Articles: cations.
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Skull Base Interd Ap · Nov 2003
Submental Orotracheal Intubation: An Alternative to Tracheotomy in Transfacial Cranial Base Surgery.
This retrospective study evaluated the safety and efficacy of submental intubation not only for trauma treatment but also for oncological cranial base surgery. The medical records of 24 patients who underwent submental intubation from 1996 to 2002 were reviewed. There were 6 procedures for craniofacial trauma, 12 transmaxillary approaches to the clivus for clivus chordomas, and 6 transmaxillary approaches to the cranial base for chondrosarcomas. ⋯ It avoids the complications associated with tracheostomy. It also permits considerable downward retraction of the maxilla after a Le Fort I osteotomy and is associated with good clival exposure. Furthermore, it does not interfere with maxillomandibular fixation at the end of the surgery.
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Semin Respir Crit Care Med · Oct 2003
Bronchiolar disorders: classification and diagnostic approach.
Bronchiolitis is a process in which inflammatory cells and mesenchymal tissue are both present, mainly centered in and around membranous and/or respiratory bronchioles, with sparing of a considerable portion of the other parenchymal structures. The distribution and amounts of the cellular and mesenchymal components vary from case to case, which accounts for the variety of histopathologic, radiographic, and clinical aspects of bronchiolitis. The clinical classification of bronchiolar diseases considers the causes or the clinical settings in which bronchiolitis develops: inhalation of toxic fumes, irritant gases or organic dusts, infectious and postinfectious bronchiolitis, collagen-vascular disease-associated bronchiolitis, posttransplant bronchiolitis, or rarer associations. ⋯ High-resolution computed tomographic scanning (HRCT) is currently the best imaging technique for the evaluation of patients suspected of having bronchiolitis. HRCT findings in bronchiolar diseases with a good correlation with histopathologic changes are classified as follows: centrilobular tubular branching or nodular opacities; ground-glass attenuation or consolidation; mosaic perfusion; a mixed pattern. This article presents and briefly discusses the diagnostic approach to these diseases.
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Bronchiolar pathologic lesions result from the interplay between inflammatory and mesenchymal cells following injury to bronchioles. Offending agents include viruses, bacteria, fungi, cigarette smoke, toxic inhalants, inorganic dusts, allergens, and systemic or localized autoimmune or inflammatory processes. Bronchiolar pathologic lesions also arise in the context of allograft transplantation and pathology of the large airways and in the setting of an idiopathic disorder. ⋯ After a survey of the normal histology of bronchioles, we present a pragmatic classification that reflects the spectrum of bronchiolar pathology, illustrating the intimate interdependence of clinical, radiological, and pathologic findings in assessing the significance of bronchiolar lesions. This classification is intended to be applicable to surgical pathology material that can be correlated with clinical disease syndromes. It includes asthma-associated bronchiolar changes, chronic bronchitis/emphysema-associated bronchiolar changes, cellular bronchiolitis, respiratory bronchiolitis, bronchiolitis obliterans with intraluminal polyps/ BOOP, constrictive bronchiolitis, mineral dust small airway disease, peribronchiolar fibrosis and bronchiolar metaplasia, and bronchiolocentric nodules.
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Facet or zygapophysial joint blocks are used extensively in the evaluation of chronic spinal pain. However, there is a continuing debate about the value and validity of facet joint blocks in the diagnosis of chronic spinal pain. The value of diagnostic facet joint injections may have been overlooked in the medical literature. ⋯ The diagnostic accuracy of controlled local anesthetic facet joint blocks is high in the diagnosis of chronic spinal pain.
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Radiofrequency heat lesioning has been advocated to prolong the duration of therapeutic effect of lumbar sympathetic block in Complex Region Pain Syndrome (CRPS) of the lower extremity. Prior to radiofrequency lesioning of the lumbar sympathetic trunk, sensory and motor stimulation may be used to verify that the active needle tip is not adjacent to a spinal nerve to avoid unwanted neural injury. However, the value of sensory stimulation to aid in precise needle positioning at the desired target remains controversial. ⋯ Motor stimulation did not occur up to the maximum voltage tested (2.0 V at 2 Hz) Sensory stimulation of the lumbar sympathetic trunk may be used to aid in localization of the active tip of the radiofrequency needle, in preparation for lesioning. A dermatomal sensory pattern was observed, suggesting that afferent sensory fibers travel in the lumbar sympathetic trunk. The implications of this observation for understanding the mechanism of CRPS-related pain are discussed.