Search

Purpose: To evaluate post-tonsillectomy healing process using combined cold dissection and bipolar cautery for hemostasis. Methods: This case series included patients for whom tonsillectomy was done by cold dissection and limited the bipolar cautery for hemostasis and dealing with the lower pole only. Saline irrigation was used for the tonsillar bed after tonsillectomy and a wet saline-moistened pack was placed into the tonsil fossa. Intra-oral digital photographs were reviewed postoperative, at 3rd, 5th, 7th, 9th, 11th, 13th, 15th, and 21st day after surgery. Patients were asked to register their postoperative pain using a standardized visual analog scale. The time of separation of the healing membrane (HM) and any blood clot and/or bleeding surface were recorded. Results: Among included 114 patients, the HM color was white without odor in all cases. Extension of the HM was limited to the tonsillar bed in 112 patients (98%) and exceeded in 2 patients (2%). The mean time for HM separation was 8.8 ± 1.1 days (range = 7–14) with a significantly longer period of separation in females (p = 0.0008). There was no significant correlation between the time of the HM separation and the age of the patients (P = 0.9). Conclusion: Cold dissection tonsillectomy with limited hot tools usage for hemostasis by bipolar cautery with frequent saline wash leads to odorless HM and a good healing process with an average separation of the HM and so less pain and post-tonsillectomy bleeding. [ABSTRACT FROM AUTHOR]

Aim To elicit the diagnostic value of smaller than expected crown-rump length ( CRL) to predict the occurrence of subsequent miscarriage in women with a viable first trimester pregnancy. Methods A cohort study was conducted in the fetal special care unit of a tertiary care maternity hospital. The recruited participants were young pregnant women at 6-13 weeks of gestation. Transvaginal ultrasonography was performed to determine pregnancy viability and measure the embryonic CRL. To compare the differences in CRL between those pregnancies that remained viable and those that subsequently miscarried, the deviation of observed and expected CRL was calculated and expressed in standard deviations ( SD) as Z score. The primary outcome measure was the percentage of pregnancies with antecedent growth delay that miscarried by the end of the first trimester. Results Of the pregnancies that subsequently miscarried, 79.3% (42/53) had smaller than expected CRL, and in 56.6% (30/53) the CRL was 2 SD or less from that expected for gestational age ( GA). The mean Z score for CRL was significantly lower in pregnancies that subsequently miscarried compared to pregnancies that remained viable (−2.9 ± 2.6 vs −0.8 ± 2.1, respectively, P < 0.001). A CRL of 2 SD or less from that expected for GA as a cut-off point had a sensitivity of 56.6, specificity of 81.9, positive predictive value of 36.6, negative predictive value of 91.1, likelihood ratio positive of 3.1 and likelihood ratio negative of 0.5 in predicting subsequent miscarriage. Conclusion Viable first trimester pregnancies with small for GA CRL were associated with a higher probability of a subsequent miscarriage. [ABSTRACT FROM AUTHOR]