ABSTRACT
Sleep apnea, the periodic cessation of breathing during sleep, is a common and underdiagnosed condition. Treatment can improve quality of life as well as reduce morbidity and mortality from sleep apnea-related hypertension, stroke, and traffic accidents. In this article, the authors discuss types of sleep apnea, diagnostic tools, and treatment strategies for both adults and children.
Subject(s)
Sleep Apnea Syndromes/diagnosis , Sleep Apnea Syndromes/therapy , Continuous Positive Airway Pressure , Humans , Medical History Taking , Otorhinolaryngologic Surgical Procedures , Physical Examination , PolysomnographyABSTRACT
Despite increased strictness in surgical criteria, tonsillectomy continues to be one of the most common outpatient surgical procedures performed in the United States. The primary care physician is integrally involved in the diagnosis and treatment of tonsillitis, the chief reason for tonsillectomy. This article gives guidelines for diagnosis and management of tonsillitis and provides an overview of its potential complications.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Tonsillitis/drug therapy , Acute Disease , Diagnosis, Differential , Humans , Palatine Tonsil/microbiology , Peritonsillar Abscess/etiology , Streptococcal Infections/complications , Streptococcal Infections/diagnosis , Streptococcal Infections/drug therapy , Streptococcus pyogenes/drug effects , Streptococcus pyogenes/isolation & purification , Tonsillitis/diagnosis , Tonsillitis/etiologyABSTRACT
OBJECTIVES/HYPOTHESIS: Maxillofacial fractures often occur with serious concomitant injury in trauma patients, and knowledge of the type and severity of associated injuries can assist in rapid assessment and treatment. The objective was to identify the most commonly occurring injuries associated with facial fractures in severely injured trauma patients. STUDY DESIGN: Review of medical records. METHODS: A retrospective review was made of 151 patients with facial fractures presenting to a level-one trauma center over a 4-year span. All patients had an injury severity score of 12 or greater. Chart data recorded included demographics, etiology, presentation, facial fracture site, concomitant injury, imaging studies, hospital stay and course, interventions, and outcome. RESULTS: The most common cause or origin of facial fracture was assault (41%), followed by motor vehicle accident (26.5%). Orbital fracture was the most common overall facial fracture (24.2%), with nasal fractures being the most common isolated fracture (23.2%). Cerebral hematoma occurred in 43.7% of patients, with subdural hematoma being the most frequent. Pulmonary injury was the second most commonly associated injury (31.1%) with lung contusion being the most frequent. Seventy-two patients (42%) required intubation, and 22 (14.8%) required tracheostomy during their hospital stay. The hospital complication rate was 50.3% and included primarily pulmonary complications, septicemia, renal failure, and severe anemia. Thirteen patients died during their hospital stay; 11 of them died of neurologic injuries, 1 of pulmonary failure, and 1 of overwhelming sepsis. CONCLUSIONS: Cerebral and pulmonary injuries are often associated with maxillofacial fractures in severely injured trauma patients. Knowledge of these associated injuries provides useful strategies for patient care and prevention of further complications. A multidisciplinary and coordinated approach is important for optimum stabilization and ongoing treatment of patients with facial fractures.
Subject(s)
Facial Bones/injuries , Maxillofacial Injuries/mortality , Maxillofacial Injuries/therapy , Multiple Trauma/mortality , Multiple Trauma/therapy , Accidents, Traffic , Adolescent , Adult , Aged , Aged, 80 and over , Brain Injuries/complications , Brain Injuries/diagnosis , Brain Injuries/mortality , Brain Injuries/therapy , Child , Child, Preschool , Combined Modality Therapy , Female , Follow-Up Studies , Humans , Injury Severity Score , Male , Maxillofacial Injuries/complications , Maxillofacial Injuries/diagnosis , Middle Aged , Multiple Trauma/diagnosis , Respiration, Artificial , Retrospective Studies , Surgical Procedures, Operative , Survival Rate , Thoracic Injuries/complications , Thoracic Injuries/diagnosis , Thoracic Injuries/mortality , Thoracic Injuries/therapy , Trauma Centers , Treatment Outcome , Triage , ViolenceABSTRACT
Preview Acute anterior nosebleeds are frightening because bleeding is often so copious and seemingly unstoppable. But, ironically, this type is usually less severe than posterior epistaxis, in which blood may run briskly but unseen down the throat. The choice among the many treatment methods available depends on the source and cause of epistaxis. The authors present a methodical approach to patient evaluation and describe the best therapy for various situations.
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Preview Even though the oral cavity is one of the most accessible areas for examination, oral cancer is often diagnosed at an advanced stage. Why is this so, and how can this tendency be reversed? In this article, Dr Alvi stresses the importance of education of both physicians and patients in achieving the goal of earlier diagnosis. He also discusses warning signs of cancerous oral lesions, diagnosis, and treatment choices.
ABSTRACT
Preview Neck masses in children and young adults are often benign, whereas masses in adults, especially those over age 40, are commonly malignant. In either case, because of the intricate anatomic structures in the neck, physicians are confronted with an unusually broad and formidable array of possible diagnoses, which Drs Alvi and Johnson discuss in this article.
