scholarly journals Is Routine Nasoendoscopy Warranted in Epistaxis Patients after Removal of Nasal Packing?

2011 ◽  
Vol 2 (1) ◽  
pp. ar.2011.2.0003 ◽  
Author(s):  
Tafadzwa P. Makarawo ◽  
David Howe ◽  
Samuel K. Chan
Keyword(s):  
Nasal Cavity ◽  
Final Diagnosis ◽  
Additional Benefit ◽  
Initial Presentation ◽  
Bleeding Point ◽  
Bleeding Vessel ◽  
Anterior Rhinoscopy ◽  
Additional Information ◽  
Investigative Tool ◽  
Nose And Throat

Fiberoptic nasoendoscopy (FNE) is a powerful investigative tool in ear, nose, and throat practice in which its use in the management of epistaxis is varied among clinicians. The practice of assessing the nasal cavity after removal of nasal packs is common but its usefulness has not been evaluated. Therefore, we assessed the benefits of routine FNE after removal of nasal packs in epistaxis patients. Our study was performed retrospectively involving 62 adult patients admitted over a 6-month period between 2005 and 2006. Data regarding the emergent management of epistaxis cases on presentation, the use of FNE, and the final diagnosis and outcome of each patient were specifically investigated during the study. Anterior rhinoscopy was performed in 27 patients at initial presentation, of whom 45% (10/27) had anterior bleeding points identified. FNE examination after removal of nasal packs in eight patients yielded evidence of a posterior bleeding point in only one case (12.5%). Of those patients in whom anterior rhinoscopy revealed no anterior bleeding point at presentation (17/27), 12 patients went on to have FNE after removal of their nasal packs, and of these, 33% (4/12) of patients were found to have a posterior bleeding vessel. Overall, FNE was performed in 24 patients, of whom only 1 (1/24) had an active posterior bleeding vessel needing nasal repacking. Four patients (4/24) had prominent posterior vessels that required no intervention, 1 patient (1/24) had new pathology identified, and in the remaining 18 cases (18/24), FNE yielded no additional information to modify management. The routine performance of FNE in all epistaxis patients after pack removal does not appear to convey any additional benefit. We advocate the use of FNE when anterior bleeding has been excluded or bleeding is persistent and that careful nasal examination by anterior rhinoscopy should be the cornerstone of assessment.

Experimental study of the possibility of topical application of polyvinylpyrrolidone for epistaxis

2021 ◽  
pp. 15-19
Author(s):  
Viktoriya Valentinovna Bykova ◽  
Svetlana Aleksandrovna Chubka
Keyword(s):  
Experimental Study ◽  
Nasal Cavity ◽  
Topical Application ◽  
Nasal Packing ◽  
Recurrent Bleeding ◽  
Mucociliary Transport ◽  
Prolonged Stay ◽  
Bleeding Vessel ◽  
Recurrent Epistaxis ◽  
Local Fibrinolysis

Nasal packing is widely used in patients with epistaxis, especially in cases where it is impossible to electrocoagulate the bleeding vessel. The disadvantages of gauze packing are well known. First of all, this is the risk of recurrent bleeding after removing the tampons from the nose. The cause of recurrent epistaxis is the activation of local fibrinolysis during prolonged stay of the tampon in the nasal cavity. To overcome this drawback, we have proposed the topical application of polyvinylpyrrolidone (PVP). In an experiment on animals, the absence of a damaging effect of PVP on mucociliary transport was proved.

Ear, nose and throat surgery

2021 ◽  
pp. 755-782
Author(s):  
Grant Turner
Keyword(s):  
Airway Obstruction ◽  
Nasal Cavity ◽  
Neck Dissection ◽  
Surgical Procedures ◽  
Radical Neck Dissection ◽  
Anaesthetic Management ◽  
Jet Ventilation ◽  
Ent Surgery ◽  
Nose And Throat

This chapter discusses the anaesthetic management of ear, nose and throat (ENT) surgery (otolaryngological surgery). It begins with a discussion of relevant general principles (including the shared airway), and covers airway obstruction and jet ventilation. Surgical procedures covered include grommet insertion; tonsillectomy; adenoidectomy; myringoplasty; stapedectomy; tympanoplasty; nasal cavity surgery; microlaryngoscopy; tracheostomy; laryngectomy; radical neck dissection, and parotidectomy. It includes pertinent anaesthetic features for a series of additional miscellaneous ENT procedures.

Ear, nose, and throat surgery

2018 ◽  
Author(s):  
Fred Roberts
Keyword(s):  
Airway Obstruction ◽  
Nasal Cavity ◽  
Neck Dissection ◽  
Surgical Procedures ◽  
Radical Neck Dissection ◽  
Anaesthetic Management ◽  
Sleep Apnoea ◽  
Nose And Throat

This chapter discusses the anaesthetic management of ear, nose, and throat surgery (otolaryngological surgery). It begins with a discussion of relevant general principles (including the shared airway) and covers airway obstruction and sleep apnoea. Surgical procedures covered include grommet insertion, tonsillectomy, adenoidectomy, myringoplasty, stapedectomy, tympanoplasty, nasal cavity surgery, microlaryngoscopy, tracheostomy, laryngectomy, pharyngectomy (including glossectomy), radical neck dissection, and parotidectomy. It concludes with a series of vignettes of other ear, nose, and throat procedures.

