RESUMO
This article describes the sequence of acute clinical deterioration seen in a head and neck oncology patient who developed serotonin syndrome peri-operatively. It highlights the clinical dilemma that can be encountered when a septic picture masks the onset of serotonin syndrome and reinforces the importance of awareness of the potential interactions and side effects associated with drugs that surgeons prescribe. We discuss the pathophysiology, causal factors, clinical presentation and diagnosis of serotonin syndrome as well as highlighting some of the dilemmas that this condition presents in the surgical setting.
Assuntos
Inibidores da Monoaminoxidase/efeitos adversos , Complicações Pós-Operatórias/induzido quimicamente , Inibidores Seletivos de Recaptação de Serotonina/efeitos adversos , Síndrome da Serotonina/induzido quimicamente , Idoso , Carcinoma de Células Escamosas/cirurgia , Transtorno Depressivo/induzido quimicamente , Transtorno Depressivo/tratamento farmacológico , Diagnóstico Diferencial , Interações Medicamentosas , Febre/induzido quimicamente , Humanos , Masculino , Staphylococcus aureus Resistente à Meticilina , Neoplasias Palatinas/cirurgia , Receptores de Serotonina/fisiologia , Sepse/diagnóstico , Síndrome da Serotonina/diagnóstico , Infecções Estafilocócicas/complicações , Infecções Estafilocócicas/tratamento farmacológicoRESUMO
OBJECTIVES: To evaluate the degree of adherence to guidelines for facial radiography. METHODS: A retrospective review of 1538 facial radiographs from a consecutive series of 414 patients attending the Accident & Emergency Department of the North Staffordshire Hospital with suspected facial injuries over a 6 month period was undertaken. Information on age, sex and aetiology of injury was recorded along with the type of view and total number of films taken. The results were compared with guidelines from the Department of Oral & Maxillofacial Surgery. RESULTS: Almost one-half of all injuries were due to assault. There was general adherence to the guidelines in terms of the number of films taken for mid-face and mandibular fractures. CONCLUSIONS: There was a good adherence to the guidelines in terms of the number of films taken for midface and mandibular fractures. However, a small number of patients were still being exposed to a high radiation dose where combinations of skull and facial views were taken. Guidelines need to be subjected to regular audit.
Assuntos
Serviço Hospitalar de Emergência , Traumatismos Maxilofaciais/diagnóstico por imagem , Guias de Prática Clínica como Assunto , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Auditoria Odontológica , Inglaterra , Ossos Faciais/diagnóstico por imagem , Ossos Faciais/lesões , Feminino , Humanos , Lactente , Masculino , Fraturas Mandibulares/diagnóstico por imagem , Traumatismos Maxilofaciais/etiologia , Pessoa de Meia-Idade , Doses de Radiação , Radiografia , Estudos Retrospectivos , Fatores Sexuais , Fraturas Cranianas/diagnóstico por imagem , ViolênciaRESUMO
Chylous fistulae are uncommon but serious complications of neck surgery, occurring with an incidence of 1-3% after radical neck dissection. The majority occur on the left side (75-92%) and are due to damage to the terminal segment of the thoracic duct as it drains into the great veins of the neck in the region of the venous angle. The risk of trauma to the terminal thoracic duct may be influenced by anatomical variations. The macroscopic arrangement of the termination of the thoracic duct in the left neck was examined in 24 UK cadavers. Twenty-one ducts terminated as a single vessel, two ducts showed a bifid termination and one duct had three terminal branches. The precise site of termination was variable. Five thoracic ducts showed branching and reanastamosing patterns prior to their termination, irrespective of the number of terminal branches. Subsidiary cervical lymph trunks were identified in four dissections. These variations are described and their relevance to surgery involving the left side of the neck is discussed.
Assuntos
Veias Jugulares/anatomia & histologia , Veia Subclávia/anatomia & histologia , Ducto Torácico/anatomia & histologia , Adulto , Cadáver , Quilotórax/etiologia , Humanos , Complicações Intraoperatórias , Sistema Linfático/anatomia & histologia , Sistema Linfático/patologia , Pescoço/anatomia & histologia , Pescoço/irrigação sanguínea , Pescoço/cirurgia , Esvaziamento Cervical/efeitos adversos , Ducto Torácico/anormalidades , Ducto Torácico/lesões , Ducto Torácico/patologiaRESUMO
A patient is described with generalized gastrointestinal involvement by Crohn's disease. Symptoms of recurrent ulceration and mucosal tags are well-described oral manifestations of Crohn's disease; however, in our patient recurrent facial abscesses, which required extraoral drainage, also developed. This complication has not previously been reported.
Assuntos
Abscesso/etiologia , Doença de Crohn/complicações , Doenças da Boca/etiologia , Infecções Estafilocócicas , Adulto , Feminino , Humanos , Recidiva , Úlcera/etiologiaRESUMO
A case is described in which extensive pulmonary barotrauma occurred due to the application of a face mask to an indwelling cuffed endotracheal tube. The design of the mask is such that a seal was made between the mask and the tube. The design of mask is widely used in theatre recovery areas and clinicians are alerted to this potential hazard.
Assuntos
Barotrauma/complicações , Intubação Intratraqueal/efeitos adversos , Lesão Pulmonar , Máscaras , Oxigenoterapia/efeitos adversos , Complicações Pós-Operatórias , Adulto , Desenho de Equipamento , Feminino , Humanos , Intubação Intratraqueal/instrumentação , Pescoço , Oxigenoterapia/instrumentação , Pneumopericárdio/etiologia , Enfisema Subcutâneo/etiologiaRESUMO
A patient with multiple self-healing squamous cell carcinomas of the skin is presented. Mucous membrane involvement in this condition is very uncommon and the lesions may show aggressive behaviour.
Assuntos
Carcinoma de Células Escamosas/patologia , Neoplasias Faciais/patologia , Recidiva Local de Neoplasia , Neoplasias Primárias Múltiplas/patologia , Neoplasias Cutâneas/patologia , Neoplasias da Língua/patologia , Idoso , Carcinoma de Células Escamosas/secundário , Feminino , Humanos , Metástase LinfáticaRESUMO
Two cases of Graves ophthalmopathy (GO) are presented, both of which required orbital decompression. The indications for orbital decompression and techniques used are discussed and the advantages of inferior orbitotomy presented.