Phytochemical profile, antioxidant and cytotoxic potential of Parkinsonia aculeata L. growing in Saudi Arabia.

Parkinsonia aculeata L. growing in Saudi Arabia was investigated for its phytochemical profile, antioxidant, and cytotoxic properties. UPLC-ESI-MS/MS was employed as a powerful technique for the characterization of secondary metabolites from a hydroalcoholic extract, dichloromethane, and ethyl acetate fractions of P. aculeata L. aerial parts. Sixty-nine compounds (flavonoids, anthocyanins, phenolics and fatty acids) were detected and characterized; flavonoids were the abundant components in the analyzed samples. The dichloromethane fraction was rich in phenolics as vanillic acid hexoside, flavonols as 3,7-dimthylquercetin, and flavones as 3'-hydroxymelanettin. However, the ethyl acetate fraction was rich in flavonoid-C-glycosides as luteolin-8-C-ß-D-glucoside (orientin) and apigenin-8-C-glucoside (vitexin), flavonoid- O, C-diglycosides such as luteolin 7-O-[6''-dihydrogalloyl]-glucosyl-8-C-pentosyl-(1 → 2)-glucoside and 2''-O-rhamnosyl isoorientin. These compounds were identified for the first time in dichloromethane and ethyl acetate fractions of Saudi P. aculeata L. Additionally, all the samples were assessed for antioxidant activity using DPPH radical scavenging method and for cytotoxic activity through MTT assay. Accordingly, the most active fraction was the ethyl acetate which showed the highest antioxidant activity (SC50 = 57.4 ±â€¯1.2 µg/mL) compared with the positive control, ascorbic acid (SC50 = 12.4 ±â€¯0.5 µg/mL) and moderate cytotoxicity against HepG-2 (hepatocellular carcinoma) and MCF-7 (breast carcinoma) cell lines with IC50 = 56.9 ±â€¯3.1 and 95.8 ±â€¯3.8 µg/mL, respectively compared with cisplatin (IC50 = 3.67 ±â€¯0.22 and 5.71 ±â€¯0.57 µg/mL, respectively for both cell lines). The antioxidant and cytotoxic activities may be attributed to the presence of high percentage of phenolic compounds and hydroxylated flavonoids detected in ethyl acetate fraction using UPLS-ESI-MS/MS.

Phytochemical analysis and anti-diabetic, anti-inflammatory and antioxidant activities of Loranthus acaciae Zucc. Grown in Saudi Arabia.

The Loranthus genus has been demonstrated to be used in the treatment of wide range of diseases e.g. diabetes, inflammations and cancers. Many species of Loranthus represent a major source of biologically active constituents. Therefore, our study was carried out to investigate the anti-diabetic, anti-inflammatory and antioxidant effects of Loranthus acaciae Zucc. (Loranthaceae) grown in Saudi Arabia. Moreover, our research concerned the guided-fractionation and isolation of possible active compounds from this species. The crude ethanolic extract and its n-hexane, chloroform and n-butanol fractions were investigated for antidiabetic activity utilizing two methods namely, in alloxan-induced diabetic rats and glucose tolerance test in normal rats. Additionally, the anti-inflammatory activity was studied by the carrageenan-induced rat paw oedema method while DPPH free radical scavenging and ß-carotene bleaching assays were utilized to determine the antioxidant activity. Various chromatographic and spectroscopic techniques were utilized for the isolation and characterization of the active compounds. Our results exhibited that the crude extract and chloroform fraction has the greatest hypoglycemic and antidiabetic effects. The chloroform fraction and crude extract produced at a dose of 500 mg/kg a significant hypoglycemic effect in diabetic rats with 47.0 and 33.6% reduction in blood sugar levels and in normoglycemic rats 35.6 and 35.4% respectively. A potent anti-inflammatory effect (67.2% at 500 mg/kg) was detected for the chloroform fraction. In addition, the chloroform fraction exhibited a high antioxidative and DPPH-radical inhibitory activity (85.4 and 88.3% respectively). The phytochemical analysis of L. acaciae led to the isolation and characterization of four compounds namely, quercetin 3-O-ß-D-glucopyranoside (compound 1), quercetin 3-O-ß-(6-O-galloyl)-glucopyranoside (compound 2), (-) catechin (compound 3), and catechin 7-O-gallate (compound 4). Among these compounds quercetin 3-O-ß-D- glucopyranoside, quercetin 3-O-ß-(6-O-galloyl)-glucopyranoside and catechin 7-O-gallate, are isolated for the first time from this plant.

