RESUMO
Many publications have addressed the medical complications of tattoos, but to our knowledge there are no reports of their use to alert people in our field of potentially dangerous conditions. We present a new way to inform oral and maxillofacial colleagues about patients with a history of malignant hyperthermia (or any other life-threatening medical problem) and discuss the potential advantages and disadvantages of medical alert tattoos.
Assuntos
Hipertermia Maligna , Procedimentos Cirúrgicos Bucais , Tatuagem , HumanosRESUMO
Vertebral metastases from primary head and neck cancers are uncommon, and so there are no clear guidelines about management. The spinal cord can be compressed by a vertebral fracture or invasion of a tumour, and may present as an oncological and spinal emergency. The goals of treatment are to relieve pain and maintain neurological function. However, surgical treatments in this group of patients have not been defined, and primary operative treatment of spinal metastases remains controversial. Here we discuss their contemporary management. Surgical options should be considered for treatment to achieve stability of the spine, relieve pain, and preserve neurological function in certain cases.
Assuntos
Vértebras Cervicais , Neoplasias de Cabeça e Pescoço/patologia , Neoplasias da Coluna Vertebral/secundário , Tomada de Decisão Clínica , Humanos , Neoplasias da Coluna Vertebral/diagnóstico , Neoplasias da Coluna Vertebral/terapiaRESUMO
Babies born with clefts of the lip, and the alveolus or palate, or both, require multidisciplinary, highly specialised treatment from birth to early adulthood. We review the contemporary management of clefts and outline the current treatment protocol adopted by cleft networks in the United Kingdom. We also look at the level of evidence and the restructuring of services that has defined current practice. In light of the recent Cleft Care UK study, we ask whether it is now time to adopt a new philosophy towards the surgical techniques that are used.
Assuntos
Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Assistência Integral à Saúde , Procedimentos Clínicos , Prática Clínica Baseada em Evidências , Humanos , Equipe de Assistência ao Paciente , Procedimentos de Cirurgia Plástica/métodos , Reino UnidoRESUMO
The term 'woody neck' is widely used by surgeons and oncologists to describe the fibrosis that can occur following radiotherapy for head and neck malignancy. These soft tissue and skin changes can be compounded by neck dissection, either before or after radiotherapy. To our knowledge, there is no classification published in the literature to describe the degree of woody hardness following treatment. We propose a simple ABC classification for varying degrees of indurated oedema and neck fibrosis secondary to radiotherapy or long-standing pathology, using the hardness of different woods to enable a suitable description to be made of severity.
Assuntos
Neoplasias de Cabeça e Pescoço/radioterapia , Pescoço/efeitos da radiação , Terminologia como Assunto , Edema/classificação , Edema/patologia , Fibrose , Dureza , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Pescoço/patologia , Esvaziamento Cervical/métodos , Maleabilidade , Pressão , Pele/patologia , Pele/efeitos da radiação , Madeira/classificaçãoRESUMO
During the creation of a university digital library and press intended to serve as a medical reference and education tool for health care providers and their patients, six distinct and complex digital publishing challenges were encountered. Over nine years, through a multidisciplinary approach, solutions were devised to the challenges of digital content ownership, management, mirroring, translation, interactions with users, and archiving. The result is a unique, author-owned, internationally mirrored, university digital library and press that serves as an authoritative medical reference and education tool for users around the world. The purpose of this paper is to share the valuable digital publishing lessons learned and outline the challenges facing university digital libraries and presses.
