We Give Routine Postoperative Intravenous Fluids After Cleft Surgery?

OBJECTIVE: In 2012, the James Lind Alliance, together with the Craniofacial Society of Great Britain and Ireland and the Cleft Lip and Palate Association, set priorities for unanswered questions in cleft management. One of these priorities included postoperative fluid management. The authors' postoperative regimen does not include intravenous fluids unless the child fails to achieve adequate oral intake by the first evening postoperatively. This audit evaluated whether this is appropriate and safe practice. METHODS: All patients undergoing cleft-related surgery by a single surgeon in a single center during August 2011 to August 2012 were included. Patient age, weight, and surgery type were recorded together with fluid requirement, length of stay, and any returns to theater or readmissions. RESULTS: Of the 79 patients included, none required readmission or return to theater, and the mean length of stay was 1.72 days. Nineteen patients (24%) required intravenous fluids, but these tended to be the older children in the group (P value .034). In the youngest patients undergoing primary lip repair, only 1 of 20 required intravenous fluids. CONCLUSIONS: This study demonstrates that, especially in the younger patients, omitting intravenous fluids as a postoperative routine is associated with a shorter length of stay without an increased complication rate. The authors advocate early postoperative feeding and the return to physiological fluid balance.

Should We Give Routine Postoperative Intravenous Fluids After Cleft Surgery?

OBJECTIVE: In 2012, the James Lind Alliance, together with the Craniofacial Society of Great Britain and Ireland and the Cleft Lip and Palate Association, set priorities for unanswered questions in cleft management. One of these priorities included postoperative fluid management. The authors' postoperative regimen does not include intravenous fluids unless the child fails to achieve adequate oral intake by the first evening postoperatively. This audit evaluated whether this is appropriate and safe practice. METHODS: All patients undergoing cleft-related surgery by a single surgeon in a single center during August 2011 to August 2012 were included. Patient age, weight, and surgery type were recorded together with fluid requirement, length of stay, and any returns to theater or readmissions. RESULTS: Of the 79 patients included, none required readmission or return to theater, and the mean length of stay was 1.72 days. Nineteen patients (24%) required intravenous fluids, but these tended to be the older children in the group (P value .034). In the youngest patients undergoing primary lip repair, only 1 of 20 required intravenous fluids. CONCLUSIONS: This study demonstrates that, especially in the younger patients, omitting intravenous fluids as a postoperative routine is associated with a shorter length of stay without an increased complication rate. The authors advocate early postoperative feeding and the return to physiological fluid balance.

Computer-aided surgical planning in the treatment of soft-tissue sarcoma.

INTRODUCTION: Soft-tissue sarcoma resections are often highly complex procedures that demand meticulous pre-operative planning in order to maximise the potential for complete excision with clear margins, while preserving vital neurovascular structures and muscle groups. SUBJECTS AND METHODS: We present a computer-aided model for surgical planning using Microsoft Powerpoint as a tool for cross referencing magnetic resonance images and normal anatomical diagrams. RESULTS: Using this system the operator follows a sequence of pre-planned steps, minimising intra-operative decision making and unexpected adverse events. Four case studies are discussed. CONCLUSIONS: The visual plan optimises the potential to meet surgical and oncological goals, and serves as an excellent adjunct to the operation note for documentation of the procedure.

Supraorbital neuroma masquerading as local recurrence from a previously excised microcystic adnexal carcinoma.

We present a case of a 53 year old gentleman with a previous history of a microcystic adnexal carcinoma in the supraorbital region who represented with pain and tenderness 3 years postoperatively. Although this was thought to represent local recurrence, it proved to be a supraorbital neuroma.

The development of in vivo tracer methods to obtain new information about human disease: a study of the hallucinating brain.

An outline is provided of the development of methodological strategies to address the question of focal cerebral activation during hallucinations in schizophrenic patients. In so doing, the innovation and diligence required to tailor in vivo tracer procedures to specific clinical research issues are highlighted. Attention is drawn to the complexity of methodological advances and the way in which they are based upon close scientific and technical collaboration between clinical scientists, and non-clinical scientists and research support staff.

A functional neuroanatomy of hallucinations in schizophrenia.

Hallucinations, perceptions in the absence of external stimuli, are prominent among the core symptoms of schizophrenia. The neural correlates of these brief, involuntary experiences are not well understood, and have not been imaged selectively. We have used new positron emission tomography (PET) methods to study the brain state associated with the occurrence of hallucinations in six schizophrenic patients. Here we present a group study of five patients with classic auditory verbal hallucinations despite medication, demonstrating activations in subcortical nuclei (thalamic, striatal), limbic structures (especially hippocampus), and paralimbic regions (parahippocampal and cingulate gyri, as well as orbitofrontal cortex). We also present a case study of a unique, drug-naive patient with visual as well as auditory verbal hallucinations, demonstrating activations in visual and auditory/linguistic association cortices as part of a distributed cortical-subcortical network. Activity in deep brain structures, identified with group analysis, may generate or modulate hallucinations, and the particular neocortical regions entrained in individual patients may affect their specific perceptual content. The interaction of these distributed neural systems provides a biological basis for the bizarre reports of schizophrenic patients.

Deficits in cerebral glucose metabolism demonstrated by positron emission tomography in individuals at risk of familial Alzheimer's disease.

In order to establish whether positron emission tomography (PET) can identify metabolic changes in Alzheimer's disease at a presymptomatic stage, we have examined 24 asymptomatic at risk individuals from families with Alzheimer's disease. A significant reduction in global cerebral metabolic rate for glucose was found when compared with 16 age-matched controls. There was also a focal, parieto-temporal deficit similar to, although less extensive than, that found in 18 symptomatic individuals from familial Alzheimer's disease (FAD) pedigrees. Follow up of this cohort will establish whether these metabolic changes relate to a presymptomatic stage of the disease.