ABSTRACT
A 52-year-old previously healthy woman suffered death from choking. Asphyxia after aspiration of a foreign body is a well-known, but frequently overlooked cause of sudden death. We describe a case in which a foreign body in the airway was initially overlooked. Early recognition and treatment might have altered the outcome.
Subject(s)
Airway Obstruction/diagnosis , Asphyxia/diagnosis , Food/adverse effects , Foreign Bodies/complications , Airway Obstruction/etiology , Airway Obstruction/mortality , Airway Obstruction/surgery , Asphyxia/etiology , Asphyxia/mortality , Asphyxia/surgery , Bronchoscopy , Fatal Outcome , Female , Humans , Laryngoscopy , Middle AgedABSTRACT
INTRODUCTION: Coblation (Co) is a relatively new technique, which may offer a better postoperative course after tonsillectomy than traditional techniques. The purpose of this study was to determine whether Co outperforms classic dissection. Coblation uses radiofrequency energy to excite the electrolytes in a saline solution, creating a precisely focused plasma. The plasma's energized particles have sufficient energy to break molecular bonds within tissue, causing the tissue to dissolve at temperatures between 40 degrees C and 70 degrees C. MATERIAL AND METHODS: A case-control study was conducted in which 26 patients undergoing Co tonsillectomy were matched concerning gender, age and the surgeon's charge with 26 patients undergoing classic tonsillectomy. Furthermore, to compare the rates of postoperative haemorrhage, we reviewed the health records of all patients undergoing Co (60 patients) and routine dissection tonsillectomy (403) at Roskilde County Hospital. RESULTS: Intraoperative bleeding was significantly lower in the Co group (median (MD) 5.0 ml; range (R) 1-32 ml) than in the control group (MD 10.0 ml; R 5-200 ml) (p < 0.0001). The median operation time was also significantly shorter for the Co group (23 min.; R 13-40 min. vs. 32 min.; R 21-63 min.; p = 0.002). Postoperatively, there was no significant difference between the two groups regarding pain scores, analgesics intake, time to return to work and normal diet or weight changes. Neither the primary (0% vs. 2%, p = 0.60) nor the secondary (3.3% vs. 2.5%, p = 0,66) haemorrhage rate was significantly different between Co and traditional tonsillectomy. CONCLUSION: The intraoperative bleeding was lower and the surgery times were shorter in the Co group compared with classic dissection. There was no difference in the postoperative haemorrhage rate between the two tonsillectomy methods.
Subject(s)
Tonsillectomy/methods , Adult , Blood Loss, Surgical , Case-Control Studies , Catheter Ablation/instrumentation , Child , Chronic Disease , Female , Humans , Male , Outcome Assessment, Health Care , Postoperative Hemorrhage/etiology , Tonsillitis/surgeryABSTRACT
We present a case of epistaxis caused by a nontraumatic cavernous internal carotid artery aneurysm. A 43-year-old woman was hospitalised due to profuse epistaxis. Investigation with sinoscopy showed a pulsating artery in the sinus sphenoidalis and a follow-up MR angiography showed an aneurysm on the internal carotid artery. She was treated with coiling. The patient had no further bleeding episodes, and half a year after surgery she was neurologically intact. Carotid artery aneurysms must be considered in the differential diagnosis of profuse epistaxis.