Revisiting CT Signs of Unilateral Vocal Fold Paralysis: A Single, Blinded Study.

BACKGROUND AND PURPOSE: Several CT findings are thought to be indicative of vocal cord paralysis; however, these signs have never been validated in a blinded fashion. This study attempts to compare and validate these signs and determine their accuracy in predicting vocal cord paralysis. MATERIALS AND METHODS: A retrospective chart review was performed, and CT scans from patients with known unilateral vocal cord paralysis and known normal vocal cord movement were reviewed by 3 radiologists who were blinded to the status of the patients' laryngeal function. The scans were reviewed and scored for 8 accepted signs of vocal cord paralysis as well as for predicting a final diagnostic conclusion. Statistical analysis using odds ratios for signs and the Fleiss κ for criterion agreement among the radiologists was performed for diagnostic accuracy. RESULTS: The presence of medial displacement of the posterior ipsilateral vocal fold margin and ipsilateral laryngeal ventricular dilation yielded the greatest positive predictive value. Other signs demonstrated high specificity, but interrater discrepancy was greater than expected and diminished the reliability of these signs in predicting vocal cord paralysis. Overall, sensitivity and negative predictive values were low. CONCLUSIONS: Predicting vocal cord paralysis on the basis of CT findings is not as accurate or straightforward in prospectively predicting vocal cord paralysis as implied in prior studies.

Ex vivo and in vivo evaluation of residual chlorhexidine gluconate on skin following repetitive exposure to saline and wiping with 2% chlorhexidine gluconate/70% isopropyl alcohol pre-operative skin preparations.

BACKGROUND: Skin antisepsis is performed before surgery to minimize the risk of surgical site infections. Chlorhexidine gluconate (CHG) is routinely used in this application, but it may be removed during surgery when prepped areas are exposed to fluid and repeated blotting. AIM: This work evaluated the effect of adding a film-forming acrylate copolymer to a CHG-containing skin preparation on minimizing CHG loss during a simulated surgical irrigation and wiping procedure. The results were compared with those obtained with a commercially available water-soluble CHG preparation. METHODS: Two studies using excised porcine skin and one study on human volunteers were performed. In each study, the CHG preparations were applied and the treated sites were challenged with repetitive saline soaks and gauze dabbing to simulate surgical conditions. Challenged and unchallenged sites were analysed either for CHG content by high-performance liquid chromatography, or for bacterial log recovery after seeding an indicator organism (reflecting remaining CHG activity). FINDINGS: After irrigation and wiping, skin treated with the film-forming CHG preparation had more CHG remaining both on excised pig skin and in the human model. In the pig model, there was a lower recovery of inoculated bacteria with the CHG preparation containing the film-forming copolymer. No skin irritation or adverse events were reported in the human study. CONCLUSIONS: The addition of a film-forming copolymer has the potential to improve the retention of CHG on skin throughout a surgical procedure compared to a water-soluble preparation. This improved retention may lead to better antimicrobial activity.

Patients with History of Colonoscopy Are Less Likely to Achieve High Quality Preparation After Implementing Split-Dose Bowel Preparation.

BACKGROUND: Anecdotally, we observed that patients who had previous colonoscopies were less likely to follow newly implemented split-dose bowel preparation (SDBP) instructions. We investigated whether the indication for colonoscopy is an independent factor for achieving high quality bowel preparation among patients asked to follow SDBP. METHODS: We performed a retrospective study of data from 1478 patients who received outpatient colonoscopies in 2014 (the year of SDBP implementation) at our Veterans Affairs Medical Center. We collected information related to demographics and factors known to affect bowel preparations. Reasons for colonoscopy were dichotomized into surveillance (previous colonoscopy) vs. non-surveillance (positive occult blood test or screening). Bowel preparation quality was scored using the Boston Bowel Preparation Scale (BBPS), and was categorized as either excellent vs. not excellent (BBPS≥7 vs. BBPS<7), or adequate vs. inadequate (BBPS≥6 vs. BBPS<6). RESULTS: Bowel preparation quality was excellent in 60% of colonoscopies and adequate in 84% of colonoscopies. Thirty-six percent (535) were surveillance colonoscopies. In multivariate logistic regression analysis, more patients in the non-surveillance group achieved excellent (OR 0.8 ; 95% CI [0.7-0.8], P <0.0001) and adequate (OR 0.8 ; 95% CI [0.7-0.9], P <0.006) bowel preparation than did patients in the surveillance group. CONCLUSION: Patients with a prior colonoscopy might not follow the split-dose bowel preparation instructions. Educational interventions emphasizing the benefits of SDBP in this group of patients may help ensure compliance and prevent the habitual use of day-before preparations.