Benchmarking of venous thromboembolism prophylaxis practice with ENT.UK guidelines.

The aim of this study was to benchmark our guidelines of prevention of venous thromboembolism (VTE) in ENT surgical population against ENT.UK guidelines, and also to encourage healthcare providers to utilize benchmarking as an effective method of improving performance. The study design is prospective descriptive analysis. The setting of this study is tertiary referral centre (Assir Central Hospital, Abha, Saudi Arabia). In this study, we are benchmarking our practice guidelines of the prevention of VTE in the ENT surgical population against that of ENT.UK guidelines to mitigate any gaps. ENT guidelines 2010 were downloaded from the ENT.UK Website. Our guidelines were compared with the possibilities that either our performance meets or fall short of ENT.UK guidelines. Immediate corrective actions will take place if there is quality chasm between the two guidelines. ENT.UK guidelines are evidence-based and updated which may serve as role-model for adoption and benchmarking. Our guidelines were accordingly amended to contain all factors required in providing a quality service to ENT surgical patients. While not given appropriate attention, benchmarking is a useful tool in improving quality of health care. It allows learning from others' practices and experiences, and works towards closing any quality gaps. In addition, benchmarking clinical outcomes is critical for quality improvement and informing decisions concerning service provision. It is recommended to be included on the list of quality improvement methods of healthcare services.

Choanal Atresia Repair With Stents and Flaps: A Systematic Review Article.

BACKGROUND: Choanal Atresia is an obliteration by an atretic plate of the posterior choanae due to a failure of the bucconasal membrane to rupture. The insertion of stents post choanal atresia repair is familiar. Still, there are limited studies in the literature that specify the time to remove it, the best materials, and the effectiveness of each kind. OBJECTIVE: Our study aims to compare different types of choanal atresia stents and flaps and the outcome of different kinds of stents and flaps that use post-operatively. Also, to assess the risk of restenosis post-operatively with varying types of Stent and flaps. METHODS: A systematic review via databases for different types of stents and flaps used in choanal atresia, including 31 studies with precise technique, variety of stents, restenosis rates, and risk factors (unilaterality, the component of the atretic plate). And about 10 different approaches to flaps reconstruction were mentioned. RESULTS: According to the data, we observed a successful rate of choanal atresia repair by using the ordinary ETT post-operatively ranged from 28 to 94.2%, which could be explained due to many factors. Post-operative Instructions on care and suctioning provided a good impact. Other types of stents found in case series like steroid eluting stents, Nelaton catheters, Silastic stents, or modified ETT have a promising future during 26 to 39 weeks follow-up. Still, they need further studies with randomization and more data. Flaps with different approaches and techniques showed promising results and fewer complication rates with or without stents, also now have been used in practice providing suitable alternatives for stents. CONCLUSION: The original types of choanal atresia stents were shown to have a wide variety of results, while innovative materials of stents showed promising results, however, in relatively small case studies. Flaps were now used in practice giving other choices for stents with fewer complications, better healing, and new choana formation.

Incidence of perioperative cardiac arrest: analysis of anesthetics over 18-year period.

