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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To describe patterns of patient involvement in head and neck cancer decision making. ⋯ Decision making in serious illness unfolds differently than in less serious problems. The conventional model does not fit this patient population, and reliance on trust of the physician figures prominently. Decision support should be aimed at physician decision making, promoting explicit incorporation of patient-specific data into the process.