Comparison of enhanced recovery protocol with conventional care in patients undergoing urogynecological surgery.

OBJECTIVE: The impact of enhanced recovery after surgery (ERAS) protocol on postoperative outcomes after urogynecological surgery is yet to be a matter of investigation. This study sought to evaluate this issue by comparing the patients who had conventional or ERAS--guided perioperative care for several clinical end-points including ambulation, length of hospital stay (LOS), readmissions, and postoperative complications. MATERIALS AND METHODS: A total of 121 patients undergoing pelvic organ prolapse surgery were allocated to two study arms, ERAS protocol (Group E) or conventional care (Group C). Variables reflecting the restoration of appetite and bowel movements, bleeding events, other complications, LOS and readmissions were compared between the groups. RESULTS: The patients in Group C significantly received a more intensive intravenous fluid treatment compared to Group E (2,760 ± 656 vs. 1,045 ± 218 mL, P < 0.001). Time required for first flatus, first defecation, eating solid food, and ambulation (P < 0.001) were also longer in the former group of patients. Moreover, LOS was significantly reduced when the ERAS protocol was applied (2.5 ± 1.1 vs. 2.0 ± 0.6 days, P < 0.001). On the other hand, the two groups were similar with respect to the frequency of the postoperative complications, including surgical site infections, cardiovascular complications, non-specific abdominal pain, sub-ileus, blood loss and readmission rate. CONCLUSION: In our sample population, ERAS protocol led to early initiation of oral intake, early recovery of bowel function, early mobilization, and early discharge of patients without compromise in safety concerns after urogynecological surgery.

The role of video-based multimedia information in reduction of anxiety before dilatation and curettage.

OBJECTIVE: Considerable amount of women undergoing dilatation and curettage (D&C) are subject to preoperative anxiety. We hypothesized that the implementation of video-based multimedia information (MMI) before the D&C might facilitate patients' education and provide clear information regarding the procedure. This study aimed to compare the impact of video-based MMI and conventional written information on anxiety, pain severity, and satisfaction in patients undergoing D&C. METHODS: Seventy four women scheduled for D&C for abnormal uterine bleeding were enrolled in this prospective randomized study. Subjects were assigned to receive a video-based MMI or conventional written information (controls). The trait and state anxiety were assessed using the State and Trait Anxiety Inventory (STAI) before the MMI or written information. STAI-state (STAI-S) was repeated after the application of the MMI or written information. All patients underwent D&C by the same gynecologist. Following D&C, patient satisfaction and procedural pain were ranked using a Likert scale and Visual Analogue Scale. RESULTS: Post-informational STAI-S score was significantly lower than the pre-informational STAI-S score in the video group (p<0.001), whereas no significant change occurred in STAI-S score in the control group (p=0.210). The satisfaction rate of the patients receiving MMI before the D&C was significantly higher than the satisfaction rate of the controls (75% vs. 50%, p=0.027). CONCLUSION: Implementation of MMI before the D&C procedure is associated with less anxiety, less severe postoperative pain and improved patients satisfaction, compared to the conventional written information.

Anaesthesia-Related Internet Search: A Survey with Turkish Participants.

OBJECTIVE: The Internet may facilitate active participation of the patient in specifying the priorities of disease management and improve rehearsal for awaiting interventions. In this study, we sought to assess the relationship of Internet use with the anaesthesia-related variables. METHODS: A 15-question survey was formed involving questions about demographics, Internet use habits and awareness of the planned interventions. A previous online search for anaesthesia and topics of search were specifically asked. Searching for anaesthesia on the Internet was determined as the primary end-point. RESULTS: One-hundred and fifty-seven patients (41.1 6 14.4 years, 63.1% female) responded to our survey. The ratio of the participants who had previous experience of anaesthesia was 62.4%. Seventy-nine percent of the subjects had an Internet access frequency of couple of times a week or more often. However, only 39.5% (n » 49) of those specifically searched about anaesthesia on the Internet. Individuals who searched for anaesthesia on the Internet were younger and used to be online everyday. Regional anaesthesia was more frequently preferred method in this group. However, previously discussed anaesthesia issues with the surgeon were designated as the only closely associated variable of the primary end-point (OR » 0.25, 95% CI [0.102-0.616], P » .003). CONCLUSION: Possibly due to local cultural myths, our participants were more eager to get answers to their concerns about anaesthesia when compared with their counterparts in previous reports. Although Internet search habits played a role in this sense, the entity of "online search for anaesthesia" was closely associated only with having the surgeons' ideas about anaesthesia procedure.

A rare tumor of trachea: Inflammatory myofibroblastic tumor diagnosis and endoscopic treatment.

Inflammatory myofibroblastic tumors (IMTs) are rare childhood neoplasms, with benign clinical course. Although etiology of IMTs are not clear, recent studies have reported that IMT is a true neoplasm rather than a reactive or inflammatory lesion. IMTs are rarely seen in adults and tracheal involvement is also rare both in adults and also in children. We describe a 16-year old female patient who was misdiagnosed and treated as asthma in another center for a few months and presented with acute respiratory distress due to upper airway obstruction. Computerized tomography (CT) of the chest and rigid bronchoscopy revealed a mass lesion that was nearly totally obliterating tracheal lumen. Bronchoscopic resection was performed under general anesthesia and the final pathological diagnosis was tracheal IMT.