Near Disappearance of Splenorrhaphy as an Operative Strategy for Splenic Preservation After Trauma.

BACKGROUND: Splenorrhaphy was once used to achieve splenic preservation in up to 40% of splenic injuries. With increasing use of nonoperative management and angioembolization, operative therapy is less common and splenic injuries treated operatively are usually high grade. Patients are often unstable, making splenic salvage unwise. Modern surgeons may no longer possess the knowledge to perform splenorrhaphy. METHODS: The records of adult trauma patients with splenic injuries from September 2014 to November 2018 at an urban level I trauma center were reviewed retrospectively. Data including American Association for the Surgery of Trauma splenic organ injury scale, type of intervention, splenorrhaphy technique, and need for delayed splenectomy were collected. This contemporary cohort (CC) was compared to a historical cohort (HC) of splenic injuries at a single center from 1980 to 1989 (Ann Surg 1990; 211: 369). RESULTS: From 2014 to 2018, 717 adult patients had splenic injuries. Initial management included 157 (21.9%) emergent splenectomy, 158 (22.0%) angiogram ± embolization, 371 (51.7%) observation, and only 10 (1.4%) splenorrhaphy. The HC included a total of 553 splenic injuries, of which 313 (56.6%) underwent splenectomy, while splenorrhaphy was performed in 240 (43.4%). Those who underwent splenorrhaphy in each cohort (CC vs HC) were compared. CONCLUSION: The success rate of splenorrhaphy has not changed. However, splenorrhaphy now involves only electrocautery with topical hemostatic agents and is used primarily in low-grade injuries. Suture repair and partial splenectomy seem to be "lost arts" in modern trauma care.

Ultrasound Image Features under Decomposition Algorithm to Analyze the Nursing Intervention on Patients with Colon Polyps Undergoing Endoscopic Resection.

Based on the ultrasonic imaging and endoscopic resection of the intelligent segmentation algorithm, this study is aimed at exploring whether nursing intervention can promote the good recovery of patients with colon polyps, hoping to find a new method for clinical treatment of the colon polyps. Patients with colon polyps were divided into an experimental group (fine nursing) and a control group (general nursing). The colonoscopy polyp ultrasound image was preprocessing to select the seed points and background points. The random walk decomposition algorithm was applied to calculate the probability of each marked point, and then, the marked image was outputted. The accuracy of the intelligent segmentation algorithm was 81%. The incidence of complications in the experimental group was 4.83%, which was lower than 16.66% in the control group, and the difference was statistically obvious (P < 0.05). Perioperative refined nursing intervention for colon polyp patients undergoing endoscopic electrosurgical resection can decrease postoperative adverse reactions; reduce postoperative mucosal perforation, blood in the stool, abdominal pain, and small bleeding; lower the incidence of postoperative complications; and allow patients to recover quickly, enhancing the life comfort of patient.

Selective fetal reduction in complicated monochorionic twin pregnancies: A comparison of techniques.

OBJECTIVE: To compare perinatal outcomes associated with three methods of selective reduction in complicated monochorionic (MC) twin pregnancies: bipolar cord coagulation (BC), fetoscopic or ultrasound guided laser cord occlusion and radiofrequency ablation (RFA). METHODS: Retrospective cohort study of complicated MC twin pregnancies undergoing selective fetal reduction at a tertiary fetal center over a 20-year period. Obstetric and perinatal outcomes were compared. RESULTS: 105 procedures met inclusion criteria: 74 RFAs, 17 lasers and 14 BCs. Procedure duration was significantly shorter for RFA (27.4 ± 15.8 minutes) compared to BC (91.7 ± 38.7 minutes) and laser (83.4 ± 40.4 minutes), P < .0001). The incidence of preterm prelabor rupture of membranes (PPROM) and co-twin demise did not differ between groups, however preterm delivery <34 weeks occurred less frequently following RFA (29.7%), compared to laser (64.7%) or BC (42.9%) (P = .02); delivery <37 weeks was also less frequent following RFA (45.9%), compared to laser (76.5%) or BC (78.6%)(P = .01). The difference in preterm birth<34 weeks between RFA and laser was maintained after adjusting for cord occlusion indication and amnionicity (OR 3.96, 95% CI 1.27-12.31). CONCLUSIONS: In our experience, RFA procedures were simpler, faster and associated with a lower risk of preterm delivery <34 and <37 weeks, compared to laser or BC.