Assuntos
Internet , Bibliotecas Médicas , Editoração/organização & administração , Hospitais , National Library of Medicine (U.S.) , Sistemas On-Line , Estados Unidos , Universidades , Interface Usuário-ComputadorRESUMO
Histamine has been shown to mediate features of pulmonary allergic reactions including increased tracheobronchial blood flow. To determine whether the increase in blood flow was due to stimulation of H1- or H2-histamine receptors, we gave histamine base (0.1 micrograms/kg iv) or histamine dihydrochloride as an aerosol (10 breaths of 0.5% "low dose" or 5% "high dose") before and after H1- or H2-receptor antagonists. Blood velocity in the common bronchial branch of the bronchoesophageal artery (Vbr) was continuously measured using a chronically implanted Doppler flow probe. Pretreatment with H2-receptor antagonists cimetidine, ranitidine, or metiamide did not affect the increase in Vbr induced by intravenous histamine [106 +/- 45% (SD)]. Addition of the H1-receptor antagonists diphenhydramine or chlorpheniramine, however, reduced the Vbr response to 16 +/- 22, 21 +/- 28, 23 +/- 23, and 37 +/- 32% of the unblocked responses (P less than 0.05) when intravenous histamine was given at 3, 10, 20, and 30 min, respectively, after the H1 antagonist. At 40, 50, and 60 min the H1-receptor blockade appeared to attenuate, but subsequent continuous infusion of chlorpheniramine (2 mg.kg-1.min-1) then blocked the histamine response for 60 min. Low-dose histamine aerosol did not change mean arterial or pulmonary arterial pressures, cardiac output, or arterial blood gases but increased Vbr transiently from 15.2 +/- 3.4 to 37.6 +/- 8.4 (SE) cm/s. After chlorpheniramine, the Vbr response to histamine, 16.3 +/- 2.2 to 22.6 +/- 3.6 cm/s, was significantly reduced (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Brônquios/irrigação sanguínea , Brônquios/efeitos dos fármacos , Histamina/farmacologia , Vasodilatação/efeitos dos fármacos , Aerossóis , Animais , Cimetidina/farmacologia , Difenidramina/farmacologia , Histamina/administração & dosagem , Injeções Intravenosas , Receptores Histamínicos H1/efeitos dos fármacos , Receptores Histamínicos H1/fisiologia , Receptores Histamínicos H2/efeitos dos fármacos , Receptores Histamínicos H2/fisiologia , Ovinos , Vasodilatação/fisiologiaRESUMO
Complete analysis of retinal tissue is difficult because it consists of a thin neural tissue spread across the back of a hemispheric surface. Conventional sectioning in a plane parallel to a central axis of symmetry produces a large number of samples, each containing only a small amount of the tissue of interest. Consequently, quantitative comparison of any feature of interest typically uses a small fraction of the sections from each retina, because analysis of the entire collection of sections is too time consuming. Such a sampling process can lead to misleading or erroneous conclusions. We present a new method which allows complete analysis of the retina using a small number of samples produced by sectioning flattened retinas. This procedure is straightforward as illustrated using an antibody against proliferating cell nuclear antigen (PCNA) to locate dividing cells in the teleost fish retina. Immunocytochemical staining on flat-sectioned retinas was quantified using a computer-based image analysis system. When the cells of interest are randomly distributed, conventional sampling procedures can seriously under- or over-estimate their number. The new technique presented allows significantly more efficient examination and quantification of the entire retina as compared to conventional techniques.
Assuntos
Imuno-Histoquímica/métodos , Retina/imunologia , Animais , Contagem de Células , Divisão Celular/fisiologia , Peixes , Células Fotorreceptoras/citologia , Antígeno Nuclear de Célula em Proliferação/análise , Retina/química , Retina/ultraestruturaRESUMO
BACKGROUND: Adequate analgesia is important after surgery and in particular after ambulatory surgery. Preemptive administration of analgesics, ie, prior to commencing surgery, has many theoretical advantages. METHODS: In this prospective randomized study, the use of preincisional bupivacaine was compared with a postincision dose for the relief of postoperative pain, in 74 patients undergoing day-case breast biopsy. RESULTS: Demographic criteria were similar in both groups. There were no differences in pain scores postoperatively on the visual analog scale (VAS): VAS at 30 minutes 4.5 ([SD] 2.4) versus 4.7 (1.9); P = not significant (NS); VAS at 60 minutes 3.3 (2. 3) versus 3.6 (2.2); P = NS; VAS at 120 minutes 1.9 (1.7) versus 2.5 (2.0); P = NS; VAS at 240 minutes 0.9 (1.0) versus 1.3 (1.4); P = NS. There was no difference in the number of patients requiring additional analgesia: 13 (36%) versus 18 (47%); P = NS. Nor was there a difference in the time to additional analgesia: 55.0 (37.8) versus 55.3 (39.2) minutes; P = NS. CONCLUSIONS: The administration of local anaesthesia prior to starting surgery does not appear to have any advantage over its postoperative administration in patients undergoing ambulatory breast biopsy.
