Endoscopic sinus surgery for maxillary sinus mucoceles

BACKGROUND: Maxillary sinus mucoceles are relatively rare among all paranasal sinus mucoceles. With the introduction of endoscopic sinus surgical techniques, rhinologic surgeons prefer transnasal endoscopic management of sinus mucoceles. The aim of this study is to describe the clinical presentation of maxillary sinus mucoceles and to establish the efficacy of endoscopic management of sinus mucoceles. METHODS: Between 2003 and 2005, 14 patients underwent endoscopic sinus surgery for maxillary sinus mucocele. The presenting sign and symptoms, radiological findings, surgical management and need for revision surgery were reviewed. RESULTS: There were eight males and six females with an age range of 14 to 65. Ten patients complained of nasal obstruction, five of nasal drainage, five of cheek pressure or pain and one of proptosis of the eye and cheek swelling. The maxillary sinus and ipsilateral ethmoid sinus involvement on computed tomographic studies was seen in 4 patients. Four patients had history of endoscopic ethmoidectomy surgery for ethmoid sinusitis and one had Caldwell-Luc operation in the past. Ethmoidectomy with middle meatal antrostomy and marsupialization of the mucocele was performed in all patients. Postoperative follow-up ranged between 8 to 48 months. All patients had a patent middle meatal antrostomy and healthy maxillary sinus mucosa. No patients need revision surgery. CONCLUSION: The most common causes of mucoceles are chronic infection, allergic sinonasal disease, trauma and previous surgery. In 64% of the patients of our study cause remains uncertain. Endoscopic sinus surgery is an effective treatment for maxillary sinus mucoceles with a favorable long-term outcome

Complications of Formaldehyde Injection for a Cystic Mass of the Neck

Formaldehyde is a colorless reactive chemical with suffocating and pungent odor. It is irritant to mucous membranes and can enter the body by either oral ingestion or inhalation. Formaldehyde is toxic to living tissue. In this report, we present the case of a 22-year-old woman who was treated with formaldehyde injection for a cystic mass of the neck with developing complications

The Role of PET-CT in Evaluation of Cervical Lymph Node Metastases in Oral Cavity Squamous Cell Carcinomas

Objective: The aim of this study is to determine the sensitivity and specificity of positron emission tomography-computed tomography (PET-CT) in the evaluation of cervical lymph node metastasis in oral cavity squamous cell cancers (SCCs) and to determine the SUV-max values in differentiating reactive and metastatic lymph nodes as a supportive parameter. Methods: In this study, 23 patients were included who were diagnosed with oral cavity SCC and treated with surgery between 2006 and 2013 in our department. All the patients were scanned with PET-CT during the pretreatment evaluation. Detailed pretreatment PET-CT (retention sites and SUV-max values) and histopathological examination results were obtained. SPSS 17.0 software package was used for statistical analysis of the data. Categorical measurement was summarized as number and percentage and continuous measurements as mean and standard deviation (median and minimum-maximum where necessary). Chi-square test or Fisher's test were used in the comparison of categorical variables. Compliance of methods was assessed by Kappa coefficient analysis. In this study, the advantages of PET-CT were determined by the calculation of sensitivity and specificity values with histopathological examination results considered as the gold standard, and SUV-max value was assessed by examining the area under the ROC curve. In all tests, the level of statistical significance was accepted as 0.05. Results: The threshold value for SUV-max depending on the data of the histopathological examination and results of PET-CT of the 23 patients was 2.50. The reliability of this threshold was determined as AUC=0.819. In demonstrating neck metastasis in patients with cancer of the oral cavity, PET-CT has a sensitivity of 89% and specificity of 98%. Compliance between the histopathological examination and PET-CT for metastatic cervical lymph nodes was determined to be 0.416 by kappa coefficient analysis. Conclusion: There was FDG uptake on PET-CT in the cervical lymph node regions of all patients with metastatic cervical lymph nodes. There were no metastases in any of the patients with no FDG retention. The sensitivity and specificity of PET-CT in determining cervical lymph node metastasis were 89% and 98%, respectively, with a threshold SUV-max value considered as 2.50 in patients with FDG retention

REVISTA BRASILEIRA DE ANESTESIOLOGIA Administration of paracetamol versus dipyrone by intravenous patient-controlled analgesia for postoperative pain relief in children after tonsillectomy PALAVRAS-CHAVE

