Breathing straws

Following nasal, septal or endoscopic surgery, it is common practice to insert nasal packs in both nasal cavities to achieve haemostasis, if there has been any bleeding at the end of the procedure. However, such packs make it difficult for patients to breathe, mainly in the first post-operative night which leads to discomfort and poor sleep. To enable patients to breathe better with nasal packs in situ, we describe a simple technique using trimmed straws and wrapped Netcell® packs for post-operative care following septal surgery, rhinoplasty and endoscopic sinus surgery. These packs also assist suction of any blood or mucous from the post-nasal spac

Fettemboliesyndrom nach Unterschenkelfraktur trotz sofortiger Versorgung mit einem Fixateur externe: Zwei Kasuistiken und Literaturübersicht

Zusammenfassung: Das Auftreten eines Fettemboliesyndroms (FES) wird mit 0,9-2,2% als bekannte Komplikation bei Frakturen langer Röhrenknochen beschrieben. Die klassische Symptomtrias besteht aus Atemnot, neurologischen Symptomen und Petechien. Gemäß Literatur verringert eine frühzeitige Versorgung der Fraktur die Inzidenz eines FES. Diese Kasuistiken beschreiben jedoch interessanterweise die Entstehung eines FES trotz sofortiger operativer Versorgung der Unterschenkelfrakturen mittels Fixateur externe zweier völlig gesunder junger Männer. Somit sollte nach jeglichem Therapieverfahren bei der Versorgung langer Röhrenknochen an die Komplikation durch ein FES gedacht werde

Perforatationstrauma im Gesichtsschädel. Eine ungewöhnliche Verletzung beim Skifahren

Facial perforation injuries are very rare. We describe a case of a 48-year-old man who sustained a perforation trauma from an 11 cm long wooden tree branch in the middle of the face in a skiing accident. He suffered from additional injuries, such as fractures of the ribs and hand, but was neurologically without pathologic findings and was cardiopulmonary stable.The branch penetrated the head from the sinus maxillaris through the maxilla just missing the internal and external carotid arteries and ending just short of the cervical vertebra. The patient was transported to a center for oral and maxillofacial surgery and underwent several operations.He could return to his normal social and professional life 8 months after the accident

Minimal-invasive, ballonassistierte Aufrichtung und innere Fixation von Tibiaplateaufrakturen

Zusammenfassung: Aufgrund der häufig insuffizienten Weichteilsituation im Rahmen von Tibiaplateaufrakturen und der damit assoziierten höheren Rate an postoperativen Wundheilungsstörungen und Weichteilinfektionen ist ihre operative Behandlung nicht selten eine herausfordernde Aufgabe. Die klassische offene Reposition und Plattenosteosynthese beinhaltet eine ausgiebige Weichteilpräparation und partielle Periostablösung, um so die abgesunkenen Fragmente zu bergen und aufzurichten. Die Wiederherstellung der Gelenkfläche gestaltet sich dabei häufig als schwierig. In der vorliegenden Arbeit beschreiben wir eine neuartige operative Technik, in der das eingesunkene Tibiaplateau durch einen perkutan eingebrachten Ballon in Kombination mit einer minimal-invasiven Plattenosteosynthese versorgt wird. Darüber hinaus berichten wir über 5Fälle, welche mit diesem Verfahren bislang behandelt wurde

Ear, nose and throat manifestations of Lyme disease

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 childre

Asymptotic Level Density of the Elastic Net Self-Organizing Feature Map

Whileas the Kohonen Self Organizing Map shows an asymptotic level density following a power law with a magnification exponent 2/3, it would be desired to have an exponent 1 in order to provide optimal mapping in the sense of information theory. In this paper, we study analytically and numerically the magnification behaviour of the Elastic Net algorithm as a model for self-organizing feature maps. In contrast to the Kohonen map the Elastic Net shows no power law, but for onedimensional maps nevertheless the density follows an universal magnification law, i.e. depends on the local stimulus density only and is independent on position and decouples from the stimulus density at other positions.Comment: 8 pages, 10 figures. Link to publisher under http://link.springer.de/link/service/series/0558/bibs/2415/24150939.ht

