Use of a novel drape 'tent' as an infection prevention control measure for mastoid surgery.

BACKGROUND: Mastoid surgery is an aerosol-generating procedure that involves the use of a high-speed drill, which produces a mixture of water, bone, blood and tissue that may contain the viable coronavirus disease 2019 pathogen. This potentially puts the surgeon and other operating theatre personnel at risk of acquiring the severe acute respiratory syndrome coronavirus-2 from contact with droplets or aerosols. The use of an additional drape designed to limit the spread of droplets and aerosols has been described; such drapes include the 'Southampton Tent' and 'OtoTent'. OBJECTIVES: To evaluate the use of a novel drape 'tent' that has advantages over established 'tent' designs in terms of having: (1) a CE marking; (2) no requirement for modification during assembly; and (3) no obstruction to the surgical visual field. RESULTS AND CONCLUSION: During mastoid surgery, the dispersion of macroscopic droplets and other particulate matter was confined within the novel drape 'tent'. Use of this drape 'tent' had no adverse effects upon the surgeon's manual dexterity or efficiency, the view of the surgical field, or the sterility. Hence, our findings support its use during mastoid surgery in the coronavirus disease 2019 era.

Natural history of carotid artery disease on the side contralateral to endarterectomy.

The natural history of the nonoperated carotid artery opposite an endarterectomy was examined in 134 patients by means of ultrasonic duplex scanning over a period extending to 48 months. None of the nine deaths that occurred during follow-up was stroke related. A total of 22 arteries showed progression of disease over this period. By life-table analysis the mean annual rate of progression for all categories of disease was 12.6% and 7.4% for progression to a diameter reduction greater than 50%. Disease progression was more rapid in patients under 65 years of age. Symptoms occurred in 13 patients for an overall incidence of 10% and a mean annual rate estimated at 5%. All symptoms indicated transient ischemic attacks; there were no strokes. There was a strong relationship between the development of symptoms and stenoses greater than 80% either at the initial examination or secondary to progression. No correlation was found between the presence of bruits or their change over time and the progression or appearance of symptoms. Conservative management of nonoperated vessels opposite an endarterectomy appears appropriate until symptoms develop or a lesion greater than 80% is detected.