Patients With Atypical Chest Pain: Epidemiology and Reported Consequences.

BACKGROUND: Approximately a quarter of the global population experiences chest pain during their lifetime worldwide. Although largely non-life-threatening, many patients experience mental, physical, social, and financial consequences. AIM: This study aimed to describe and determine the epidemiology and consequences of patients presenting with atypical chest pain (ACP).  Method: Data were obtained from 102 participants, from a desired sample size of 166. The target population was patients who presented with ACP at the Accident and Emergency Department of a Teaching Hospital in Trinidad during a two-year period, from January 2021 to December 2022. The data collection instrument used was a 34-item online questionnaire. Data were analyzed using both descriptive and inferential statistical methods. RESULTS: Participants were predominantly women (63.7%; n = 65), between 31 and 50 years of age (74.5%; n = 76), in full-time employment (n = 58; 56.9%), who lived with at least one person (90.2%; n = 92) at the time of the episode. Overall, 61.8% (n = 63) reported having a stressful life. Hypertension (30.4%; n = 31) and diabetes (18.6%; n = 19) were the leading comorbidities. Participants experienced mild to severe anxiety (53.9%; n = 55), moderate to severe depression (25.5%; n = 26), moderate stress (65.7%; n = 67), and loneliness (25.5%; n = 26). A stressful life was associated with, and was a predictor of, both anxiety and loneliness. No sociodemographic variables were associated with depression or stress. The most common self-reported consequences were "fear as a result of the pain" (68.6%; n = 69), "interruptions to daily life" (60.8%; n = 61), "reduction in time spent on hobbies" (62.7%; n = 63), and costly diagnostic/investigative tests (62.7%; n = 64). The majority of patients (52.9%; n = 53) reported reduced quality of life. The most common treatment prescribed was paracetamol (53.9%; n = 55) and exercise (23.5%; n = 24). CONCLUSION: The study participants were mainly women, 31-50 years old, who had experienced anxiety, stress, or depression. They mainly experienced fear and self-reported a reduced quality of life.

Tisseel to reduce postparotidectomy wound drainage: randomized, prospective, controlled trial.

BACKGROUND: Tisseel (Baxter Corp. Ontario, Canada) is a fibrin-based tissue glue that has been widely used to reduce wound drainage, achieve hemostasis, and decrease surgical complications. To date, Tisseel has not been evaluated in a randomized prospective trial for use in parotid surgery. OBJECTIVES: To determine whether the use of Tisseel in parotidectomy decreases postoperative wound drainage, the duration of percutaneous drainage, the length of hospital stay, and the frequency of complications. METHODS: Sixty consecutive parotidectomy patients were randomized into two groups: a group treated with 2 cc of Tisseel prior to wound closure and a control group. Postoperative wound drainage was measured for all patients by blinded hospital staff. The duration of percutaneous drainage, duration of hospital stay, and incidence of complications at the 3-week follow-up were assessed. RESULTS: A statistically significant difference in total drainage volume (p < .02) and frequency of postoperative seroma (p < .05) was demonstrated between patients treated with Tisseel prior to wound closure and the control group. CONCLUSION: The use of Tisseel in parotidectomy patients prior to wound closure significantly decreases total drainage volume and the frequency of postoperative seroma.

Functional outcomes after primary mandibular resection and reconstruction with the fibular free flap.

OBJECTIVE: This study examined prospectively the functional outcomes of a cohort of patients who have undergone mandibulectomy and primary fibular free flap reconstruction, with particular emphasis on longitudinal comparison of the preoperative function with that in the postoperative and post-radiation therapy time periods. METHODS: Speech and swallowing data were gathered at three evaluation times (preoperatively, pre-radiation therapy, and post-radiation therapy) for patients treated for oral cavity cancer with mandibular resection and reconstruction with a fibular free flap. Single words and sentences were recorded and analyzed for speech intelligibility. Modified barium swallows of liquid, pudding, and cookie consistencies were analyzed and graded for problems in the oral preparatory and oral phase according to the University of Chicago Center for Speech and Swallowing Disorders Oropharyngeal Mobility Data Form. RESULTS: There was no significant difference across any of the evaluation times for single-word or sentence intelligibility. The swallowing data showed no instances of post-treatment aspiration or laryngeal penetration. There were also no significant differences in any of the swallowing parameters across treatment times. CONCLUSIONS: Osteocutaneous fibular free flaps are an excellent reconstructive option for mandibular and floor of the mouth defects.