Lowry Erlandsen (calfyoke2)

Reaction to sutures is a rare cause of non-healing in clean wounds. Cases of severe reaction to silk sutures have been reported, causing chronic infection and failure of thyroidectomy wound healing. We report a case of retained polyglactin 910 suture presenting with a chronically discharging sinus of the neck after sub-total thyroidectomy. The patient, a 37-year old female, presented with a simple benign multinodular goitre. She had subtotal thyroidectomy and was discharged on day six postoperatively, after satisfactory primary wound healing. The patient observed swelling, pus/discharge and extrusion of the suture in the neck three weeks after surgery. Discharge did not stop after initial wound debridement under local anaesthesia. Computed tomography (CT) scan showed a small area of ring-enhancement soft tissue density, anterior to the right thyroid remnant. Subsequent wound exploration under general anaesthesia revealed a sinus tract extending to the thyroid bed with undegraded strands of thickened polyglactin 910 suture. Suture remnants were removed and the wound healed satisfactorily a week later. Non-healing post thyroidectomy wounds should raise suspicion of a retained suture. Early recognition and surgical intervention will shorten the period of morbidity. Non-healing post thyroidectomy wounds should raise suspicion of a retained suture. Early recognition and surgical intervention will shorten the period of morbidity. To compare consultations carried out via video with those performed in person for patients with painful, hard-to-heal ulcers, with a focus on ulcer pain and pain treatment. A further aim was to investigate predictors for pain and pain treatment. This was a register-based, quasi-experimental study based on data from the Swedish Registry of Ulcer Treatment (RUT). A total of 100 patients with hard-to-heal ulcers diagnosed via video consultation were compared with 1888 patients diagnosed in person with regard to pain assessment, intensity and treatment. Ulcer pain intensity was assessed by the visual analogue scale (VAS). Normally distributed variables (age, VAS) were compared between consultation groups using Student's t-test. Non-normally distributed variables (ulcer size, ulcer duration) were compared using the Mann-Whitney U-test, except for healing time, which was analysed with a log-rank test. Categorical variables (gender, ulcer aetiology and prescribed analgesics) were compared using Pearson's chi-squients with hard-to-heal ulcers suffer from high-intensity ulcer pain, with a discrepancy between pain and pain relief. Further well-designed randomised controlled studies are necessary to understand how best to deploy telemedicine in ulcer pain treatment. To identify, assess and treat ulcer pain is equally possible via video as by in-person consultation. The results of this study confirm that patients with hard-to-heal ulcers suffer from high-intensity ulcer pain, with a discrepancy between pain and pain relief. Further well-designed randomised controlled studies are necessary to understand how best to deploy telemedicine in ulcer pain treatment.Fat and sweeteners contribute to obesity. However, it is unknown whether specific bacteria are selectively modified by different caloric and noncaloric sweeteners with or without a high-fat diet (HFD). Here, we combined extensive host phenotyping and shotgun metagenomics of the gut microbiota to investigate this question. We found that the type of sweetener and its combination with an HFD selectively modified the gut microbiota. Sucralose and steviol glycosides led to the lowest α-diversity of the gut microbiota. Sucralose increased the abundance of B. fragilis in particular, resulting in a decrease in the abundance of occludin and an increase in proinflammatory cytokines, glucose intolerance, fatty acid oxidation and ketone bodies. Sucrose+HFD showed