Subject(s)
Anesthesia, Dental , Carticaine , Anesthetics, Local , Double-Blind Method , Epinephrine , Humans , Lidocaine , Mandibular Nerve , Molar/surgeryABSTRACT
Neurofibromas are defined as benign tumours arising from peripheral nerve sheaths. Few intraoral palatal cases have been reported. Neurofibromas can occur as part of neurofibromatosis, type 1 (NF1) or type 2 (NF2). A 41-year-old patient presented with a slowly enlarging soft tissue mass on the hard palate. An incisional biopsy was performed, which confirmed the diagnosis of a neurofibroma associated with NF1. It should be considered that there is a chance of malignant transformation. Here, we discuss the clinical features, types, diagnosis, histopathology and treatment options.
Subject(s)
Neurofibroma , Neurofibromatosis 1 , Adult , Humans , Neurofibroma/diagnostic imaging , Palate, HardABSTRACT
We report the case of an initial misdiagnosis of significant scalp soft tissue hidden beneath a semirigid cervical collar. A 16-year-old unrestrained rear seat passenger was involved in an RTA sustaining a subdural haematoma, cervical spine fractures and what was initially diagnosed as a significant degloving scalp injury. The patient was admitted to the intensive care unit intubated sedated, and with a cervical collar. The scalp injury was dressed with a view that potential reconstructive surgery would be needed subsequently.This case demonstrates that while cervical collars remain a fundamental aspect of initial prehospital care in trauma, they have potential drawbacks to their use, which need to be carefully noted. Some of these drawbacks have been reported extensively in the literature. This case outlines the necessity of a thorough secondary survey in the trauma patient as the cervical collar can obscure the assessment of significant head and neck soft tissue injuries.
Subject(s)
Cervical Vertebrae/injuries , Immobilization/adverse effects , Orthotic Devices/adverse effects , Soft Tissue Injuries/diagnosis , Spinal Fractures/therapy , Splints/adverse effects , Accidents, Traffic , Adolescent , Craniocerebral Trauma , Diagnostic Errors , Female , Humans , Immobilization/instrumentation , Scalp/injuries , Soft Tissue Injuries/complications , Spinal Fractures/complicationsABSTRACT
INTRODUCTION: 30-day mortality is routinely used to assess proximal femoral fracture care, though patients might remain at risk for poor outcome for longer. This work has examined the survivorship out to one year of a consecutive series of patients admitted for proximal femoral fracture to a single institution. We wished to quantify the temporal impact of fracture upon mortality, and also the influence of patient age, gender, surgical delay and length of stay on mortality from both cardiorespiratory and non-cardiorespiratory causes. PATIENTS AND METHODS: Data were analysed for 561 consecutive patients with 565 fragility type proximal femoral fractures treated surgically at our trauma unit. Dates and causes of death were obtained from death certificates and also linked to data from the Office of National Statistics. Mortality rates and causes were collated for two time periods: day 0-30, and day 31-365. RESULTS: Cumulative incidence analysis showed that mortality due to cardiorespiratory causes (pneumonia, myocardial infarction, cardiac failure) rose steeply to around 100 days after surgery and then flattened reaching approximately 12% by 1 year. Mortality from non-cardiorespiratory causes (kidney failure, stroke, sepsis etc.) was more progressive, but with a rate half of that of cardiorespiratory causes. Progressive modelling of mortality risks revealed that cardiorespiratory deaths were associated with advancing age and male gender (p<0.001 for both), but the effect of age declined after 100 days. Non-cardiorespiratory deaths were not time-dependent. CONCLUSION: We believe this analysis extends our understanding of the temporal impact of proximal femoral fracture and its surgical management upon outcome beyond the previously accepted standard (30 days) and supports the use of a new, more relevant timescale for this high risk group of patients. It also highlights the need for planning and continuing physiotherapy, respiratory exercises and other chest-protective measures from 31 to 100 days.
Subject(s)
Heart Failure/mortality , Hip Fractures/surgery , Myocardial Infarction/mortality , Physical Therapy Modalities , Pneumonia/mortality , Age Factors , Aged , Aged, 80 and over , Cause of Death , Female , Heart Failure/etiology , Heart Failure/prevention & control , Hip Fractures/mortality , Humans , Incidence , Male , Myocardial Infarction/etiology , Myocardial Infarction/prevention & control , Patient Selection , Pneumonia/etiology , Pneumonia/prevention & control , Prognosis , Risk Factors , Sex Factors , Time FactorsABSTRACT
Prospective evidence suggests that the selection of feeding tube during chemoradiation (CRT) indirectly affects swallowing outcome. This study explores the patients' perspective on long-term swallowing ability comparing these two feeding routes. Two groups, receiving nutritional supplementation via a prophylactic gastrostomy tube (group G) and by the oral route or via a nasogastric tube (group NG) during CRT, disease-free at ≥24 months following treatment were matched for age, site and stage of tumour. Patient-reported swallowing outcomes for both groups were assessed using the MD Anderson Dysphagia Inventory (MDADI). Group G consisted of 16 patients and group NG of 15 patients. There was statistically significant difference in MDADI scores between the two groups in all domains of the questionnaire (p<0.001), with superior outcomes in group NG. Use of gastrostomy tubes during CRT conferred a worse swallowing outcome in the long term in this tightly matched cohort of patients.
