HNO
-
It is discussed controversially whether cervicogenic pain in the head and/or neck is a pathogenic entity. The good results obtained with manual therapy in patients with head and neck pain contradict the refusal of the majority of the neurologists to accept the diagnosis "cervicogenic headache." Complaints about headache are frequently encountered in the general ENT clinic. ⋯ The versatile picture of the cervicogenic headache is caused by the complex neural connections in the region of the upper cervical spine. The differential diagnosis of the cervicogenic headache is described.
-
Review
[Heart arrest in children after intravenous injection of succinylcholine in the ENT operating room].
Acute rhabdomyolysis with hyperkalemia has been followed by ventricular dysrhythmia, cardiac arrest and death after the administration of succinylcholine to apparently healthy children who were subsequently found to have undiagnosed skeletal muscle myopathies. Boys have mostly been affected. Reports of anesthesia emergencies from the United States and Germany have indicated that serious side effects of succinylcholine are not as rare as previously thought. ⋯ Due to the abrupt onset of rhabdomyolysis, routine resuscitative measures are likely to be unsuccessful. Extraordinary measures (including institution of extracorporeal circulation) and prolonged efforts have resulted in successful resuscitation of some cases. Since there are usually no signs or symptoms to alert the practitioner to patients at risk, the use of succinylcholine in children should be reserved for emergency intubations or instances in which immediate securing of the airway is necessary.
-
In patients suffering from advanced or recurrent cancers that are no longer amenable to curative treatment, palliation and symptomatic care have to take the place of cure. In such cases, palliation aims at relief of pain, alleviation of functional disabilities and restoration of mental and social balance. Since the clinicians effort is concentrated on the control of symptoms of uncontrollable disease, decisions have to be made concerning the relative value of the various methods available for treatment and support in the individual patient. Criteria for the physician's decision-making are important parameters in any approach to the patient with incurable cancer and have particular significance in caring for terminal disease.
-
The technique of tissue expansion can now be used to prepare skin for reconstructive operations. This method has been propagated during the last 15 years, but its use has varied from great enthusiasm with exaggerated expectations to disillusion due to high complication rates. ⋯ In this review, the biological principles of expansion, various expansion protocols and their objectives, control during the filling phase and preventive measures to avoid complications are described. For clinical use it is important that there is not one but three distinct types of expansion: an intraoperative, intermittent expansion for gentle subcutaneous skin mobilization, a short time period for expansion (between 1-2 weeks) to increase the dermal microcirculation and the "classic" prolonged period of expansion to create new skin for the reconstruction required.