Hong Kong medical journal = Xianggang yi xue za zhi / Hong Kong Academy of Medicine
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Multicenter Study Comparative Study
Surgical outcome of daytime and out-of-hours surgery for elderly patients with hip fracture.
Surgery for hip fracture may be performed out-of-hours to avoid surgical delay. There is, however, a perception that this may constitute less-than-ideal conditions and result in a poorer outcome. The aim of this study was to evaluate the surgical outcome of elderly patients with hip fracture who underwent daytime versus out-of-hours surgery in Hong Kong. This will help make decisions about whether to operate out-of-hours or to delay surgery until the following day. ⋯ The two groups were homogeneous in terms of demographic characteristics. Outcomes for 30-day mortality and postoperative surgical complications were comparable between the two groups. Surgeons' qualifications and number of surgeons involved were also not associated with the outcomes. Out-of-hours surgery remains a viable option in order to facilitate early surgery.
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Review
Spinal cord stimulation for chronic non-cancer pain: a review of current evidence and practice.
Spinal cord stimulation provides analgesia through electrical stimulation of the dorsal column of the spinal cord via electrode leads placed into the epidural space. In traditional tonic stimulation, a painful sensation is replaced with paraesthesia. Spinal cord stimulation is effective in reducing neuropathic pain, enhancing function, and improving quality of life in different chronic pain conditions. ⋯ Results are encouraging to date, and they may provide superior analgesia and cover for deficiencies of traditional tonic stimulation. Although complications are not uncommon, they are rarely life threatening or permanently disabling. Nonetheless, device removal is occasionally needed.
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With advances in mechanical circulation, venoarterial extracorporeal membrane oxygenation has become an established technique to provide cardiopulmonary support for patients with cardiovascular collapse. This article reviews the physiological principles of such extracorporeal technique and its interaction with the native heart. Practical aspects including equipment, patient selection, and common complications with their prevention and specific management are summarised. The strategy for weaning from venoarterial extracorporeal membrane oxygenation is also discussed.