Assuntos
Procedimentos Cirúrgicos Ambulatórios , Analgesia , Anestésicos Locais/uso terapêutico , Biópsia/métodos , Mama/patologia , Bupivacaína/uso terapêutico , Dor Pós-Operatória/prevenção & controle , Pré-Medicação , Adulto , Analgésicos/uso terapêutico , Análise de Variância , Anestesia Geral , Área Sob a Curva , Distribuição de Qui-Quadrado , Intervalos de Confiança , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Medição da Dor , Estudos Prospectivos , Estatísticas não Paramétricas , Fatores de TempoRESUMO
The purpose of this study was to measure vestibular function in Belgian Waterslager canaries using short latency vestibular evoked potentials (VsEPs) elicited by linear acceleration stimuli. Responses were recorded with vertex to mastoid leads using traditional signal averaging. Response thresholds, latencies, and amplitudes were quantified and compared to non-Waterslager controls. Cochlear and vestibular organs were also processed for scanning electron microscopy. Results indicated that vestibular response thresholds were slightly, but significantly, higher for Belgian Waterslager canaries and response amplitudes at 0 dBre: 1.0 g/ms were significantly reduced compared to non-Waterslagers. Response peak latencies were not significantly different. The most striking morphological finding was that the stereociliary bundles of Waterslager saccular hair cells showed no common orientation. Previous reports have also found significantly less hair cells in Waterslager saccules (Weisleder and Park, Hear. Res. 80 (1994) 64-70); however, the present study did not confirm this finding. The utricle and ampullae appeared normal. The present results indicate that vestibular neural function, as measured with VsEPs, is affected in Belgian Waterslager canaries. The results also suggest that one structural correlate of the functional loss is the disordered stereociliary bundles in the sacculus.
Assuntos
Canários/fisiologia , Vestíbulo do Labirinto/fisiologia , Estimulação Acústica , Animais , Limiar Auditivo , Cóclea/ultraestrutura , Potenciais Evocados Auditivos do Tronco Encefálico , Células Ciliadas Auditivas/fisiologia , Células Ciliadas Auditivas/ultraestrutura , Microscopia Eletrônica de Varredura , Sáculo e Utrículo/fisiologia , Sáculo e Utrículo/ultraestrutura , Especificidade da Espécie , Testes de Função Vestibular , Vestíbulo do Labirinto/ultraestruturaRESUMO
Transient linear acceleration stimuli have been shown to elicit eighth nerve vestibular compound action potentials in birds and mammals. The present study was undertaken to better define the nature of the adequate stimulus for neurons generating the response in the chicken (Gallus domesticus). In particular, the study evaluated the question of whether the neurons studied are most sensitive to the maximum level of linear acceleration achieved or to the rate of change in acceleration (da/dt, or jerk). To do this, vestibular response thresholds were measured as a function of stimulus onset slope. Traditional computer signal averaging was used to record responses to pulsed linear acceleration stimuli. Stimulus onset slope was systematically varied. Acceleration thresholds decreased with increasing stimulus onset slope (decreasing stimulus rise time). When stimuli were expressed in units of jerk (g/ms), thresholds were virtually constant for all stimulus rise times. Moreover, stimuli having identical jerk magnitudes but widely varying peak acceleration levels produced virtually identical responses. Vestibular response thresholds, latencies and amplitudes appear to be determined strictly by stimulus jerk magnitudes. Stimulus attributes such as peak acceleration or rise time alone do not provide sufficient information to predict response parameter quantities. Indeed, the major response parameters were shown to be virtually independent of peak acceleration levels or rise time when these stimulus features were isolated and considered separately. It is concluded that the neurons generating short latency vestibular evoked potentials do so as "jerk encoders" in the chicken. Primary afferents classified as "irregular", and which traditionally fall into the broad category of "dynamic" or "phasic" neurons, would seem to be the most likely candidates for the neural generators of short latency vestibular compound action potentials.
Assuntos
Aceleração , Potenciais Evocados/fisiologia , Vestíbulo do Labirinto/fisiologia , Animais , Galinhas , Neurônios/fisiologia , Limiar Sensorial , Nervo Vestibulococlear/fisiologiaRESUMO
Human Immunodeficiency Virus, Hepatitis B and C are important blood borne viruses and pose occupational risks for operating room personnel. Increasing numbers of patients with these infections are appearing in Irish hospitals. In this review we describe in detail the occupational risks of these blood borne viruses for operating room personnel and how best to minimise them.
Assuntos
Patógenos Transmitidos pelo Sangue , Infecções por HIV/transmissão , Hepatite B/transmissão , Hepatite C/transmissão , Transmissão de Doença Infecciosa do Paciente para o Profissional , Salas Cirúrgicas , Equipe de Assistência ao Paciente , Infecções por HIV/prevenção & controle , Hepatite B/prevenção & controle , Hepatite C/prevenção & controle , Humanos , Transmissão de Doença Infecciosa do Profissional para o Paciente , Fatores de RiscoRESUMO
There seems to be only individual clinical experience and some anecdotal evidence about a relation between the width of the great auricular nerve (GAN) and the size of the main trunk of the facial nerve during parotidectomy. To our knowledge no anatomical studies have been published. In this cadaveric and clinical study we measured the widest point of the GAN as it crosses the sternomastoid muscle before it divides, and the main trunk of the facial nerve before it bifurcates. Measurements were obtained from 16 patients who required formal superficial parotidectomies with identification of the facial nerve, and from 21 cadavers (16 formalin-fixed and 5 fresh frozen) where both sides were dissected. We recorded the results and the side of dissection. The mean (SD) width of the GAN and facial nerve from all the dissections was 2.75 (0.53)mm and 2.83 (0.54)mm, respectively. There was a strong correlation between the width of the nerves from both sides (left: r=0.934, p<0.001; right: r=0.940, p<0.001). The nerves did not differ significantly in size in patients or cadavers (GAN: right, p=0.873; left, p=0.486; facial nerve: right, p=0.931; left, p=0.691). We have found that the GAN accurately predicts the width of the main trunk of the facial nerve. This is particularly useful surgically as a narrow GAN can alert the surgeon to expect a small facial nerve.
Assuntos
Orelha Externa/inervação , Nervo Facial/anatomia & histologia , Glândula Parótida/inervação , Cadáver , Plexo Cervical/anatomia & histologia , Dissecação , Feminino , Previsões , Humanos , Masculino , Músculos do Pescoço/inervaçãoRESUMO
With the increasing use of hyaluronic acid-based injectable fillers for cosmetic enhancement a variety of adverse reactions are being reported in the literature. Although most adverse outcomes occur early we describe an interesting case study of a female presenting with granulomatous complications ten years postoperatively. To our knowledge this is one of the longest reported delayed reactions. For the general dental practitioner offering such treatments it is important to be fully aware of the potential risks and how they may be managed in order to consent appropriately for cosmetic procedures.
Assuntos
Técnicas Cosméticas/efeitos adversos , Reação a Corpo Estranho/etiologia , Metilmetacrilato/efeitos adversos , Envelhecimento da Pele/efeitos dos fármacos , Idoso , Feminino , Humanos , Ácido Hialurônico/administração & dosagem , Injeções SubcutâneasRESUMO
The surgical management of advanced cervical metastases with carotid artery involvement in patients with primary squamous cell carcinoma of the head and neck can be difficult. The authors retrospectively reviewed 73 patients over a 15-year period comparing the outcomes of carotid artery resection versus peeling the tumour off the carotid artery. Based on these findings, the authors suggest that in the absence of carotid wall involvement, nodal metastatic tumour should be peeled off the carotid artery where possible. This practice appears to have a lower morbidity than that associated with arterial reconstruction. Steps to minimize cerebrovascular injury are discussed.
