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In 1980, postlaryngectomy voice and speech rehabilitation was revolutionized with the introduction of a surgical-prosthetic method termed tracheoesophageal puncture (TEP) voice restoration (Singer & Blom, 1980). This approach to voice [...], Purpose: The literature on postlaryngectomy voice and speech rehabilitation is long-standing. Although multiple rehabilitation options have existed over the years, the acquisition and use of esophageal speech (ES) has decreased significantly over the past 40 years. This reduction coincides with the increased application of tracheoesophageal puncture (TEP) voice restoration. The literature suggests that voice acquisition failures observed secondary to TEP may represent a similar phenomenon that led to ES acquisition failures. Method: A comprehensive review of the literature on ES and TEP voice/speech was conducted. Specific attention was directed toward information on ES and TEP speech failures. Information on pharyngoesophageal segment (PES) spasm in the context of ES and TEP voicing failures was of specific importance. Results: Similarities between voicing failures with both ES and TEP were identified. In order to resolve spasm in TEP speech, proactive efforts to eliminate it were undertaken, and regardless of the method used, voicing improvements were observed. These data suggest that both ES and TEP speech acquisition failures may be related to the same control mechanisms influencing the PES. Conclusions: The elimination of PES spasm provides evidence that justifies the reconsideration of ES. Consequently, ES may return as an increasingly viable postlaryngectomy voice and speech rehabilitation option.

Author(s): Ch Rama Krishna Prasad [1]; A. Chaitanya Pratyusha (corresponding author) [2]; Chaganti Sharmila [3]; Padmaja Durga [3]; K Sowjanya [3]; Kandala Harika [3] INTRODUCTION Residual neuromuscular block continues to [...], Background and Aims: Residual neuromuscular block continues to be a significant postoperative complication despite neuromuscular monitoring. This study aims to determine the applicability of a hand-held forced dynamometer for hand grip strength assessment as an objective measure of residual muscle weakness. Methods: The study included patients undergoing surgery under general anaesthesia. A demonstration was given to the patient on the usage of a dynamometer for handgrip strength and a peak expiratory flow meter for peak expiratory flow rate (PEFR) and baseline values were recorded. The parameters were monitored at 15 minutes post-extubation and again at intervals of 15 minutes until one hour, half-hourly until four hours, and hourly until six hours post-operatively. Paired t-test was used for comparison of baseline muscle strength and PEFR with the parameters at different time points. Association between muscle strength and PEFR was tested with the Pearson-correlation test. Results: Muscle strength was 50 to 60, 75 and 100 of baseline at 15, 45 and 210 minutes after extubation, respectively. PEFR was 50 to 60, 75 and 100 of baseline at 15, 60 and 180 minutes after extubation. The Pearson-correlation test established a positive correlation between handgrip strength and PEFR (correlation-coefficient 0.86). Conclusion: A significant reduction in the postoperative muscle strength can be detected using an objective forced dynamometer to measure handgrip strength even when train of four count has returned to unity and even when there are no clinical signs of muscle weakness. The residual muscle weakness is significant enough to affect the PEFR in the postoperative period. Keywords: Hand grip strength, neuromuscular monitoring, peak expiratory flow rate, residual muscle weakness, residual neuromuscular block

Author(s): Jan Waskowski [sup.1] , Joerg C. Schefold [sup.1] , Carmen A. Pfortmueller [sup.1] , Martin Müller [sup.2] , Benjamin Hess [sup.1] , Patrick Zuercher [sup.1] Author Affiliations: Dear Editor, [...]

