Comparison of the effects of dexmedetomidine and remifentanil on potential extreme haemodynamic and respiratory response following mask ventilation and laryngoscopy in patients with mandibular fractures.

OBJECTIVE: The safety profile and efficacy were compared for remifentanil and dexmedetomidine with respect to haemodynamic and respiratory response during mask ventilation and laryngoscopy in patients with mandibular fractures. PATIENTS AND METHODS: Seventy patients undergoing elective mandibular fracture surgery were randomly assigned to the remifentanil group (Group R, n = 35) or the dexmedetomidine group (Group D, n = 35). The primary outcomes were preoperative pain scores caused by jaw movement; haemodynamic response; intubation score; and side effects, such as the incidence of oxygen desaturation and muscle rigidity. Other side effects, such as tachycardia, bradycardia, hypertension and hypotension, were also compared. RESULTS: Preoperative pain scores caused by jaw movement were significantly high for both groups, but there were no statistically significant differences between the groups. The incidence of oxygen desaturation and muscle rigidity was significantly lower in Group D than in Group R (p = 0.025). No significant differences existed between the groups in terms of intubation score, haemodynamics, and other side effects (p > 0.05). DISCUSSION: Dexmedetomidine and remifentanil had equal effectiveness on the control of haemodynamic response due to mask ventilation and intubation in patients with mandibular fractures. However, at the doses used in this study, dexmedetomidine had a significant advantage over remifentanil in terms of respiratory stability.

Metastatic malignant peripheral nerve sheath tumor in neurofibromatosis type 1: a geriatric patient report.

Neurofibromatosis type 1 (NF1) (von Recklinghausen disease) is an autosomal dominantly inherited neurocutaneous disorder which affects many systems like ocular, cutaneous and nervous systems and seen in 1:3500 births. Cardinal diagnostic criteria of NF1 were established in 1987 by National Institutes of Health Consensus.Early diagnosis and the findings of NF1 are unclear in childhood, but with age the clinical symptoms become apparent. NF1 is occasionally associated with mental retardation.In this report, together a review of the literature, we present a quite elderly patient, 79-year-old-man, with NF1 suffering from metastatic malignant peripheral nerve sheath tumor in the axillary lymph node invading the brachial plexus and pleura. Moreover, this enormous metastatic mass had restricted movement of the extremity. He had multiple neurofibromas of different sizes almost covering his entire body, massively. To the best of our knowledge, our patient's malignant peripheral nerve sheath tumor and massive neurofibromatosis is a rare case to present in the eighth decade of life.

An alternative micrographic method for decreasing bleeding and recurrence in the treatment of rhinophyma.

Rhinophyma is a subtype of rosacea which develops at the advanced stage of rosacea and is characterized by an excessive enlargement of the sebaceous glands. Its etiology is not well-defined beyond the following usual suspects: vitamin deficiencies, stress, hormonal factors and the Demodex folliculorum mite. Carcinoma may develop in rhinophyma patients. The first surgical process for rhinophyma was applied by Daniel Sennert in 1629. The ideal surgical method for treatment of rhinophyma is still unclear and controversial. Massive bleeding makes a controlled excision of the mass impossible, which contributes to the recurrence of rhinophyma. In this case, we combined trichloroacetic acid (TCA 45%) with dermabrasion, a treatment which hasn't been reported previously. Our method was suggested by the Mohs micrographic surgery technique, which employs serial excisions.