Treatment efficacy for human papillomavirus-related anal squamous cell dysplasia in an under-represented population: human immunodeficiency-negative, non-men having sex with men, and non-transplant population.

AIM: Human papillomavirus (HPV)-related anal squamous cell dysplasia has been well-reported in high-risk (HR) patients [human immunodeficiency virus (HIV)-positive, men having sex with men (MSM) or immune-suppressed transplant recipients]. However, data are extremely limited for all other patients. This study reports treatment outcomes for HPV-related dysplasia in a population of non-HR patients. METHOD: A retrospective study was performed to review treatment efficacy in non-HR patients diagnosed with anal dysplasia or superficially invasive squamous cell carcinoma of the anus (SISCCA) with at least 12-months' follow-up; HR patients were excluded. Medical records were reviewed for demographics, pathology, cytopathology, treatment and recurrences. RESULTS: Forty-one patients were identified (34 women). The median age at diagnosis was 58 years (range 26-85) and median follow-up was 26 months (range 12-51). At diagnosis, 36 patients had anal dysplasia and five patients had SISCCA. Treatment outcomes (resolved versus recurrent) differed between treatment modalities (P = 0.014). Topical and fulguration-only treatment modalities were superior to wide local excision (WLE) (P < 0.006 and P < 0.008, respectively). Fourteen (39%) patients had recurrent dysplasia at a median of 14 months (range 4-62); eight patients developed a second recurrence at a median of 14 months (range 11-26). No SISCCA patient had a recurrence, but two patients progressed to anal cancer after treatment. CONCLUSION: The behaviour of anal dysplasia reported in this under-represented, small group of non-HR patients reveals that treatment for anal dysplasia is not necessarily a single event and nonexcisional treatments may be favourable to WLE. Though the true denominator of this population is unknown, treatment may not prevent the recurrence of dysplasia or progression to cancer, warranting close follow-up.

Thermo-coagulation versus cryotherapy for treatment of cervical precancers: A prospective analytical study in a low-resource African setting.

AIMS: To evaluate the outcomes of cryotherapy and thermo-coagulation in the treatment of cervical precancers. METHOD: Prospective analytical study. Women who screened positive to visual inspection with acetic acid and confirmed by colposcopy using the Swede's score were randomized to receive either cryotherapy or thermo-coagulation. Participants were re-evaluated 6 months later. RESULTS: A total of 11 124 women were screened. Only 1023 of the 1294 colposcopically confirmed positive cases were eligible for ablative therapy. Five hundred and twelve women received cryotherapy while 511 women received thermo-coagulation. Cryotherapy had similar cure rate with thermo-coagulation (85.5 vs 89.2%, P = 0.09). The mean patient satisfaction score for thermo-coagulation was higher than that for cryotherapy (3.9 ± 1.3 vs 2.8 ± 1.7; P < 0.0001). The mean duration of treatment per patient was higher for cryotherapy than thermo-coagulation (660.0 ± 0.0 vs 50.9 ± 15.3 s, P < 0.0001). The mean cost of treatment per patient was significantly higher for cryotherapy than for thermo-coagulation (2613.1 ± 254.9 vs 533.2 ± 45.2 Nigerian Naira, P < 0.0001). Higher proportion of women who had thermo-coagulation reported no side effect (55.2 vs 12.5%, P < 0.0001). CONCLUSION: Cryotherapy and thermo-coagulation have similar efficacy in the treatment of cervical precancers. Thermo-coagulation offers lower cost and lower duration of treatment, less side effects and higher patient satisfaction than cryotherapy. Thermo-coagulation should be the recommended ablative treatment method for low-resource settings of the world.

Is hook diathermy safe to dissect the mesoappendix in paediatric patients? A 10-year experience.

