International journal of oral and maxillofacial surgery
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Int J Oral Maxillofac Surg · Jul 2004
Effects of standardized acute normovolemic hemodilution on intraoperative allogeneic blood transfusion in patients undergoing major maxillofacial surgery.
The aim of the present study was to demonstrate the practicality and efficacy of acute normovolemic hemodilution (ANH) to reduce allogeneic red blood cell (RBC) transfusion in patients undergoing elective surgery with anticipated high intraoperative blood loss (BL). 124 patients (age 48 +/- 18 years, ASA classes I-III) underwent major maxillofacial surgery in a university hospital (68% tumor surgery, 32% dysgnathia correction). After induction of general anesthesia, ANH was performed by standardized withdrawal of 900 ml (2 units) of whole blood and simultaneous infusion of 500 ml of hydroxyethyl starch solution (6% HES 130,000/0.4) and 1500 ml of crystalloidal solution. Intraoperative BL was fluid-compensated until physiologic parameters indicated the need for RBC transfusion. ⋯ ANH took 16 +/- 2 min and was void of any adverse event. The costs for ANH was 24 per patient. 55 patients had a mean BL(fract) of 44 +/- 28% and required an intraoperative transfusion; 49/55 patients with an average BL(fract) of 37 +/- 14% were transfused with only autologous ANH-blood; 6/55 patients with a mean BL(fract) of 100 +/- 47% underwent additional transfusion with allogeneic RBC. Standardized, 2 unit, ANH is a practicable, safe and economic blood conservation technique that allowed for the complete avoidance of allogeneic RBC transfusion in 89% of patients undergoing maxillofacial surgery that required an intraoperative RBC transfusion.
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Int J Oral Maxillofac Surg · Apr 2004
Randomized Controlled Trial Comparative Study Clinical TrialPreoperative intravenous tramadol versus ketorolac for preventing postoperative pain after third molar surgery.
The objective of this study was to compare the analgesic efficacy of a single-dose of preoperative intravenous tramadol versus ketorolac in preventing pain after third molar surgery. Sixty-four patients undergoing elective third molar surgery were randomly assigned into one of the two groups (32 in each group): Group I received tramadol 50 mg, and Group 2 received ketorolac 30 mg intravenously preoperatively before the surgery. After injection of the study drugs, a standard intravenous sedation technique was administered and the impacted third molars were removed under local anaesthetic. ⋯ Throughout the 12-h investigation period, patients reported significantly lower pain intensity scores in the ketorolac versus tramadol group (P = 0.05, Mann-Whitney U-test). Patients also reported significantly longer median time to rescue analgesic (9.0 h versus 7.0 h, P = 0.007, log rank test), lesser postoperative acetaminophen consumption (P = 0.02, Mann-Whitney U-test) and better global assessment (P = 0.01, chi2 test) for the ketorolac versus tramadol group. Preoperative intravenous ketorolac 30 mg is more effective than tramadol 50 mg in the prevention of postoperative dental pain.
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Int J Oral Maxillofac Surg · Apr 2004
ReviewPeripheral odontogenic tumours--differential diagnosis in gingival lesions.
Peripheral odontogenic tumours (POT) are rare benign focal overgrowths of the oral soft tissue, usually occurring in the gingiva. Between 1996-2000, 6 out of 406 excised gingival lesions were diagnosed as POT (1.5%). ⋯ Review of the literature reveals that peripheral odontogenic fibroma and peripheral ameloblastoma were the most common POT. The purpose of this article was to analyse the clinical data of these tumours according to the presented cases and the literature review, to elucidate typical features of each tumour type and enhance easy identification.
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Int J Oral Maxillofac Surg · Mar 2004
Case ReportsThe peripherally inserted central venous catheter; friend or foe?
The use of a peripherally inserted central catheter (PICC) is now commonplace in clinical practice both for monitoring and intravenous administration of drugs or fluids. The authors describe the case of a complication not previously reported following placement of a PICC prior to a head and neck procedure. The literature on complications following PICC use is reviewed.
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Int J Oral Maxillofac Surg · Mar 2004
The status of the deep surgical margins in tongue and floor of mouth squamous cell carcinoma and risk of local recurrence; an analysis of 68 patients.
The objective of this study is to retrospectively assess the clinical relevance, i.c. the event of a local recurrence, in patients surgically treated for tongue and floor of mouth squamous cell carcinoma when tumour cell are observed histopathologically at a distance of less than 0.5 cm. Furthermore, the pattern of invasion and the presence or absence of perineural spread were recorded. A total of 68 patients, surgically treated because of a tongue or floor of mouth squamous cell carcinoma, were examined. ⋯ Local recurrence occurred in 2 out of 30 patients with a free surgical margins >0.5 cm and in 3 out of 38 patients with a free surgical margin <0.5 cm, the difference being not statistically significant. Apparently, the presence of tumour cells within a distance of less than 0.5 cm, but not into the deep surgical margin, does not necessarily seem to require additional treatment. The pattern of invasion and the presence or absence of perineural spread were not significantly related with local recurrence either.