Dangling regimes after free flap surgery to the lower limb vary between centres and clinicians. There is currently no accepted gold standard. This review examines the evidence for early versus late ...post-operative dangling after free flap reconstruction of the lower limb. The secondary aim is to evaluate the regimes used.
Medline, Embase and the Cochrane library were searched for all studies on dangling or rehabilitation after free flap reconstruction in the lower limb (December 2015). All studies outlining a clear dangling regime were included. Data were extracted by two authors independently and analysed using the software package Review Manager (RevMan 5). All authors were contacted for further information.
197 patients were included from 8 studies: 1 randomized, 6 cohort and 1 case-series. Although some studies did not state the aetiology, of those that did; 42% were trauma, 31% oncology, 20% complex wounds and 7% infection. The majority of flaps were latissimus dorsi, 18% parascapular, 15% anterolateral thigh and the remainder was mixed. Forty-eight percent of patients dangled on post-operative day (POD) 7, 29% on day 6, 4% on day 5 and 18% on day 3, with varying regimes. A meta-analysis of comparable studies showed circulatory benefit after 4 days of dangling using tissue oxygen saturation as a measure. Four flap failures (2.0%) were reported.
There is physiological benefit in post-operative dangling. A 3-day flap training regime is sufficient for physiological training. However, the optimal flap training regime remains unclear. It may be appropriate to start dangling as early as POD 3. More research is needed to determine the optimal time to start dangling and the regime.
A new form of airway has recently been described, which is introduced blindly into the hypopharynx to form a seal around the larynx, so permitting spontaneous or positive pressure ventilation without ...penetration of the larynx or oesophagus. The further development of this new airway is described and the results of 18 months' clinical experience are presented. The airway was used successfully in 118 patients, 17 of whom received controlled ventilation of their lungs. It was used in place of the facemask in routine anaesthesia, and was of particular value in ophthalmic, dental and ear, nose and throat procedures and where difficulties with the airway were expected. The incidence of sore throat and other problems was low. Experience of more than 500 cases suggests that the laryngeal mask airway may have a valuable rôle to play in all types of inhalational anaesthesia, while its proven value in some cases of difficult intubation indicates that it may contribute significantly to the safety of general anaesthesia.
Objectives To compare the effect of delivering early to pre‐empt terminal hypoxaemia with delaying for as long as possible to increase maturity.
Design A randomised controlled trial.
Setting 69 ...hospitals in 13 European countries.
Participants Pregnant women with fetal compromise between 24 and 36 weeks, an umbilical artery Doppler waveform recorded and clinical uncertainty whether immediate delivery was indicated.
Methods The interventions were ‘immediate delivery’ or ‘delay until the obstetrician is no longer uncertain’. The data monitoring and analysis were Bayesian.
Main outcome measures ‘Survival to hospital discharge’ and ‘developmental quotient at two years of age’, this latter to be reported later.
Results Of 548 women (588 babies) recruited, outcomes were available on 547 mothers (587 babies). The median time‐to‐delivery intervals were 0.9 days in the immediate group and 4.9 days in the delay group. Total deaths prior to discharge were 29 (10%) in the immediate group versus 27 (9%) in the delay group (odds ratio 1.1, 95% CI 0.61–1.8). Total caesarean sections were 249 (91%) in the immediate group versus 217 (79%) in the delay group: (OR 2.7; 95% CI 1.6–4.5). These odds ratios were similar for those randomised at gestational ages above or below 30 weeks.
Interpretation The lack of difference in overall mortality suggests that clinicians participating in this trial were on average prepared to randomise at about the correct equivocal threshold between delivery and delay. However, there was insufficient evidence to convince enthusiasts for either immediate or delayed delivery that they were wrong.
Context: California is one of eight states that allow a woman to obtain emergency contraceptives from a pharmacy without a physician prescription. Because many women do not know about emergency ...contraception or direct pharmacy access, it is important to understand barriers to getting the method and women's reasons for choosing the pharmacy option. Methods: In a 2004 survey at 25 predominantly independent pharmacies across California that offered pharmacy access, 426 women completed questionnaires after obtaining emergency contraceptives. They were asked about their reasons for seeking the method, the time of unprotected intercourse, barriers to access, how they learned about pharmacy access and their reasons for choosing it. Chi-square tests and analysis of variance were used to assess differences between subgroups. Results: Eighty-six percent of women wanted emergency contraceptives for immediate use, and women obtained the method an average of 36 hours after unprotected intercourse. Those younger than 16, those who had had unprotected sex on the weekend and those who were embarrassed to ask for the method or who did not know about it all took a longer time to get the medication than did their respective comparison groups. Women who chose pharmacy access did so because they thought it was faster (54%) and more convenient (47%) than seeking a physician prescription. The majority reported that talking to a pharmacist was very helpful (84%) and that it was very important to be able to get the method directly from a pharmacy (81%). Conclusions: Increasing women's knowledge about emergency contraception and its availability directly from pharmacies has the potential to improve the effectiveness of this contraceptive method by reducing the time interval between unprotected intercourse and initiation of treatment.
The FDA report on intraocular lenses Stark, W J; Worthen, D M; Holladay, J T ...
Ophthalmology (Rochester, Minn.)
90, Številka:
4
Journal Article
Recenzirano
Clinical studies of intraocular lenses (IOLs) as investigational devices have been regulated in the United States by the Food and Drug Administration (FDA) since February 9, 1978. As of August 1982, ...data have been collected on more than one million IOLs implanted. During the last 12 months of the study, 409,000 IOLs were implanted. Visual acuity of 20/40 or better at one year after surgery was present in 85% of over 45,000 cases reviewed. Increasing patient age, surgical problems, postoperative complications, and adverse reactions were factors that reduced the visual acuity. The current trend in the USA is for implantation of the posterior chamber and anterior chamber IOLs.
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