From (Psycho) Pathology to Diagnosis: Psychiatry Nosology Beyond Dichotomy

2017 ◽  
Vol 41 (S1) ◽  
pp. S45-S45
Author(s):  
A. Erfurth ◽  
G. Sachs
Keyword(s):  
Final Diagnosis ◽  
Classification Systems ◽  
Careful Examination ◽  
Potential Consequence ◽  
Additional Information ◽  
Diagnostic Categories ◽  
Competing Interest ◽  
Initiation Of Therapy ◽  
Medical Disciplines ◽  
System 1

As in all medical disciplines, diagnosis in clinical psychiatry should be reached in a step-wise approach: after assessing the chief complaint of the patient, a careful examination of the psychopathology follows e.g. by using the AMDP system [1] to preliminarily conclude the process with a syndromal classification [2]. This syndromal classification is of great importance as it guides the initiation of therapy in daily life practice. After gaining additional information (e.g. investigation in the course of the disease, brain imaging, thorough assessment of cognitive function, exclusion of organic causes) a final diagnosis is possible. Unfortunately, a premature jumping to diagnosis is not uncommon (with the potential consequence of incorrect therapies).In addition to these difficulties, recent neurobiological research has shown that nosologic assignments through conventional diagnostic classifications are far less specific than assumed, revealing a large overlap between diagnostic categories [3,4], e.g. between Schizophrenia and affective disorders. Consequences of this finding are discussed both for the construction of future classification systems and for therapy.Disclosure of interestThe authors declare that they have no competing interest.

scholarly journals Ischemic Stroke in an HIV Positive Patient: An Initial Presentation of Neurosyphilis

2018 ◽  
Vol 2018 ◽  
pp. 1-5
Author(s):  
Kalimullah Jan ◽  
Rebecca Hoe Hui Min ◽  
Tan Seow Yen ◽  
Shekhawat Ravindra Singh
Keyword(s):  
Risk Factors ◽  
Human Immunodeficiency Virus ◽  
Ischemic Stroke ◽  
Final Diagnosis ◽  
Initial Presentation ◽  
Neurological Deficits ◽  
Hiv Positive ◽  
Middle Cerebral Artery Territory ◽  
Immunodeficiency Virus ◽  
High Index Of Suspicion

Ischemic stroke occurring in patients with human immunodeficiency virus (HIV) needs to be approached with a vast differential diagnosis in mind. We report a case of middle-aged male patient with immune reconstituted HIV on therapy without known cardiovascular risk factors who had a right middle cerebral artery territory infarct. After a thorough evaluation, he received a final diagnosis of neurosyphilis-associated vasculitis leading to stroke. He recovered without any neurological deficits following treatment with intravenous benzylpenicillin. Neurosyphilis is an easily diagnosed and treatable cause of a stroke that can be an initial presentation of neurosyphilis but requires a high index of suspicion.

scholarly journals Transthoracic Ultrasound in Infectious Organizing Pneumonia: A Useful Guide for Percutaneous Needle Biopsy

2021 ◽  
Vol 8 ◽  
Author(s):  
Donato Lacedonia ◽  
Carla Maria Irene Quarato ◽  
Cristina Borelli ◽  
Lucia Dimitri ◽  
Paolo Graziano ◽  
...  
Keyword(s):  
Ct Scan ◽  
Needle Biopsy ◽  
Final Diagnosis ◽  
Organizing Pneumonia ◽  
Percutaneous Needle Biopsy ◽  
Aggressive Approach ◽  
Additional Information ◽  
Ultrasound Findings ◽  
Chest X Ray ◽  
Transthoracic Ultrasound

In patients presenting with classical features of CAP (i.e., new peripheral pulmonary consolidations and symptoms including fever, cough, and dyspnea), a clinical response to the appropriate therapy occurs in few days. When clinical improvement has not occurred and chest imaging findings are unchanged or worse, a more aggressive approach is needed in order to exclude other non-infective lesions (including neoplasms). International guidelines do not currently recommend the use of transthoracic ultrasound (TUS) as an alternative to chest X-ray (CXR) or chest computed tomography (CT) scan for the diagnosis of CAP. However, a fundamental role for TUS has been established as a guide for percutaneous needle biopsy (US-PNB) in pleural and subpleural lesions. In this retrospective study, we included 36 consecutive patients whose final diagnosis, made by a US-guided percutaneous needle biopsy (US-PTNB), was infectious organizing pneumonia (OP). Infective etiology was confirmed by additional information from microbiological and cultural studies or with a clinical follow-up of 6–12 months after a second-line antibiotic therapy plus corticosteroids. All patients have been subjected to a chest CT and a systematic TUS examination before biopsy. This gave us the opportunity to explore TUS performance in assessing CT findings of infective OP. TUS sensitivity and specificity in detecting air bronchogram and necrotic areas were far lower than those of CT scan. Conversely, TUS showed superiority in the detection of pleural effusion. Although ultrasound findings did not allow the characterization of chronic subpleural lesions, TUS confirmed to be a valid diagnostic aid for guiding percutaneous needle biopsy of subpleural consolidations.