OBJECTIVE: Several studies have surveyed perioperative cardiac arrests and their outcomes, regardless of whether patients were successfully resuscitated or died. No such studies have originated from the Kingdom of Saudi Arabia. This is a study of perioperative cardiac arrests and their outcome in a Saudi General Hospital, over an 18-year period. METHODS: Armed Forces Hospital, Wadi Al-Dawasir, Kingdom of Saudi Arabia, serves military personnel and their families, in addition to eligible civilian members of the community. Operating theaters' records were examined to collect details of patients who underwent some form of surgical procedure since the commission of the Hospital on 12.07.1992 up until 30.09.2010. Those surgical cases were traced in the Medical Records Department and the outcome of each case was reviewed. The numbers and causes of cardiac arrests and death occurring during the intraoperative and within the first postoperative 24 hours, were noted. RESULTS: There were 15,832 patients received anesthesia during the 18-year period. Five patients died during this period (an incidence of 0.03%), all were emergency cases and were due to non-anesthetic causes; four of them died intraoperatively and the fifth died within the first 24 hour postoperatively. CONCLUSION: There were 5 non-anesthetic deaths in the perioperative period during the 18-year period. The absence of anesthesia-related cardiac arrests in such patient population has demonstrated that adopting quality improvement measures, teamwork approach and applying strict, but updated and evidence-based, guidelines are essential in the prevention of such catastrophes. A multicentre similar survey is needed to include all types of surgical operations.

Foreign bodies in otorhinolaryngology. Management and outcome.

OBJECTIVES: To analyze the data of patients with otorhinolaryngological foreign bodies and to evaluate the management and outcomes of foreign bodies to prevent complications. METHODS: A retrospective study was conducted over 8 years at Aseer Central Hospital to examine all admitted cases with foreign bodies in the ear, nose, throat, esophagus and bronchus during the period from January 2011 to January 2019. Patient demographic data, type of foreign body, and most common site were analyzed. RESULTS: A total of 184 patients were admitted, including 72 (39.1%) males and 112 (60.9%) females. The age range was from one year old to 70 years old; the mean±standard deviation of age was 10.6±12.55 years. Foreign bodies were most commonly located in the esophagus (n=97, 52.7%), followed by the bronchus (n=55, 29.9%). A statistically significant difference was found, with a p-value of 0.00001. The most common site in children was the bronchus (n=39, 21%); the most common site in adults was the esophagus (n=18, 72%). CONCLUSION: Otorhinolaryngological foreign bodies are found most frequently in preschool-aged children. The most common site in children was the bronchus, and the most common site in adults was the esophagus. Prevention measures are essential to reduce the risk of ingestion and admission, which can be challenging.

Benchmarking of World Health Organization surgical safety checklist.

OBJECTIVE: To compare the quality of our services with the World Health Organization (WHO) surgical safety recommendations as a reference, to improve our services if they fall short of that of the WHO, and to publish our additional standards, so that they may be included in future revision of WHO checklist. METHODS: We conducted this study on 15th July 2008 at the Armed Forces Hospital, Wadi Al-Dawasir, Kingdom of Saudi Arabia. We compared each WHO safety standard item with its corresponding standard in our checklist. There were 4 possibilities for the comparison: that our performance meet, was less than or exceeded the quality-of-care measures in the WHO checklist, or that there are additional safety measures in either checklist that need to be considered by each party. RESULTS: Since its introduction in 1997, our checklist was applied to 11828 patients and resulted in error-free outcomes. Benchmarking proved that our surgical safety performance does not only match the standards of the WHO surgical safety checklist ,but also exceeds it in other safety areas (for example measures to prevent perioperative hypothermia and venous thromboembolism). CONCLUSION: Benchmarking is a continuous quality improvement process aimed at providing the best available at the time in healthcare, and we recommend its adoption by healthcare providers. The WHO surgical safety checklist is a bold step in the right direction towards safer surgical outcomes. Feedback from other medical establishments should be encouraged.

Intubation-induced tracheal stenosis -- the urgent need for permanent solution.