BACKGROUND: Laparoscopic appendicectomy is one of the most commonly performed abdominal surgical procedures in children, with many different techniques used to isolate and control the appendiceal artery. Previous studies have looked into the utility of different methods of mesoappendix dissection, however these have been predominantly small-scale studies performed on adults. AIM: The current study aimed to assess the safety and efficacy of 'hook' diathermy as a sole means of mesoappendix dissection in children under 15 years of age undergoing laparoscopic appendicectomy. METHODS: Retrospective review of hospital database and electronic clinical notes of children aged under 15 who underwent laparoscopic appendicectomy at Starship Children's Hospital between 1 January 2007-31 December 2016. RESULTS: During the study period, 2,793 children had appendicectomy using hook diathermy to dissect the mesoappendix. No children required blood transfusions or return to theatre for bleeding. There were 103 intra-operative complications related to the use of hook diathermy (3.7%), including one case that required conversion to open for bleeding. CONCLUSION: Dissection of the mesoappendix using hook diathermy is a safe, quick and effective method during laparoscopic appendicectomy, with low complication and conversion to open rates.

Managing Seborrheic Keratosis: Evolving Strategies and Optimal Therapeutic Outcomes.

Seborrheic keratosis (SK) is the most common skin tumor seen by dermatologists in everyday practice. Although the lesions are mostly benign, many patients still elect to have asymptomatic SK removed. The historical standards of treatment are cryosurgery and electrocautery, two surgical options that are effective at lesion removal but have high rates of postoperative adverse events such as treatment-site scarring and pigmentary alterations. The cosmetic outcomes of SK treatment modalities are of keen interest to dermatologists, as the American population becomes increasingly more diverse. In this article, the inclusion of darker Fitzpatrick skin types into clinical studies investigating post-treatment side effects of SK therapy is reviewed. The recent approval of a 40% hydrogen peroxide topical formulation is discussed in light of these issues, and several non-invasive topical treatments that optimize cosmetic outcomes of SK lesion removal are highlighted. Finally, treatment strategies aimed at reducing cost and minimizing the burden of adverse sequelae are provided. J Drugs Dermatol. 2018;17(9):933-940.

Comparação da eficácia e segurança do laser cirúrgico de diodo com o eletrocautério no tratamento da hiperplasia fibrosa inflamatória / Efficacy and safety comparison of diode surgical laser with electrocautery in the treatment of inflammatory fibrous hyperplasia

A hiperplasia fibrosa inflamatória (HFI) é uma lesão comum na cavidade bucal que acomete aproximadamente de 5 a 16,7% dos indivíduos que utilizam prótese dentária. É caracterizada por uma irritação crônica de baixo grau em consequência de próteses mal ajustadas. O tratamento da HFI em sua maioria consta de remoção do fator causal que permite a regressão da lesão, mas, algumas vezes, há necessidade da associação com a excisão cirúrgica. Esse tratamento pode ser feito por meio de bisturi, crioterapia, eletrocautério ou laser cirúrgico. Sendo assim, o objetivo do presente estudo foi avaliar e comparar, por meio de um ensaio clínico randomizado triplo-cego, a segurança e a eficácia das técnicas cirúrgicas utilizando eletrocautério e laser de diodo no tratamento da HFI. Foram avaliados os parâmetros clínicos trans-operatórios: quantidade de tubetes anestésicos utilizados, sangramento, energia tecidual depositada, fluxo energético, tempo de incisão, e variação térmica superficial ao tecido lesional. Os parâmetros pós-operatórios avaliados no período de 28 dias foram: dor, uso de analgésico, aumento de volume, dificuldade de mastigação e de fala e área de ferida em cicatrização. A amostra foi constituída de 36 pacientes, divididos em dois grupos de 18 indivíduos, para tratamento cirúrgico com laser de diodo e com eletrocautério. Os resultados deste estudo não apontaram diferenças significativas na avaliação dos parâmetros clínicos trans- e pós-operatórios para a remoção de HFI utilizando o laser ou o eletrocautério, sendo ambas as técnicas cirúrgicas igualmente eficazes e seguras para o tratamento da HFI. O laser de diodo parece ser tão eficaz e seguro quanto o eletrocautério, quando aplicado sob condições similares à remoção de HFI.(AU)

