ABSTRACT
The aims of this study were to see if ENT review at 1 week following ventilation tube insertion in paediatric patients reduced the complication rate and the number of consultations with the general practitioner in the first postoperative month. Sixty-six children were prospectively randomized into two follow-up groups: group A was reviewed at 1 week and 1 month and group B at 1 month only. There was no statistically significant difference in postoperative otorrhoea (P = 0.59), ventilation tube patency (P = 0.44), ventilation tube extrusion rate (P = 0.64) and number of consultations with the general practitioners (GP) for postoperative otorrhoea (P = 0.19) between the two groups at 1 month. In conclusion, there seems to be no advantage with early postventilation tube insertion review as it does not reduce complications or decrease the GP consultation rate.
Subject(s)
Continuity of Patient Care , Middle Ear Ventilation , Otitis Media with Effusion/surgery , Outcome Assessment, Health Care , Adolescent , Cerebrospinal Fluid Otorrhea/epidemiology , Cerebrospinal Fluid Otorrhea/etiology , Child , Child, Preschool , Female , Hearing Disorders/diagnosis , Hearing Disorders/etiology , Humans , Infant , Male , Office Visits , Otitis Media with Effusion/complications , Postoperative Complications/epidemiology , Primary Health Care , Prospective Studies , Treatment OutcomeABSTRACT
CS gas (2-chlorobenzylidene malonitrile) is widely used in an incapacitant spray that causes intense lacrimation, blepharospasm and burning sensations in the throat and nose. Questions have been raised about its safety. We obtained information on short-term and long-term symptoms, and performed ear, nose and throat examinations and respirometry at 8-10 months, in 34 young adults who had been exposed to CS spray in a confined space during a confrontation with police. The group was subdivided into those who had been sprayed directly on the face (n=10) and those exposed indirectly. At one hour, all but 2 individuals still had symptoms; respiratory and oral symptoms were significantly more prevalent in the directly exposed group. At one month, only oral symptoms were significantly more prevalent. At 8-10 months, symptoms were still reported but there were no differences between the groups and clinical examinations revealed no specific abnormalities. There was no convincing evidence of long-term physical sequelae from exposure to CS spray.
Subject(s)
Riot Control Agents, Chemical/adverse effects , o-Chlorobenzylidenemalonitrile/adverse effects , Adult , Female , Follow-Up Studies , Humans , Male , Mouth Diseases/chemically induced , Respiration Disorders/chemically induced , Riot Control Agents, Chemical/administration & dosage , o-Chlorobenzylidenemalonitrile/administration & dosageABSTRACT
The authors present a technique for emergency management of a tracheo-brachiocephalic artery fistula.
Subject(s)
Brachiocephalic Trunk/surgery , Emergency Treatment/methods , Respiratory Tract Fistula/surgery , Tracheal Diseases/surgery , Vascular Fistula/surgery , Emergencies , Humans , Tracheostomy/adverse effectsABSTRACT
The Ultracision harmonic scalpel (UHS) cuts and coagulates tissue with high-frequency ultrasound. We describe the results of our use of the UHS to perform tonsillectomies in 59 patients. The mean operative blood loss was 7 ml (range: 0 to 75); 56% of patients experienced no measurable blood loss. The mean length of operating time was 8 minutes and 10 seconds (range: 3:45 to 20:25). Patients were assessed for 2 weeks for postoperative pain on the basis of a 10-point linear analog scale. The mean pain score on postoperative day 1 was 4.7; the score peaked at 6.0 on day 4 and fell to less than 3.0 by day 11. Patients returned to full function in an average of 10.9 days (range: 3 to 15). Three patients experienced secondary hemorrhage, one of whom required surgical intervention. We found the UHS to be a well-designed and easy-to-use instrument. Operating time was short, blood loss was minimal, and the degree of early postoperative pain was low. We believe that our findings are encouraging and that the UHS might well have a place in the surgical armamentarium for tonsillectomy.
Subject(s)
Surgical Instruments , Tonsillectomy/methods , Tonsillitis/diagnostic imaging , Tonsillitis/surgery , Adolescent , Adult , Child , Child, Preschool , Equipment Design , Female , Humans , Laser Therapy/instrumentation , Male , Middle Aged , Treatment Outcome , UltrasonographyABSTRACT
The treatment of pharyngeal pouches by endoscopic stapling diverticulotomy has gained popularity over the last few years. We assessed the results of this technique in 44 patients by means of a clinical questionnaire and by reviewing case records. Thirty-six (82 per cent) patients commenced oral intake within 18 hours of the procedure and 37 (84 per cent) patients were discharged within 48 hours. Five patients had complications that included throat discomfort, a loose incisor tooth, shoulder pain, pharyngeal perforation and one mortality due to mediastinitis. Of the 37 patients that completed the questionnaire, nine (24 per cent) had some residual symptoms although only two (five per cent) felt that there had been no improvement at all following the stapling procedure. Thirty-five (95 per cent) of the patients stated that they would undergo the procedure again. It appears that pharyngeal pouches can be successfully treated by endoscopic stapling, with patients commencing oral intake within a few hours of surgery and having a short hospital stay. However, as there can be serious complications, we recommend that the procedure be performed by an experienced surgeon.
Subject(s)
Endoscopy/methods , Surgical Stapling/methods , Zenker Diverticulum/surgery , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Patient Satisfaction , Postoperative Complications , Retrospective Studies , Surveys and Questionnaires , Treatment OutcomeSubject(s)
Endoscopy/methods , Surgical Stapling/methods , Zenker Diverticulum/surgery , Aged , HumansABSTRACT
Invasive peri- and post-operative monitoring is being increasingly utilized, and a corresponding increase of concomitant complications are becoming apparent. Two cases of complete right vocal fold paralysis are reported as a possible complication of right central venous catheterization. The underlying aetiology of this complication is presumed to be either direct trauma at the time of introduction of the central venous catheter, or by thrombosis and fibrosis around the recurrent laryngeal or vagus nerve. It is suggested that multiple attempts at cannulation and leaving the central line in situ for long periods increases the risk of this complication. When the integrity of the left recurrent laryngeal nerve or vagus is jeopardized or must be sacrificed during surgery, it is suggested that ipsilateral central lines are inserted to minimize the risk of bilateral vocal fold paralysis. Cases of vocal fold paralysis secondary to central line insertion should be followed expectantly and surgical intervention only be considered after 12 months review.
Subject(s)
Catheterization, Central Venous/adverse effects , Vocal Cord Paralysis/etiology , Adult , Female , Humans , Jugular Veins , Middle Aged , Risk FactorsSubject(s)
Esophagus , Foreign Bodies/complications , Respiration Disorders/etiology , Humans , Infant , MaleABSTRACT
A new surgical technique for the treatment of moderate to large hypopharyngeal diverticula is described. The procedure is particularly useful in debilitated patients in that it is quick and guarantees closure of the party wall between the pouch and upper oesophagus.
