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PubMedDate not supplied

Cervical vertebral problems as a cause of variations in the nystagmographic R-factor.

All patients who complained of dizziness during 1981 and in whom the nystagmograms indicated either central damage or were found normal, were investigated further regarding changes in their R-factor (an expression for amplitude). This was deduced from the nystagmographic readings produced by caloric testing in these patients. It was thus found that patients with pain or stiffness in the neck had a significantly raised R-factor in all age groups.

Adolescent↗
PubMed1991

The efficacy of Lasix-vitamin therapy (L-V therapy) for sudden deafness and other sensorineural hearing loss.

The efficacy of Lasix-vitamin therapy (L-V therapy) for sudden deafness (SD) was compared with that of conventional therapeutic regimens. There was no significant difference in efficacy between the two therapies. However, in fresh cases (within 7 days from onset of SD), L-V therapy gave a cure rate of 42.3% and an effectiveness rate of 88.4%, these rates being higher than those obtained with conventional therapy; and in cases treated within 4 weeks, L-V therapy was significantly more effective than conventional therapy. Besides, in cases with severe hearing loss (more than 70 dB hearing level) or vestibular symptoms, which were important factors of prognosis, L-V therapy proved more efficient. The efficacy of L-V therapy for other sensorineural hearing loss was also evaluated. In Meniere's disease, L-V therapy proved effective in 45.9% of cases, but with only a 20-30% effectiveness rate in other cases, e.g. idiopathic hearing loss, head and neck injury, noise-induced hearing loss and chronic otitis media.

Adult↗
PubMedDate not supplied

The effect of PACS on the visualization of the lateral cervical spine and the management of patients presenting with trauma.

In patients presenting with trauma, early diagnosis of neck injuries is likely to affect long-term outcome. This paper reports a study that compared lateral images of the cervical spine produced by a Picture Archiving and Communication System (PACS) with the same images produced using computed radiography (CR). The study was undertaken at the Hammersmith Hospital, London. Data were collected on 100 patients who presented with trauma. Both soft copy (PACS) and hard copy (CR) images of the cervical spine were produced for each patient from the same radiographic exposure. The images were viewed by five clinical members of the Accident and Emergency Department. Data were collected on the level of the cervical spine that could be viewed, the clinical management following the viewing of the image and the use of PACS 'tools'. Overall no statistically significant differences between modalities were found in the level of visualization. Within viewer differences were found for three viewers: one indicating better visualization with PACS and two indicating better visualization with CR. The results relating to patient management indicate greater clinician confidence following the viewing of PACS images for two viewers. The use of PACS 'tools' improved visualization of the cervical spine for one viewer.

Adult↗
PubMed2004

Changing the face of pain management. Mechanism-based treatment most likely to succeed.

A 48-year-old mechanic presented to his new primary care physician with complaints of ongoing neck and upper back pain. He had sustained a neck injury while at work 3 years earlier. Magnetic resonance imaging revealed a herniated C5-6 disk resulting in moderate spinal stenosis and right foraminal encroachment. Persistent pain in the right arm and scapula prompted physical therapy and pharmacologic treatment, neither of which was helpful. Epidural corticosteroid treatment was only transiently effective.

Analgesia↗
PubMed2005

Considerations for the head-injured air-evacuated patient: a case report of frontal sinus fracture and review of the literature.

Head and neck injuries are not uncommon in combat environments and may be increasing due to survivable injuries from the use of kevlar helmets and body armor. With the current capability of rapid evacuation from the battlefield, acutely injured patients with frontal sinus injuries may undergo further barometric challenges. Proper care during transport can prevent the occurrence of secondary injury (increased intracranial pressure, tension pneumocephalus) that would complicate the patient's management at the next level of care. Management principles (importance of low-level flight/pressurized cabin, preflight use of decongestants, avoidance of valsalva, and ability to manage complications either procedurally or by landing) are reviewed. In addition, we propose a simple mechanism for pressure equilibration of a compromised frontal sinus during air evacuation using an angiocatheter placed through the wound before closure.

Adult↗
PubMed1998

[One-stage operative treatment of atlanto-axial instability with stenosis of lower cervical level of spinal canal].

