romana english

Original papers

Tracheal stenosis diagnosis and treatment principles, results

Ciprian Bolca, Codin Saon, Cristian Paleru, Radu Matache, Mihaela Codresi, Olga Danaila, Adrian Istrate, Genoveva Cadar, Radu Stoica, Ion Cordos
Tracheal stenosis diagnosis and treatment principles, results

During November 2001 - April 2010, 107 tracheal resections were performed in our department for different types of tracheal stenosis: iatrogenic or tumoral, benign or malignant. We present the diagnosis and treatment principles that we used, along with our results. We operated on 74 (69,15%) iatrogenic postintubation tracheal stenosis 6 (5,6%) of them complicated with tracheo-esophageal fistula, 6 (5,6%) benign tumors, 11 (10,28%) primary malignant and 16 (14,97%) secondary malignant ones, with a 3.8% total mortality. Tracheal resection and reconstruction is the only curative treatment for all types of tracheal stenosis. Interventional endoscopy is of a major importance in the assessment and treatment of tracheal stenosis. We believe that each patient diagnosed with a tracheal stenosis should be referred to a tertiary center with multidisciplinary experience in the treatment of tracheal stenosis.

Key words: tracheal stenosis; tracheal tumor; tracheal resection

Improvement of venous thromboembolism prophylaxis by attaching printed thrombosis risk assessment tool and recommendations to patients hospital charts

Mohammad Hossein Rahimi-Rad, Seidsoma SeidSalehi
Improvement of venous thromboembolism prophylaxis by attaching printed thrombosis risk assessment tool and recommendations to patients hospital charts

Evidence suggests that venous thromboembolism prophylaxis (VTEP) is still significantly underused despite its relationship with morbidity, mortality. Previous studies showed that computerized reminders have resulted in increased rates of VTEP. However, this system is not available in most hospitals especially in developing countries. We hypothesized that attaching written guidelines to patients hospital chart during admission would act as reminder. Methods:  This pre and post-interventional study included three parts: (i) Baseline survey of VTEP (ii) over the following nine months we attached a printed risk assessment tool and recommendation during admission to first page of patient chart. (iii) We reevaluated VTEP similar to phase one. Result: This prospective pre-intervention post-intervention study was conducted in 1202 surgical patients evaluated for venous thromboembolism risk and VTEP performance. Any type prophylaxis was 20.0% before and 37.6% after intervention (p value<0.001). Appropriateness of  prophylaxis was 19.1% before and 33.8% after intervention (p value<0.001). After intervention VTEP rate increased from 8.5% to 19.3% in moderate risk group, from 18.5% to 39.1% in high risk and from 28.1% to 45.1% in highest risk group.  Conclusion: A simple intervention can improve VTEP rate in setting that electronic alert is not available. VTEP is underused despite improvement still there is high gap between evidence and practice.

Key words: venous thromboembolism, prophylaxis, thrombosis risk assessment tool