JAMA otolaryngology-- head & neck surgery
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JAMA Otolaryngol Head Neck Surg · Jun 2014
Case ReportsA Case of Trigeminocardiac Reflex During Infrastructure Maxillectomy.
The trigeminocardiac reflex refers to the sudden development of bradycardia or even asystole with arterial hypotension from manipulation of any sensory branches of the trigeminal nerve. Although it has only rarely been associated with morbidity and tends to be self-limited with removal of the stimulus, it is an important phenomenon for head and neck surgeons to recognize and respond to. ⋯ The trigeminocardiac reflex can be provoked by a number of head and neck and skull base procedures including parotidectomy and posterior maxillectomy. Surgeons and anesthesiologists should be wary of inciting the reflex during manipulation of trigeminal branches. Careful dissection for prevention and early intervention with stimulus removal and anticholinergic use as needed are paramount to ensure good outcomes.
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JAMA Otolaryngol Head Neck Surg · Jun 2014
Case ReportsRight Aortic Arch With Kommerell Diverticulum: A Rare Cause of Dysphagia.
Dysphagia is a common condition with multiple causes. Fortunately, a thorough evaluation will often lead to a correct diagnosis, even when the cause is a rare entity. A right aortic arch with associated aberrant left subclavian artery is an uncommon anatomical variant. Physicians involved in the management of dysphagia should be aware of vascular anomalies that can cause dysphagia. ⋯ Kommerell diverticulum, a remnant of the left dorsal arch, is a rare cause of dysphagia. However, vascular causes should be considered in the algorithm when evaluating patients who present with dysphagia, especially when there is compression of the esophagus noted on imaging or examination.
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JAMA Otolaryngol Head Neck Surg · Jun 2014
Physician and Patient and Caregiver Health Attitudes and Their Effect on Medicare Resource Allocation for Patients With Advanced Cancer.
Physicians must participate in end-of-life discussions, but they understand poorly their patients' end-of-life values and preferences. A better understanding of these preferences and the effect of baseline attitudes will improve end-of-life discussions. ⋯ Patients with cancer and their caregivers have different preferences from physicians. These preferences are, for these patients and their caregivers, affected by their baseline health attitudes, but physician preferences are not. Understanding the effect of baseline attitudes is important for effective end-of-life discussions.