To cure patients suffering from atlanto-axial instability following old fracture of odontoid process concomitant with stenosis of lower end of cervical spinal canal, a new operative method was designed. It included atlanto-axial fusion by Gallie technique and resection of right half of the laminae of C3-C7 spine at one stage. A female of 63 years old was treated. She was admitted with neck pain and numbness of the upper and lower limbs. A history of neck injury was noted in enquiry. In physical examination showed the sensation of pain of the upper limbs was decreased and the muscle power of the upper and lower limbs ranged from III degree to IV degree. The X-ray film and MRI suggested that there was instability of the atlanto-axial joint with stenosis of 4th-6th cervical spinal canal. The operation was satisfactory. After operation, the patient was followed up for 11 months. The physical examination indicated that sensation of the upper limbs had recovered to normal and the muscle power of the upper limbs reached IV degree and that the lower limbs reached V degree and X-ray showed bony fusion of the atlanto-axial joint. The conclusions were: 1. The stability of atlanto-axial joint was reconstructed with expanding of the spinal canal at the same time. 2. The duration, risk and cost of the therapy were reduced, and maintenance of the stability of the cervical spine throughout whole period of treatment was recommended.

Atlanto-Axial Joint↗
PubMed1999

[Tracheobronchoscopy in injuries of the thorax and neck].

The results of examination and treatment of patients with penetrating wounds of the thorax and the neck are analysed. Diagnostic potential abilities of roentgenography and tracheobronchoscopy are evaluated comparatively. High diagnostic and curative effectiveness of tracheobronchoscopy is detected, which is indicated in diagnosis of the wounds of the larynx and the trachea as well as in cases of technical difficulties during endotracheal intubation. Besides, tracheobronchoscopy is indicated in postoperative period for sanation of the tracheobronchial tree under visual control for prevention of broncho-pulmonary complications.

Adolescent↗
PubMed2000

Neck pain. Primary care work-up of acute and chronic symptoms.

Acute or chronic neck pain can arise from degenerative processes, musculoskeletal trauma, or structural changes. For all patients presenting with neck pain, determining the presence of radiculopathy or myelopathy is an important step in initial assessment. Depending on the duration of pain, the work-up should include appropriate use of traditional and advanced imaging studies. For cases that do not suggest traumatic, structural, or rheumatologic origins, alternate considerations should include stress, depression, and--because of its increased incidence in older persons--cancer. Nonsteroidal anti-inflammatory agents, mild oral analgesics, and short-term corticosteroid therapy are the mainstays of treatment, although physical therapy and traction can be helpful for some patients. The presence of a herniated disk, cord compression (severe stenosis), tumor, or other structural lesion may require surgical decompression.

Acute Disease↗
PubMed2000

Head tremor in cervical dystonia.

OBJECTIVE: To compare the clinical characteristics, natural history, and therapeutic outcome of patients with cervical dystonia (CD) with head tremor (HT+) and without head tremor (HT-). METHODS: We prospectively evaluated 114 consecutive patients of CD over a 9-month period with a detailed questionnaire. Chi-square and t-tests were employed for statistical analysis. RESULTS: Seventy-eight (68.4%) patients had head tremor and 27 of them (34.6%) had tremor as one of the first symptoms. Age at onset of symptoms were similar in HT+ and HT- groups; however there was a higher prevalence in women in the former group (66.7% vs. 41.7%; p=0.01). HT+ patients had more frequent positive family history of essential-like hand/head tremor (21.8% vs. 5.5%; p<0.05), associated neck pain (92.3% vs. 77.8%: p<0.05), and essential-like hand tremor (40% vs. 8.3%; p<0.001). They also appeared to have more frequent history of preceding head/neck trauma (14.1% vs. 8.3%), frequent head rotation (88.5% vs. 69.4%) and antecollis (12.8% vs. 5.5%) but less often head tilt (37.2% vs. 47.2%) and gestes antagonistes (60.2% vs. 75%) than the HT- patients; however these differences were not statistically significant. The frequency of prior psychiatric illnesses, the incidence of dystonias in other parts of the body, frequency of retrocollis and shoulder elevation, and spontaneous remission were similar in the two groups. CONCLUSION: Head tremor is common in CD and is more commonly associated with hand tremor and family history of tremor or other movement disorders. This supports a possible genetic association between CD and essential tremor (ET). Linkage studies are required to evaluate the genetic association between CD and ET.

Adult↗
PubMed2000

[Laryngeal mask for intubation (Fastrach)].

The laryngeal mask for intubation (MLI), or "Fastrach", is a new device designed by Brain for airway management. The MLI, a modified version of the conventional laryngeal mask, allows for blind intubation through the device using endotracheal tubes up to 8 mm in diameter. Insertion with the head in a neutral position makes this system useful for managing the airway when neck injury is present. The device has been used successfully in patients assessed as having difficult-to-manage airways and its use in emergencies inside or outside the hospital is promising. The MLI has been used with high rates of success in combination with other techniques such as fiberoptic bronchoscopy (success rate 99 to 100%) and transillumination (95 to 100% success rate) in patients whose airways have been considered difficult to manage. Given such high rates of success for MLI placement (95 to 100%) and for blind orotracheal intubation (81 to 100%), the Fastrach may offer an alternative to the conventional laryngeal mask in algorithms for airway management.

