The Laryngoscope
-
Electrosurgical instruments are routinely used in many applications by otolaryngologist-head and neck surgeons; and a complete description of their historical development, physics of operation, histological effects, and technological advancements is necessary for our specialty to take full advantage of this instrumentation. Because of the electrical current, heat production, and common use associated with these instruments, compounded by the complex environments in which they are used, potential complications must be considered and are likely underreported in the literature. This thesis describes the important aspects of electrosurgery along with a study of complications so otolaryngologists can use these instruments to their fullest potential while limiting complications. ⋯ Electrosurgery has proliferated since its original application by William T. Bovie and Harvey Cushing in the 1920s. Because surgeons use this technology frequently, a thorough understanding of these instruments and their potential complications is critical to their safe and successful use. Electrosurgical units operate on basic fundamental principles of physics and involve the passage of electrical current through tissue to create the desired tissue effect. With knowledge of the history, physics, techniques, histological effects, and safety issues of electrosurgery, the field will continue to proliferate and electrosurgery will continue to assist surgeons in alleviating human suffering.
-
Lyme borreliosis has been implicated in the pathogenesis of acute peripheral facial palsy (APFP). Few studies, however, have used Western blot analyses to confirm the serological diagnosis. ⋯ Although it is one of the endemic areas of Lyme disease in Japan, the prevalence of APFP caused by Lyme borreliosis is low in Hokkaido Island. In addition, cross-reactivity to B. afzelii in IgM blots is often observed in patients with HSV-1 reactivation, suggesting that careful interpretation of Borrelia IgM immunoblot data are needed for accurate serological diagnosis.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Bedside tracheostomy in the intensive care unit: a prospective randomized trial comparing open surgical tracheostomy with endoscopically guided percutaneous dilational tracheotomy.
Objectives of the study were 1) to analyze the complication incidence and resource utilization of two methods of bedside tracheostomy and 2) to define selection criteria for bedside tracheostomy. ⋯ This investigation prospectively confirms the safety of bedside tracheostomy placement in properly selected patients. Complication incidence and resource utilization are defined for two methods of bedside tracheostomy. The results of this study confirm that open surgical tracheostomy represents the standard of care in bedside tracheostomy placement by providing a more secure airway at a markedly reduced patient charge. These findings will aid in the development of protocols and pathways for surgical airway management in critically ill patients to maximize cost-effective, high-quality care.
-
Hemorrhages are main complications after tonsillectomy, whatever technique is used. This prospective study aimed at revealing pros and cons associated with monopolar electrodissection tonsillectomy. ⋯ Monopolar electrodissection tonsillectomy was fast and resulted in little intraoperative bleeding. However, postoperative hemorrhages were common, and the mean use of analgesics was for more than 10 days. Preoperative counseling must be thorough and realistic. Our results indicate that better methods for tonsillectomy still need to be developed.
-
Ethmoid osteoma is a slow-growing, benign, and encapsulated bony tumor. Symptoms occur earlier than with osteomas of the frontal sinus because of the small volume of the ethmoid sinus. Interestingly, orbital extension is uncommon. Treatment remains controversial, with open procedures typically being used. In this article, we present a less invasive yet safe and effective approach to treatment. ⋯ The 30 degrees nasoendoscopic approach using an intranasal drill provides a good operative field and is a safe and effective technique, with the potential to become the treatment of choice in selected cases.