B-ENT
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In search for less invasive operative techniques, the da Vinci Robot System was introduced in thyroid surgery. Previous studies have reported on safety, effectiveness and improved cosmetics of transaxillary endoscopic thyroidectomy procedures in selected cases. ⋯ Transaxillary robotic thyroid surgery is demanding, but feasible. Selected patients can benefit from this technique with an optimal cosmetic outcome. Ideal indication in the hand of our team is a hemithyroidectomy for benign nodules ranging up to 5 cm.
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This retrospective study assessed several clinical, case history and functional parameters to investigate benign paroxysmal positional vertigo (BPPV) in patients with migraine. ⋯ A high prevalence of BPPV and earlier onset in migraine are the main findings of this study. There is a higher incidence of a range of neurotological patterns in the intervals between BPPV episodes in migraineurs with recurrent vertigo. No direct pathophysiological link between migraine and BPPV has yet been established; comorbidity seems to affect clinical features in a sub-population of patients and make BPPV more debilitating.
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Rhabdomyolysis is increasingly recognized as a cause of acute renal failure. Although it is often the result of extensive trauma, rhabdomyolysis may also appear as a rare and serious complication during the postoperative period. Postoperative rhabdomyolysis is a rare but serious complication. Early diagnosis of postoperative rhabdomyolysis is based on laboratory tests and clinical examination. Renal hyperperfusion with hydration and diuretics may prevent a nephrotoxic reaction. We describe two recent cases in patients undergoing head and neck surgery. ⋯ Early recognition and aggressive treatment with intravenous fluids and diuresis may prevent the development of acute renal failure due to rhabdomyolysis. Rhabdomyolysis causing acute renal failure is a rare but serious postoperative complication. Adequate prevention in high-risk patients, early diagnosis and, aggressive treatment are the keys to a successful recovery.
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Randomized Controlled Trial
Efficacy of preincisional levobupivacaine for adult tonsillectomy patients.
We compared the effects of preincisional peritonsillar infiltration of 5 ml levobupivacaine hydrochloride (50 mg/10 ml) on bleeding during surgery and pain after tonsillectomy in patients aged 16 years or older. ⋯ Preincisional levobupivacaine infiltration seems to be a safe and easily applied medication for postoperative pain control, and decreased the volume of intraoperative blood loss in adult patients after tonsillectomy.
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Case Reports
Life-threatening macroglossia after posterior fossa surgery: a surgical positioning problem?
A 55-year-old woman was operated in the lateral park bench position with significant neck flexion and oral packing. Macroglossia was noticed immediately postoperatively after endotracheal extubation. The patient was reintubated for 13 days and subsequently required a tracheostoma. ⋯ It can cause airway obstruction, which could be a life-threatening complication, and it therefore requires prompt treatment. The aetiology of postoperative macroglossia remains uncertain and has been attributed to arterial, venous and lymphatic compression, mechanical compression, or neurogenic causes. This article describes new insights into aetiology and also describes preventive measures and possible treatment.