[Compulsive swallowing of foreign bodies. Esophageal foreign body].
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Adult↗
Biomedical subjects
P Dost
Publications and source records attributed to P Dost.
Improving staffing with a resource management plan.
To change from a crisis to a proactive mode for staffing, scheduling, resource pool utilization, information management, and unit workload, nursing leaders developed a resource management plan. Changes that assisted in achieving that goal included: revision of department scheduling guidelines, elimination of day shift central supervisor, responsibility for daily staffing moved to unit-based managers, creation of a staffing model for the nursing resource pool staff, establishment of ideal complement of positions for every unit, expectation for unit to meet its staffing model every shift, reinforced department efforts to fill vacant positions, participation in computerized databases to study the use of resources, and identified critical staffing indicators for each unit.
Appointments and Schedules↗
Ultrasonographic biometry in normal salivary glands.
Specifications about the sizes of normal salivary glands are not available. We used ultrasonography to determine the sizes of the submandibular and parotid glands in 50 subjects, who were not suffering from diseases of the salivary glands. Volunteers were distributed equally concerning sex and age. Body weight did not differ more than 20% from ideal weight. Dimensions of the submandibular glands were: anterior-posterior length, 35 +/- 5.7 mm; paramandibular extension to gland depth, 14.3 +/- 5.7 mm; extension in frontal scanning, 33.7 +/- 5.4 mm. The parotid glands measured 46.3 +/- 7.7 mm in the axis parallel to the mandibular ramus and 37.4 +/- 5.6 mm in a transverse axis. The extensions of the parotid parenchyma were 7.4 +/- 1.7 mm lateral to the mandible and 22.8 +/- 3.6 mm dorsal to the mandible.
Adult↗
Ultrasonographic biometry in salivary glands.
Specifications about the size of healthy salivary glands are not available to date. Therefore, we determined the size of the submandibular and the parotid glands by ultrasonography in 50 subjects (25 men, 25 women, mean age 45 y, range 20-68) with no history of disease affecting the salivary glands. The subjects were equally distributed concerning gender and age. Body weight did not differ more than 20% from the ideal weight following Broca's formula (mean body weight 71 kg, range 46-95 kg). In the submandibular glands we found an anterior-posterior length of 35 mm +/- 5.7 mm, a paramandibular dimension to the depth of 14.3 mm +/- 2.9 mm and a dimension in frontal scanning of 33.7 mm +/- 5.4 mm. The parotid glands were measured 46.3 mm +/- 7.7 mm in the axis parallel to the mandibular ramus and 37.4 mm +/- 5.6 mm in the transversel axis. The dimension of the parotid parenchyma was measured with 7.4 mm +/- 1.7 mm lateral to the mandible and 22.8 mm +/- 3.6 mm dorsal to the mandible. No statistically significant difference to the 5%-level was found concerning gender. The dimension of the parotid glands correlated statistically significantly with body weight (p = 0.03). This correlation was not found in the dimension of the submandibular glands. Age did not correlate with the dimension of salivary glands. Results of the submandibular glands were compared with volume measurements of submandibular glands from cadavers.
Adult↗
[Single suture closure and surgical staplers in neck interventions after previous radiotherapy].
BACKGROUND: Impaired wound healing has to be expected more often in a tissue with diminished circulation. The technique of wound closure could have some influence on the healing result in such situations. METHODS: This prospective randomized study was carried out to evaluate whether staples or nylon sutures give better results regarding primary wound healing. Fifty patients who had previously been irradiated for head and neck tumors and underwent secondary surgery of the neck region were included in the study. RESULTS: Four of 26 wounds closed by conventional sutures evidenced delayed healing, while one of 24 wounds closed by stapler showed signs of impaired wound healing. This difference was not statistically significant. Further parameters (duration of operation, high age, high dosage of irradiation, long interval between irradiation and operation, previous chemotherapy, anemia, low body weight, relaxing incision, pharyngotomy) were also not associated with a higher incidence of delayed wound healing. CONCLUSIONS: Even in the irradiated cervical operation field no advantage for staples could be demonstrated in comparison with nylon sutures.
Adult↗
Nasal turbinate dislocation caused by nasotracheal intubation.
A case of nasal turbinate dislocation secondary to nasotracheal intubation is presented. Although mild epistaxis had occurred in the days following extubation, the complication was not recognized until after the patient presented with headache and impairment of nasal breathing 6 months later. Endoscopy revealed the dislocation of the middle turbinate into the nasopharynx. Treatment by resection of the dislodged turbinate resulted in relief of symptoms. Physicians should be aware of the possibility of severe nasal damage following even apparently uncomplicated intubation and obtain consultation by an otorhinolaryngologist after epistaxis or obstructed nasal breathing.
Airway Obstruction↗
[Endoscopically controlled dilatative puncture tracheostomy].
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Bronchoscopes↗
[The time span between symptom onset and starting treatment in head and neck tumors].
The interval between the onset of symptoms in patients with head and neck cancers and the introduction of treatment was evaluated. During a 1-year period, patients were interviewed to determine the duration of any delays from the onset of complaints until the first visit to a doctor. Also asked was how long it took to be referred to an ENT specialist and actual referral to our department. We then determined the interval from diagnosis to the introduction of therapy. It was found that the delay of patients who went directly to an otorhino-laryngologist was shorter (median, 8 weeks) than that of patients who first went to their family doctors (median, 13 weeks) (P < 0.02). The latter then took an additional 4 weeks before sending patients to an otorhinolaryngologist. Referral from the ENT specialist to our department took another 2 weeks, as well as our staging and pre-therapeutic management. Our findings show that the patient himself is the critical factor in delaying diagnosis and therapy. Tumor patients with greater professional qualification went to their doctors earlier (P < 0.0001) or more often went directly to an ENT specialist (P < 0.002). Consultations of physicians without experience in otorhinolaryngology caused yet further delays.
