One percent lidocaine control exhibited the expected initial vasodilatory effect for approximately 5 minutes. In this experimental model, using a lower concentration of 1:200,000 epinephrine would supply equivalent vasoconstriction in the ear compared with higher concentrations, thus reducing the possible systemic toxicity and related morbidity.
We conducted a study to determine if the risk of airway compromise following tonsill ectomy with uvulopalatopharyn goplasty ju stifies the added cost and inconvenience of step-down monitoring in an intensive care unit. We perform ed a retrospective chart review of 130 patients with obstructive sleep apnea who had undergone isolated tonsillectomy with uvulopalatopharyngoplasty at our tertiary care center. The average length ofstay in the step-down unit was 18 hours. Wefound that only eight ofthese pati ents (6.2 %) had a postoperati ve desaturation level of less than 90%, includin g three of 12 patients (25 %) who had como rbid conditions. No patient had an adverse respirato ry event. We conclude that step-down monitoring in an intensive care unit is not neces sary, althou gh caution should be exercised in monitoring patients with comorbidities because they appear to be more pron e to desaturation. A comp lete lack of adverse respiratory events has not been reported in previous studies.
Surgical residency programs have long sought objective measures of determining applicants' long-term success, given the limited training positions and significant time and money expended in their training. Current data to evaluate and rank applicants focus on academic and standardized test performance, letters of recommendation, honor society membership, and research experience. Spatial and manual skills currently are not assessed as part of the application process.We hypothesized that dexterity and visual spatial testing of applicants for general surgery and otolaryngology residency provides information that is not assessed through the current process, and that these assessments would not correlate with the variables traditionally used to rank applicants. Additionally, we wanted to assess whether these tests could be completed during a single scheduled interview day without significant disruption to the interview structure.
MethodsMedical student applicants to our institution's general surgery and otolaryngology residency programs were included in the study. Applicants interviewed were given the option to participate in the study or to decline but still undergo testing to blind faculty to an individual's participation status.
AbstractBackground Manual dexterity and visual spatial ability are not routinely used to evaluate candidates for surgical residency training as part of the application interview.
Our objective was to perform a pilot study comparing intracapsular radiofrequency ablation tonsillectomy with subcapsular tonsillectomy in adult patients with keratosis pharyngeous. Patients diagnosed with keratosis pharyngeous between December 2010 and February 2013 were randomized to undergo either intracapsular or subcapsular tonsillectomy using radiofrequency ablation. Postoperative pain scores and amount of pain medication taken were recorded for 2 weeks. A 6-month follow-up questionnaire was used to assess efficacy of the procedure. Twenty-two patients completed the initial 2-week questionnaire. Eighteen completed the 6-month follow-up questionnaire. The amount of pain medication consumed on postoperative days 8 (p = 0.0293), 9 (p = 0.0146), and 10 (p = 0.035) was significantly less in the intracapsular group. Risk of recurrence of tonsilloliths was significantly greater at the 6-month follow-up in the intracapsular cohort (p = 0.0291). Based on these findings, in patients undergoing tonsillectomy for keratosis pharyngeous, intracapsular radiofrequency ablation tonsillectomy may result in decreased pain medication consumption compared with subcapsular tonsillectomy. Intracapsular tonsillectomy, however, resulted in a higher rate of recurrence of tonsilloliths. The benefit of decreased pain medication may be offset by the greater likelihood for symptoms to recur. Larger studies are needed to confirm these findings.
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