Minimising trauma in dental extractions: the use of the periotome.
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Humans↗
Biomedical subjects
P J Thomson
Publications and source records attributed to P J Thomson.
Cancelled operations. A current problem in oral and maxillofacial surgery.
Public concern has recently focused on the problem of cancelled operations. In order to investigate the extent of oral and maxillofacial surgery cancellations, the University of Manchester initiated a 12-month prospective audit of lost operating time. During 1990, 31% of planned operations were cancelled, while nearly 20% of operating lists were lost completely. With the exception of public holidays and theatre maintenance days, the commonest reasons for cancellation included financial cut-backs, nursing staff shortages and failure of patients to attend.
Appointments and Schedules↗
Reducing failure rates for in-patient oral surgery. The use of a pre-admission clinic.
A large proportion of oral and maxillofacial surgery operations are non-urgent, elective procedures. Approximately 30% of patients called for operation from routine waiting lists consistently fail to attend, thus leading to inefficient bed utilisation and wastage of theatre time. In an attempt to reduce patient failure rates and to investigate reasons for non-attendance, the Department of Oral and Maxillofacial Surgery developed a new pre-admission clinic; admission dates for in-patient surgery are only arranged following successful attendance and satisfactory 'clerking in' at the pre-admission clinic. Over an initial 5-month period, in-patient attendance rates increased to 87% and, at the same time, validation of waiting lists was facilitated, with nearly three-quarters of clinic non-attenders eventually being removed from the lists. The pre-admission clinic thus appears to offer a useful and versatile approach towards more efficient in-patient management.
Admitting Department, Hospital↗
A central venous catheter complicating head and neck surgery.
A case is reported of a central venous catheter that was placed inadvertently into the internal jugular vein during the anaesthetic preparation for surgery. The catheter tip was sectioned during surgery and was feared to have embolised into the central circulation but it was subsequently identified in the pathological specimen. A summary of the complications associated with central venous catheterisation is reported and a simple protocol is proposed to avoid a similar complication.
Aged↗
Changes in oxygen saturation using two different sedation techniques.
Pulse oximetry was used to assess the degree of hypoxia observed in patients receiving simple midazolam sedation for removal of lower third molars and compared to that seen in patients receiving a combination sedation technique using nalbuphine and midazolam. Results showed that the degree of hypoxia experienced by patients receiving the combination technique was significantly more profound in both incidence and depth than that seen in the group receiving midazolam alone (p less than 0.05).
Procedural Sedation↗
The effects of sodium ions and potassium ions on glycine uptake by mouse ascites-tumour cells in the presence and absence of selected metabolic inhibitors.
1. The initial rate, v, of glycine uptake by ascites-tumour cells respiring their endogenous nutrient reserves was studied as a function of the respective extracellular concentrations of glycine, Na(+) and K(+). With the extracellular concentration of Na(+)+K(+) constant at 158m-equiv./l. and that of glycine either 4 or 12mm, v tended to zero as the extracellular concentration of Na(+) approached zero. Glycine appeared to enter the cells as a ternary complex with a carrier and Na(+). K(+) competed with Na(+) for one of the carrier sites, whereas glycine was bound at a second site. The values of the five relevant binding constants showed that the two sites interacted. 2. The glycine uptake rate at various extracellular concentrations of glycine and Na(+) was scarcely affected by starving the cells for 30min. in the presence of 2mm-sodium cyanide provided that cellular Na(+) and K(+) contents were kept at the normal values. When the cells took up Na(+), however, v decreased approximately threefold. 3. When their Na(+) content was relatively small and the extracellular concentration of Na(+) was large, the starved cells accumulated glycine in the presence of cyanide for about 15min. Glycine then tended to leave the cells. An average of about 5mumoles of glycine/ml. of cell water was taken up from a 1mm solution, representing about 20% of the accumulation observed during respiration. Studies with fluoride, 2,4-dinitrophenol and other metabolic inhibitors supported the view that ATP and similar compounds were not implicated. The relation between the transient accumulation of glycine that occurred in these circumstances and the normal mode of active transport was not established.
Adenosine Triphosphate↗