The Laryngoscope
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Randomized Controlled Trial Comparative Study
The quality of the surgical field during functional endoscopic sinus surgery--the effect of the mode of ventilation--a randomized, prospective, double-blind study.
The outcome of functional endoscopic sinus surgery (FESS) depends on a clean surgical field achieved by minimizing intraoperative bleeding. High frequency jet ventilation (HFJV), due to lower airway pressures, offers the benefit of improved venous return, less bleeding, and improved operating conditions. HFJV was compared to intermittent positive pressure ventilation (IPPV) by assessment of surgical conditions and measurement of intraoperative blood loss. ⋯ HFJV significantly reduced the amount of intraoperative bleeding and thus significantly improved the quality of the surgical field. It is suggested that increased venous return due to lower intrathoracic pressures resulted in less bleeding and improved operating conditions. HFJV can be effectively used for FESS in order to improve endoscopic view with no adverse effects.
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Comparative Study
Diagnostic evaluation of squamous cell carcinoma metastatic to cervical lymph nodes from an unknown head and neck primary site.
To discuss our experience with the diagnostic evaluation in patients with squamous cell carcinomas (SCCAs) of the head and neck metastatic to the cervical lymph nodes from an unknown primary site. ⋯ Diagnostic evaluation should include a thorough physical examination, CT and/or MRI of the head and neck, and panendoscopy with directed biopsies. Unilateral or bilateral tonsillectomy should be performed on patients with adequate lymphoid tonsillar tissue. FDG-PET or FDG-PET/CT should be considered for those with indeterminate findings on physical examination and/or head and neck CT and/or MRI if those sites are located outside of the oropharynx.