Inflammatory fibrous hyperplasia (IFH) is a common lesion in the oral cavity, which affects approximately 5 to 16.7% of individuals who wearing prosthesis. It is a lesion characterized by low-grade chronic irritation due to ill-fitting prostheses. The main treatment of IFH is the removal of the causal factor that allows regression of the lesion and sometimes is necessary the association with surgical excision. Surgical treatment could be using scalpel, cryotherapy, electrocautery or surgical laser. The aim of the present study was to evaluate and compare, through a randomized tripleblind clinical trial, the safety and the efficacy of surgical techniques using electrocautery and diode laser in the treatment of IFH. It was evaluated the peroperative clinical parameters: the number of anesthetic tubes used, bleeding, deposited tissue energy, energetic energetic flow, time of incision and superficial thermal variation tissue, and the post operative parameters: pain, use of analgesic, development of swelling, chewing difficulty, speaking difficulty, wound healing area, for a period of 28 days post-operatively. The individuals were divided into two groups: surgical treatment with diode laser with wavelength of 808 nm and with electrocautery. A total of 36 patients were included in the study, 18 in each group. No significant differences were found in the evaluation of per and postoperative clinical parameters for the removal of IFH using laser or electrocautery. Thus, it is possible to affirm that both surgical techniques are effective and safe for the treatment of IFH in the same proportion.(AU)

Predictors of intraoperative electrosurgery-induced implantable cardioverter defibrillator (ICD) detection.

BACKGROUND: In the USA, the number of people needing implantable cardioverter defibrillators (ICDs) has grown dramatically. Many ICD recipients will need to undergo a surgical procedure at some point following ICD implantation. Most surgeries involve the use of electrocautery. Currently, the effects of electrocautery-induced electromagnetic interference (EI-EMI) on ICDs are poorly understood. The aim of this study was to study EI-EMI using prospectively collected clinical data. METHODS: We analyzed prospectively collected ICD data from patients undergoing a surgical procedure at Mayo Clinic between 2011 and 2012. Information on clinical, device history, device interrogation pre- and post-surgery, and surgical information were collected for all patients. ICDs were programmed with detections on and therapies off. The patients were then categorized into two groups: those with EI-EMI inappropriate arrhythmia detection and those without detection. The stored electrograms were reviewed. Clinical and device parameters were analyzed to identify predictors of EI-EMI. RESULTS: Of 103 patients studied, bipolar cautery did not induce EI-EMI (0/11 cases), whereas monopolar cautery resulted in noise detection in 11/92 procedures. Among 11 inappropriate episodes of detection, 10 had surgery at chest, neck, and upper extremity sites with cautery current across the ICD lead tip; 1 had abdominal surgery; and none had back or low extremity surgery. On average, the near-field electrogram amplitude values were greater than the far-field amplitude values. CONCLUSIONS: EI-EMI does not occur when bipolar cautery or monopolar cautery is used below the hips with the dispersive ground pad applied to the lower extremities. In contrast to external EMI, EI-EMI may be larger on near-field than far-field electrograms.

Diathermy versus scalpel in transverse abdominal incision in women undergoing repeated cesarean section: A randomized controlled trial.

AIM: The aim of this study was to evaluate the volume of blood loss, wound incision time and wound complication according to use of scalpel or electrosurgery during the creation of transverse abdominal incisions during repeated cesarean section (CS). MATERIAL AND METHODS: A randomized controlled trial was carried out at Ain Shams University Maternity Hospital. We recruited 130 women with a history of one previous CS at the time of their planned lower-segment CS. Participants were randomized to anterior abdominal wall opening from subcutaneous tissue till the peritoneum by either the use of scalpel with disposable blade (No. 22) or diathermy using the standard diathermy pen electrode. The main outcome measures were the volume of blood loss from skin incision to the end of the peritoneal incision, the operative time and wound complication. RESULTS: We observed a highly significant difference between the two groups in blood loss (median [interquartile range], 11 [8-15.25] g for the diathermy group vs 20 [18-23] g for the scalpel group, P < 0.001) and skin-to-peritoneum incision time (median [interquartile range], 7 [5-7.25] min for the diathermy group vs 10 [7-11] min for the scalpel group, P < 0.001). The postoperative pain was less in the diathermy group but wound complications showed no statistical difference. CONCLUSION: The use of diathermy in the opening of anterior abdominal wall during CS decreases blood loss and operative time but has no impact on postoperative pain or wound complications.

