Acta chirurgica Iugoslavica
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Historical Article
[A look into the larynx--two centuries along the path of laryngoscopy].
Both the design and purpose of the laryngoscope have been changed significantly since Alfred Kirstein invented his own "laryngeal mirror"--the autoscope. An initially straight, rigid oesophageal tube has been reshaped into a number of laryngeal blade modifications, suitable for use in various patient subpopulations. ⋯ As direct laryngoscopy depends greatly upon individual manual skills, there has been almost no beginner who feels no proud of his first successful intubation. Thus, we should never forget the pioneers of laryngoscopy whose curiosity, creativity, and enthusiasm enabled us to give a clear and safe look into the larynx.
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Cancer of unknown primary origin is not an uncommon clinical state, usually accounting for 2%-7% of all cancer patients. ⋯ FDG PET/CT demonstrates very good whole-body imaging method in evaluation of patients with unknown primary carcinoma.
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Determination of patient's functional status in early postoperative period is a delicate task, because of its general health status. Measures that can be used for that purpose are walk tests and functional status questionnaires. ⋯ 2MWT was sensitive to change postoperatively. Significant correlation of 2MWT postoperatively with DASI preoperatively, age and VAS, as well as prediction capacity of age and DASI, gives us possibility to utilize those parameters in early rehabilitation program in order to achieve maximal functional recovery of patients.
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Randomized Controlled Trial
[Hemodynamic effect of local infiltrative 2% lidocaine adrenaline anesthesia in general balanced anesthesia during middle ear surgery].
Hemodynamic effect of different techniques and type of anesthesia are defined. The volume of reduced hemorrhage in surgical field is debatable, without any definite conclusion. The objective of the study is to investigate the effects of local infiltrative anesthesia with adrenaline during general balanced anesthesia and nitroglicerol on blood presure and hemorrhage reduction in middle ear operations. ⋯ Blood pressure and heart rate was not different between the two groups. But, intraoperatively, the study showed lowering of sistolic and diastolic blood pressure. This mode of treatment and surgeon's verbal reply confirmed that local infiltrative anesthesia with adrenaline under balanced anesthesia had no effect on hemorrhage reductionin surgical field.
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Neurointensive care of patients with subarachnoid haemorrhage is based on the theory that clinical outcome is the consequence of the primary haemorrhage and a number of secondary insults in the acute post haemorrhage period. Several neuromonitoring techniques have been introduced or accomplished into clinical practice in the last decade with the purpose of monitoring different but related aspects of brain physiology, such as cerebral blood flow (CBF), pressure within the cranial cavity, metabolism, and oxygenation. The aim of these techniques is to obtain information that can improve knowledge on brain pathophysiology, and especially to detect secondary insults which may cause permanent neurological damage if undetected and untreated in "real time", at the time when they can still be managed. ⋯ Expense, technical difficulties, invasiveness, limited spatial or temporal resolution and the lack of sensitivity add to the limitation of any individual monitor. These problems have been partially addressed by the combination of several monitors known as multimodality monitoring. In this review, we describe the most common neuromonitoring methods in patients with subarachnoidal hemorrhage that can assess nervous system function, cerebral haemodynamics and cerebral oxygenation.