RESUMO
A retrospective case-control study was performed to characterize the rate of missed follow-up appointments after facial trauma and identify associated risk factors.Follow-up appointments for facial trauma over a 3-month period at a single, safety net hospital were analyzed. Appointment-specific, sociodemographic, trauma, and management data were compared between cases (missed appointments) and controls (attended appointments). Univariate testing and multivariable logistic regression were employed.A total of 116 cases and 259 controls were identified, yielding a missed appointment rate of 30.9% (116/375). Missed appointments were significantly associated with initial clinic appointments compared to return visits (odds ratio [OR] 2.21 [1.38-3.54]), afternoon visits compared to morning (OR 3.14 [1.94-5.07]), lack of private health insurance (OR 2.91 [1.68-5.18]), and presence of midface fractures (OR 2.04 [1.28-3.27]). Missed appointments were negatively associated with mandible fractures (OR 0.56 [0.35-0.89]), surgical management (OR 0.48 [0.30-0.77]), and the presence of nonremovable hardware (OR 0.39 [0.23-0.64]). Upon multivariable logistic regression, missed appointments remained independently associated with afternoon visits (adjusted OR [aOR] 1.95 [1.12-3.4]), lack of private health insurance (aOR 2.73 [1.55-4.8]), and midface fractures (aOR 2.09 [1.21-3.59]).Nearly one-third of facial trauma patients missed follow-up appointments, with the greatest risk among those with afternoon appointments, lacking private health insurance, and with midface fractures.
RESUMO
Merkel cell carcinoma (MCC) is a cutaneous cancer often found on sun-exposed areas. MCC is rare but very often lethal making early diagnosis challenging although critical. There are only a few cases that have reported MCC of the eyelid making it often hard to identify in clinic. A 52-year-old woman with a firm nodule on the left eyelid was diagnosed with MCC that had also metastasized to a left submandibular lymph node. She underwent surgical excision of the mass and lymph node as well as parotid gland and neck dissection to rule out other metastases and then underwent radiation therapy. The aim of this study is to report a case of eyelid MCC with metastasis to a local lymph node to provide another example of the rare cancer in hopes that diagnosis and treatment options for MCC are more thoroughly studied and understood.
RESUMO
The aim of this study was to assess whether transversus abdominis plane (TAP) blocks can be utilized to decrease patient pain scores and narcotic use during the first 24 h following robot-assisted laparoscopic prostatectomy (RALP). 100 patients received a TAP block with a mixture of 1.3% liposomal bupivacaine, 0.5% Marcaine and 0.9% NaCl prior to RALP. This was in addition to an already established pain management regiment, which included preoperative PO acetaminophen (650 mg), celecoxib (200 mg), and tolterodine ER (4 mg). These patients were prospectively followed and then retrospectively compared to a 1:1 propensity matched group of 100 patients that did not receive a TAP but did receive the preoperative PO medications. Pain scores were assessed on a scale from 1-10 in the PACU, as well as the surgical floor at 8, 16, and 24-h post-surgery. Intra-/post-operative narcotic use and time to ambulation following arrival to the surgical floor were also analyzed. Patient receiving TAP blocks had immediate post-op pain scores of 2.23 vs 4.26 for those not receiving TAP blocks (p = 0.000). The pain scores at 8, 16, and 24 h for TAP patients were 2.68, 2.62, and 2.62 as compared to 2.89, 2.87, and 3.36 for non-TAP patients. The difference was statistically significant for immediate and 24-h pain scores (p = 0.000, 0.001, respectively). On average, TAP block patients ambulated faster than non-TAP patients, 2.68 vs 4.91 h (p = 0.000). Intra-operative narcotic use was decreased in the TAP group for each of the opioids that were used: fentanyl 177.5 vs 205mcg (p = 0.001), morphine 5.5 vs 10 mg (p = 0.000), and hydromorphone 0.75 vs 1.75 mg (p = 0.001). Narcotic usage in the PACU was limited to hydromorphone and TAP patients used 0.7 mg compared to 1.36 mg (p = 0.003) for non-TAP patients. Oral oxycodone/acetaminophen (5 mg/325 mg) was used for pain control on the surgical floor and on average TAP patients received less, 2.4 vs 5 tabs (p = 0.000). Average time to perform the TAP block was 3.5 min and total OR time for TAP vs non-TAP patients was 107.41 vs 106.58 min (p = 0.386). TAP blocks as part of a perioperative pain management protocol can be utilized during RALPs to decrease patient pain scores at two different time intervals, immediately post-operative and 24 h after surgery. Patients also ambulate sooner following surgery and require a decreased amount of narcotics during the intra-operative and post-operative periods. TAP blocks are quick, effective, and do not add a significant amount of OR time to RALPs.