Surveillance for recurrent stenosis after endovascular procedures. A prospective study.

Eighty-nine endovascular procedures were performed during a 1-year period. Techniques included balloon angioplasty (n = 50), laser-assisted balloon angioplasty (n = 32), and atherectomy (n = 7). Indications were claudication (65.2%), critical ischemia (30.3%), and failing bypass (4.5%). Preoperative evaluation included a history and physical examination, segmental limb pressures, and color duplex ultrasonography. Postoperative surveillance consisted of a history and physical examination, ankle-arm indexes, and color duplex examinations at 1-week, 1-month, and then 3-month intervals. All levels of aortoiliac and infrainguinal disease were treated. Immediate technical success rate was 89.8%. Recurrence rates by life-table analysis reveal a 9-month patency rate of 45.4%. Early results of this prospective study indicate that endovascular procedures are subject to significant restenosis rates. Restraint is advised concerning general acceptance of endovascular procedures pending critical study.

Double-blind comparison of meclofenamate sodium with codeine and placebo for the pain of episiotomy.

Meclofenamate sodium, a nonsteroidal anti-inflammatory agent, was compared at two dose levels (100 mg and 200 mg) with codeine (60 mg) and placebo in a double-blind, randomized study of 218 women after normal vaginal delivery. The purpose was to determine the analgesic efficacy and safety of meclofenamate sodium for the short-term treatment of acute episiotomy pain. Meclofenamate sodium was significantly better than placebo in most measures of pain relief and reduction of pain intensity. The 100-mg dose of meclofenamate sodium was significantly better than codeine in relieving pain. Adverse experiences with the study medications were minimal (6.4%). Patients receiving codeine reported more side effects than did those receiving either dose of meclofenamate sodium. Meclofenamate sodium is a safe, effective analgesic for acute episiotomy pain.

Pain and anxiety with burn dressing changes: patient self-report.

Pain and anxiety are integral parts of burn dressing care. Descriptions of pain and anxiety from the patients' perspectives enhance our understanding of their experiences. This descriptive study measured relationships between self-reported pain and anxiety. Twenty-four patients who had an uncomplicated flame or scald wound reported scores immediately before, immediately after, and 1/2 hour after dressing changes. Results indicated that pain and anxiety increased until day 4. Pain correlated with anxiety. Self-report scores showed that pain and anxiety are perceived by patients in a similar manner. Self-report scores are of great value because they indicate the degree of relief achieved with medication. Through the descriptive study, we found that the pain score immediately after dressing changes was greater than 3 on all study days. This finding indicates a need to further examine the way pain is managed with dressing changes.

Laser assisted balloon angioplasty: bypassing the traditional methods.

No two procedures will be identical as each patient will have different needs. Therefore, knowledge of sizes and limitations of catheters and laser probes is imperative to facilitate the LABA procedure. Advance preparation of the OR suite facilitates the procedure, which can proceed quickly after guidewire passage. Laser safety guidelines must be established and enforced throughout the procedure. A laser nurse, not responsible for circulating the case, should be identified and is responsible for laser safety during the procedure.

The clinical consequences of an industrial aerosol plant explosion.

The factors relating to the clinical outcome of an industrial aerosol plant explosion are reviewed. Eighteen of 24 workers inside the plant required hospitalization and five died. Proximity to the blast was associated with extensive injuries unless workers were shielded by physical barriers or partitions. Burn severity and mortality were increased in those wearing synthetic garments compared to their counterparts wearing fiber clothing. Facial burns occurred in all unprotected workers. Forearm and hand burns in 11 patients required decompressive escharotomies. Topical treatment with silver sulfadiazine was associated with more significant leukopenia and neutropenia than treatment with silver nitrate. We conclude that industrial design should include safeguards which isolate workers from flammable materials, including isolation of explosive materials from working areas, alarm systems to detect leakage of flammable agents, protective barriers and shields, and the regulation and institution of flame and flash-resistant clothing.

Cáncer de ano / Cancer of the anus

Se presenta nuestra experiencia con 21 casos de cáncer de ano. Se establecen consideraciones anatómicas, histológicas y patológicas de la afección. Se describen la incidencia, localización y tratamiento efectuado y los resultados alejados y sobrevida a 5 años. El cáncer de ano se beneficia con nuevos elementos diagnósticos y terapéuticos, lo que se traduce en un importante incremento de los índices de curación en las estadísticas actuales (AU)

Cáncer de ano / Cancer of the anus

Se presenta nuestra experiencia con 21 casos de cáncer de ano. Se establecen consideraciones anatómicas, histológicas y patológicas de la afección. Se describen la incidencia, localización y tratamiento efectuado y los resultados alejados y sobrevida a 5 años. El cáncer de ano se beneficia con nuevos elementos diagnósticos y terapéuticos, lo que se traduce en un importante incremento de los índices de curación en las estadísticas actuales

El cierre del colon con sutura mecánica: uso del instrumento TA 55 / Colonic closure with a mechanical suture using the TA 55 instrument

Se presenta una corta serie de cierre de colostomías laterales y colotomía (13 casos), efectuados con el aparato de sutura lineal TA 55. Los casos corresponden a 10 colostomías transversas y una sigmoide, y a dos colotomías. Las causas de las aberturas colónicas fueron traumatismos, cánceres, enfermedad diverticular y adenomas. Se señala la selección de pacientes en cuanto a colostomías pequeñas y no complicadas. Se describe la técnica empleada. En todos los casos se utilizó el aparato TA 55 que brindó una sutura hermética evertida; no se efectuó segundo plano de sutura. Las complicaciones fueron dos casos con supuración de escasa magnitud. Se comenta la utilidad del método y la limitación de su empleo por el costo actual.(AU)

El cierre del colon con sutura mecánica: uso del instrumento TA 55 / Colonic closure with a mechanical suture using the TA 55 instrument

Se presenta una corta serie de cierre de colostomías laterales y colotomía (13 casos), efectuados con el aparato de sutura lineal TA 55. Los casos corresponden a 10 colostomías transversas y una sigmoide, y a dos colotomías. Las causas de las aberturas colónicas fueron traumatismos, cánceres, enfermedad diverticular y adenomas. Se señala la selección de pacientes en cuanto a colostomías pequeñas y no complicadas. Se describe la técnica empleada. En todos los casos se utilizó el aparato TA 55 que brindó una sutura hermética evertida; no se efectuó segundo plano de sutura. Las complicaciones fueron dos casos con supuración de escasa magnitud. Se comenta la utilidad del método y la limitación de su empleo por el costo actual.