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The proper positioning of the Nerve Integrity Monitoring® endotracheal tube during recurrent laryngeal nerve monitoring is of paramount importance. This article describes our experience with the GlideScope® and explains how it can facilitate the accurate placement of the Nerve Integrity Monitoring endotracheal tube.
Endotracheal intubation with the Nerve Integrity Monitoring endotracheal tube was performed in 250 patients undergoing thyroidectomies using the GlideScope video laryngoscope. The correct positioning of the tube was determined according to impedance values of less than 5 kohm and an impedance imbalance of less than 1 kohm.
Successful intubation was achieved in all cases. The GlideScope aided the correct placement of the Nerve Integrity Monitoring endotracheal tube in the majority of the cases.
The GlideScope provides an excellent means to ensure the correct positioning of the Nerve Integrity Monitoring tube. It allows both the surgeon and the anaesthesiologist to participate in the intubation process and confirm correct placement of the tube, whilst also allowing gentle intubation with improved visibility.
Although race and ethnic background are known to be important factors in the completion of advance directives, there is a dearth of literature specifically investigating the effect of race and ethnicity on advance directive completion rate after palliative care consultation (PCC).
A chart review of all patients seen by the PCC service in an academic hospital over a 9-month period was performed. Data were compiled using gender, race, ethnicity, religion, and primary diagnosis. For this study, advance directives were defined as: “Do Not Resuscitate” (DNR) and/or “Do Not Intubate” (DNI).
Of the 400 medical records reviewed, 57% of patients were female and 71.3% documented their religion as Christian. The most common documented diagnosis was cancer (39.5%). Forty-seven percent reported their race as white. White patients completed more advance directives than did nonwhite patients both before (25.67% vs. 12.68%) and after (59.36% vs. 40.84%) PCC. There was a significantly higher proportion of whites who signed an advance directive after a PCC than of nonwhites (p = 0.021); of the 139 whites who did not have an advance directive at admission, 63 signed an advance directive after a PCC compared with 186/60 nonwhites (45% vs. 32%, respectively, p = 0.021). Further analysis revealed that African Americans differed from whites in the likelihood of advance directive execution rates pre-PCC, but not post-PCC.
Significance of results:
This study demonstrates the impact of a PCC on the completion of advance directives, on both whites and nonwhites. The PCC Intervention significantly reduced differences between whites and African Americans in completing advance directives, which have been consistently documented in the end-of-life literature.
We describe a new technique of helix advancement meatoplasty. This technique is useful in both mastoid surgery and some cases of otitis externa. The technique is designed to avoid the problems of (1) inferior positioning of the meatoplasty at the time of surgery, and (2) later inferior migration of the pinna (as can occur when the suspensory ligaments of the pinna have been cut or weakened). Such outcomes can result in a mastoid cavity which is difficult to clean as the approach to it is awkward; in such cases, it is common to have to look up into the cavity rather than directly into it. Helix advancement meatoplasty improves post-operative visualisation and aeration. It eases cleaning of the cavity by creating a more superiorly placed meatoplasty, which is supported by the tragus and is therefore less likely to drop.
We have performed a coordinated experimental and theoretical investigation of the structure and stability of Ti/C multilayers. The samples were prepared by conventional techniques and the lattice structure was characterized by X-ray diffraction. Electron Energy Loss and Auger spectroscopies (EELS,AS), in conjunction with Rutherford Backscattering (RBS) were employed to characterize the chemical composition of the samples. It was observed that the Ti/C interface is isolated by a thin titanium oxide layer. The center of the Ti layer gives a typical EELS spectrum of Ti metal. The carbon shows a graphitic character. We have used total energy calculations to study the crystallographic structure and electronic behavior at the interface in Ti-C superlattices. This involved examining a series of structures in the Ti-C system proceeding from the ground state NaCl structure to superlattices. In particular we performed total energy calculations for an arrangement of atoms designed to allow direct investigation of the competition between Ti-C bonds and C-C bonds. We conclude that the equilibrium structure is dominated by C-C bonding and so we find that the interface has a graphite like atomic arrangement rather than a carbide like arrangement. We than further explored the interactions in this graphitic arrangement and found that the interface does not have a significant Ti-C bonding and that the interface most likely consists of simply a layer of graphite adjoining a titanium surface. This carries important implications for the diffusion and bonding at the interface.