The most common site for the occurrence of intubation-induced tracheal damage is at the area in contact with the inflatable cuff. After the change from high-pressure to low-pressure cuffs, major tracheal lesions still continue to occur. This is a case of tracheal stenosis that occurred after 7 days of intubation with standard cuffed tube whose cuff pressure was assessed by subjective means. Three weeks later, patient was in need of reintubation, the trachea was found to be stenotic at the site of the previous tube cuff. Emergency tracheostomy had to be performed and computed axial tomography (CT) confirmed the tracheal stenosis. A month later, the patient had another cardiac arrest from which he did not recover. Our message in this report is to throw light and alert clinicians involved in tracheal intubation, of the presence of the Lanz endotracheal tube whose pilot balloon is designed to automatically regulate the intra-cuff pressure and thus prevent the occurrence of tracheal stenosis due to high pressure. We strongly recommend the presence of Lanz tracheal tubes as standard emergency equipment in intensive care settings and in any situation in which cuff pressure is likely to increase.

Myringoplasty outcome. Five-year experience at a tertiary teaching hospital.

OBJECTIVES: To assess the outcome of a myringoplasty procedure during a 5-year period at a tertiary teaching hospital in Abha, Kingdom of Saudi Arabia. METHODS: All patients with chronic suppurative otitis media (CSOM) who underwent elective myringoplasty between August 2012 and February  2018 were included in the study. Patients were investigated preoperatively and postoperatively by pure tone audiometry (PTA). The patients' demographic data were collected together with the surgical outcome. Postoperatively, patients were followed at the first week, at 6 weeks and then every 3 months, thereafter for one year. RESULTS: A total of 67 myringoplasty procedures were performed during the period of study. There were 41 females and 26 males, and they had an age range of 16-60 years and a mean age of 32.37±12.95 years. Preoperative PTA indicated that 58 (86.6%) patients had a hearing gap greater than 20 dB. However, after surgery, only 9 (13.4%) patients remained with hearing gaps greater than 20 dB. The success rate of graft stability at the end of one year was 94% with significant difference p=0.0001. However, one patient of the 4 patients with failed graft stability demonstrated graft atrophy, and the remaining 3 developed graft infection. Conclusion: Myringoplasty remains a useful technique for the management of CSOM. However, it depends on the surgeon's skills and expertise and on the site of perforation. The success rate of myringoplasty in this study was comparable with that of the quoted literature.

Could post-thyroidectomy bleeding be the clue to modify the concept of postoperative drainage? A prospective randomized controlled study.

BACKGROUND/OBJECTIVE: To unveil the real effect of surgical drains on the outcomes of thyroidectomy for benign thyroid disorders. METHODS: A prospective randomized study was conducted at Abha Private Hospital, Saudi Arabia on 108 patients suffered from benign thyroid disorders undergoing elective thyroidectomy from 1 August 2015 to 28 February 2017. Patients were allocated randomly into drainage group (A) and non-drainage group (B). The demographic data, operation (type and duration), postoperative complications, histopathological results and length of stay were assessed, documented and statistically verified to check its significance. RESULTS: A total of 108 patients were enrolled in the study; 94 females and 14 males with mean age of 38.02 years, two patients developed hematoma (1.85%); one in each group and another two patients had seroma with no significant difference between both groups, the mean length of stay was significantly higher in group (A) (p = 0.001). CONCLUSION: This prospective study verified that routine drainage adds no significant advantage in the prevention of post-thyroidectomy bleeding, but it prolongs hospitalization. This aids in changing the concept from the "wide" use of drains into the "wise" use in selected patients with risk factors of bleeding.

Rates, Causes, and Reduction of 30-Day Readmissions of Otolaryngology-Head and Neck Surgical Cases.

