Clar as Mud? Origins of the head mirror: A historical note.

In Europe, the name "Clar" immediately evokes to any otorhinolaryngologist the classic head mirror that remains a symbol of our profession. Yet, the origin of Clar has never been investigated. In this clinical and historical review, based on an Internet and PubMed database search together with perusal of Fischer's Biographical Lexikon, the authors seek to elucidate this medical enigma. The data presented suggest that Clar was not a physician but rather a term picked by the company that designed the mirror by the end of the 19th century to underscore the bright and sharp view provided by this then innovative medical device. © 2015 Wiley Periodicals, Inc. Head Neck 38: 930-932, 2016.

[Evolution of laryngectomy based on a comparison of two cohorts a century apart: an illustration of the progress, difficulties and conflicts encountered in medicine]. / Histoire des laryngectomies illustrée par l'analyse de deux cohortes à un siècle de distance : un reflet du progrès, des difficultés et des conflits rencontrés en médecine.

Based on a comparison of two cohorts of patients with laryngeal cancer managed by laryngectomy one century apart, and an analysis of original textbooks from the end of the nineteenth century, we examine the development of laryngectomy, the difficulties encountered in this first therapeutic approach to laryngeal carcinoma, and the conflicts it generated. The overall death rate changed little over the course of a century, although the 5-year actuarial survival estimate improved from 22.6% in 1888 to 75.1% in 1988 (p < .0001). The causes of death also changed (p < .0001), with fewer deaths related to post-operative complications and/or local failure (82.7% in 1888, 9% in 1988). The rate of suicide deaths fell from 1.8% to 0.04%. In contrast, the percentage of deaths due to metachronous second primary tumors and/or intercurrent disease increased from 9% in 1888 to 76.7% in 1998. Analysis of actuarial survival rates demonstrated that 77.4% of patients died before the 60th post-operative month in 1888, while this percentage was only reached 275 months post-operatively a century later. Our research also underscores the importance of patient information and medical ethics.

[Analysis of the variables affecting patients' memorization and interpretation of information on thyroidectomy-related risks]. / Analyse des facteurs qui influent sur la mémorisation et l'interprétation par le malade de l'information concernant les risques de la thyroïdectomie.

We prospectively analyzed patients' memorisation and interpretation of preoperative information on the risks of thyroidectomy. This study was conducted in an academic tertiary care referral center, based on an inception cohort of 280 patients who were consecutively informed of the risks of thyroidectomy (unilateral laryngeal immobility, bilateral laryngeal immobility, hypocalcemia, common surgical complications, and perioperative death) by the same surgeon during the period 2003-2006. Univariate analysis was used to identify factors affecting memorisation and interpretation of the information delivered. After being informed of the risks, 14.6% of patients declined surgery, and 5% decided to postpone the operation for a few months. Among the 215 patients who underwent thyroidectomy, 0.9% remembered all five risks, 17.2% three or four, 61.4% one or two, and 20.4% none. The number of risks remembered did not vary over time. Age, occupation, and the year of the analysis influenced memorisation. In the immediate post-operative period, 85.5% of the patients had a positive opinion and 45.1% a negative opinion of the preoperative information, and 35.3% simultaneously expressed positive and negative opinions. The number of preoperative visits and the interval between the final preoperative visit and surgery both affected the patients' interpretation of the information. Patient memorisation of information on surgical risks is poor, and this results in major stress for the patient. After receiving this information, a significant proportion of patients decide to forego surgery.

[Dexmedetomidine in general anesthesia for surgical treatment of cerebral aneurysm in pregnant patient with specific hypertensive disease of pregnancy: case report.]. / Uso de dexmedetomidina em anestesia geral para tratamento cirúrgico de aneurisma cerebral, em paciente gestante, portadora de doença hipertensiva específica da gestação: relato de caso.

BACKGROUND AND OBJECTIVES: The incidence of non-obstetrical surgeries in pregnant patients is about 0.36% to 2%. However, surgeries aiming at surgical treatment of cerebral aneurysm in pregnant women are extremely rare. Specific hypertensive disease of pregnancy, shows clinical prevalence of 10%. It is a disease with high clinical complexity compromising multiple organs and systems. Dexmedetomidine, alpha2-adrenoceptor agonist drug, in therapeutic clinical doses has major selectivity for these receptors and promotes suitable hemodynamic stability if used in the preoperative period. The purpose of this report was to present an anesthetic technique able to provide adequate maintenance of maternal homeostasis, preserving to the highest level uterus-placental blood flow and fetal vitality, without neglecting fundamental aspects regarding the optimization of brain oxygen supply/demand ratio and favorable brain tissue conditions for surgical management. CASE REPORT: Pregnant patient, 19 years old, 27 weeks of gestation, was referred to the operating room for surgical treatment of cerebral aneurysm. In the preoperative period she was conscious, oriented, eupneic but with left side motor deficit and clinical signs compatible with toxemia of pregnancy. Dexmedetomidine (1 microg.kg-1.h-1) was administered in 20 minutes, followed by anesthetic induction with propofol (2.5 mg.kg-1), fentanyl (7.5 microg.kg-1), lidocaine (1 mg.kg-1) and rocuronium (1.2 mg.kg-1) in rapid sequence. Anesthesia was maintained with propofol (50 microg.kg-1.min-1), alfentanil (1 microg.kg-1.min-1) and dexmedetomi- dine (0.7 microg.kg-1.h-1). Surgical procedure went on with no complications, including brain sequelae. CONCLUSIONS: This case report has shown that dexmedetomidine made possible the handling of hemodynamic responses, keeping optimized uterus-placental blood flow and fetal vitality. Adequate conditions of surgical brain tissue manipulation and the absence of influence in postoperative morbidity are also emphasized.