Is Electrocautery of Patella Useful in Patella Non-Resurfacing Total Knee Arthroplasty?: A Prospective Randomized Controlled Study.

There is controversy over the need for electrocauterization of the patella in non-resurfacing total knee arthroplasty (TKA). We investigated whether this procedure is beneficial through a prospective randomized controlled trial. Fifty patients who underwent electrocautery were compared with 50 patients who did not undergo this procedure. We determined cartilage status, preoperative and postoperative American Knee Society (AKS) score, the Western Ontario and McMaster Universities score (WOMAC) and the Patellofemoral (PF) scores for a minimum of 5 years. The two groups did not differ significantly in demographics, intraoperative cartilage status, or preoperative or postoperative outcomes. No complications were detected in either group. We found no benefits of electrocautery of the patella in patellar non-resurfacing TKA up to 5 years.

Complications of Electromechanical Morcellation Reported in the Manufacturer and User Facility Device Experience (MAUDE) Database.

STUDY OBJECTIVE: To evaluate adverse events associated with electromechanical morcellation as reported to the Manufacturer and User Facility Device Experience (MAUDE) database. DESIGN: Retrospective analysis of an established database (Canadian Task Force classification III). INTERVENTION: A search of the MAUDE database for terms associated with commercially available electromechanical morcellation devices was undertaken for events leading to injury or death between 2004 and 2014. Data, including the types of injury, need for conversion to open surgery, type of open surgery, and clinical outcomes, were extracted from the records. MEASUREMENTS AND MAIN RESULTS: Over a 10-year period, 9 events associated with death and 215 events associated with patient injury or significant delay of the surgical procedure were recorded. These involved 137 device failures, 51 organ injuries, and the morcellation of 27 previously undiagnosed malignancies. Of the 9 deaths, 1 was associated with organ injury, and the other 8 were associated with morcellation of cancer. Of the 27 undiagnosed cancers, 5 were reported by the manufacturer, 8 were reported by the patient or family, 9 were reported by medical or news reports, 2 were reported by medical professionals, and 3 were due to litigation. Morcellation of an undiagnosed malignancy was first reported to the database in December 2013. CONCLUSIONS: The MAUDE database appears to detect perioperative events, such as device failures and organ injury at the time of surgery, but appears to be poor at detecting late events after surgery, such as the potential spread of cancer. Outcome registries are likely a more efficient means of tracking potential long-term adverse events associated with surgical devices.

Olfactory outcomes after endoscopic pituitary surgery with nasoseptal "rescue" flaps: electrocautery versus cold knife.

BACKGROUND: Olfaction has been shown to have a large impact on patients' lives. Endoscopic pituitary surgery is associated with potentially significant damage to olfactory tissues. The objective of this study was to determine the effect of cauterization on olfactory function when performing endoscopic pituitary surgery with a nasoseptal "rescue" flap. METHODS: A retrospective review was performed of prospectively collected data. Olfaction was the primary outcome and was measured using the subjective visual analog scale (VAS; 0-100) and Cross-Cultural Smell Identification Test (CC-SIT) before and 3 months after surgery. Significant olfactory deficit was defined as >20% loss compared with preoperative functions. Patients who underwent an endoscopic transsphenoidal approach with NSRFs for pituitary adenoma from June 2012 to March 2013 were included. Included patients were divided into two groups; group 1 underwent rescue flaps raised by monopolar cautery and group 2 underwent rescue flaps by cold knife. RESULTS: Forty-nine patients were included in this study. There were 19 patients in group 1 and 30 patients in group 2. There was no significant difference in subjective olfactory change between the two groups (p = 0.386; group 1, 13.68 ± 17.7, versus group 2, 6.83 ± 8.25). However, 5 of 19 patients (26.3%) had significant olfactory loss in group 1 and 1 of 30 (3.3%) in group 2. This difference was statistically significant (p = 0.027). None of the patients showed a significant decrease in CC-SIT score. CONCLUSION: Raising the rescue flap by cold knife could reduce the rate of hyposmia compared with using an electrocautery postoperatively.

