Ann Oto Rhinol Laryn
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Ann Oto Rhinol Laryn · Sep 1993
Case ReportsPerioperative stroke in patients undergoing head and neck surgery.
The risk of perioperative strokes has been demonstrated to be very low in general surgical procedures, and somewhat higher in cardiac and carotid artery procedures. We describe 5 patients who underwent major head and neck procedures not requiring carotid ligation and who postoperatively suffered strokes. These occurred between the first and ninth postoperative days. ⋯ All patients had risk factors for stroke. The cases in our series were difficult to diagnose because of the delayed onset and subtle nature of symptoms, as well as masking of speech and communication due to the operative involved. Thrombogenesis within the internal carotid and vertebral artery systems due to patient positioning and intraoperative cervical manipulation may be an important etiologic factor in this form of stroke.
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The causes of transient hypocalcemia after thyroid surgery are not fully understood. In 95 consecutive patients undergoing total thyroidectomy (n = 30), subtotal thyroidectomy (n = 14), or hemithyroidectomy (n = 51), we serially measured total calcium, parathyroid hormone (PTH), and proteins before surgery and 6, 24, 48, 72, and 96 hours after surgery, and we calculated the corresponding ionized calcium levels. In the whole population, there was a statistically significant decrease of PTH, total calcium, and proteins at nearly every time of blood withdrawal, when compared with the preoperative levels. ⋯ Severe hypocalcemia was found in 8 patients after total thyroidectomy, compared with 2 after hemithyroidectomy (p < .05), and was present in 3 of the 5 patients with thyroid carcinoma, compared with 7 of the 90 patients with nonmalignant thyroid diseases (p < .01). Despite careful preservation of the parathyroid glands and their blood supply, thyroidectomy was often followed by transient hypocalcemia, the determinants of which are hypoparathyroidism and hemodilution. No patients had persistent symptoms of hypocalcemia from 2 to 3 months after surgery.
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Ann Oto Rhinol Laryn · Jun 1993
The Hayek oscillator: a new method of ventilation in microlaryngeal surgery.
The Hayek oscillator is an externally (body) mounted cuirass ventilator used in the intensive care unit. We have used it to ventilate patients undergoing microlaryngeal surgery. It was found to be a relatively safe method of ventilation in these cases, with the advantage of dispensing with any form of endolaryngeal or endotracheal intubation.
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Ann Oto Rhinol Laryn · May 1993
Validation of World Health Organization guidelines for pain relief in head and neck cancer. A prospective study.
In a prospective study of 167 patients with head and neck cancer, we assessed the causes and mechanisms of pain, as well as the efficacy and side effects of analgesic treatment, along World Health Organization (WHO) guidelines. The majority of patients had pain caused by cancer (83%) and/or treatment (28%), 4% had pain due to debility, and 7% had pain unrelated to cancer. Palliative antineoplastic treatment was performed in 32% of patients. ⋯ The treatment proved to be very successful, as severe pain was experienced only during 5% of the observation period. In the absence of serious side effects, the most frequent symptoms observed were insomnia, dysphagia, anorexia, constipation, and nausea. The use of analgesic and adjuvant drugs along WHO guidelines to treat pain in head and neck cancer is highly effective and relatively safe.
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Ann Oto Rhinol Laryn · Apr 1993
Eighteenth Daniel C. Baker, JR, Memorial Lecture. Art and science of laryngeal photography.
Photography of the pharynx, larynx, and trachea has exercised the ingenuity of laryngologists and photographers for 100 years. There have been many successful methods. The most reliable and versatile modern system uses a 35-mm single frame, single lens reflex camera with Hopkins telescopes and a synchronized, automatic exposure, computer-controlled, remote electronic flash generator. The technique described, which has been used by the author for many years, not only allows excellent visualization and reliable documentation, but yields consistently reproducible photographs under all conditions.