Negative pressure wound therapy for sternal wound infections following congenital heart surgery.

OBJECTIVE: This study examines the efficacy of a comprehensive, multidisciplinary wound management team and negative pressure wound therapy (NPWT) for the treatment of sternal wound infections in congenital heart surgery patients. METHOD: A single-institution retrospective review of all congenital heart surgery patients with post-operative sternal wound infections who were treated with NPWT was performed. Patients were evaluated based on (a) whether NPWT occurred before or after the establishment of a multidisciplinary wound management team, and (b) whether NPWT was initiated early (within 2 days) or late (greater than 2 days) after diagnosis of a sternal wound infection. RESULTS: The median duration of NPWT was 12 days (range 2-50 days). NPWT was successfully initiated in patients as young as 15 days of age. There was a trend toward shorter duration of both NPWT and antibiotic use following (a) the implementation of the multidisciplinary wound management team, and (b) in patients with early use of NPWT; however, these results did not achieve statistical significance. CONCLUSION: NPWT can be successfully utilised in congenital heart surgery patients, including young neonates, for the treatment of sternal wound infections. The trends observed in the reduction of wound therapy duration and antibiotic duration with early implementation of negative pressure therapy and multidisciplinary wound management require further investigation to verify their clinical efficacy in patient care.

The acceptability of transrectal ultrasound guided prostatic biopsy without anaesthesia.

AIM: The suspicion of prostatic adenocarcinoma requires confirmatory biopsy of the prostate. The transrectal ultrasound scanner (TRUS) allows visualisation of the prostate and accurate placement of the biopsy needle. Traditionally this procedure has been performed under general anaesthetic. More recently however, there has been a trend to carry out TRUS and biopsy without anaesthetic. The acceptability of this procedure has never been formally investigated in a New Zealand population. The aim of this study was to determine the acceptability of TRUS and prostatic biopsy without anaesthesia. METHOD: One hundred consecutive patients undergoing TRUS guided prostatic biopsy without anaesthetic were included in the study. The indications for biopsy were an elevated serum prostate-specific antigen or an abnormal gland on digital rectal examination. The procedure was performed by the same surgeon on each occasion, using the same equipment (6 MHz multiplanar transrectal probe with 18 gauge biopsy needle) and standard techniques (left lateral position, sextant biopsies). The patients were contacted by telephone a minimum of three months after the procedure and were asked a set of standardised questions about their experience. RESULTS: Seventy-nine percent of patients found the procedure only slightly, or not at all, uncomfortable. Despite the fact that 21% of the patients would prefer the same technique (no anaesthetic) if they were to require a further biopsy. Those patients who felt that they would prefer a general anaesthetic if they had to have a future biopsy were on average younger and had a significantly higher discomfort score. CONCLUSION: Transrectal ultrasound scanning and biopsy without anaesthetic is well tolerated by New Zealand men.

The tarnished history of a posterior restoration.

Galvanic corrosion is an electrochemical reaction between dissimilar metals that has the potential to cause unpleasant and even painful biological effects intra-orally. A case is presented where a full gold crown underwent galvanic change after being placed in contact with an amalgam restoration.

Transmigration of permanent mandibular canines.

Transmigration is a rare occurrence relating to the movement of a mandibular canine across the mid-line of the mandible. Two cases are presented where patients referred for assessment of third molar problems subsequently revealed on radiological examination the asymptomatic phenomenon of transmigration. With dental panoramic radiography becoming more widespread among dental practitioners it is possible that more cases of transmigration will be observed.