Unblocking the Nose by Unplugging the Ear: The Use of Foam Ear Defenders as a Splint following Secondary Cleft Rhinoplasty

2009 ◽  
Vol 46 (1) ◽  
pp. 6-8 ◽  
Author(s):  
Linda J. Treharne ◽  
Jacques J. N. M. van der Meulen
Keyword(s):  
Outcome Measures ◽  
Postoperative Period ◽  
Clinical Case ◽  
Case Series ◽  
Senior Author ◽  
Nasal Vestibule ◽  
Aesthetic Result ◽  
Nasal Pack ◽  
Cleft Rhinoplasty

Objective: The functional and aesthetic result from secondary cleft rhinoplasty is commonly impaired by a bulge in the lateral nasal vestibule, which can relapse in the postoperative period despite careful intraoperative correction. We aim to improve our results by using a foam ear defender as a postoperative splint to prevent relapse. Design: Case series of 10 patients with photographs of a typical clinical case. Interventions: The postoperative nasal pack was exchanged with a foam ear defender on day 5. The splint was worn continuously for 3 to 4 weeks, then nightly for 3 months. The splint was changed daily by the patient. Main Outcome Measures: The results were assessed clinically by the senior author. Results: The patients had little or no recurrence of the lateral vestibular bulge following nasal splintage. Conclusions: Foam ear defenders are a simple, cheap, and comfortable method to provide splintage to the nasal vestibule following secondary cleft rhinoplasty.

scholarly journals Minimally invasive treatment for gynecomastia: ultrasound-guided vacuum-assisted excision – case series

Mastology ◽  
2020 ◽  
Vol 30 (Suppl 1) ◽  
Author(s):  
Henrique Lima Couto ◽  
Carolina Nazareth Valadares ◽  
Osmar Pellegrini ◽  
Shirley das Graças Ferreira ◽  
Julia Grichtolik Cantagalli Paiva
Keyword(s):  
Postoperative Period ◽  
Breast Tissue ◽  
Case Series ◽  
Complication Rates ◽  
Open Approach ◽  
Ultrasound Guided ◽  
Aesthetic Result ◽  
Postoperative Hematoma ◽  
Areolar Complex ◽  
Patient Reported

Introduction: Gynecomastia (GM) is the benign proliferation of breast tissue in men. Its prevalence is of up to 65% according to age. It can be unilateral or bilateral. The standard surgery is periareolar incision, even though it can lead to asymmetry (AS), anesthetic scar, retraction or necrosis of the nipple-areolar complex (NAC). The vacuum-assisted excision (VAE) is the alternative approach. Objectives: To describe the technique and results of ultrasound-guided VAE for GM. Methods: series of 7 cases of Simon I and II GM, submitted to US-guided VAE (10G needle and ENCOR® BD) between December 20, 2018, and October 26, 2019. The cases were assessed considering clinical, laboratory and imaging aspects with mammography (MMG) and US. The pre-surgical consent form was obtained. US-guided VAE was performed with a 3 mm incision, in the ambulatory, with local anesthesia (2% lidocaine) and no sedation, in the “fine precision” and “dense breast” modes, in order to leave a 1cm flap in the retroareolar region. At the end, a vacuum and/or manual drainage of the cavity was performed to reduce the postoperative hematoma (HMA). In the postoperative period, MMGs were performed 1 and 6 months after the VAE, and the revisions occurred on the 7th and 14th day, and the 1st, 2nd and 6th months. The patients wore vests for 30 postoperative days. The outcomes were good or excellent when the amount of residual breast tissue was minimum, and AS, retractions, necrosis, anesthetic scar or NAC deviation, absent. The patients filled out a form of satisfaction level and perception of the VAE. Results: Mean age was 26.7 years. Mean time of VAE was 28 minutes. The main complaint regarding VAE was aesthetic discomfort, followed by physical deformity. One patient presented with areola skin tear during the procedure. It was sutured and did not impact the aesthetic result. All patients and surgeons reported excellent or sufficient levels of satisfaction. There were no recurrences or re-approach in 6 months. There was no hemorrhage in the peri or postoperative period, with no open approach. No patient required sedation. They all had histology of GM. No cases of breast deviation, necrosis or NAC retraction, infection, AS our anesthetic scar. No patient reported changes in erection or breast sensitivity. They all presented with hemorrhagic suffusion and hematoma with spontaneous resolution in 30 days, without interfering in the outcome. No intervention or hematoma drainage was necessary in the postoperative period. Conclusion: US-guided VAE for GM is alternative to the conventional surgical treatment in Simon I and II cases, with good or excellent results. It presents low complication rates and high satisfaction rates. It is performed in the ambulatory, without intercurrences. Comparative studies of traditional surgery and VAE should be performed.