Nephrotoxicity, high frequency ototoxicity, efficacy and serum kinetics of once versus thrice daily dosing of netilmicin in patients with serious infections

The effect of dosing regimen on nephrotoxicity, high frequency ototoxicity, efficacy and serum kinetics was studied in a prospective, randomised clinical study. Therapy was started with total daily doses of 6 mg/kg given once (od) or thrice (tid) daily to 56 and 57 patients, respectively. Subsequent doses were adjusted according to serum levels. No major differences in toxicity or efficacy were noticed between od and tid regimens: clinical failures occurred in two and two patients, four and five patients suffered from a decrease of ≥20 dB at least unilaterally at one frequency between 8 and 18 kHz, six and seven patients had a >25 μmol/L or >25% increase in serum creatinine, respectively. Serum creatinine or creatinine clearance did not change significantly during either therapy. Major differences between the two study groups were limited to pharmacokinetic parameters. Od dosing resulted in higher peak (mean of 21.6 vs 7.2 mg/L) and lower trough levels (0.5 vs 1.4mg/L). Half-lives of netilmicin determined between 1 and 8 h increased significantly during therapy with tid (from a mean of 2.75 to a mean of 3.33 h, P<0.01) but not significantly with od (rise from 2.8 to 3.03 h). Much longer half-lives were determined between 8 and 24 h in the od group (mean of 5.7 h, P<0.01). In conclusion, only minimal differences in toxicity and efficacy were observed. Their clinical relevance appears to be minima

Limitations of balloon sinuplasty in frontal sinus surgery

Balloon sinuplasty is a tool that is used to treat selected patients with paranasal sinus pathologies. No studies have investigated the aetiology of failed access to the frontal sinus. The aim of our study was to specify the intraoperative technical failure rate and to analyse the aetiology of the failed access to predict potential technical difficulties before surgery. We retrospectively analysed the charts of patients who underwent balloon sinuplasty from November 2007 to July 2010 at three different ENT-Centres. CT-analysis of the patients with failed access was performed. Of the 104 frontal sinuses, dilation of 12 (12%) sinuses failed. The anatomy of all failed cases revealed variations in the frontal recess (frontoethmoidal-cell, frontal-bulla-cell or agger-nasi-cell) or osteoneogenesis. In one patient, a lymphoma was overlooked during a balloon only procedure. The lymphoma was diagnosed 6months later with a biopsy during functional endoscopic sinus surgery. In complex anatomical situations of the frontal recess, balloon sinuplasty may be challenging or impossible. In these situations, it is essential to have knowledge of classical functional endoscopic sinus surgery of the frontal recess area. The drawbacks of not including a histopathologic exam should be considered in balloon only procedure

The calcar screw in angular stable plate fixation of proximal humeral fractures - a case study

Background: With new minimally-invasive approaches for angular stable plate fixation of proximal humeral fractures, the need for the placement of oblique inferomedial screws ('calcar screw') has increasingly been discussed. The purpose of this study was to investigate the influence of calcar screws on secondary loss of reduction and on the occurrence of complications. Methods: Patients with a proximal humeral fracture who underwent angular stable plate fixation between 01/2007 and 07/2009 were included. On AP views of the shoulder, the difference in height between humeral head and the proximal end of the plate were determined postoperatively and at follow-up. Additionally, the occurrence of complications was documented. Patients with calcar screws were assigned to group C+, patients without to group C-. Results: Follow-up was possible in 60 patients (C+ 6.7 ± 5.6 M/C- 5.0 ± 2.8 M). Humeral head necrosis occurred in 6 (C+, 15.4%) and 3 (C-, 14.3%) cases. Cut-out of the proximal screws was observed in 3 (C+, 7.7%) and 1 (C-, 4.8%) cases. In each group, 1 patient showed delayed union. Implant failure or lesions of the axillary nerve were not observed. In 44 patients, true AP and Neer views were available to measure the head-plate distance. There was a significant loss of reduction in group C- (2.56 ± 2.65 mm) compared to C+ (0.77 ± 1.44 mm; p = 0.01). Conclusions: The placement of calcar screws in the angular stable plate fixation of proximal humeral fractures is associated with less secondary loss of reduction by providing inferomedial support. An increased risk for complications could not be shown