The Laryngoscope
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Since the advent of endonasal skull base surgery, internal carotid artery (ICA) injury has been considered the most dramatic and challenging intraoperative complication. A large vascular injury creates an immediately challenging surgical scenario with rapid blood loss that may result in exsanguination of the patient. Recently we have developed an animal model of the endoscopic, endonasal vascular injury. We describe important surgical steps required in managing the surgical field during a catastrophic vascular event. ⋯ Controlling the endoscopic endonasal surgical field during vascular injuries relies on the cooperation of the surgical team and a step-based approach including careful endoscopic maneuvering within the nasal corridor, and appropriate suction selection and positioning with respect to the endoscope.
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Our overarching objective is to provide a comprehensive analysis of goiter data in two paired articles. This first article focuses on the preoperative evaluation. The following null hypotheses have been tested: 1) there is no correlation between goiter size and preoperative symptoms, 2) there is no correlation between preoperative neck imaging abnormalities and preoperative symptoms, and 3) there are no predictors for goiter recurrence. SUDY DESIGN: A retrospective review of 200 consecutive thyroidectomies meeting inclusion/exclusion criteria for cervical or substernal goiter. ⋯ Goiter size is associated with increasing symptoms. Tracheal compression but not deviation was related to shortness of breath. Females and patients with a positive family history of goiter have an increased risk of goiter recurrence.
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tracheitis is an acute, infectious, potentially life-threatening condition of the pediatric airway. Historically, patients have often required urgent invasive airway support, and have been treated with broad-spectrum antibiotics, often combined with direct laryngoscopy and bronchoscopy. ⋯ This study highlights the importance of early disease identification and urgent surgical intervention in the management of bacterial tracheitis. It also demonstrates an approach with the potential to improve patient outcomes from this dangerous condition.