[Day-surgery operative hysteroscopy with loco-regional anesthesia]. / L'isteroscopie operativa in regime di day-surgery con l'utilizzo dell'anestesia loco-regionale.

BACKGROUND: Nowadays hysteroscopic surgery offers the opportunity of treating in Day Hospital even patients who cannot undergo a traditional surgery because of high anesthesiological risk. The aim of this study is to prove that minimal invasive hysteroscopic procedures in loco-regional anesthesia can replace laparotomic gynecological surgery in many intrauterine lesions with the same effectiveness on pain and outcome. METHODS: From September 1999 to December 2000 at the Obstetric and Gynecological Department in Asti 200 hysteroscopic procedures have been performed. The patients (all i.v. line inserted, ECG and pulsometer monitored, and sublingual BDZ sedated) were divided into two groups: a group of 50 patients who underwent operation on paracervical block alone, and the other one of 150 women on paracervical block plus periorificial infiltration of local anesthetic. RESULTS: Only one woman in the first group paracervical block was totally insufficient and she needed a general anesthesia. In the same group, 44% of paracervical blocks required an additional conscious sedation with Propofol and Fentanyl. In the second group only 16 % of cases required an additional sedation. In all cases outcome was very good with complete recovery of the patients dismissed the same afternoon. CONCLUSIONS: In our experience operative hysteroscopies under loco-regional anesthesia with paracervical block and periorificial infiltration is a very satisfactory alternative to general anesthesia. Moreover the type of intrauterine lesion did not influence the tolerability of the operation.

Effects of stripping and laser excision on vocal fold mucosa in cats.

We compared the effects of stripping and laser excision on vocal fold mucosa in cats. Of particular interest were the comparative effects of each procedure on the mucosa's sensory structures. Mucosa was stripped from one vocal fold in three cats, lased in three additional cats, and histologically examined at 1-, 2-, and 3-week intervals postoperatively. Results indicate that both procedures produce unique and degenerative effects that are still apparent 3 weeks after operation; however, nervous elements in lased tissue samples appeared less disrupted than in stripped tissue. Unique effects on the composition of epithelial tissue also were noted for the two procedures. Implications for voice quality in human patients undergoing similar procedures are discussed.

Unusually large nasopalatine cyst: CT findings.

In a patient presenting with nasal obstruction the clinical suspicion of a nasal mass led to computed tomography that demonstrated findings thought to be characteristic of an unusually large nasopalatine cyst. The definitive diagnosis of nasopalatine cyst is more easily made on plain films. The entity is described, emphasizing once again the necessity of including dental and facial abnormalities in the differential diagnosis of lesions of the sinuses and nose.

Pigmented villonodular synovitis of the temporomandibular joint.

Pigmented villonodular synovitis (PVNS) rarely occurs in the temporomandibular joint. The bony changes are easily assessed by tomography. Pluridirectional tomography cannot, however, evaluate the soft tissue component of the lesion especially that medial to the mandibular condyle. This area is accessible to CT scan evaluation. A case is presented in which the medial extent of the lesion was determined by CT scan. The radiologic findings of PVNS of the temporomandibular joint are discussed.

Pigmented villonodular synovitis of the temporomandibular joint: a case report.

The eighth known case of pigmented villonodular synovitis of the temporomandibular joint is presented. Pigmented villonodular synovitis is a benign but locally destructive lesion of obscure cause. In the temporomandibular joint, this lesion is characterized by the insidious onset of a mildly symptomatic preauricular mass. The treatment of choice is complete excision.

Tracheostomal stenosis following total laryngectomy.

Stenosis of the tracheostoma after laryngectomy is an infrequent but often distressing postoperative complication. Recognition of possible predisposing factors will allow appropriate preventive measures in preoperative planning, surgical technique and postoperative care. We describe a surgical technique which can be utilized to correct tracheostomal stenosis or can be used at the time of initial stomal construction. Our method emphasizes mobilization of the tracheal stump, extensive excision of subcutaneous fat, excision of redundant skin and creation of a posterior-superior skin flap which is interdigitated into a vertical posterior tracheal incision. Our method is compared to other techniques described in the literature.

Cervical necrotizing fasciitis.

The fourth known case of cervical necrotizing fasciitis is presented to illustrate pertinent clinical, diagnostic, and therapeutic features of this entity. The case occurred after a dental abscess; complications included acute airway obstruction, mediastinitis, and septic shock. Extensive surgical exposure and drainage were required for control.

The incidence of neoplastic versus inflammatory disease in major salivary gland masses diagnosed by surgery.

What is the incidence of non-neoplastic diseases when dealing with masses of the major salivary glands? A knowledge of this information would aid the physician in making decisions relative to the management of the masses. Furthermore, the expected malignancy rate may need to be adjusted according to the findings of this study. Many reported series of salivary gland neoplasms show the relative incidence of benign vs. malignant neoplasms; however, not every patient with a mass of the salivary gland who comes to surgery is finally diagnosed as having had a neoplasm. Knowing the relative incidence of neoplastic vs. non-neoplastic salivary gland diseases has important diagnostic, therapeutic, and prognostic implications. Records of all patients who underwent either a parotidectomy or submandibular gland excision from 1975 to the present at the Eye and Ear Hospital of Pittsburgh were reviewed; 73% of the parotidectomies performed were done for neoplastic disease. A patient with a parotid mass has a likelihood of 1:10 of having a malignancy. Similarly, on a population basis, 1 submandibular mass in 12 will be malignant.

Management of buccal space masses.

Lesions in the substance of the cheek--the buccal space--may present diagnostic and management difficulties. The buccal space, that potential fascia space lying within the bulk of the cheek, is anatomically described. While the history and physical characteristics of the buccal mass and selected radiographic and special procedures may suggest a specific cause, the diagnosis is often elusive and requires removal of the mass for histologic evaluation. The surgical approach to a mass in the cheek is governed by its location within the buccal space and by the index of suspicion of malignancy. The preauricular, submandibular approach is the authors' choice for most buccal space lesions. Five case reports are presented to illustrate features in the diagnosis and management of a buccal space mass.

Chondrosarcoma of mandible misdiagnosed as chondromyxoid fibroma.

The diagnosis of chondrosarcoma of the jaws is often difficult due to the often indistinct boundaries between benign and malignant chondromatous tumors. In view of the often considerable variation in histological characteristics within a tumor, repeated biopsies and step sections through a specimen are recommended in difficult cases. This paper is a follow-up of the case described by DAVIS & TIDEMAN (1978) in this journal.

Le Fort I advancement with segmental palatal osteotomies in patients with cleft palates.

A modification of the Henderson-Jackson technique of Le Fort osteotomy and oronasal fistula closure is presented. The primary advantage of the procedure is that the palatal osteotomy allows precise positioning of the collapsed cleft dentoalveolar segment with negligible relapse.