[Prevention of obstetrical complications following LEEP, is it possible?]. / Prévention des conséquences obstétricales des conisations à l'anse diathermique, est-ce possible ?

Recent epidemiological data suggest an increase of the incidence and prevalence of CIN as well as a decrease of the mean age of the patients presenting these lesions. Large loop electrosurgical procedure (LEEP) is the most commonly used treatment method. According to recent studies LEEP provides a 1.4 to 7.0 fold increase of preterm delivery. Cervical cerclage does not show efficiency in reducing this risk, even if cervical shortening is measured by transvaginal ultrasound. Considering histological severity of lesions and the age of patients, number of currently conducted conizations in France could be avoided and so their obstetrical consequences prevented, just because no treatment is necessary or could be done by ablative procedures.

A perioperative management algorithm for cardiac rhythm management devices: the PACED-OP protocol.

BACKGROUND: Limited data are available regarding the perioperative management of cardiac rhythm management devices (CRMDs) exposed to intraoperative electromagnetic interference. We postulated that implementation of a simple, standardized approach to CRMD management using our own institution's Pacing And Cardioverting Electronic Devices peri-Operative Protocol (the PACED-OP protocol) would be associated with a reduction in the amount of device reprogramming without an increase in CRMD-related complications. METHODS: Records of patients with CRMDs undergoing 497 consecutive surgical procedures were analyzed retrospectively. Roughly half (51%, n = 254) of these procedures occurred before implementation of the PACED-OP protocol, when patients were generally treated according to the American Society of Anesthesiologists' 2005 guidelines. These cases were compared to the remaining surgeries that occurred after implementation of the PACED-OP protocol. Records were screened for evidence of intraoperative CRMD malfunction that was directly associated with the use of electrocautery. Postoperative complications that could be indirectly or possibly linked to electrocautery-mediated CRMD malfunction were also identified. RESULTS: Implementation of the PACED-OP protocol was associated with a significant reduction in the odds of device reprogramming (adjusted odds ratio [aOR] 0.19, P < 0.001). There was no direct evidence of CRMD malfunction in either cohort. The rate of postoperative complications that could be indirectly or possibly linked with electrocautery-mediated CRMD damage did not differ significantly between cohorts (aOR = 1.37, 95% confidence interval 0.56-3.3, P = 0.49). CONCLUSION: The PACED-OP protocol implementation was associated with a significant reduction in the odds of device reprogramming without a significant difference in the odds of CRMD-related complications.

[Management of ovarian endometriomas: intraperitoneal cystectomy versus fenestration and coagulation]. / Prise en charge des endometriomes ovariens : quelle technique choisir : kystectomie intraperitoneale ou fenestration coagulation ?

BACKGROUND: Ovarian endometriomas is a common condition among women of reproductive age and represents a major cost in terms of public health. Despite these implications for public health, it remains difficult to arrive at a consensus on the optimal surgical treatment. AIMS: To study the clinical and paraclinical characteristics of this pathology and to compare two major surgical techniques: the intraperitoneal cystectomy and fenestration -coagulation in terms of recurrence and prognosis for future fertility. METHODS: A retrospective study of 31 patients who underwent surgical treatment for ovarian endometrioma histologically proved. The study period covers 10 years from January 2000 to December 2009. RESULTS: Laparoscopy was performed in 27 patients. The endometrioma was located to the left side in 64% of cases. The main strategy performed is intraperitoneal cystectomy in 18 patients (58.8%). In second place we find the fenestration-coagulation. The mean duration of postoperative follow-up is 10.3 months. The recurrence of the cyst and the persistence of pain symptoms were significantly less frequent in the group of patients who underwent intraperitoneal cystectomy. CONCLUSION: The laparoscopic surgery remains the first line approach in terms of ovarian endometrioma.Cystectomy offers performance equal or superior to the fenestration-coagulation technique, and exposes to fewer recurrences. For these reasons, it should be recommended. The fenestration-coagulation is possible in case the cystectomy is difficult or incomplete.

