ABSTRACT
BACKGROUND: Intraoperative intraorbital bleeding is a rare but potentially catastrophic event that can lead even to blindness, if not treated promptly. The goal of surgery is to quickly reduce intraorbital pressure thus restoring normal visual function. Aim of our work is to propose a practical algorithm helping the surgeon in the setting of this critical event. METHODOLOGY: An Italian multi-institutional retrospective study was conducted. All the cases of intraoperative intra-orbital bleeding requiring at least some form of surgical management were analyzed. Cases simply managed conservatively were excluded from this analysis. RESULTS: Sixteen cases were collected. Of these, 12 were initially treated with a medial wall orbital decompression, while 4 were treated via a lateral canthotomy and inferior cantholysis (LCC). Ten patients recovered completely. Four patients presented post-op sequelae (diplopia, enophthalmous and/or eyelid malpositioning). Two major negative outcomes (blindness) were observed. CONCLUSIONS: Timely surgical intervention is critical. According to the setting in which the bleeding occurs, different options are available. LCC is probably the most rapid maneuver that can be done to reduce intraorbital pressure. Anyway, if the patient is still in the OR and a complete ethmoidectomy yet done we advise, as first step, to perform a medial orbital wall decompression.
Subject(s)
Decompression, Surgical , Orbit , Humans , Retrospective Studies , Orbit/surgery , Algorithms , Blindness/surgeryABSTRACT
BACKGROUND AND AIM: The efficiency of tele-monitoring or tele-assistance in patients with severe chronic ventilatory failure in home mechanical ventilation (HMV) is still being investigated. Our aim was to test the feasibility of a model which consisted in: 1) once a week nocturnal telemonitoring, supervised by a doctor in charge in a Respiratory Intensive Care Unit, who also provided a telephone-counselling (24/7) on demand; 2) a scheduled visit every two months. METHODS: A 2-year observational study was carried out on 16 patients ventilated for at least 1 year and for > or = 8 hours/day. Once a week patients underwent a nocturnal monitoring during HMV. The compliance was evaluated by regular transmission of data and regular follow-up, the level of satisfaction by a telephone-questionnaire. RESULTS: The adherence to the protocol study was good in 9/16 (56%) and poor in 7/16 (44%) patients. For each patient, the mean number of connections was 46.12 +/- 36.39 (70.7% of that expected), in those with good compliance it increased to 63.8 +/- 32.7 (114% of that expected). The median hours of connection was 343 (138-1019) and 89 (0-521) for patients with good and poor compliance respectively, p = 0.038. The mean scheduled visits for patient with good compliance was 6.9 +/- 4.14 (100% of that expected). Emergency visits were avoided in 62.5% of cases. The satisfaction score was higher in compliant versus non compliant patients (p = 0.019). CONCLUSION: This pilot study showed that the telemonitoring system employed was feasible and effective in more compliant patients who claimed a high rate of satisfaction.
Subject(s)
Respiratory Insufficiency/physiopathology , Telemetry/methods , Adult , Aged , Aged, 80 and over , Female , Follow-Up Studies , Humans , Male , Middle Aged , Patient Compliance , Pilot Projects , Retrospective Studies , Young AdultABSTRACT
BACKGROUND: Sarcomatoid carcinoma (SC) of the upper aerodigestive tract is a rare malignancy of which the diagnosis, optimum treatment, and prognosis remain controversial. A series of 17 patients with SC is presented, along with an analysis of potential prognostic factors, outcome following treatment, and patterns of failure. MATERIALS AND METHODS: Hospital charts and pathology material were reviewed in all cases. The end points chosen were overall survival (OS), disease-free survival, and local control above the clavicles. RESULTS: There were 15 male and 2 female patients with a median age of 70 years. With a median follow-up length of 29 months, the median survival time was 32 months with an actuarial survival of 72% and 42% at 2 and 5 years, respectively. CONCLUSION: All recurrences were detected within 30 months from diagnosis. There was an OS advantage for patients with early-stage disease, patients with extralaryngeal presentations, and patients treated with surgery.
Subject(s)
Carcinosarcoma , Head and Neck Neoplasms , Aged , Carcinosarcoma/mortality , Carcinosarcoma/pathology , Carcinosarcoma/radiotherapy , Disease-Free Survival , Female , Head and Neck Neoplasms/mortality , Head and Neck Neoplasms/pathology , Head and Neck Neoplasms/radiotherapy , Humans , Male , Neoplasm Recurrence, Local , Prognosis , Treatment OutcomeABSTRACT
4 studies addressed children's sex-related stereotyping of colors. Study 1 examined preschoolers' awareness of color stereotypes. Children were presented with 6 toy animals, identical except for color, and were asked to identify the sex of each animal and to select a favorite. Both sex identifications and toy preferences were highly consistent with adult color stereotypes. Study 2 demonstrated that clothing color influences preschool, kindergarten, and first-grade children's impressions of other children whose sex is known. Studies 3 and 4 indicated that the effects of stereotyping based on color are modest in comparison to the effects of stereotyping based directly on sex. In addition, color stereotyping did not show the regular age-related increase that is characteristic of sex-role stereotyping.