RESUMO
OBJECTIVE: This study aimed to investigate the prevalence of and risk factors for Eustachian tube dysfunction leading to middle-ear pathology in patients on chronic mechanical ventilation via tracheostomy tube. METHODS: A total of 40 patients on chronic ventilation were included in a prospective cohort study. Middle-ear status was determined by tympanometry. Tympanograms were categorised as types A, B or C; types B and C were defined as middle-ear pathology. RESULTS: In all, 57 ears of 40 patients were examined. Disease was found in at least 1 ear in 26 out of 40 patients. Middle-ear pathology was found in 25 out of 34 patients who were tube fed (via nasogastric tube or percutaneous endoscopic gastrostomy) vs 1 patient out of the 6 fed orally (p = 0.014), and in 23 out of 31 with conscious or cognitive impairment vs 3 out of 9 cognitively intact patients (p = 0.044). CONCLUSION: Middle-ear pathology is common in patients on chronic mechanical ventilation via tracheostomy tube. The highest prevalence was in those with impaired consciousness or cognition, and oral feeding appeared protective.
Assuntos
Otopatias/epidemiologia , Tuba Auditiva/fisiopatologia , Respiração Artificial/efeitos adversos , Testes de Impedância Acústica , Adulto , Idoso , Idoso de 80 Anos ou mais , Otopatias/fisiopatologia , Orelha Média/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Adulto JovemRESUMO
Exposure of pacemaker wires has become a common challenge in plastic surgery. Suggested techinques for dealing with this problem include removal and reintroduction of the entire pacemaker system or coverage with local flaps. We propose a new technique, which in addition to local flap coverage, eliminates the problem future pressure necrosis by placing the wires in the clavicle rather than about it.
Assuntos
Marca-Passo Artificial/efeitos adversos , Úlcera Cutânea/cirurgia , Infecções Estafilocócicas/cirurgia , Idoso , Feminino , Humanos , Síndrome do Nó Sinusal/terapia , Úlcera Cutânea/etiologia , Infecções Estafilocócicas/etiologia , Retalhos CirúrgicosRESUMO
A 64-year-old white man was operated on for acute gastrointestinal bleeding. The patient was known to have a duodenal polyp for 15 years. Surgery revealed a small duodenal ulcer and a large cystic hamartoma of Brunner's glands. Incidence, aspects of pathogenesis, clinical features and treatment of this rare tumor are discussed.