Ear, nose, and throat surgery

2016 ◽  
Author(s):  
Fred Roberts
Keyword(s):  
Airway Obstruction ◽  
Nasal Cavity ◽  
Neck Dissection ◽  
Surgical Procedures ◽  
Radical Neck Dissection ◽  
Anaesthetic Management ◽  
Sleep Apnoea ◽  
Nose And Throat

This chapter discusses the anaesthetic management of ear, nose, and throat surgery (otolaryngological surgery). It begins with a discussion of relevant general principles (including the shared airway) and covers airway obstruction and sleep apnoea. Surgical procedures covered include grommet insertion, tonsillectomy, adenoidectomy, myringoplasty, stapedectomy, tympanoplasty, nasal cavity surgery, microlaryngoscopy, tracheostomy, laryngectomy, pharyngectomy (including glossectomy), radical neck dissection, and parotidectomy. It concludes with a series of vignettes of other ear, nose, and throat procedures.

Abstract 12412: Imaging the PM/AICD Patient; Does the Diagnostic Value Justify the Risk?

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Huma Y Samar ◽  
June Yamrozik ◽  
Ronald Williams ◽  
Mark Doyle ◽  
Robert Biederman
Keyword(s):  
Mr Imaging ◽  
Final Diagnosis ◽  
Diagnostic Value ◽  
List Type ◽  
Mri Imaging ◽  
Mri Scan ◽  
Additional Information ◽  
Patient Diagnosis ◽  
Life Saving ◽  
Mri Study

Background: MR imaging is infrequently performed on patients with implanted pacemakers/AICDs. When the risk justifies the end, however, consideration to perform 'high-risk’ scanning can be made on a case-by-case basis but typically with trepidation. This raises a critically important question: "Is the MRI scan adding valuable and irrefutable information to warrant such risk? Methods: 84 patients with implanted devices (13AICD,10 AICD/PM,5 retained leads, 6 REVO and 50 dual chamber PM.) were imaged via MRI/CMR (1.5T GE, Milwaukee, WI) over 3 years in a single institution. Specific criteria were followed for all patients to objectively define whether final diagnosis by MRI imaging enhanced patient care. A checklist of 3 questions was answered following scan interpretation by both the technologist and performing MRI physician(s): 1) Did the diagnosis change? 2) Did the MRI provide additional information to the existing diagnosis? 3) Did patient management change? If ‘Yes’ was answered to any of the above questions, it was considered that the MRI scan was of value to patient diagnosis and/or therapy. Results: All patients completed the procedure with no death, VT/VF, power-on-reset or adverse events. Average MRI study time: 20±55min. The device was interrogated pre and post MRI by EP/cardiologist to determine changes in impedance, amplitude or threshold. No clinically meaningful changes occurred, no post-procedure revisions to generator/lead or parameters were required. Conclusion: The use of PM/AICD imaging in MRI remains controversial. Our study shows that MR imaging in carefully selected patients under the supervision of experienced physicians is not only safe but extremely beneficial, substantially adding value and often irrefutable information to patient diagnosis and management. PM/AICDs when imaged properly are safe and no longer 'forbidden’ in the MRI environment. Moreover there is frequently marked life-altering and life-saving information obtained.

scholarly journals Managing a patient with globus pharyngeus

2017 ◽  
Vol 9 (3) ◽  
pp. 208.1-212 ◽  
Author(s):  
Philip R Harvey ◽  
Byron T Theron ◽  
Nigel J Trudgill
Keyword(s):  
Speech Therapy ◽  
Final Diagnosis ◽  
Behavioural Therapy ◽  
Upper Gastrointestinal Endoscopy ◽  
Cognitive Behavioural ◽  
Benign Nature ◽  
Unusual Stress ◽  
Upper Gastrointestinal ◽  
Nose And Throat

A woman aged 47 years reported the feeling of a lump in her throat for the past year. The sensation was present intermittently and usually improved when she ate. She noted it was worse with dry swallows when she felt like a tablet was stuck in her throat. The sensation had become more persistent in recent weeks leading her to worry that she had cancer. She had no cough, sore throat or hoarseness. There were no precipitating factors and no symptoms of weight loss, dysphagia, odynophagia or change in her voice. She had smoked previously and rarely had heartburn. She had no other anxieties and was not under any unusual stress. She was initially assessed by an ear, nose and throat surgeon, who found no abnormalities on examination of her neck, throat and oral cavity. Nasolaryngoscopy was normal. An upper gastrointestinal endoscopy was organised and reported a hiatus hernia, but a 3-month trial of a proton pump inhibitor did not have any impact on her symptoms. The benign nature of her symptoms was discussed at her gastroenterology follow-up appointment. She was discharged back to primary care with a final diagnosis of ’globus'. A trial of speech therapy, cognitive behavioural therapy or amitriptyline would be recommended if her symptoms became more troublesome in future.

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