HNO
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Measures taken to assure medical quality in hospital departments have focused on external quality control. Public health insurance organizations and the society of hospital holders in Germany have now agreed to carry out activities that aims not only at outcome but also at structural and procedural aspects of medical quality. The next step will be the introduction of quality management systems according to ISO 9000.
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Endonasal nasal and sinus surgery using an endoscope for visual control has minimized the risks of surgery. A new technique is presented in which a suction-irrigation endoscope is used for visual control during surgery. The instrument is combined with a suction-rotation microdebrider with different tips and a power generator. The handling of this instrument is easy and atraumatic and it achieves a relatively bloodless field to reduce further the risk of inadvertent penetration of the skull base and lamina papyracea during endoscopic surgery.
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Malignant tumors of the larynx are an important disease entity in otorhinolaryngology and mainly involve squamous cell carcinomas. Different epithelial or mesenchymal malignant tumors are reported only sporadically and metastases localized in the larynx are even rarer. ⋯ An ovarian carcinoma treated 7 years previously was the primary tumor and first metastasized into the left lung and then into the subglottig area of the larynx. Because the surgical procedures and chemotherapy used for each lesion were successful and no local recurrences were found, the same therapeutic rules for the treatment of metastases to the larynx should be applied as in cases of primary malignancies.
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Review
[Heart arrest in children after intravenous injection of succinylcholine in the ENT operating room].
Acute rhabdomyolysis with hyperkalemia has been followed by ventricular dysrhythmia, cardiac arrest and death after the administration of succinylcholine to apparently healthy children who were subsequently found to have undiagnosed skeletal muscle myopathies. Boys have mostly been affected. Reports of anesthesia emergencies from the United States and Germany have indicated that serious side effects of succinylcholine are not as rare as previously thought. ⋯ Due to the abrupt onset of rhabdomyolysis, routine resuscitative measures are likely to be unsuccessful. Extraordinary measures (including institution of extracorporeal circulation) and prolonged efforts have resulted in successful resuscitation of some cases. Since there are usually no signs or symptoms to alert the practitioner to patients at risk, the use of succinylcholine in children should be reserved for emergency intubations or instances in which immediate securing of the airway is necessary.