Ultrasound Bronchoscopic a b s t r a c tBackground: The purpose of this study was to evaluate the efficacy of ultrasound guided percutaneous tracheostomy (USPCT) and bronchoscopic guided percutaneous tracheostomy (BPCT) and the incidence of complications in critically ill, obese patients. Methods: Seventy four consecutive patients were included in a prospective study and randomly divided into USPCT and BPCT. Incidence of complications, ease and efficacy were compared in obese USPCT (n ¼ 38)and BPCT (n ¼ 36). Results are expressed as the median (25the75th percentile) or number (percentage). Results: The median times for tracheostomy were 12 min (9e14) in USPCT patients and 18 min (12e21.5) in BPCT (p ¼ 0.05). The overall complication rate was higher in BPCT than USPCT patient group (75% vs. 321%, p < 0.05). Most complications were minor (hypotension, desaturation, tracheal cuff puncture and minor bleeding) and of higher number in the BPCT. Ultrasound-guided PCT was possible in all enrolled patients and there were no surgical conversions or deaths. Conclusions: This study demonstrated that real US-guided PCT is a favourable alternative to BPCT with a low complication rate and ease, thus proving more efficacious. A US examination provides information on cervical anatomy, vasculature etc. and hence modifies and guides choice of the PCT puncture site.
Aim:To assess the association of various clinical parameters and proinflammatory cytokines in the wound-healing process of dental implants with the presence or absence of antibiotic prophylaxis. Materials and methods:The present study included evaluation of early wound-healing process in patients undergoing dental implant placement procedures with and without antibiotic prophylaxis. A total of 50 patients with partial edentulous arch were included in the present study. All the subjects were broadly divided into two study groups depending upon the presence or absence of prophylactic antibiotic therapy, with 25 patients in each group. One group consisted of subjects who were given prophylactic amoxicillin (2 gm), 1 hour before the starting of the surgery, followed by 500 mg 3 times a day for 1 week. Detection of interleukin (IL)-1β and -8 cytokine levels in the gingival crevicular fluid (GCF)/peri-implant crevicular fluid (PICF) was done immediately after the dental surgery. All the results were compiled and analyzed by Statistical Package for the Social Sciences (SPSS) software version 17.0.Results: A significant increase in the PICF IL-1β concentration at postoperative follow-up time was observed in the antibiotic group in comparison with the baseline values. A significant increase in the IL-8 concentration postoperatively in comparison with the baseline values in the antibiotic group was also observed. At the time of surgery, the IL-8 concentrations were statistically lower in the antibiotic group in comparison with the other study group. Concentration of amoxicillin, as observed by high-performance liquid chromatography (HPLC), was lower than the minimum detection levels. Conclusion:Detection of amoxicillin is not feasible within the GCF samples immediately after dental surgery procedure.Clinical significance: Clinical usefulness of prophylactic use of amoxicillin is still doubtful.
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