Patulous eustachian tube after balloon eustachian tuboplasty in a post-radiation patient.

BACKGROUND: Balloon eustachian tuboplasty (BET) is a minimally invasive surgical treatment that is effective and safe for obstructive eustachian tube dysfunction. However, BET complications include excessive widening of the eustachian tube, causing a patulous eustachian tube (PET). Herein, we report a case of PET following BET in a patient who underwent radiation therapy and reviewed the literature on considerations for reducing complications after BET. CASE PRESENTATION: A 63-year-old woman complained of bilateral ear fullness after concurrent chemoradiation therapy for nasopharyngeal lymphoma. BET was performed on the left side because the left-sided serous otitis media persisted. A left-sided PET was performed two weeks after the BET, along with eustachian tube silicone plug insertion on the left side. The patient became asymptomatic immediately after the surgery, with no recurrence reported after a 12-month follow-up period. CONCLUSIONS: To our knowledge, there has been no report of PET following BET in a post-radiation patient, and it was successfully treated via ET silicone plug insertion.

Comparative analysis of sublingual immunotherapy medicines for adherence and clinical outcomes.

OBJECTIVE: Sublingual immunotherapy (SLIT) has been considered as an effective and safe alternative to the subcutaneous route. However, different modalities and administration methods may lead to significant changes in their adherence and clinical outcomes. The purpose of this study was to compare the adherence, efficacy, and side effects of SLIT medicines: SLITone®, Lais®, and Staloral®. SUBJECTS AND METHODS: Eighty-two patients suffering from AR symptoms and sensitized only to house dust mite allergens were included. The patients were treated with SLITone®, Lais®, or Staloral®. Treatment outcomes related to efficacy, dropout rate, and adverse events were evaluated. The visual analogue scale (VAS) including sneezing, rhinorrhea, nasal obstruction, and itching was scored from 0 (normal) to 10 (severe), before and after SLIT. Dropout rate was defined as the number of patients who discontinue SLIT of oneself compared to the number of patients who receive SLIT. RESULTS: All of the nasal symptoms and total symptom scores were significantly decreased in SLITone®, Lais®, and Staloral®. Furthermore, there were significant difference in the improvement of rhinorrhea and TNSS between SLITone® and Staloral® group (p = 0.011 and p = 0.001, respectively). Four patients out of 26 in SLITone® group, 4 patients out of 30 in Lais® group, and 11 patients out of 26 in Staloral® group have stopped SLIT of themselves. The dropout rate was significantly higher in the Staloral® group than other two groups (p = 0.024). Only one patient complained adverse reaction such as swelling of mouth floor in the Staloral® group. CONCLUSION: Although all three SLIT medicines are effective in improving AR symptoms, the adherence to SLIT assessed in accordance with dropout rate was the lowest in the Staloral®.

Comparison of impacts of intraperitoneal saline instillation with and without pulmonary recruitment maneuver on post-laparoscopic shoulder pain prevention: a randomized controlled trial.

BACKGROUND: Intraperitoneal isotonic saline instillation (SI) and pulmonary recruitment maneuver (RM) were indicated to alleviate post-laparoscopic shoulder pain (PLSP) effectively. The aim of this study was to compare the effects of the single strategy using SI alone and the combined strategy using SI and RM on PLSP reduction. METHODS: Subjects undergoing elective gynecologic laparoscopy were randomly allocated to a control group (no intervention, n = 48) and two intervention groups (single strategy of SI alone, n = 48; combined strategy of SI and RM, n = 48). In the control group, carbon dioxide was removed only via passive evacuation through the port sites at the completion of the laparoscopic procedure. In the saline instillation group, 20-mL/kg of body weight SI was performed. In the combined strategy group, RM using five pulmonary inflations was performed, in addition to SI. The PLSP scores, which were the primary outcome, were recorded using a visual analog scale postoperatively. RESULTS: The PLSP scores 24 and 48 h after surgery were significantly lower in the two intervention groups than in the control group (P = 0.014 and P = 0.001, respectively), while no significant differences were observed between the two intervention groups. CONCLUSIONS: The single strategy using SI alone is as effective as the combined strategy of SI and RM for removing residual carbon dioxide and consequently preventing PLSP. Therefore, considering the potential risks of pulmonary or hemodynamic complications associated with RM, the single strategy using SI alone might be a better choice than the combined strategy.

Thyroid cancer that developed around the operative bed and subcutaneous tunnel after endoscopic thyroidectomy via a breast approach.

Endoscopic thyroidectomy is gaining greater acceptance because of its excellent cosmetic result. As the surgical skill and understanding of the endoscopic cervical anatomy has improved, the surgical indications for endoscopic thyroidectomy have recently expanded to small size thyroid cancer. Despite the many advantages of laparoscopic surgery, there have been incidental reports about recurrences at the site of insertion of the laparoscope or other instruments in other cancers. Herein, we present a case of 25-year-old woman who had recurrent cancers around the operative bed and subcutaneous tunnel after endoscopic thyroidectomy.

Clonidine premedication prevents preoperative hypokalemia.

STUDY OBJECTIVE: To test the hypothesis that clonidine premedication could prevent an increase of plasma epinephrine occurring as a result of anxiety, and a decrease of the serum potassium (K+) levels before the induction of anesthesia. DESIGN: Randomized, double-blinded study. SETTING: University Hospital of Seoul. PATIENTS: 44 ASA physical status I and II patients, aged 20 to 50 years, scheduled for knee, ear, or nose surgery. INTERVENTION: 44 patients were randomly allocated into one of two groups: 22 patients (clonidine group) received clonidine 300 microg orally at 120 minutes before the induction of anesthesia. The other 22 patients (control group) received a placebo. MEASUREMENTS AND MAIN RESULTS: Anxiety level, serum K+, and plasma epinephrine were measured at an outpatient clinic, and immediately before the induction of anesthesia. There were no differences between groups in degree of anxiety experienced, serum K+, or plasma epinephrine levels as measured at the out-patient clinic. Immediately before the induction of anesthesia, the serum K+ levels of the clonidine group were higher than those of the control group (3.89 +/- 0.26 mEq/L vs. 3.50 +/- 0.36 mEq/L), and anxiety and plasma epinephrine levels of clonidine group were lower than those of the control group (p < 0.05). The frequency of hypokalemia (K+ < or = 3.5 mEq/L) of the clonidine group immediately before the induction of anesthesia was significantly lower than that of the control group (0% vs. 50%). CONCLUSIONS: Clonidine premedication was effective in preventing hypokalemic episodes occurring before the induction of anesthesia.