Herpetic Whitlow of the Hand in Infants

2020 ◽  
Author(s):  
Mohammad M. Al-Qattan ◽  
Nada G. AlQadri ◽  
Ghada AlHayaza
Keyword(s):  
Bacterial Infection ◽  
Case Reports ◽  
Case Series ◽  
Individual Case ◽  
Senior Author ◽  
Secondary Bacterial Infection ◽  
Clinical Appearance ◽  
History Of ◽  
Mode Of Transmission ◽  
Time Of Presentation

Abstract Introduction Herpetic whitlows in infants are rare. Previous authors only reported individual case reports. We present a case series of six infants. Materials and Methods This is a retrospective study of six cases of herpetic whitlows in infants seen by the senior author (MMA) over the past 23 years (1995–2017 inclusive). The following data were collected: age, sex, digit involved in the hand, mode of transmission, time of presentation to the author, clinical appearance, presence of secondary bacterial infection, presence of other lesions outside the hand, method of diagnosis, treatment, and outcome. Results All six infants initially presented with classic multiple vesicles of the digital pulp. In all cases, there was a history of active herpes labialis in the mother. Incision and drainage or deroofing of the vesicles (for diagnostic purposes) resulted in secondary bacterial infection. Conclusion The current report is the first series in the literature on herpetic whitlows in infants. We stress on the mode of transmission (from the mother) and establishing the diagnosis clinically. In these cases, no need for obtaining viral cultures or polymerase chain reaction; and no medications are required. Once the vesicles are disrupted, secondary bacterial infection is frequent and a combination of oral acyclovir and intravenous antibiotics will be required.

Regenerative treatment of peri-implantitis following implant surface decontamination with titanium brush and antimicrobial photodynamic therapy: a case series with reentry

2020 ◽  
Author(s):  
Pier Poli ◽  
Francisley Avila Souza ◽  
Mattia Manfredini ◽  
Carlo Maiorana ◽  
Mario Beretta
Keyword(s):  
Photodynamic Therapy ◽  
Clinical Case ◽  
Case Series ◽  
Antimicrobial Photodynamic Therapy ◽  
Implant Surface ◽  
Surface Decontamination

Not required for Clinical case letters according to the authors' guidelines.

Combined Extended High Spinal Anesthesia and Endotracheal Narcosis: a Clinical Case

2019 ◽  
Vol 4 (2) ◽  
pp. 152-154
Author(s):  
A. B. Yakushevsky ◽  
A. N. Plekhanov ◽  
A. B. Ayusheev
Keyword(s):  
Abdominal Surgery ◽  
Spinal Anesthesia ◽  
Postoperative Period ◽  
Initial Dose ◽  
Clinical Case ◽  
Central Hemodynamics ◽  
Narcotic Analgesics ◽  
Spinal Catheter ◽  
The Right ◽  
Endotracheal Anesthesia

Background. In recent years, various methods of combined anesthesia during abdominal surgery have been introduced into clinical practice.Aim. To demonstrate the possibilities of a combination of high prolonged spinal anesthesia and endotracheal anesthesia during abdominal surgery.Materials and methods. A clinical case of combined use of high prolonged spinal anesthesia and endotracheal anesthesia in a 48-year-old patient with a tumor in the right half of the ascending part of the right half of the colon is presented.Results. The patient received a puncture of the spinal space at a standard point and was installed a spinal catheter in the cranial direction for 3 cm. An isobaric solution of marcaine in the initial dose of 20 mg was injected into the catheter. The regulation of the development of the block was regulated by the inclination of the head end of the table by 60°. After that endotracheal anesthesia was performed on the basis of fentanyl and propofol. This combination allowed to expand the scope of surgical intervention, provided adequate pain relief intraoperatively and in the postoperative period, without the use of narcotic analgesics. With the appearance of signs of recovery of pain sensitivity, intraoperatively or in the postoperative period, re-introduction of the anesthetic into the spinal catheter was performed in half of the initial dose with liquor barbotage. In the early postoperative period, the patient was on strict bed rest with a head end of the bed raised at 30–45°. The method provides complete segmental blockade and muscle relaxation in the area of operation, stability of central hemodynamics during surgery and in the postoperative period.Conclusion. This type of anesthesia is more easily tolerated by patients, accompanied by early awakening and extubation, characterized by stability of central hemodynamics, reduced risk of complications, the possibility of prolonging anesthesia with lower doses of narcotic analgesics in the intraoperative period, providing high-quality anesthesia in the postoperative period without resorting to the use of narcotic analgesics.

scholarly journals ALTERNATIVE TO THE INVERTED “Y” INCISION IN SCOLIOSIS SECONDARY TO MYELOMENINGOCELE

2019 ◽  
Vol 18 (1) ◽  
pp. 14-16
Author(s):  
Diego Veiga Bezerra ◽  
Luis Eduardo Munhoz da Rocha ◽  
Dulce Helena Grimm ◽  
Carlos Abreu de Aguiar ◽  
Luiz Müller Ávila ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Spina Bifida ◽  
Postoperative Period ◽  
Medical Records ◽  
Surgical Intervention ◽  
Case Series ◽  
Material Failure ◽  
Spinal Deformities ◽  
Level Of Evidence ◽  
Skin Conditions