Approximately 26 000 Canadians experience hip fractures each year, (1) with just under 4500 cases per year requiring hemiarthroplasty. (2) We know from multiple studies that hip fractures carry a [...], Background: Tranexamic acid (TXA) has been shown to reduce perioperative blood loss in elective orthopedic surgery. The safety of intravenous TXA in nonelective hip fracture surgery is uncertain. The purpose of this study was to evaluate the efficacy and safety of topical TXA in hip fracture surgery. Methods: Adult patients presenting to a community hospital with a hip fracture requiring surgery were randomly assigned to receive topical TXA or placebo. Hemoglobin and troponin I levels were measured preoperatively and on postoperative days 1, 2 and 3. All postoperative blood transfusions were recorded. Complications, including acute coronary syndrome (ACS), venous thromboembolism (VTE), cerebrovascular accidents (CVA), surgical site infections (SSI) and 90-day mortality, were recorded. Results: Data were analyzed for 65 patients (31 in the TXA group, 34 in the control group). Hemogloblin level was significantly higher on postoperative days 1 and 2 in the TXA group than in the control group. The difference in hemoglobin level between the groups was not statistically significant by postoperative day 3. Significantly fewer units of packed red blood cells were transfused in the TXA group (2 units v. 8 units); however, 2 of the units in the control group were given intraoperatively, and when these were excluded the difference was not significant. The incidence of ACS, CVA, VTE, SSI, transfusion and all-cause mortality at 90 days did not differ significantly between the groups. Conclusion: Topical TXA reduces early postoperative blood loss after hip fracture surgery without increased patient risk. Trial registration: Clinicaltrials.gov, no. NCT02993341. Contexte: L'acide tranexamique (TXA) a permis de reduire les pertes sanguines perioperatoires lors de chirurgies orthopediques non urgentes. On ne connait pas pre-cisement l'innocuite du TXA lors de chirurgies urgentes pour fracture de la hanche. Cette etude avait pour but d'evaluer l'efficacite et l'innocuite du TXA topique lors de chirurgies pour fracture de la hanche. Methodes: Des patients adultes ayant consulte dans un hopital communautaire pour une fracture de la hanche necessitant une chirurgie ont ete assignes aleatoirement soit au TXA topique, soit a un placebo. Les taux d'hemoglobine et de troponine I ont ete mesures avant, puis 1, 2 et 3 jours apres l'intervention. Toutes les transfusions sanguines ont ete consignees, ainsi que les complications, telles que le syndrome corona-rien aigu (SCA), la thromboembolie veineuse (TEV), l'accident vasculaire cerebral (AVC), l'infection de la plaie operatoire et la mortalite a 90 jours. Resultats: Les donnees ont ete analysees pour 65 patients (31 dans le groupe sous TXA et 34 dans le groupe temoin). Le taux d'hemoglobine etait significativement plus eleve aux jours postoperatoires 1 et 2 dans le groupe sous TXA que dans le groupe temoin. La difference de taux d'hemoglobine entre les groupes n'etait plus statistique-ment significative au 3 (e) jour postoperatoire. Un nombre significativement moindre d'unites de culots globulaires ont ete administrees dans le groupe TXA (2 unites c. 8 unites); par contre, 2 des unites dans le groupe temoin ont ete administre pendant l'intervention, et lorsqu'elles ont ete exclues, la difference n'etait plus significative. L'incidence des SCA, des AVC, des TEV, des infections de plaies, des transfusions et de la mortalite de toute cause a 90 jours n'a pas ete significativement differente entre les 2 groupes. Conclusion: Le TXA topique reduit les pertes sanguines durant la periode post-operatoire immediate apres la chirurgie pour fracture de la hanche, sans exposer les patients a un risque accru. Numero d'enregistrement de la recherche: ClinicalTrials.gov, no. NCT02993341.

