Subcutaneous emphysema and hypercarbia as a complication of laparoscopic procedure: case report.

Subcutaneous emphysema (SE) is a rare complication of laparoscopic procedures, with an incidence rate of only 0.43-2.3%. In this report, we present a case of a 28-year-old male who underwent an elective laparoscopic inguinal hernia repair and developed surgical emphysema, hypercarbia and respiratory acidosis intraoperatively. Based on our findings, we concluded that regardless of the low incidence of SE, awareness of the associated risk factors should be ensured to avoid laparoscopic procedure-related complications.

Proximal contact tightness of class â ¡ bulk-fill composite resin restorations: An in vitro study.

This study investigated the effect of bulk-fill composites on proximal contact tightness (PCT) of composite restorations using different matrix systems. 150/standardized-MO-ivorine cavity preparations were divided into 5 groups; Smart Dentin Replacement (SDR), SonicFill (SF), Tetric EvoCeram Bulk-Fill (TEB), G-ænial Universal Flo (GF) and Tetric EvoCeram (TE). Each group was subdivided into 3 sub-groups (n=10); Dixieland band in Tofflemire retainer, FenderMate and Palodent plus matrix systems. PCT was measured 24 h post-curing using Tooth Pressure Meter. PCT means were calculated and statistically-analyzed using ANOVA and Tukey's post-hoc test (p<0.05). Means and SD of PCT for Tofflemire subgroup were: 1.75(0.13), 3.21(0.1), 3.06(0.19), 2.49(0.21) and 3.18(0.1) for (SDR), (SF), (TEB), (GF) and (TE), respectively. Using FenderMate, values were: 1.87(0.08), 3.35(0.12), 3.17(0.16), 2.64(0.1) and 3.26(0.11) for (SDR), (SF), (TEB), (GF) and (TE), respectively, while with Palodentplus; 3.16(0.17), 4.23(0.11), 4.1(0.1), 3.46(0.17) and 3.98(0.1) for (SDR), (SF), (TEB), (GF) and (TE), respectively. ANOVA revealed significant differences (p<0.05) between all samples except between (SF), (TEB) and (TE) and also significant difference between Palodentplus and two subgroups. Effect of bulk-fill composites on PCT is material dependent. Separation ring is recommended for proper PCT.

An observational study of the fresh frozen plasma: red blood cell ratio in postpartum hemorrhage.

BACKGROUND: Postpartum hemorrhage is the leading cause of maternal death worldwide. Recent data from trauma patients and patients with hemorrhagic shock have suggested that an increased fresh frozen plasma:red blood cell (FFP:RBC) ratio may be of benefit in massive bleeding. We addressed this issue in cases of severe postpartum hemorrhage. METHODS: We reviewed data from all patients diagnosed with severe postpartum hemorrhage during a 4-year period (2006-2009). Patients who were treated with sulprostone and required transfusion within 6 hours of delivery were included in the study and were divided into 2 groups according to their response to sulprostone: bleeding controlled with sulprostone alone (sulprostone group) and bleeding requiring an additional advanced interventional procedure including arterial angiographic embolization and/or surgical procedures (arterial ligation, B-Lynch suture, or hysterectomy; intervention group). The requirement or no requirement for advanced procedures constituted the primary end point of the study. Propensity scoring was used to assess the effect of a high FFP:RBC ratio on bleeding control. RESULTS: Among 12,226 deliveries during the study period, 142 (1.1%) were complicated by severe postpartum hemorrhage. Bleeding was controlled with sulprostone alone in 90 patients (63%). Advanced interventional procedures were required for 52 patients (37%). Forty-one patients were transfused with both RBCs and FFP. The FFP:RBC ratio increased over the study period (P < 0.001), from 1:1.8 at the start to 1:1.1 at the end of the study period. After propensity score modeling (inverse probability of treatment weighting), a high FFP:RBC ratio was associated with lower odds for advanced interventional procedures (odds ratio [95% confidence interval], 1.25 [1.07-1.47]; P = 0.008). There were no deaths, severe organ dysfunction, or other complications as a consequence of severe postpartum hemorrhage. CONCLUSIONS: In this retrospective study, a higher FFP:RBC ratio was associated with a lower requirement for advanced interventional procedures in the setting of postpartum hemorrhage. The benefits of transfusion using a higher FFP:RBC ratio should be confirmed by randomized-controlled trials.