OBJECTIVES: The aim of this study was to determine risk factors associated with 30-day readmission for patients undergoing inpatient otolaryngologic head and neck surgery. STUDY DESIGN: Retrospective cohort study analysis. SETTING: Study at 2 tertiary hospitals. METHODS: A 10-year retrospective cohort analysis was performed for 30-day readmissions of otolaryngology surgical cases between July 1, 2006, and June 30, 2016, at Assir Central Hospital and Abha Private Hospital. Data included total number of patients, type of surgical procedure, number of and reasons for readmissions, and length of hospital stay. RESULTS: There were 32,662 discharges for otolaryngology operations over the 10-year period of the study, of which 364 patients were readmitted, giving a rate of 11.14 readmissions per 1000 operative procedures (95% CI, 10.1-12.3). The male:female ratio was 1.4:1. Period of postoperative stay ranged from 1 to 3 days and, after readmission, 2 to 5 days. The main reasons for readmission were bleeding in otolaryngologic cases and wound hematoma in head and neck surgical cases. Overall readmission rates dropped significantly from 12.72 per 1000 operative procedures in the first 5 years to 10.16 in the second 5 years. CONCLUSIONS: This study helped to establish special policies and procedures to prevent readmission by utilizing best practices, including addressing quality care, using preadmission clinics, preventing surgical site infection, and improving communication with community physicians. Plans based on these results also include the development of national model for predicting readmission within 30 days of discharge.

The Surgical Safety Checklist: Results of Implementation in Otorhinolaryngology.

OBJECTIVES: To assess the impact of implementing the surgical safety checklist (SSCL) on the outcome of patient safety in otorhinolaryngology (ENT) surgical procedures in two hospitals in Saudi Arabia: Aseer Central and Abha Private Hospitals. METHODS: This retrospective study conducted over seven years (1 July 2008 to 30 June 2015) followed a staff educational and training program for the implementation of the World Health Organization Surgical Safety Checklist (WHO SSCL). The program included the use of audiovisual aids and practical demonstrations. Incidents of non-compliance were treated as sentinel events and were audited by the process of root cause analysis. RESULTS: There were 5 144 elective ENT surgical cases in both hospitals in which the SSCL was utilized over the seven-year study period. The average compliance rate was 96.5%. Reasons for non-compliance included staff shortage, fast staff turnover, excessive workload, communication problems, and presence of existing processes. CONCLUSIONS: The implementation of the SSCL was a substantial leap in efforts towards ensuring surgical patients' safety. It is compulsory in the healthcare system in many countries. Such progress in healthcare improvement can be accomplished with the commitment of the operating suite staff by spending few moments checking facts and establishing an environment of teamwork for the benefit of the surgical patient.

Quality improvement in anesthetic practice--incidence of sore throat after using small tracheal tube.

BACKGROUND AND OBJECTIVE: Sore throat following surgery is common and is due to multitude of factors. The highest incidence of sore throat tends to occur in patients who have undergone tracheal intubation. Between 14.4% to 50% of intubated patients complain of sore throat and hoarseness in the immediate postoperative period, 3% of them are still hoarse after a week. This contributes to higher incidence of postoperative morbidity and patient dissatisfaction of the service. A prospective study was conducted to demonstrate the incidence of hoarseness and sore throat following the use of small tracheal tubes. METHODS: Adult patients, 16 years old and above, presented for tonsillectomy, nasal surgery and/or for functional endoscopic sinus surgery (FESS) were included in the study. Patients who had signs of, common cold were excluded from the study. Size 7-7.5 mm cuffed tracheal tube was used in males and size 6-6.5 mm in females. Patients were asked during 24 hours postoperatively about the presence of hoarseness of voice and of their satisfaction of the service. RESULTS: There were 1618 patients 883 males and 735 females, ages: 16-62 yrs included in the study between February 2000 and end of May 2003. 189 (11.7%) developed postoperative hoarseness of voice and 1429 (88.3%) did not have hoarseness or sore throat (P = 0.0001). Patient satisfaction was 95%. CONCLUSIONS: The use of small tube in intubating the trachea, together with other measures such as lubricating the tube with water soluble jelly, careful airway instrumentation, intubation only when patient was fully relaxed, careful suctioning technique, and extubation when the tracheal tube cuff was fully deflated, have dramatic effects on minimizing the incidence of postoperative hoarseness and sore throat. Accordingly, patient satisfaction has been reported to be high.

The Dental Solid Waste Management in Different Categories of Dental Laboratories in Abha City, Saudi Arabia.

