Comparison of 3 mm versus 4 mm rigid endoscope in diagnostic nasal endoscopy.

OBJECTIVE: Compare nasal endoscopy with 3 mm versus conventional 4 mm rigid 30° endoscopes for visualization, patient comfort, and examiner ease. METHODS: Ten adults with no previous sinus surgery underwent bilateral nasal endoscopy with both 4 mm and 3 mm endoscopes (resulting in 20 paired nasal endoscopies). Visualization, patient discomfort and examiner's difficulty were assessed with every endoscopy. Sino-nasal structures were checked on a list if visualized satisfactorily. Patients rated discomfort on a standardized numerical pain scale (0-10). Examiners rated difficulty of examination on a scale of 1-5 (1 = easiest). RESULTS: Visualization with 3 mm endoscope was superior for the sphenoid ostium (P = 0.002), superior turbinate (P = 0.007), spheno-ethmoid recess (P = 0.006), uncinate process (P = 0.002), cribriform area (P = 0.007), and Valve of Hasner (P = 0.002). Patient discomfort was not significantly different for 3 mm vs. 4 mm endoscopes but correlated with the examiners' assessment of difficulty (r = 0.73). The examiner rated endoscopy with 4 mm endoscopes more difficult (P = 0.027). CONCLUSIONS: The 3 mm endoscope was superior in visualizing the sphenoid ostium, superior turbinate, spheno-ethmoid recess, uncinate process, cribriform plate, and valve of Hasner. It therefore may be useful in assessment of spheno-ethmoid recess, nasolacrimal duct, and cribriform area pathologies. Overall, patients tolerated nasal endoscopy well. Though patient discomfort was not significantly different between the endoscopes, most discomfort with 3 mm endoscopes was noted while examining structures difficult to visualize with the 4 mm endoscope. Patients' discomfort correlated with the examiner's assessment of difficulty.

Giant fibrolipoma of the esophagus.

Benign tumors of the esophagus are uncommon, representing <0.5% of esophageal tumors. Fibrolipomas are a subset of benign fibrovascular tumors, which present with dysphagia, odynophagia, and substernal fullness. These intraluminal tumors can become elongated and molded into a long pedunculated polyp by constant peristaltic movements. They can cause esophageal obstruction if large and long enough and can cause asphyxiation if they become lodged into the glottis. A barium swallow is the main diagnostic tool; treatment is surgical via a transoral, transcervical, or transthoracic approach. We report the excision of a large esophageal fibrolipoma through a transoral laser microsurgical approach.

Effects of antithrombogenic agents on microvenous anastomoses in a rat model.

OBJECTIVE: To compare venous thrombosis rates among animals treated with aspirin, clopidogrel bisulfate, and ketorolac tromethamine using an anastomotic "tuck" model. DESIGN: Single-blind randomized animal study. SETTING: An animal laboratory at a tertiary care academic referral center. SUBJECTS: Forty-two retired Lewis breeder rats divided into 3 equal groups. INTERVENTIONS: Before surgical intervention, 1 group received aspirin (10 mg/kg) through gavage; 1 group, clopidogrel bisulfate (5 mg/kg) through gavage; and the final group, ketorolac tromethamine (3 mg/kg) through intramuscular injection. Each rat was then anesthetized, and the femoral veins were prepared bilaterally. A 180° venotomy was made, and the vessels were anastomosed with the tuck model set-up for anastomotic failure. The vessels were checked for patency every 15 minutes for 2 hours after clamp removal. MAIN OUTCOME MEASURES: The rate of venous thrombosis and the time to thrombosis. RESULTS: In both the aspirin and clopidogrel groups, 2 of 28 vessels (7%) were thrombosed. Thrombosis occurred in 3 of 28 vessels (11%) in the ketorolac group (P = .86). All thromboses in the aspirin and clopidogrel groups took place at 7.5 minutes after clamp removal. In the ketorolac group, the mean time to thrombosis was 7.5 minutes (range, 0-22.5 minutes). There was no difference in time to thrombosis among the 3 groups (P = .86). CONCLUSION: Using a microvenous tuck model set-up for anastomotic failure, we found no difference in the rate of thrombosis or the time to thrombosis in rats pretreated with aspirin, clopidogrel, or ketorolac.

Repair of esophageal perforation due to anterior cervical spine instrumentation.

The complication of esophageal perforation after anterior cervical spine fusion for cervical spine disease is rare but potentially fatal. We describe two cases of esophageal perforation found by esophagoscopic visualization. In one patient, primary closure could not be achieved, and a submental island flap was used to repair the defect. In the second patient, primary closure was achieved and a pectoralis major flap was interposed between the closure and the residual instrumentation. Postoperatively, both patients had no evidence of persistent perforation and had resolution of preoperative symptoms.