Subject(s)
Maxillary Sinus/abnormalities , Nose Neoplasms/surgery , Papilloma, Inverted/surgery , Paranasal Sinus Neoplasms/surgery , Aged , Endoscopy , Humans , Male , Nose Neoplasms/diagnosis , Nose Neoplasms/epidemiology , Papilloma, Inverted/diagnosis , Papilloma, Inverted/epidemiology , Paranasal Sinus Neoplasms/diagnosis , Paranasal Sinus Neoplasms/epidemiologyABSTRACT
A retrospective review is presented of 44 consecutive patients requiring hospitalization for epistaxis at a tertiary care center. The study had the following objectives: 1. to identify predictors of surgical treatment, and 2. to compare the effectiveness of different surgical treatments. Length of stay, complications, and cost analysis are also presented. Eighteen patients were successfully treated nonsurgically, whereas 26 patients received surgical treatment. Posterior epistaxis (P<0.05) and an admission hematocrit less than 38% (P<0.05) were significant predictors of surgical treatment. The rebleed rate after first surgical therapy was 33% for embolization, 33% for endoscopic cautery, and 20% for ligation. Since embolization, ligation, and endoscopic cautery may have nearly equivalent failure rates, other factors, such as cost and institutional expertise, should guide the selection of surgical treatment.
Subject(s)
Epistaxis/surgery , Adult , Aged , Aged, 80 and over , Cost-Benefit Analysis , Embolization, Therapeutic , Epistaxis/economics , Epistaxis/therapy , Fees, Medical , Female , Hematocrit , Humans , Ligation , Male , Maxillary Artery/surgery , Middle Aged , Recurrence , Retrospective Studies , Treatment OutcomeABSTRACT
Topical antimicrobial solutions are used commonly for prevention or treatment of purulent otorrhea even though most solutions contain ototoxic agents. This study compares the cochlear and middle ear toxicity of cortisporin otic solution (COS), 0.3% gentamicin ophthalmic solution (GOS), benzalkonium chloride (0.026% and 0.05%), and 1.0% Ofloxacin, a new quinolone antibiotic. Saline 0.9% was used as a control. The agent was instilled daily for 7 days into the bulla of juvenile guinea pigs. The animals were sacrificed on the 14th day. The organ of Corti was examined using surface preparation light microscopy and scanning electron microscopy. The tympanic membrane (TM) and adjacent middle ear mucosa were examined with light microscopy. The average cochlear hair cell damage was 66% for COS, 6.5% for GOS, and 1% for Ofloxacin, benzalkonium and saline. COS and benzalkonium 0.05% produced moderate mucosal thickening and inflammation. However, this was not statistically different from the mild mucosal thickening produced by saline, GOS, Ofloxacin and 0.026% benzalkonium. There was statistically significant mild to moderate thickening of the TM for all agents compared to the saline control.
Subject(s)
Benzalkonium Compounds/adverse effects , Benzalkonium Compounds/therapeutic use , Cerebrospinal Fluid Otorrhea/drug therapy , Cochlea/drug effects , Ear, Middle/drug effects , Gentamicins/adverse effects , Gentamicins/therapeutic use , Hydrocortisone/adverse effects , Hydrocortisone/therapeutic use , Neomycin/adverse effects , Neomycin/therapeutic use , Ofloxacin/adverse effects , Ofloxacin/therapeutic use , Polymyxin B/adverse effects , Polymyxin B/therapeutic use , Sodium Chloride/adverse effects , Sodium Chloride/therapeutic use , Animals , Benzalkonium Compounds/pharmacology , Cerebrospinal Fluid Otorrhea/prevention & control , Drug Combinations , Ear, Middle/ultrastructure , Female , Gentamicins/pharmacology , Guinea Pigs , Hair Cells, Auditory/drug effects , Hair Cells, Auditory/ultrastructure , Hydrocortisone/pharmacology , Male , Neomycin/pharmacology , Ofloxacin/pharmacology , Organ of Corti/drug effects , Organ of Corti/ultrastructure , Polymyxin B/pharmacology , Sodium Chloride/pharmacology , Tympanic Membrane/drug effectsABSTRACT
A retrospective review of 100 adult tracheotomies performed by the University of Washington Department of Otolaryngology-Head and Neck Surgery was done to evaluate our complication rate and the role of postoperative chest radiography (CXR). In an attempt to identify specific risk factors for pneumothorax (PTX), the following items were reviewed: age, urgency (elective, urgent, and emergent), awake or general anesthesia, diagnosis (reason for tracheotomy), "difficulty" of tracheotomy, postoperative signs or symptoms of PTX, and findings on postoperative CXR. The series had a PTX rate of 2%. Both patients with complications reviewed here had definite risk factors, or signs and symptoms of PTX. The causes, risk factors, and treatments for PTX are reviewed. Postoperative CXR is indicated in cases at increased risk for PTX, and in patients with clinical signs or symptoms of PTX. Had we followed our proposed criteria, we would have performed postoperative CXR 13 times instead of 93. This would have resulted in a total savings of $10,020. We conclude that postoperative CXR after a routine, uncomplicated tracheotomy is of low yield and incurs unnecessary expense.
Subject(s)
Pneumothorax/diagnostic imaging , Postoperative Complications/diagnostic imaging , Radiography, Thoracic/statistics & numerical data , Tracheotomy , Adult , Cost-Benefit Analysis , Costs and Cost Analysis , Head and Neck Neoplasms/surgery , Humans , Incidence , Male , Middle Aged , Pneumothorax/epidemiology , Pneumothorax/etiology , Postoperative Complications/epidemiology , Radiography, Thoracic/economics , Retrospective Studies , Risk FactorsABSTRACT
To study the effect of lateral splinting on limb development, 14 immature rabbit femurs and tibias were marked with six parallel pins. Of these, the lower limbs of seven rabbits were splinted in lateral rotation for 3 weeks (1-year human equivalent). The static position of the foot in the splinted group was 23 degrees more lateral (p greater than 0.05) than in the control group. No significant difference was found in the axial alignment of the pins across the growth plate or diaphyses between the splinted or control groups. This study suggests that night splinting alters the joint relationships and not the shape of the femur or tibia.