Assuntos
Carcinoma de Células Escamosas/secundário , Artérias Carótidas/cirurgia , Neoplasias de Cabeça e Pescoço/secundário , Neoplasias Vasculares/secundário , Procedimentos Cirúrgicos Vasculares/métodos , Adulto , Idoso , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/cirurgia , Artérias Carótidas/patologia , China , Feminino , Neoplasias de Cabeça e Pescoço/patologia , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento , Reino Unido , Neoplasias Vasculares/cirurgiaRESUMO
Facial skin lesions present routinely to clinic and are largely dermatological in origin. Odontogenic infections are an unusual cause of facial lesion and are well-described in the dental literature; however they are regularly overlooked and mismanaged, often to considerable aesthetic detriment. We present such a case and highlight important avoidable pitfalls.
Assuntos
Fístula Cutânea/cirurgia , Fístula Dentária/cirurgia , Periodontite Periapical/cirurgia , Adulto , Queixo , Doença Crônica , Fístula Cutânea/diagnóstico , Fístula Dentária/diagnóstico , Diagnóstico Diferencial , Humanos , Imageamento por Ressonância Magnética , Masculino , Periodontite Periapical/diagnóstico , Radiografia Panorâmica , Extração DentáriaRESUMO
The British Journal of Oral and Maxillofacial Surgery (BJOMS) publishes many types of papers including original articles, review articles, and short communications. Many of the latter are isolated case reports of rare or interesting diseases or of difficult or unexpected complications. While case reports are sometimes considered to be of little educational or clinical value, and as such do little to advance medical knowledge, they do have an important role, and many trainees begin their publishing careers writing such papers. There is increasing pressure for space in paper medical journals and, for this reason, some journals either limit or do not publish short publications in print copy but instead put them online. Using established criteria, we previously evaluated all 142 short communications published in the BJOMS during 2008-2009 and found that 48% of them had little or no educational value. As a result, the editorial board of BJOMS took the decision to publish most short communications online only. We have now analysed 48 short communications that were published online only during 2010-2011. Most (80%) were single case reports that covered virtually the whole remit of the specialty, and over half (56%) were published by authors based in the UK. While many of these papers did not add important new information to existing knowledge, these types of article are clearly of value both for trainees and for experienced surgeons. We think that these should continue to be supported as, in addition to their educational value, they are an excellent way for trainees to start to write.
Assuntos
Bibliometria , Registros Odontológicos/estatística & dados numéricos , Internet , Publicações Periódicas como Assunto , Cirurgia Bucal , Humanos , Publicações Periódicas como Assunto/normas , Editoração , Cirurgia Bucal/educação , Reino UnidoRESUMO
Unusual or unexpected medical causes for free flap failure do occur but are uncommon. We present a rare case of a fibula free flap failure due to an acute vasculitis which was undiagnosed until after the flap had failed. In addition to two successful flap salvages and intravenous heparin, an epoprostenol infusion was commenced but a third salvage was not successful. The vasculitis resulted in marked blood vessel wall thickening, and cutaneous manifestations which presented as late signs. High peri-nuclear anti nuclear cytoplasmic antibody (pANCA) and myeloperoxidase (MOP) titres were subsequently found and histology from several blood vessels showed marked inflammation throughout the wall. A diagnosis of microscopic polyangiitis was made and high dose steroids were subsequently commenced. Interestingly, he had vasculitis several years previously treated with oral steroids but had been discharged from the rheumatology clinic. This rare case illustrates the potential hazards of free flap surgery in the vasculitides and discusses the warning signs and various management options to reduce the likelihood of flap failure in these patients.