ABSTRACT
INTRODUCTION: While the treatment of pediatric sinusitis can be controversial, there is evidence that performing antral lavage in combination with adenoidectomy can improve treatment outcomes. We present an "over the wire" technique using new technology that can improve accuracy and reliability when performing antral lavage. METHODS: The LUMA fiberoptic light wire (Acclarent Inc.) and Vortex sinus irrigation catheter (Acclarent Inc.) were used to perform antral lavage as an adjunct in the treatment of pediatric sinusitis. DISCUSSION: We found this method to have multiple advantages over other techniques of lavage. These advantages include: 1) confirmation of position in the maxillary sinus by transillumination, 2) improvement of the safety and accuracy of the lavage, 3) ability to balloon dilate the natural ostium and ethmoid infundibulum or to obtain cultures at the time of lavage if clinically warranted or indicated by CT evidence, 4) avoidance of radiation from the use of fluoroscopy associated with other balloon sinuplasty equipment and techniques, and 5) no alteration of normal anatomy. CONCLUSION: We found this technique to give the surgeon a reliable, safe, versatile, and efficacious alternative before consideration of more invasive procedures in the pediatric population with chronic sinusitis.
Subject(s)
Catheterization/instrumentation , Maxillary Sinusitis/therapy , Therapeutic Irrigation/instrumentation , Anesthesia, General , Catheterization/methods , Child , Child, Preschool , Chronic Disease , Cohort Studies , Equipment Design , Equipment Safety , Female , Fiber Optic Technology/methods , Humans , Male , Maxillary Sinusitis/diagnosis , Pediatrics/methods , Quality of Life , Therapeutic Irrigation/methods , Treatment OutcomeABSTRACT
Reperfusion therapies--percutaneous coronary intervention and fibrinolysis- can be viewed as complementary approaches for the treatment of an acute ST segment elevation myocardial infarction. The objective was to review current land mark trials that have settled the ground for discussion for the pharmacoinvasive approach. Shortening the time to reperfusion of the infarct artery by prompt initiation of pharmacological reperfusion followed by a mechanical approach may consolidate the initial reperfusion process and prevent reocclusion of the infarct artery. We suggest a TRANSFER-AMI-Pragmatic Indian model. This model of care involves the use of tenecteplase and percutaneous coronary intervention. It has the ability to aid in the categorical organization of patients dependent on factors such as the hemodynamic and financial status. Utilizing such a model may encourage a more standardized format when treating patients on an individual hospital basis. This may encourage cooperation between the prehospital personnel, hospitals (with or without percutaneous coronary intervention) and the government. The creation of regional systems of care for ST-segment elevation myocardial infarctions may guarantee that patients receive the adequate reperfusion therapy in a timely fashion.