Abstract Background and objective: We compared the efficacy of intravenous (IV) paracetamol versus dipyrone via patient-controlled analgesia (PCA) for postoperative pain relief in children. Methods: The study was composed of 120 children who had undergone elective tonsillectomy after receiving general anesthesia. Patients were divided into 3 groups according to the dosage of postoperative intravenous-patient-controlled analgesia: paracetamol, dipyrone, or placebo. Pain was evaluated using a 0-to 100-mm visual analog scale and 1-to 4-pain relief score at 30 min, 1, 2, 4, 6, 12, and 24 h postoperatively. Pethidine (0.25 mg kg −1 ) was administered intravenously to patients requiring rescue analgesia. Pethidine requirements were recorded during the first 24 h postoperatively, and treatment related adverse effects were noted. Results: Postoperative visual analog scale scores were significantly lower with paracetamol group compared with placebo group at 6 h (p < 0.05), dipyrone group compared with placebo group at 30 min and 6 h (p < 0.05). No significant differences regarding visual analog scale values at 1, 2, 4, 12, and 24 h were found. No significant differences were found between groups with respect to pain relief score (p > 0.05). Postoperative pethidine requirements were significantly lower with paracetamol and dipyrone groups compared with placebo group (62.5%, 68.4% vs 90%, p < 0.05). No significant differences were found between groups with respect to nausea, vomiting and the any other adverse effects of the drugs (p > 0.05). Conclusions: Paracetamol and dipyrone have well tolerability profile and effective analgesic properties when administered IV-PCA for postoperative analgesia in children after tonsillectomy. © 2013 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved. PALAVRAS-CHAVE Analgesia; Controlada pelo paciente; Pediatria; Dor; Pós-operatório; Tonsilectomia Administração de paracetamol versus dipirona em analgesia controlada pelo paciente por via intravenosa para alívio da dor no pós-operatório de crianças após tonsilectomia Resumo Justificativa e objetivo: Comparamos a eficácia da administração de paracetamol versus dipirona em analgesia controlada pelo paciente (PCA) por via intravenosa (IV) para alívio da dor no período pós-operatório em crianças. Métodos: O estudo foi composto por 120 crianças submetidas à tonsilectomia sob anestesia geral. Os pacientes foram divididos em três grupos de acordo com a dose IV de analgesia controlada pelo paciente no pós-operatório: paracetamol, dipirona ou placebo. A dor foi avaliada usando uma escala visual analógica de 0-100 mm e escore de 1-4 para alívio da dor nos tempos de 30 minutos, 1, 2, 4, 6, 12 e 24 horas de pós-operatório. Petidina (0,25 mg kg −1 ) foi administrada IV aos pacientes que precisaram de analgesia de resgate. A necessidade de petidina foi registrada durante as primeiras 24 h de pós-operatório, e os efeitos adversos relacionados ao tratamento foram registrados. Resultados: Os escores da escala visual analógica no pós-operatório foram significativamente menores no grupo paracetamol em comparação com o grupo placebo em 6 h (p < 0,05), no grupo dipirona em comparação com o grupo placebo em 30 min e 6 h (p < 0,05). Não houve diferença significativa em relação aos valores da escala visual analógica nos tempos avaliados de 1, 2, 4, 12 e 24 horas. Não houve diferença significativa entre os grupos quanto ao escore de alívio da dor (p > 0,05). A necessidade de petidina foi significativamente menor nos grupos paracetamol e dipirona em comparação com o grupo placebo (62,5%, 68,4% vs. 90%, p < 0,05). Não houve diferença significativa entre os grupos em relação à incidência de náusea, vômito e outros efeitos adversos dos medicamentos (p > 0,05). Conclusões: Paracetamol e dipirona possuem um perfil de boa tolerabilidade e propriedades analgésicas eficazes quando administrados IV para ACP no pós-operatório de crianças após tonsilectomia

Administration of paracetamol versus dipyrone by intravenous patient-controlled analgesia for postoperative pain relief in children after tonsillectomy

Background and objective: We compared the efficacy of intravenous (iv) paracetamol versus dipyrone via patient-controlled analgesia (PCA) for postoperative pain relief in children. Methods: The study was composed of 120 children who had undergone elective tonsillectomy after receiving general anesthesia. Patients were divided into 3 groups according to the dosage of postoperative intravenous-patient-controlled analgesia: paracetamol, dipyrone, or placebo. Pain was evaluated using a 0- to 100-mm visual analog scale and 1- to 4-pain relief score at 30 min, 1, 2, 4, 6, 12, and 24h postoperatively. Pethidine (0.25 mg kg 1) was administered intravenously to patients requiring rescue analgesia. Pethidine requirements were recorded during the first 24h postoperatively, and treatment related adverse effects were noted. Results: Postoperative visual analog scale scores were significantly lower with paracetamol group compared with placebo group at 6h (p 0.05). Postoperative pethidine requirements were significantly lower with paracetamol and dipyrone groups compared with placebo group (62.5%, 68.4% vs 90%, p 0.05). Conclusions: Paracetamol and dipyrone have well tolerability profile and effective analgesic properties when administered iv-PCA for postoperative analgesia in children after tonsillectomy. (C) 2013 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved