The use of a classification system for temporal bone fractures that emphasizes violation or lack of violation of the otic capsule seems to offer the advantage of radiographic utility and stratification of clinical severity, including severity of Glasgow Coma Scale scores and intracranial complications such as subarachnoid hemorrhage and epidural hematoma.
To evaluate the surgical technique, cosmetic results, and complications of patients who underwent a midface-lift via a minimal-incision brow-lift performed by the senior author (E.F.W.).
Without any increase in complications, subjective and objective measurement showed that the use of the microdissection needle resulted in significantly less postoperative pain by day 3.
Spondyloepiphyseal dysplasia is a disorder characterized by abnormalities of growth. Previous studies of this disorder have identified a significant incidence of associated hearing loss. Hearing loss has been reported to occur in 25 to 30% of affected patients. To date, all reports of associated hearing loss have indicated the presence of a sensorineural component. In this article, we report the case of a child who was diagnosed with spondyloepiphyseal dysplasia congenita and who was found to have a significant conductive hearing loss with a Carhart's notch, indicating the likely presence of stapes footplate fixation. We also review the diagnosis of this condition and the literature associated with hearing loss as it occurs with this disorder.
Operations without sepsis remain an unfulfilled goal since the introduction of antisepsis by Lister who made it a realistic objective. 1 Wound infection accounts for nearly one-fourth of the total number of nosocomial infections. 2 Even though the complete elimination of wound infection is not possible, a reduction of the wound infection rate to a minimum level could have marked benefits in terms of both patient comfort and resources used.
METHODSA total of 120 patients were randomized into two groups of 60 each. Controls Group A received single dose intravenous ceftriaxone (1 gm), whereas test Group B received intra-incisional ceftriaxone given subcutaneously along the incision line preoperatively with single dose intravenous ceftriaxone (1 gm). Patients in both groups received routine post-operative antibiotics in dirty, clean contaminated and contaminated cases. An intraoperative swab was taken and sent to Department of Microbiology where they inoculated in Blood agar and MacConkey's medium. The patients were seen on daily basis till the day of discharge from the hospital and followed up as outpatient basis once a week for 30 days. Discharge from patient's wound were collected and sent to Department of Microbiology for processing.
RESULTSThe rate of surgical site infection was more in Group A than Group B (25% vs. 8.33%). In Group B no cases of SSI was found in clean, clean contaminated and dirty group and 5 cases of SSI out of 24 were found in contaminated cases (20.83%), whereas in Group A all wound class had SSI. Among the organisms cultured from various swabs taken, there was predominance of E. coli (75%).
CONCLUSIONPre-operative intra-incisional antibiotics reduce the rate of SSI in all wound classes. The higher concentration achieved at the incision site by the intra-incisional route theoretically makes it a better mode of administering prophylactic antibiotics.
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