University of Michigan Guidelines for Health System Clinical Care Gastroesophageal Reflux Disease (GERD) Patient population: Adults Guideline Team Objective: To implement a cost-effective and evidence-based strategy for the diagnosis and Team Leader treatment of gastroesophageal reflux disease (GERD). Joel J Heidelbaugh, MD Family Medicine Key Points:
Bardzo tanie apteki z dostawą w całej Polsce kupic cialis i ogromny wybór pigułek.
Microsoft word - parotidectomy.docxLake County ENT/Head & Neck Specialists
Phone (847) 662-4442
Fax (847) 662-4446
Post-operative Instructions following
The parotid gland is a large, saliva producing gland found deep to the cheek skin,
extending from the area just in front of each ear to just below each ear. Both parotid
glands have a small duct that collects saliva from the gland and transmits it to the mouth
through a small opening on the inside of each cheek. Parotidectomy or partial
parotidectomy is performed to remove malignant and benign tumors or cysts of the
parotid gland. On rare occasion, parotidectomy is undertaken to remove an irreversibly
inflamed or diseased parotid gland. This surgery is performed through an incision that
extends from the front of each ear, around the angle of the jaw, to the upper neck skin.
This is performed under general anesthesia and you may be hospitalized for one night
following your procedure. At the time of surgery, a small drainage tube may be placed in
the upper neck (under your earlobe) to prevent accumulation of blood and fluid under the
skin. The drain is usually removed the day after surgery.
You should avoid non-steroidal anti-inflammatory drugs (NSAIDS) such as aspirin,
ibuprofen, naproxen (Excedrin, Motrin, Naprosyn, Advil) for 10 days prior to the
surgery. These drugs are mild blood thinners and will increase your chances of bleeding.
Unless otherwise directed, you may have liquids by mouth once you have awakened from
anesthesia. If you tolerate the liquids without significant nausea or vomiting then you
may take solid foods without restrictions.
Patients report moderate facial and neck pain for several days following parotidectomy.
This is usually well controlled with prescription strength oral pain medications. Please
take the pain medication prescribed by your surgeon when needed. You should avoid
non- steroidal anti-inflammatory drugs (NSAIDS) such as aspirin, ibuprofen, naproxen
(Excedrin®, Motrin®, Naprosyn®, Advil®) because these drugs are mild blood thinners
and will increase your chance of having a post-operative bleed into the facial or neck
Sleep with the head elevated for the first 48 hours. You may use two pillows to do this or
sleep in a reclining chair. Gentle rotation, flexion and extension of the head and neck is
permitted. No heavy lifting or straining for 2 weeks following the surgery. You should
plan for 1 week away from work. If your job requires manual labor, lifting or straining
then you should be out of work for 2 weeks or limited to light duty for 2 weeks.
Do not wash or manipulate the neck wound for 48 hours following the surgery (except to
apply Vaseline). The neck dressing (if applied) will be removed on the morning
following your surgery. The skin has been closed with sutures that will be removed at
your follow-up appointment. Mild redness and swelling around the wound is normal and
will decrease over the 2 weeks following surgery. If a drain has been placed, it will be
removed the day after surgery. Once you are home, apply a thin layer of Vaseline to the
wound 3 times daily. You may shower and allow the wound to get wet 48 hours
following the surgery. Allow soap and water to run over the wound. Do not scrub or
manipulate the wound for 7 days. Pat the area dry; don’t rub it with a towel. After 7 days
you may gently lather the wound with soap and water.
Your follow-up appointment in the office will be 5-8 days following your surgery. At the
post- operative visit the pathology report is reviewed and your sutures are removed.
Antimalarial activity of methanolic extracts from plants used in Kenyan ethnomedicine and their interactions with chloroquine (CQ) against a CQ-tolerant rodent parasite, in mice. Francis W. Muregia,c,* , Akira Ishiha , Toshio Miyaseb , Tohru Suzukia , Hideto Kinoa , Teruaki Amanod , Gerald M. Mkojic , Mamoru Teradaa aDepartment of Parasitology, Hamamatsu University School of Medicine, 1-