Use of Botulinum Toxin for Effective Management of First Bite Syndrome Secondary to Malignancy: A Case Report.

First bite syndrome may impact patients who have undergone treatment for head and neck malignancies as well as those who have had surgery in the parapharyngeal space. As the name suggests, upon salivating and/or taking the initial bites of a meal, severe, intense pain may result. Generally, as the patient continues to consume the meal, the symptoms will lessen but may still lead to decreased quality of life. While pharmacological options traditionally include anticonvulsants or tricyclic antidepressants, botulinum toxin injections are an effective alternative to pharmacotherapy. We report the case of a patient with squamous cell carcinoma of the head and neck who experienced first bite syndrome secondary to malignancy with noticeable response to botulinum toxin injections to the right masseter and temporalis muscles. Furthermore, we present this case, as it highlights a rare syndrome with various treatment options, including botulinum toxin, the latter without a predetermined treatment dose.

Spur-of-the-Moment: An Exacting Nasal Intubation.

Nasotracheal intubations are an important airway management technique in otolaryngologic surgeries and trauma distorting oropharyngeal structures. For those performing these procedures, nasal deformities are not uncommon. This case report highlights an example of recurrent cuff tears that occurred during nasotracheal intubation of a patient with an unknown nasal bone spur. A careful airway analysis with available imaging studies may predict the potential difficulty with nasotracheal intubation. A successful approach to nasotracheal intubation can then be attempted on the contralateral side if a nasal bone spur is present.

Quality of Life in People with Coeliac Disease: Psychological and Socio- Economic Aspects.

BACKGROUND AND OBJECTIVE: Coeliac disease (CD) is a chronic autoimmune intestinal disorder characterized by intolerance to gluten, a protein contained in certain cereals. The main physiopathological basis of CD is the progressive destruction of intestinal villi caused by gluten ingestion by genetically-susceptible individuals. Patients who receive a diagnosis of CD must make significant changes to their daily habits and this can affect their quality of life. The objective of this review is to summarize the evidence regarding the economic, physical and social limitations which can affect the quality of life in patients with CD. RESULTS: Different factors such as physical changes, psychological effects, interpersonal relationships, emotions and economic difficulties can affect the quality of life of these patients. Observations suggest that, in general, women with CD experience a greater deterioration in their quality of life than men. Lastly, complications in daily life are also associated with the reduced availability of gluten-free products which also usually cost more than standard products. CONCLUSIONS: Continuous health education and care regarding socio-economic issues should be continuously developed and provided to people with CD.

Liposomal bupivacaine versus bupivacaine/epinephrine after video-assisted thoracoscopic wedge resection†.

OBJECTIVES: The purpose of this research is to compare liposomal bupivacaine and bupivacaine/epinephrine for intercostal blocks related to analgesic use and length of stay following video-assisted thoracoscopic wedge resection. METHODS: A retrospective study of patients undergoing video-assisted thoracoscopic wedge resection from 2010 to 2015 was performed. We selected patients who stayed longer than 24 h in hospital. Primary outcomes were length of stay and postoperative analgesic use at 12-h intervals from 24 to 72 h. RESULTS: Intercostal blocks were performed with liposomal bupivacaine in 62 patients and bupivacaine/epinephrine in 51 patients. A Wilcoxon signed-rank test evaluated differences in median postoperative analgesic use and length of stay. Those who received liposomal bupivacaine consumed fewer analgesics than those who received bupivacaine/epinephrine, with a statistically significant difference from 24 to 36 h (20.25 vs 45.0 mg; P = 0.0059) and from 60 to 72 h postoperatively (15.0 vs 33.75 mg; P = 0.0350). In patients who stayed longer than 72 h, the median cumulative analgesic consumption in those who received liposomal bupivacaine was statistically significantly lower than those who received bupivacaine/epinephrine (120.0 vs 296.5 mg; P = 0.0414). Median length of stay for the liposomal bupivacaine and bupivacaine/epinephrine groups were 45:05 h and 44:29 h, respectively. There were no adverse events related to blocks performed with liposomal bupivacaine. CONCLUSIONS: Thoracic surgery patients who have blocks performed with liposomal bupivacaine require fewer analgesics postoperatively. This may decrease complications related to poor pain control and decrease side effects related to narcotic use in our patient population.