Medication safety: does intravenous acetaminophen promote perioperative hypothermia for total hip arthroplasty?

As an effective antipyretic with a yet-unknown mechanism-of-action, intravenous (IV) acetaminophen use for total hip arthroplasties (THA) may worsen perioperative hypothermia when combined with the known hypothermia-inducing effects of general anesthesia (GA), affecting wound healing, recovery times, and patient satisfaction. This retrospective chart review of primary THA cases compared perioperative heat loss for patients who received IV acetaminophen with GA (group A, n = 74) to those receiving GA alone (group B, n = 197). All patients received forced-air warming blankets. Neuraxial anesthesia cases were excluded. No significant temperature differences existed between group A (-0.33°C, SD = 0.36) and group B (-0.30°C, SD = 0.34, P > 0.05). IV acetaminophen use for THA does not appear to promote hypothermia under general anesthesia.

UV-A Collagen Cross-Linking Treatment of Bullous Keratopathy Combined With Corneal Ulcer.

PURPOSE: To evaluate the therapeutic effect of corneal cross-linking (CXL) in 2 cases of bullous keratopathy combined with corneal ulcer. METHODS: Two patients (2 eyes) were recruited for the sake of the study. Both suffered from bullous keratopathy and presented a gradually deteriorating, vision-threatening, central corneal ulcer, despite intense local antibiotic therapy. The same surgical procedure was performed in both eyes. De-epithelialization of the affected corneas was accompanied by UV-A cross-linking and finally by the application of a therapeutic contact lens. Local antibiotic therapy was resumed after the procedure. RESULTS: Within 24 hours of the treatment, both patients reported significant subjective improvement of their visual acuity and ocular discomfort. Clinical evaluation revealed improvement of the corneal ulcer and the bullous keratopathy associated with significant decrease of the corneal thickness and haziness. During the 2-month follow-up period, a significant improvement of visual acuity was recorded in both cases. CONCLUSION: CXL should be considered as a potential adjuvant therapeutic tool in patients with combined bullous keratopathy and infectious keratitis, who are resistant to traditional topical therapy.

Retinal nerve fiber layer thickness in patients with exfoliation, exfoliative glaucoma, and primary open angle glaucoma.

PURPOSE: to evaluate the retinal nerve fiber layer(RNFL) profile of healthy controls, persons with exfoliation syndrome (XFS), and patients with exfoliation glaucoma (XFG) and primary open angle glaucoma(POAG). METHODS: One eye from each of 269 participants was analyzed. Fifty eyes were normal , 45 eyes had XFS, 89 eyes had POAG, and 89 had XFG. Glaucoma patients were divided according to the severity of the disease into mild and advanced groups. All participants underwent imaging with the GDx-VCC device. Measurements of the parameters TSNIT average, TSNIT SD, and nerve fiber indicator (NFI) were performed. Polametric RNFL thickness values were compared by means of Bonferroni-corrected t-tests. RESULTS: Regarding control and glaucoma groups, statistically significant differences were identified in all GDx parameters. RNFL thickness values of the control group differed significantly from the values of the XFS group. There was no statistically significant difference between RNFL thickness values for the mild POAG and mild XFG groups or for the advanced POAG and advanced XFG groups. CONCLUSIONS: Polarimetry-determined RNFL in eyes with XFS is thinner than that of healthy eyes. No differences in RNFL thickness were found when eyes with POAG and XFG of similar severity were compared.