AIM: To study the awareness, attitude, practice and facilities among the different categories of dental laboratories in Abha city. MATERIALS AND METHODS: A total of 80 dental technicians were surveyed in the study. The dental laboratories included in the study were teaching institute (Group I), Government Hospital (Group II), Private Dental Clinic (Group III) and Independent laboratory (Group IV). The pre-tested anonymous questionnaire was used to understand knowledge, attitude, facilities, practice and orientation regarding biomedical waste management. RESULTS: The knowledge of biomedical waste categories, colour coding and segregation was better among Group I (55-65%) and Group II (65-75%). The lowest standard of waste disposal was practiced at Group IV (15-20%) and Group III (25-35%). The availability of disposal facilities was poor at Group IV. The continuous education on biomedical waste management lacked in all the Groups. CONCLUSION: The significant improvement in disposal facilities was required at Group III and Group IV laboratories. All dental technicians were in need of regular training of biomedical waste management. CLINICAL SIGNIFICANCE: The dental laboratories are an integral part of dental practice. The dental laboratories are actively involved in the generation, handling and disposal of biomedical waste. Hence, it is important to assess the biomedical waste management knowledge, attitude, facilities and practice among different categories of dental laboratories.

Choanal atresia repair. The use of reinforced silicone tube to prevent restenosis.

There are different approaches for the repair of congenital choanal atresia. A stent is usually inserted in the nostrils to prevent restenosis. We describe a case of an infant who was presented with recurrent choanal stenosis and was managed by a stent made of reinforced silicone rubber tracheal tube. The tube has several advantages over other known stents.

Incidence of intraoperative hypothermia. Adopting protocol for its prevention.

OBJECTIVE: To determine the incidence of hypothermia during surgical procedures when adequate methods of preserving normothermia are applied. METHODS: A prospective study in which patients ASA I-IV presented for surgery at the Armed Forces Hospital, Wadi Al-Dawasir, Kingdom of Saudi Arabia during the period from July 2000 until February 2003, in whom body core temperature was between 35-37 degree, were included. Ambient temperature of the operating room was thermostatically adjusted to record 26 degree and 24 degree if patients were less than 10 year-old or above. Depending on type of surgery; the patients were provided with space blankets and were lying on warm mattresses. Fluid or blood warmers and forced-air surface warming were used when needed. RESULTS: There were 3886 surgical patients operated upon during the period of the study. Their average age was 34.5 years (range 15 days to 104 years). Sixty patients (1.54%) developed intraoperative hypothermia (core temperature <35 C) and were admitted to the intensive care unit for monitoring and gradual rewarming. There was no mortality amongst them. Out of those 60 patients, 17 (28.3%) expressed dissatisfaction on this part of the service, but the overall patient's satisfaction scored 99.6%. CONCLUSION: Aggressive measures must be adopted to preserve normothermia as prevention of intraoperative hypothermia improves patient's outcome. All patients should have their core body temperature monitored during surgery. However, application of available methods of keeping normothermia reduces the incidence of intraoperative hypothermia but does not abolish it completely. Hypothermic patients should be closely monitored during gradual rewarming, preferably in the intensive care setting. A protocol for prevention of intraoperative hypothermia must be adopted by all operating theaters.

Awareness during surgery.