ABSTRACT Objective: To evaluate the healing of the modified inverted “Y” incision in patients with scoliosis due to myelomeningocele. Methods: Retrospective study through medical records review of patients with myelomeningocele surgically treated with a modified inverted “Y” approach between January 2013 and December 2015. Results: We analyzed the medical records of six patients. Two patients progressed with skin complications in the immediate postoperative period and only one of them required surgical intervention for debridement and suturing. In another patient, it was necessary to perform two surgical reviews due to material failure without skin complications in these interventions. Conclusions: The modified inverted “Y” technique is a great alternative to traditional incision and inverted “Y” because it has good results in patients with spina bifida associated with poor skin conditions treated surgically for correction of spinal deformities. Level of Evidence IV; Case series.

scholarly journals Anaesthesia and Postoperative Analgesia Performed by Insertion of a Perineural Catheter at the Brachial Plexus Site - Case Series

2015 ◽  
Vol 61 (3) ◽  
pp. 241-244
Author(s):  
Lazar Alexandra ◽  
Szederjesi Janos ◽  
Copotoiu Sanda Maria ◽  
Simon Noemi Szidonia ◽  
Badea Iudita ◽  
...  
Keyword(s):  
Pain Management ◽  
Side Effects ◽  
Brachial Plexus ◽  
Postoperative Analgesia ◽  
Postoperative Period ◽  
Case Series ◽  
Postoperative Pain Management ◽  
Perineural Catheter ◽  
Plexus Block ◽  
Systemic Drug

Abstract Postoperative pain management is of major importance and the existence of a device that ensures a good analgesia in the immediate postoperative period and also removes the side effects of the systemic drugs, is becoming a necessity. Objectives: The goal was to obtain a good quality anaesthesia and also a good postoperative analgesia by inserting a perineural catheter at the brachial plexus site. Material and method: This study included adult patients who underwent brachial plexus anaesthesia through a perineural catheter inserted at the brachial plexus site. The perineural catheter was introduced by ultrasound guidance with neurostimulation control. After insertion, a quantity of a an-aesthetic admixture of 0.4mg/kg is administered. The anaesthetic admixture contained Ropivacaine and Lidocaine, equimolar concentration of 0.5% In the postoperative period, the analgesia was ensured trough the already installed catheter. The analgesic mixture contained Ropivacaine and Lidocaine, equivalent concentrations of 0.25%. The administration rate was 5 ml every 4 hours, starting 6 hours postoperatively. Results: The anaesthesia, obtained through the perineural catheter, was a good quality anaesthesia ensuring both, good sensory and motor block. The feedback regarding postoperative analgesia was positive, this type of pain management being efficient and without the systemic drug side effects. This approach of brachial plexus block was accepted easily by the patients and was rated as a very satisfactory method. Conclusions: The insertion of a perineural catheter for anaesthesia and postoperative analgesia represents a safe and efficient method of achieving both analgesia and anaesthesia.

The inconsistencies between conventional and global lab tests in cardiosurgeric patient (a clinical case)

2020 ◽  
Vol 1 (1) ◽  
pp. 68-70
Author(s):  
Eugene Roitman ◽  
◽  
Keyword(s):  
Postoperative Period ◽  
Clinical Case ◽  
Early Postoperative Period ◽  
The Other ◽  
Laboratory Methods ◽  
Hemostatic System

The clinical case demonstrates inconsistencies between the results of thromboelastography and conventional coagulation lab tests at the early postoperative period of patient undergoing cardiosurgery. The analyzing of the revealed discrepancy proves that the opposition of laboratory methods as 'one against the other' for studying the hemostatic system is unacceptable.

scholarly journals Sutureless 25-Gauge Pars Plana Vitrectomy Combined with Retropupillary Fixation of an Iris-Claw Intraocular Lens

2016 ◽  
Vol 7 (3) ◽  
pp. 433-439
Author(s):  
Spyridon E. Chalkiadakis ◽  
Efstratios A. Parikakis ◽  
Simon R.J. Taylor
Keyword(s):  
Intraocular Lens ◽  
Pars Plana Vitrectomy ◽  
Case Series ◽  
Visual Rehabilitation ◽  
Aesthetic Result ◽  
Viable Solution ◽  
Pars Plana ◽  
Real Challenge ◽  
Operating Surgeon ◽  
Iris Claw

Background: The surgical case of a dropped intraocular lens inside the vitreous cavity constitutes a real challenge for the operating surgeon. Herein, we describe a case series where an alternative optical rehabilitation technique for late intraocular lens-bag complex dislocation has been used. Methods: A modern vitrectomy device was used to remove the capsule with the dropped intraocular lens using sutureless 25-gauge pars plana vitrectomy. To ensure a better aesthetic result, with faster patient recovery and a reduced number of operations, the whole procedure was performed during the same operating session; an iris-claw intraocular lens for aphakia was selected for implantation. The implant was passed behind the constricted iris with the concave surface facing it. The lens was grasped with the manufacturer’s holding forceps and fixed onto the posterior surface of the iris using the special enclavation needles. Results: We have operated 12 eyes in two different clinical centres successfully, with minimal intra- and/or postoperative complications. Conclusion: We believe that this is a viable solution for the visual rehabilitation of patients, who would otherwise need more than one operation for a lens exchange.

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