ABSTRACT
Mediastinoscopy has been an important method in the differential diagnosis of mediastinal pathology since it was presented by Carlens in 1959. Present investigation methods in radiology such as computed tomography and magnetic resonance imaging as well as the new developments in ultrasonography have resulted in a decrease in the number of mediastinoscopies performed. In addition, better results of fine-needle aspiration and core-needle biopsy investigations together with new techniques in thoracoscopy have brought alternative possibilities in examining mediastinal masses. To evaluate the role of mediastinoscopy today, a retrospective study was conducted comprising 249 consecutive patients who had undergone mediastinoscopy in the years 1989 1997 at Turku University Central Hospital. Mediastinoscopy was technically possible in 229 of the 249 cases (92.0%) and a definitive diagnosis was obtained in 210 cases (84.3%). The mortality rate was zero and only 13 complications (5.2%) were reported. Six cases of paresis of the left recurrent nerve were reported, four of which were temporary. There were also five minor intraoperative and two postoperative bleedings, which were easily controlled. We still consider mediastinoscopy as a safe and efficient way of examining mediastinal pathology.
Subject(s)
Mediastinal Diseases/diagnosis , Mediastinoscopy/trends , Adolescent , Adult , Aged , Child , Diagnosis, Differential , Female , Humans , Male , Mediastinal Diseases/pathology , Mediastinal Neoplasms/diagnosis , Mediastinal Neoplasms/pathology , Mediastinoscopy/adverse effects , Middle Aged , Retrospective StudiesABSTRACT
Long-term draining tubes (LTD) have become a common treatment in complicated and prolonged forms of maxillary sinus empyema. Since not all patients show good recovery with this treatment we used sinus-manometry, mathematical calculations, and scanning electron microscopy (SEM) to critically analyze 6 cases with a prolonged history of the disease. Five out of the 6 patients recovered quickly after removal of the LTDs, normally performed sinus punctures, and an appropriate antibacterial treatment. One patient underwent functional endoscopic sinus surgery. Two of the 6 patients had uncommon bacterial cultures (Pseudomonas mirabilis, Klebsiella oxytoga) in their sinus secreta. Two of the removed LTDs were examined with SEM. The porous polyethylene was shown to have absorbed bacterial plague which, besides narrowing the lumen, can cause recurrent infections. In 5 other patients, the draining pressure (DP) was 0.9 +/- 0.16(M +/- SD) kg/cm2, as measured during irrigation with a No. 2 Lichtwitz needle (1.8 mm, i.d). Mathematical calculation using the Hagen-Boisseouille equation indicated that with our LTDs (0.7 mm, i.d.) the DP needs to be 40 times greater than the DP when using an ordinary Lichtwitz needle to get equal flushing capacity. We recommend i) LTD treatment of maxillary sinus empyema be closely followed up ii) that, in prolonged cases, the LTDs should be removed and the sinuses repeatedly irrigated with an ordinary needle or antrostomy, and iii) that a more suitable tubing material and insertion system (to allow a larger radius of the tube) be developed.
Subject(s)
Drainage/adverse effects , Intubation/adverse effects , Maxillary Sinusitis/therapy , Adolescent , Adult , Anti-Bacterial Agents/therapeutic use , Child , Drainage/methods , Empyema/therapy , Female , Humans , Intubation/methods , Male , Manometry , Middle Aged , Time FactorsABSTRACT
Malignant peripheral nerve sheath tumors (MPNST) are very uncommon neoplasms. While the incidence of these lesions is estimated to be 0.001% in a general population, they make up 5-15% of all soft tissue sarcomas in the head and neck region. We present four cases of MPNST in the head and neck. Since certain difficulties were encountered in diagnosis, the importance of clinical evaluation is emphasized. The prognosis for these tumor patients is poor in spite of improvements in diagnostic and therapeutic modalities.