HNO
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Three cases of cervical necrotizing fasciitis are presented. One case was odontogenic in origin and two were due to pharyngeal infectious. ⋯ Intensive medical support was crucial to prevent or treat complications. Cervical necrotizing fasciitis has an overall mortality rate of 30 per cent at the University of Bern.
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3D reconstruction of the temporal bone using spiral CT techniques was performed in 51 patients with various otological diseases during routine clinical work evaluation. The 3D display was optimized by a reduced study time and improved detail accuracy by special algorithms. We were able to demonstrate comprehensively in a 3D mode the normal anatomy of the inner ear and adjacent middle ear structures, such as the modiolus of the cochlea, the semicircular canals, the cochlear and vestibular aqueduct and the ossicles. We suggest routine 3D delineation of the substructures of the temporal bone prior to otologic surgery to provide the surgeon with a 3D view of individual anatomy and specific otosurgical sites.
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In patients suffering from advanced or recurrent cancers that are no longer amenable to curative treatment, palliation and symptomatic care have to take the place of cure. In such cases, palliation aims at relief of pain, alleviation of functional disabilities and restoration of mental and social balance. Since the clinicians effort is concentrated on the control of symptoms of uncontrollable disease, decisions have to be made concerning the relative value of the various methods available for treatment and support in the individual patient. Criteria for the physician's decision-making are important parameters in any approach to the patient with incurable cancer and have particular significance in caring for terminal disease.
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The technique of tissue expansion can now be used to prepare skin for reconstructive operations. This method has been propagated during the last 15 years, but its use has varied from great enthusiasm with exaggerated expectations to disillusion due to high complication rates. ⋯ In this review, the biological principles of expansion, various expansion protocols and their objectives, control during the filling phase and preventive measures to avoid complications are described. For clinical use it is important that there is not one but three distinct types of expansion: an intraoperative, intermittent expansion for gentle subcutaneous skin mobilization, a short time period for expansion (between 1-2 weeks) to increase the dermal microcirculation and the "classic" prolonged period of expansion to create new skin for the reconstruction required.