The purpose of this study was to determine the factors which influence advance directive (AD) completion among older adults.
Direct interviews of hospitalized and community-dwelling cognitively intact patients >65 years of age were conducted in three tertiary teaching settings in New York. Analysis of AD completion focused on its correlation with demographics, personal beliefs, knowledge, attitudes, and exposure to educational media initiatives. We identified five variables with loadings of at least 0.30 in absolute value, along with five demographic variables (significant in the univariate analyses) for multiple logistic regression. The backward elimination method was used to select the final set of jointly significant predictor variables.
Of the 200 subjects consenting to an interview, 125 subjects (63%) had completed ADs. In comparing groups with and without ADs, gender (p < 0.0002), age (p < 0.0161), race (p < 0.0001), education (p < 0.0039), and religion (p < 0.0104) were significantly associated with having an AD. Factors predicting AD completion are: thinking an AD will help in the relief of suffering at the end of life, (OR 76.3, p < 0.0001), being asked to complete ADs/ or receiving explanation about ADs (OR 55.2, p < 0.0001), having undergone major surgery (OR 6.3, p < 0.0017), female gender (OR 11.1, p < 0.0001) and increasing age (76–85 vs. 59–75: OR 3.4, p < 0.0543; <85 vs. 59–75: OR 6.3, p < 0.0263).
Significance of results:
This study suggests that among older adults, the probability of completing ADs is related to personal requests by health care providers, educational level, and exposure to advance care planning media campaigns.
We present a case of a patient who had undergone embolisation and resection of a left glomus jugulare tumour, who presented three weeks post-operatively with magnetic resonance venography confirmed symptomatic cerebral venous sinus thrombosis.
We present a case report and a review of the world literature concerning glomus jugulare tumours and cerebral venous sinus thrombosis.
A 42-year-old man presented with blurred vision and reduced Snellen visual acuity just three weeks after glomus jugulare tumour surgery. Fundoscopy revealed bilateral haemorrhagic optic disc oedema. Urgent magnetic resonance venography confirmed a left lateral venous sinus thrombosis. It was felt that this was responsible for inadequate cerebrospinal fluid drainage, resulting in raised intracranial pressure and papilloedema.
To the authors' knowledge, this is the first account of a magnetic resonance venography confirmed venous sinus thrombosis and secondary papilloedema following glomus jugulare tumour surgery. Patients undergoing surgery involving resection or manipulation of the internal jugular vein may be at higher risk of developing thrombosis superior to the level of resection, and magnetic resonance venography ought to be considered an important diagnostic adjunct.
The manifestations of Lyme disease as they may present to the ENT surgeon are discussed. The most important ENT symptom is facial palsy. Particularly when combined with other cranial palsies, systemic illness or signs of meningeal irritation, the diagnosis must be considered. Three case reports are used to illustrate the presentation and diagnosis and treatment of Lyme disease. The characteristics of the disease are reviewed and the limitations of serological testing outlined. The literature has concentrated on bilateral or relapsing facial palsy. A review of palsies in Zurich that presented to the ENT clinic found only unilateral and partial palsies. The diagnosis should be considered in every case of facial palsy of unknown aetiology especially in children.
Malignant cartilaginous tumours of the larynx are very rare, and usually arise from the cricoid cartilage. We report the first documented case of a chondrosarcoma of the epiglottis. The diagnosis, histology and treatment of these tumours are discussed.
The frequency histograms of six patients' laryngographs were studied pre- and post-endotracheal intubation. The changes were correlated with the length of intubation. The post-operative hoarse voice was seen as an increase in the spread of the lower frequencies, and an increase in the fundamental frequency. The latter change was thought to be a subconscious compensation for the hoarseness. The increased lower frequency spread as measured by standard deviation was directly proportional to the length of intubation.
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