Life-threatening haemorrhage after 750 Le Fort I osteotomies and 376 SARPE procedures.

This study assessed the incidence, presenting symptoms, diagnosis, and management of patients with life-threatening postoperative haemorrhage after total Le Fort I osteotomy and surgically assisted rapid palatal expansion (SARPE). The medical records of 750 consecutive Le Fort I osteotomies and 376 consecutive SARPEs, both of which involved pterygomaxillary separation with a curved osteotome and a mallet, were analysed prospectively. Two cases of life-threatening haemorrhage were observed in the Le Fort I osteotomy group, both initiated on postoperative day 7. Anterior and posterior nasal packing were successful in one patient; the other required two embolizations for bleeding control (incidence of life-threatening postoperative haemorrhage: 2/750; confidence interval: 0.03-0.96%). In the SARPE group, one brisk epistaxis on the first postoperative day was controlled with anterior and posterior nasal packing under general anaesthesia. This haemorrhage was not considered life threatening (incidence of life-threatening postoperative haemorrhage: 0/376; confidence interval: 0-0.98%). In no case could the source of bleeding be established during re-explorative surgery or during diagnostic arteriography. The authors conclude that life-threatening haemorrhage is an exceptional finding after Le Fort I osteotomy; the observed incidence was 2/750, and life-threatening haemorrhage was not observed after SARPE in this series, despite the use of identical pterygomaxillary separation.

Pacemaker placement and shoulder surgery: is there a risk?

INTRODUCTION: Surgery to the anterior aspect of the shoulder is performed by many surgical specialties but the techniques used by our cardiology colleagues for insertion of cardiac pacemaker wires are often not appreciated by the surgical community. The deltopectoral approach has been used for open pacemaker wire insertion for many years by cardiologists. METHODS: We surveyed a group of subspecialty shoulder surgeons as well as orthopaedic trainees to see if this approach for pacemakers is well recognised. We tried to assess what level of knowledge exists regarding pacemaker placement in general as well as specific risks. RESULTS: There appears to be a paucity of knowledge regarding pacemaker placement and related patient safety issues in both surveyed groups. There was no difference between the two groups, suggesting that the level of knowledge does not increase with experience and specialisation. CONCLUSIONS: There is the potential to cause harm to patients if the insertion site and type of device is not identified before commencing surgery in this region and steps must be taken to minimise any intra-operative risk. There is a risk from direct injury to the pacemaker and/or leads as well as the hazards of using diathermy in close proximity to a pacemaker. There must be more widespread dissemination of this information in order to minimise risks to patients with pacemakers in situ.

[Cervical cancer screening in Italy: quality of colposcopy and treatment. 2010 activity]. / Lo screening per il cervicocarcinoma in Italia: qualità della colposcopia e del trattamento. Attività 2010.

Data were collected from organised Italian cervical screening programmes on: a) the correlation between colposcopic findings (according to the 1990 international classification) and histology, and (b) the treatment/management of screen-detected histologically-confirmed cervical intraepithelial neoplasia (CIN). Data routinely registered by organised programmes were obtained as aggregated tables. Of the 26,320 reported colposcopies, 39.6% were classified as normal and 11.2% as unsatisfactory. CIN2 or more severe histology was detected in 65.3% of colposcopies classified as grade 2 or higher. Of all colposcopies, the outcome of which was CIN2 or more severe histology, 42.7% were classified as grade 2 or higher. Of the 5,695 women with CIN1, 78.9% were recommended to have follow-up only. However, 1.4% of them had cold-knife conisation and 4.5% were treated by diathermocoagulation. Of the 3,841 women with CIN2 or CIN3, 6.4% had not yet been treated when data were collected, and no data rewere available for a further 12.7%. Excision by radio-frequency device was the most common treatment among these women (64.1% of those with known treatment). However, 0.7% of all CIN2 and 1.7% of all CIN3 had hysterectomy. Among the 151 women with invasive carcinoma, 10.6% plausibly with microinvasive disease, only one treatment LLETZ is reported.