Topic usage of kaolin-impregnated gauze as a hemostatic in tonsillectomy.

BACKGROUND: The main postoperative complications after tonsillectomy are due to bleeding, and effective hemostasis may lead to a reduction of overall postoperative morbidity. This study was undertaken to determine the efficacy and safety of a novel kaolin-based hemostatic dressing in tonsillectomy. METHODS: A pilot, single-blind, open label study was performed in patients aged 3-20 y with history of chronic or hypertrophic tonsillitis. Cold dissection tonsillectomy (CDT) + ligature was performed by the same surgeon. Hemostasis on each tonsillar fossa was achieved using kaolin-impregnated gauze (KG; study group) or standard surgical cotton gauze (CG; control). Time to complete hemostasis, operative time, intraoperative blood loss, pain score, analgesic use, and return to normal diet and activity were recorded for all children. RESULTS: A total of 230 patients with a mean age of 8.0 y (138 in the study group and 92 in the control group) were included in the study. Both operative time and intraoperative blood loss were significantly reduced in the KG group (P < 0.0001) versus the CG group. At 5 min, 84.8% patients using the KG successfully achieved complete hemostasis versus 34.8% in the CG group where standard gauze controlled bleeding only partially. Results show significantly less pain for the KG group at 6- and 12-h postoperative when compared with the CG group (P < 0.0001). Also, the KG group required less analgesic medications, returned to normal diet and normal activities faster than the CG group (P < 0.01). CONCLUSIONS: Preliminary findings show that the KG is effective and safe in managing surgical bleeding after tonsillectomy. In addition to rapid bleeding control, the dressing causes minimal inflammation and pain and allows patients to quickly return to normal activities. This novel dressing is a promising tool for ear, nose and throat surgical hemostasis.

[Cochleovestibular dysfunction in patients with diabetes mellitus, hypertension and dyslipidemia]. / Disfuncion cócleo-vestibular en pacientes con diabetes mellitus, hipertensión arterial sistémica y dislipidemia.

INTRODUCTION AND OBJECTIVE: Polygenic or multifactorial inheritance of chronic disorders (MICD) contribute to irreversible cochleovestibular impairment. Our aim was to determine the type and degree of cochleovestibular dysfunction (CVD) in patients with MICD. METHODS: Cross-sectional. We studied 385 patients with type 2 diabetes mellitus, systemic arterial hypertension and dyslipidemia who were referred to Otorhinolaryngology Unit with hearing and vestibular symptoms. The auditory function was evaluated using conventional tonal audiometry and the vestibular function by electronystagmography. Duration of the disease and number of comorbidities, hearing thresholds at 125-8000 Hz pure tones, speech audiometry, oculomotor evaluation and thermal caloric tests were also analysed. RESULTS: A total of 66.7% (95% CI, 61.8-73.4) of patients had 1 comorbidity; 27.7% (95% CI, 23.3-32.5) had 2 and 5.4% (95% CI, 3.4-8.2) had systemic arterial hypertension, diabetes mellitus and dyslipidemia. The mean age was 62 years (SD 12.9) and 57.1% were women. The majority showed obesity, physical inactivity and smoking (77.4%; 95% CI, 72.8-81.4). Cochlear dysfunction was more common than CVD (98.9%; 95% CI, 97.3-99.7 versus 36.1%; 95%CI, 31.2-41.1; P=.001). However, the presence of CVD was significant in patients over 60 years (χ(2)(tend), P≤.001, odds ratio: 6.43) and with MICD ≥11 years old (χ(2)(tend), P≤.001, odds ratio: 4.57). CONCLUSIONS: Cochlear dysfunction occurs in patients with MICD and the impact is greater than that of vestibular dysfunction. However, the age factor, duration and number of MICDs contribute to CVD. It is necessary to act on the MICDs and lifestyles to improve CVD.

Regeneración del nervio ciático axotomizado del perro con prótesis de quitosana precargadas con pregnenolona y la técnica de tubulización / Regeneration of the dog's axotomized sciatic nerve with pregnenolone-saturated chitosan prosthesis implanted through the tubulization technique

Peripheral nerves can be injured by traumatisms or mechanical causes, and thermal, ischemic or tumoral damage, this could present inconveniences of the mobility, sensibility and loss of motor function at the denervated area. The surgical techniques applied to repair nerves have gone through several phases of evolution such as the tubulization technique which consists of a prosthesis with a pipe shape at the segment injured. In this work the biomaterial utilized to manufacture the prosthesis was chitosan, since this compound allows to incorporate to its matrix promoting nervous growing substances that are released in situ for a long time while being degraded by titular lysosomes of organic origin. It is known, by diverse studies, that several neurosteroids are involved during the regeneration process of peripheral nerves, which functions are already described, as pregnenolone. In order to determine if there was or not regeneration and the degree of maturity of this ,12 young French Poodle female dogs of 1 to 1.5 years old were used (four were used as intact control group, four were subjected to tubulization technique with chitosan, and four went into tubulization technique with chitosan and pregnenolone neurosteroid, which is a stem hormone), in order to correct 15 mm of axotomized segment. The regenerated nerves were evaluated by means of electronic microscopy of transmission and light, performing cross cuts of 60-70 nm and 1 urn in thickness for their histological analysis. The morphological findings showed a similar structure to that of an intact nerve, since the number of myelinated axons, not myelinated and the proportion "g" (which indicates the ripening degree of the axon), were similar, indicating that the regeneration of the axotomized nerves and tubulization was achieved, independently of the administered treatment.

Los nervios periféricos se pueden lesionar por traumatismos o causas mecánicas, térmicas, daño isquémico o tumoral, pudiendo presentar trastornos de la movilidad, sensibilidad y pérdida de la función motora en el área denervada. Las técnicas quirúrgicas aplicadas en la reparación nerviosa han pasado a través de varias etapas de evolución, como la técnica de tubulización, que cosiste en usar una prótesis en forma de tubo en el segmento lesionado. En este trabajo se utilizó el biomaterial quitosana para fabricar las prótesis, ya que permite incorporar a su matriz sustancias promotoras del crecimiento nervioso que se liberan de forma prolongada in situ al ser degradado por lisosomas titulares por ser de origen orgánico. Se sabe, por diversos estudios, que en el proceso de regeneración participan diversos neuroesteroides en nervios periféricos, cuyas funciones están ya descritas, como la pregnenolona. Para determinar si había o no regeneración y el grado de madurez de ésta, se utilizaron 12 hembras, adultas jóvenes, de la raza French Poodle, de entre 1 y 1.5 años de edad (cuatro se utilizaron como grupo testigo intacto, cuatro fueron tubulizadas con quitosana, y cuatro se tubulizaron con quitosana y el neuroesteroide pregnenolona, que es una hormona madre), para corregir un segmento de 15 mm que fue axotomizado. Los nervios regenerados se evaluaron mediante microscopía electrónica de transmisión y de luz, efectuando cortes transversales de 60-70 nm y ljim de espesor, para su análisis histológico. Los hallazgos morfológicos evidenciaron una estructura similar a la de un nervio intacto, ya que el número de axones mielinizados, no mielinizados y la proporción "g" (que indica el grado de maduración del axón) fueron semejantes, lo que indica que la regeneración de los nervios axotomizados y tubulizados se logró, independientemente del tratamiento aplicado.