The Journal of laryngology and otology
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Randomized Controlled Trial Comparative Study
Hypotensive anaesthesia with remifentanil combined with desflurane or isoflurane in tympanoplasty or endoscopic sinus surgery: a randomised, controlled trial.
To compare the effect of remifentanil combined with desflurane or isoflurane on the quality of the operative field and surgical conditions, blood loss, and recovery during tympanoplasty or endoscopic sinus surgery. ⋯ Although desflurane and isoflurane both enabled good surgical conditions (in terms of quality of operative field) and convenient induction of hypotension for tympanoplasty and endoscopic sinus surgery, the recovery characteristics of desflurane were better than those of isoflurane. Therefore, desflurane may be preferable to isoflurane in such circumstances.
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To demonstrate the importance of a detailed history when assessing patients with a repeated pattern of foreign body ingestion. ⋯ Oesophageal foreign bodies are commonly encountered in otolaryngology practice. Such circumstances are often compounded by pre-existing psychiatric problems such as bulimia and/or anorexia nervosa. Patients with bulimia may often present with a very similar pattern of multiple episodes of ingestion of large foreign bodies. Identification of this eating disorder (especially when there is a recurrent history of large, accidentally ingested foreign bodies) and prompt psychiatric referral is essential for efficient long-term management of this condition.
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Foregut duplication cysts are heterotrophic rests of foregut-derived epithelium which are usually found in the abdomen and thorax; rarely are they found in the head and neck. ⋯ The occurrence of a foregut duplication cyst in the head and neck region mandates vigilance with respect to the airway. Magnetic resonance imaging is a useful part of pre-operative evaluation but cannot be relied upon for definitive diagnosis. Although foregut duplication cysts are benign lesions, definitive cure ultimately requires surgical excision, and this is often the means by which a definitive diagnosis is made. The prognosis for these lesions is excellent, with no reports in the literature of recurrence following excision.
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We aimed to highlight a rare anatomical variation involving the recurrent laryngeal nerve, and to emphasise its implications for thyroid surgery. ⋯ The recurrent laryngeal nerve must be carefully dissected and totally exposed during thyroid surgery in order to best preserve its function. Moreover, the thyroid surgeon must be aware of the existence of anatomical variations, which are not as rare as one may think.
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We postulated that epistaxis patients frequently have their nose packed in the accident and emergency department without any reasonable prior attempt at nasal assessment and nasal cautery. ⋯ Despite the majority of accident and emergency doctors claiming to attempt nasal cautery before packing, this is unlikely to be effective if performed without the correct equipment. Better training and equipment need to be provided to accident and emergency doctors in order to optimise the management of epistaxis patients. This could potentially reduce inappropriate admissions.