Airway Obstruction↗
PubMed1992

[Closed rupture of the cervical trachea].

Two patients with closed rupture of the cervical trachea secondary to blunt trauma, one secondary to neck injury and the other secondary to thoracic injury, were analysed with those reported else where (58). Signs and symptoms included subcutaneous emphysema, respiratory distress, hoarseness/dysphonia, dysphagia, hemoptysis and so on. We conclude that: (1) the diagnosis of blunt trauma of the cervical trachea requires a high index of suspicion, since this injury can easily be overlooked; (2) tracheostomy is the best means of airway control; (3) good long-term airway quality is best obtained by immediate repair of injuries.

Adult↗
PubMed2004

Work factors as predictors of sickness absence attributed to airway infections; a three month prospective study of nurses' aides.

AIMS: To identify the work factors that are related to sickness absence attributed to airway infections (AAI) in nurses' aides. METHODS: The sample comprised 5563 Norwegian nurses' aides, not on sick leave when they completed a mailed questionnaire in 1999. Of these, 4931 (88.6%) completed a second questionnaire three months later. The outcome measure was the three month incidence proportion of certified AAI (>3 days), assessed by self reports at follow up. RESULTS: Working in a paediatric ward (odds ratio (OR) 2.42; 95% confidence interval (CI) 1.39 to 4.21), perceived lack of encouraging and supportive culture in the work unit (OR 1.78; 95% CI 1.21 to 2.61), and reporting medium (OR 1.52; 95% CI 1.09 to 2.12), and high levels (OR 1.60; 95% CI 1.13 to 2.26) of role conflicts at work were associated with an increased risk of AAI, after adjustments for baseline health complaints, demographic and familial factors, smoking, and a series of physical, psychological, and organisational work factors. The individual level factors male gender, smoking 10 cigarettes per day or more, having widespread pain, having had an accident related neck injury, and having long term health problems also predicted AAI. CONCLUSIONS: In nurses' aides, sickness absence attributed to airway infections seems to be related to the type of ward in which the aides are working, and to psychological and social work factors. Declaring airway infections as occupational diseases would have important consequences for the social security system.

Absenteeism↗
PubMedDate not supplied

[Homicidal alcoholic intoxation versus manual neck compression].

A case of homicide involving a 49-year-old man is reported. In the course of a booze-up he was forced to excessive consumption of alcohol and was pushed back into a sofa by repeated grasping his neck which finally left him dead. The postmortem examination revealed a small abrasion in the right mandibular region, a contusion of the subcutaneous tissue above the left clavicle, a haemorrhage in the deep muscles of the neck at the right side of the cervical spine, a fatty tissue haemorrhage between the left cornus of hyoid and thyroid cartilage as well as petechiae of the eyelids and conjunctivae. The blood alcohol concentration amounted to 4.00@1000, the urine alcohol concentration to 5.26@1000. Thus, a manual strangulation of the neck versus a lethal alcohol intoxication had to be taken into consideration as cause of death. The morphological findings of the postmortem examination and the pathophysiological concepts of the underlying mechanisms of death in manual strangulation versus lethal alcohol intoxication are discussed with regard to their significance for the juridical assessment.

Alcoholic Intoxication↗
PubMed2003

Traumatic vertebral artery pseudoaneurysm: a case report.

A case of traumatic vertebral artery pseudoaneurysm in a 16-year-old Nigerian male following a stab wound is described. Successful surgical treatment by proximal Subclavian artery control and excision of the lesion was achieved. The value of Doppler ultrasonography in the diagnosis is highlighted. This case illustrates and re-emphasises that this rare lesion should be considered in patients with neck mass following penetrating posteriorly located neck injuries.

Adolescent↗
PubMed2004

[Bilateral internal jugular vein thrombosis following treatment of laryngeal carcinoma--a case report].

The authors present the case of bilateral internal jugular vein thrombosis, which was diagnosed in a patient after combined therapy (surgery and radiotherapy) because of laryngeal carcinoma. Thrombosis is the frequent complication and the second largest death cause from neoplasms. In review of the literature the cases of bilateral internal jugular vein thrombosis are uncommon. Jugular vein thrombosis has previously been reported in association with deep head and neck infections, sepsis, central vein catherization and the neck injuries. Because of that the presented case of internal jugular vein thrombosis seems to be interesting.

Carcinoma, Squamous Cell↗