Hospital readmission following major surgery is common and expensive and can serve as a marker for quality of care provided. In 2004, nearly 1 in 5 Medicare beneficiaries were readmitted [...], Background: Rates of hospital readmission following surgery can serve as a marker for quality of care. The aim of this study was to establish the rates and causes of readmission and emergency department visits after vascular surgery and to understand how these patients are managed. Methods: We conducted a prospective observational cohort study including all in patients who underwent major vascular surgery between September 2015 and June 2016 at a tertiary vascular care centre in Toronto. Patients were followed at 30 days after discharge via telephone interview. Results: We enrolled 133 patients (94 men [70.7%] and 39 women [29.3%] with a mean age of 65.3 years). The most common index admission diagnosis was peripheral artery disease (67 patients [50.4%]). At 30 days, 19 patients (14.8%) had been readmitted or had visited the emergency department, most commonly after lower extremity revascularization (19.4%). Ten patients were readmitted a mean of 16.8 days following discharge; surgical site infection was the most common cause for readmission (3 patients). The most common treatment was antimicrobial therapy (4 patients). The mean hospital length of stay was 14.4 days. Nine patients presented to the emergency department a mean of 10.6 days after discharge; 6 reported a wound issue, and most (6 of 9) were managed with oral antibiotic treatment. Conclusion: Early readmission/emergency department visits after lower extremity revascularization surgery in patients with peripheral artery disease are common and are often due to surgical site infection or wound-related issues. Follow-up within 7-10 days and a specialized wound care team may help reduce the occurrence of these events. Contexte : Les taux de readmission a l'hopital apres une chirurgie peuvent servir d'indicateur de la qualite des soins. L'etude visait a determiner les taux et les causes de readmissions et de visites a l'urgence chez les patients ayant subi une chirurgie vasculaire et a etudier la facon dont ces patients etaient pris en charge. Methodes : Nous avons mene une etude de cohorte observationnelle prospective portant sur tous les patients qui ont ete hospitalises pour une importante chirurgie vasculaire entre septembre 2015 et juin 2016 dans un centre de soins tertiaires vasculaires a Toronto. Nous avons fait un suivi telephonique aupres de ces patients 30 jours apres leur conge. Resultats : Nous avons recrute 133 patients (94 hommes [70,7 %] et 39 femmes [29,3 %] dont l'age moyen etait de 65,3 ans). Le diagnostic le plus courant a l'admission initiale etait la maladie arterielle peripherique (67 patients [50,4 %]). A 30 jours, 19 patients (14,8 %) avaient ete rehospitalises ou s'etaient presentes a l'urgence; la plupart avaient initialement subi une revascularisation des membres inferieurs (19,4 %). Dix patients ont ete rehospitalises en moyenne 16,8 jours apres leur conge; l'infection du site operatoire etait la cause la plus courante de readmission (3 patients). Le traitement le plus courant chez les patients rehospitalises etait le traite ment antimicrobien (4 patients). La duree mediane des sejours a l'hopital etait de 14,4 jours. Neuf patients se sont presentes a l'urgence en moyenne 10,6 jours apres leur conge; 6 ont signale un probleme avec leur plaie, et la majorite (6 des 9 patients) ont recu une antibiotherapie orale. Conclusion : Les readmissions ou les visites a l'urgence de patients atteints d'une maladie arterielle peripherique peu apres une chirurgie de revascularisation des membres inferieurs sont courantes et souvent attribuables a une infection du site operatoire ou a des problemes associes a la plaie. Un suivi apres 7 a 10 jours ainsi que les services d'une equipe specialisee en soin des plaies pourraient contribuer a reduire la frequence de ce type d'evenement.

Surgical site infections (SSIs) are a common complication after surgical procedures and have substantial associated health care costs. (1) The SSI bundle--simultaneous implementation of a variety of quality improvements --has [...], Surgical site infections (SSI) are a common complication after surgical procedures. To reduce the incidence of SSIs, Oakville Trafalgar Memorial Hospital decided to institute a bundle of initiatives to change multiple factors simultaneously based on best available evidence and the understanding of infection pathophysiology. We used National Surgical Quality Improvement Program data on the incidence of SSIs in our targeted and essentials, general surgery and orthopedic surgery cases before and after the implementation of an SSI reduction bundle. This article discusses whether the use of intervention bundles may assist in the reduction of a variety of postoperative surgical complications.