OBJECTIVE: Patients who experience awareness under surgery may suffer from the post-traumatic stress disorder with its long-lasting psychological damage. Furthermore, there are also media attention and legal consequences. In spite of understanding its causes, it is still occurring worldwide and there are no reports of awareness in the Saudi medical literature. This prospective study was conducted to determine the incidence of awareness when its causes are eliminated and to record patient satisfaction. METHODS: Surgical patients >4 years old (ASA I-III) admitted to the Armed Forces Hospital, Wadi Al-Dawasir, Kingdom of Saudi Arabia, between October 1998 and November 2002 were included in the study. Patients were given a premedicant with an amnesic effect. Anesthetic equipment with a built-in end-tidal anesthetic gas monitor was checked preoperatively. Minimal anesthetic concentrations of vapors were delivered and monitored. Intraoperative analgesia was provided whenever appropriate. Patients were closely observed for signs of intraoperative awareness under general anesthesia. All patients were interviewed within 24 hours postoperatively on the occurrence of awareness and service satisfaction. RESULTS: There were 4368 patients admitted to the study. Their ages ranged from 14-104 years (mean 40.2 years). All patients were interviewed in the postoperative period. There was no report of awareness during surgery and patient satisfaction score was 100%. CONCLUSION: Preoperative and intraoperative anesthetic attention to patients presented for surgery, together with the use of modern anesthetic delivery units possessing facilities for monitoring anesthetic gases, and the provision of good analgesia are the most important combination in eliminating awareness during surgery.

Primary endoscopic dacryocystorhinostomy with or without silicone tubing: a prospective randomized study.

BACKGROUND: Endoscopic dacryocystorhinostomy (DCR) is an effective surgical procedure to treat saccal and postsaccal stenosis or nasolacrimal duct obstruction. The use of silicone tube after endoscopic DCR is still controversial. A prospective randomized study was conducted to compare the success rate between the use of silicone stent and no use of silicone stent in endoscopic DCR. METHODS: A prospective randomized study was conducted at Aseer Central Hospital and Abha Private Hospital, Abha, Kingdom of Saudi Arabia, on all patients undergoing endoscopic DCR between July 1, 2006 and 30 June 30, 2010. Patients were allocated randomly for endoscopic DCR with or without stent. The data collection included age, sex, diagnosis, method, and duration of surgery. Patients were followed up postoperatively at 1 week, 1 month, and then every 3 months for 1 year. RESULTS: During the period of the study a total of 173 cases of postsaccal stenosis underwent endoscopic DCR (67 male and 106 female subjects). The mean age was 51.8 years (range, 18-72 years). A stent was used in 92 patients (53.2%) and not used in 81 patients (46.8%). With silicone tubing the success rate was 96%, and without silicone tubing it was 91%, an overall success rate of 94%. The odds ratio of failure without a silicone tube was 3.25 but confidence interval was from 0.84 to 12.60 and the difference between these two groups was statistically not significant (p = 0.117). CONCLUSION: In this study, there was no statistically significant advantage of using endoscopic DCR with stent over the endoscopic DCR without stent.

Post-tonsillectomy hemorrhage. Monopolar microdissection needle versus cold dissection.

OBJECTIVE: To compare the rate, severity, need for intervention, and blood transfusion requirement in post-tonsillectomy bleeding following the use of either cold dissection or the monopolar microdissection needle method. METHODS: A prospective randomized study conducted at Abha Private Hospital, Abha, Kingdom of Saudi Arabia, on patients undergoing tonsillectomy between June 2006 and December 2010. Patients were allocated randomly by using cold dissection or monopolar microdissection techniques. Collected information included demographic data, method, duration of surgery, and estimated blood loss. Timing of bleeding and management were recorded. RESULTS: A total of 1419 patients underwent tonsillectomy, 634 male and 785 female with mean age of 14.8 years (range 2-48 years). Cold dissection was used in 674 patients and monopolar microdissection needle in 745 patients. Mean surgical time in the cold dissection group was 7 minutes (range 3.5-15 minutes), while in the monopolar microdissection group was 3.2 minutes (range 2.2-9.5 minutes). Twenty-seven patients developed post-tonsillectomy bleeding (rate of 1.9%); 21 (3.1%) from the cold dissection and 6 (0.8%) from the monopolar microdissection group, (p<0.001). All patients were hospitalized. Eleven patients; 9 from the cold dissection group and 2 following monopolar microdissection, underwent surgical intervention to stop bleeding. No patient received blood transfusion. CONCLUSION: Patients underwent tonsillectomy using the monopolar microdissection (Colorado needle) had statistically significant less post-tonsillectomy bleeding rate and severity compared with those using the cold dissection method.