Adult↗
[Orbital floor reconstruction with autologous periosteum transplant].
BACKGROUND: Various implants (silicon, teflon, titanium, polydioxanone, etc.) and transplants (dura, nasal septum, wall of the maxillary sinus) are used to stabilize the fractured orbital floor. Some of these methods have disadvantages with respect to hygiene, infection, or rejection. METHOD: In four patients, the fractured orbital floor was stabilized with autologous periosteum from the mastoidal region. RESULTS: This graft is easy to obtain; the procedure is sterile, gives good cosmetic results, and is cost effective. CONCLUSIONS: Autografts are regarded as the material of choice in reconstructive surgery. For the reconstruction of the orbital floor, we suggest the use of a free periosteal flap from the mastoidal region. The risk of infection by virus or prion is excluded, rejection is unlikely, and the method is cost effective.
Fracture Healing↗
[Security the continuous intracutaneous suture].
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Humans↗
Experimental results concerning the reconstruction of the stapes superstructure with bioactive ceramics.
We examined the feasibility of rebuilding a stable stapes superstructure in the middle ear for a new articulated ossicular chain by using bioactive ceramic and glass ceramic in guinea pigs. The ceramic implants were placed on the stapes footplate without touching the tympanic membrane, thus protecting it against relative movements. The implants were removed together with the stapes footplate after six weeks, three and six months respectively. After six weeks, histological evidence of bony connections between all ceramic implants and the remnants of the crurae were found, being more pronounced after three and six months. We propose a new implant for the reconstruction of the stapes superstructure.
Animals↗
[Value of abdominal ultrasound and skeletal scintigraphy in TNM classification of tumors in the head and neck area].
After establishing the diagnosis of carcinoma in the head and neck, routine examinations comprise chest x-ray, bone scan and abdominal ultrasound and are often initiated to exclude or confirm metastatic disease. Data are few on the frequency of metastases at the time of initial diagnosis and reliability of bone scanning and sonography to detect metastases. The aim of the present retrospective study was to define criteria for the use of these latter two methods of examination. The medical records of 382 patients with squamous cell carcinoma who were examined for the first time were analyzed during a four-year period. Bone scanning was performed on 360 patients, but suspect scintigraphic evidence of bone metastasis could be confirmed in only one patient. Only three of 367 patients undergoing abdominal ultrasound were found to have hepatic metastases. Reasons for a practical use of these two methods of examination are discussed.
Bone Neoplasms↗
[Nosebleed. Etiology and treatment possibilities].
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Emergencies↗
Doppler ultrasonography as a pre-operative aid to base the forearm flap on the radial or ulnar artery.
The elevation of a forearm flap based on the ulnar artery has been described as an alternative to a flap based on the radial artery. Despite the fact that 15-30% of operated patients complain of symptoms in the hand due to impaired circulation, this flap is still regularly raised upon the radial artery. Using Doppler ultrasonographic examination before elevating the forearm flap, the dominant artery to the hand can be determined. The preliminary experience in 11 patients operated upon (the flap has been based upon the ulnar artery five times) is satisfactory. None complained of weakness of the hand, a feeling of coldness or cold intolerance.
Adult↗
[Reconstruction of the stapes superstructure with bioactive ceramics].
In this study we examined the feasibility of rebuilding a stable stapes superstructure for a new articulated ossicular chain by using bioactive ceramics. Dense hydroxylapatite and ceravital were tested in guinea pigs. The ceramic prosthesis was placed on the remnants of the footplate to create a bony connection without touching the tympanic membrane, thereby protecting it from relative movements. The implants were explanted together with the stapes footplate at six weeks and three months, respectively. Histologically, bony connections were found between all ceramic implants and the remnants of the crura even at six weeks and became more pronounced after three months.
Animals↗
[Diagnostic aspects of isolated sphenoid sinusitis].
The clinical occurrence of isolated sphenoid sinusitis is rare. Due to a long history and few initial symptoms, diagnosis of this potentially fatal infections can be difficult. Radiological aspects in 10 patients are presented (e.g. type and design of examination and whether inflammatory or destructive changes could be shown), as well as clinical aspects (cranial nerve palsy, concurrent inflammation, duration of disease and therapy). CT proved to be superior in diagnosing the extent of any bony changes, while MRI was more useful in detecting inflammation.
Adolescent↗
[Benefit of the ice pack in the treatment of nosebleed].
Cooling the nape of the neck is said to induce reflex constriction of the mucosal vessels of the nose, but there is no general agreement in the literature on the benefit of an ice pack as an adjuvant treatment of epistaxis. We investigated this effect by rhinomanometry, and the results provided theoretical support for this well tried therapy.
Adolescent↗
[Tracheal agenesis. A case report].
A case of tracheal agenesis, a rare foregut malformation, is described. This malformation is combined with a tracheo-oesophageal fistula, furthermore with rectal and anal atresia, cardiac malformations, dysplastic kidneys, wedge-shaped vertebrae, and cerebellar hypoplasia. Since a tracheo-oesophageal fistula is a possible component of the VACTERL Association [(V) vertebral defects, (A) anal atresia, (C) cardial malformations, (T) tracheo-(E)-oesophageal fistula, (R) renal or (L) limb malformations], similar cases are reviewed from the literature and their relationship to this association is discussed.
Abnormalities, Multiple↗