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A case with a marked family history of Leukonychia Totalis is described. [ABSTRACT FROM PUBLISHER]

Objective To determine the effect of penicillin on pain in untreated teeth diagnosed as having irreversible pulpitis. Design Double-blind randomised controlled trial. Intervention Forty emergency patients who had a clinical diagnosis of an irreversible pulpitis randomly received a 7-day oral dose (500 mg every 6 h) of either penicillin or placebo in a double-blind manner. No endodontic treatment was performed until 7 days later. Each patient also received ibuprofen and acetaminophen with codeine (30 mg). All patients completed the trial (0% drop-out). Patients were advised to use acetaminophen with codeine only if ibuprofen did not relieve pain. Outcome measures Patient-assessed pain, percussion pain, and number and type of pain medication taken. At 7 days teeth were pulp-tested and the presence or absence of vital tissue confirmed by clinicians on endodontic access. Results Penicillin did not significantly (P>0.05) reduce pain, percussion pain or the number of analgesics taken by patients who had untreated irreversible pulpitis. The majority of patients with untreated irreversible pulpitis had significant pain and required analgesics to manage this pain. Three quarters of the teeth tested in the penicillin group, and 80% of the teeth tested in placebo group, were vital. None of the teeth was cariously exposed clinically. Conclusions Penicillin should not be prescribed for untreated irreversible pulpitis because penicillin is ineffective for pain relief. Many teeth with untreated irreversible pulpitis remain symptomatic for at least a week. [ABSTRACT FROM AUTHOR]

The authors measured the impact of educational efforts on the number of college students who received meningococcal vaccine. First-year Brown University students from the classes of 2004 (n = 1,562) and 2005 (n = 1,518) received educational vaccine materials before they arrived on campus, whereas students from the class of 2003 (n = 1.441) did not. Students in the class of 2003, 13% (n = 184) of whom had received vaccine before their arrival on campus, served as the baseline. These educational efforts by the college health services before students arrived on campus increased the number of students immunized before campus arrival to 46% (n = 724) for the class of 2004, and 60% (n = 913) for the class of 2005. Education about the benefits of meningococcal vaccine before students' arrival on campus increased both the number of immunized students and the overall immunization rate among students. [ABSTRACT FROM AUTHOR]

Aim: New stoma patients often rely heavily on the assistance of the ward nursing staff during the hospital stay and on the availability of home nursing care services (HNCS) after discharge. An easily executable 4‐day in‐hospital educational stoma pathway was developed and implemented. The aim was to increase their level of independence (LOI) in order to reduce the need for HNCS after discharge. Method : All new stoma patients on the gastrointestinal surgery ward, physically and psychologically capable of performing independent stoma care (SC), were enrolled in this pathway. They were compared to a retrospective control group of new stoma patients before the onset of the stoma pathway. The primary outcome is the need and frequency of HNCS for SC at the moment of discharge. Secondary outcome is the LOI in SC at discharge. Results: A total of 145 patients [m:f = 102:43, median age 67 (range 27–90) years] were included in the present study. Patients requiring daily HNCS for SC decreased from 80% to 50%, P < 0.001; patients discharged without HNCS for SC increased from 5% to 27%. Patients' independence in SC at discharge increased from 8% to 68%, P < 0.001. Conclusion: This study shows that a clinical 4‐day in‐hospital educational stoma pathway is feasible and effective in increasing the LOI in SC of new stoma patients and significantly reducing their need for HNCS. Cost–benefit analysis and applicability of this pathway in multicentre settings are currently being investigated. [ABSTRACT FROM AUTHOR]

Aim: Surgical site infection in colorectal surgery is associated with significant healthcare costs, which may be reduced by using a closed‐incision negative‐pressure therapy device. The aim of this study was to assess the impact of closed‐incision negative‐pressure therapy on the incidence of surgical site infection. Method: In this retrospective cohort study we evaluated all patients who had undergone high‐risk open colorectal surgery at a single tertiary care centre from 2012 to 2016. We compared the incidence of surgical site infection between those receiving standard postoperative wound care between 2012 and 2014 and those receiving closed‐incision negative‐pressure therapy via a customizable device (Prevena Incision Management System, KCI, an Acelity company, San Antonio, Texas, USA) between 2014 and 2016. A validated surgical site infection risk score was used to create a 1:1 matched cohort subset. Results: Negative pressure therapy was used in 77 patients and compared with 238 controls. Negative pressure patients were more likely to have a stoma (92% vs 48%, P < 0.01) and to be smokers (33% vs 15%, P < 0.01). Surgical site infection was higher in control patients (15%, n = 35/238) compared with negative pressure patients (7%, n = 5/77) (P = 0.05). On regression analysis, negative pressure therapy was associated with decreased surgical site infection (OR 0.27; 95% CI 0.09–0.78). These differences persisted in the matched analysis. Conclusion: Negative pressure therapy was associated with decreased surgical site infection. Negative pressure therapy offers significant potential for quality improvement. [ABSTRACT FROM AUTHOR]

Carcinoembryonic antigen (CEA) is recommended as a serologic marker to monitor colorectal carcinoma recurrence. Elevations of CEA due to causes other than carcinoma exist and may lead to a misdiagnosis of recurrent carcinoma. We report a case of bowel sequestration with mucocele formation at the site of previous colocolic anastomosis causing a mild elevation in CEA. The patient exhibited increasing CEA levels 6 years after resection of a sigmoid colon carcinoma with end-to-end anastomosis. Subsequently, computed tomographic and positron emission tomographic scans documented the presence of a cystic mass showing increased uptake at the anastomotic site. At exploratory laparotomy a mass lesion with mucus-filled protrusions was resected. Pathologic examination documented the presence of sequestration of a segment of the bowel wall with a mucocele and no overlying defect at the mucosal anastomotic site by demonstrating the presence of all bowel layers. After resection of the lesion, the CEA level normalized. [ABSTRACT FROM AUTHOR]