NA Laryngoscope, 2018.

No abstract

Additional nonfundamental sound frequencies produced secondary to striking a tuning fork off a metal object or a wooden table could affect clinical tuning fork examination and complicate decisions regarding surgical candidacy.

A known age), weighing 4.4 kg was presented for lethargy and decreased appetite of approximately 2 weeks' duration. The referring veterinarian had diagnosed anemia [packed cell volume (PCV) = 17.8%] and treated the cat with tetracycline (250 mg PO bid for 10 days) and prednisone (2.5 mg PO sid for 7 days). The cat was referred to the North Carolina State University Veterinary Teaching Hospital after the PCV continued to decrease and icterus became clinically apparent.On physical examination, the cat was pale, ictenc, and severely depressed. He had a rectal temperature of 38.3"C, a heart rate of 144 beats per minute, and a respiratory rate of 60 per minute. An S4 gallop and a III/VI systolic murmur over the area of the mitral valve were auscultated. Hepatomegaly and splenomegaly were noted on abdominal palpation.Results of a CBC revealed Coombs'-positive anemia (hematocrit = 7.470, reference range = 24.0% to 45.0%; erythrocyte count = 1.10 X 106/gL, reference range = 5.00 to 10.0 X 106/pL; hemoglobin = 2.2 g/dL, reference range = 8.0 to 15.0 g/dL), without evidence of regeneration (uncorrected aggregate reticulocytes = 3.5%. punctate reticulocytes = 2.5%, and 1 1 nucleated red blood cells/l00 white blood cells), macrocytosis (MCV = 67.3 fL, reference range = 39.0 to 55.0 fL), thrombocytopenia (83.000/gL, reference range = 300,000 to SOO,OOO/pL), and mild anisocytosis and polychromasia. Abnormal white blood cells were not seen on peripheral blood smears. Serum biochemical abnormalities included hypoproteinemia (3.8 g/dL, reference range = 6.3 to 8.7 g/dL), hypoalbuminemia (2.1 g/dL, reference range = 2.7 to 4.6 g/dL), hyperbilirubinemia (2.9 mg/dL, reference range = 0.15 to 0.20 mg/dL), and hypokalemia (3.2 mEq/L, reference range = 4.0 to 4.8 mEq/L). No abnormalities were noted on the urinalysis or coagulation profile. Abdominal radiographs revealed moderate hepatosplenomegaly, with mild right renomegaly.Initial treatment included a transfusion of 60 m L of fresh whole blood and IV fluids (lactated Ringers solution with 20 mEq KCI/L) at a dose of 55 rnL/kg/day. Prednisone ( 5 mg PO bid) also was administered to treat suspected autoimmune hemolytic anemia. On day 2 of hospitalization, the PCV had increased to 15%, and the cat was more alert and began to eat, although his temperature had increased to 39.7". Cephalexin (90 mg IV tid) was added to the treatment regimen because of the possibility of infection. Serology results for feline leukemia and feline immunodeficiency virus were negative. A bone marrow aspirate and core biopsy were collected from the humerus. An imprint from the biopsy revealed a dense proliferation of moderately differentiated histiocytic cells with pleomorphic nuclei and indistinct cell borders ( Fig I); erythrophagocytosis was also a prominent feature. Cytological features of the liver, obtained by percutaneous aspirate, were similar to those of the bone marrow, including numcrous histiocytic cells with leukophagocytosis and erythrophagocytosis. Bone marrow smears stained positive for nonspeci...

No abstract

Objectives/Hypothesis Isolated case studies have shown improper sterilization or contamination of equipment from anesthesia carts can lead to transmission of disease and even death. Citing this literature, national accrediting agencies mandated all instruments in the otolaryngology airway carts at San Antonio Military Medical Center be packaged to prevent contamination. This study sought to determine the infection and safety implications of packaged airway cart instruments. Study Design Retrospective chart review. Methods A review of upper aerodigestive tract procedures, some of which penetrated mucosa, was performed by analyzing 100 patient records during the unpackaged period and 100 during the packaged period. A comparison of infections, deaths, and length of stay in the hospital was included in the analysis. Additionally, a timed simulation to setup a simple group of instruments for an emergency airway situation from both the unpackaged and packaged airway carts was performed using a total of 11 surgical technologists and nurses. Results Each group had a total of four airway infections and neither had any deaths. The average length of hospital stay was 0.36 days for the unpackaged period and 0.44 days from the packaged period. None of these variables reached statistical significance. The average time to find and set out the correct instruments for the two groups was 46.6 and 95.5 seconds for the unpackaged and packaged airway carts, respectively (P = .004). Conclusions This study suggests individually packaging of instruments used for emergency airway cases may put lives at risk when time matters and fails to decrease the risk of infection. Level of Evidence 3 Laryngoscope, 129:715–719, 2019

While TPO may be a rare diagnosis in the general otolaryngologist practice, symptoms frequently bring patients into the otolaryngologist's clinic, and an awareness of the disease can help minimize unnecessary interventions and allow the surgeon to appropriately counsel patients.

Aim: To describe a novel technique for the reconstruction of geometrically complex defects of the midface using an osteotomized folded scapular tip-free flap.Methods: Five patients underwent maxillectomy with defects disrupting two or more of the following facial axes: orbital, nasofacial, and palatal axes. Patients underwent primary reconstruction using an angular artery-based scapular tip-free flap with an osteotomy to fold the flap. Harvest techniques, including placement of osteotomies, folding and plating, surgical esthetic, and functional outcomes, are presented.Results: Osteotomies placed in the scapular tip-free flap allowed folding of the osseous flap and improved restoration of all three facial axes with a single flap. In one patient, the tip of the scapula was used to reconstruct the nasofacial axis, while the body and lateral border were used to reconstruct the palate. In four patients, the tip of the scapula was used to reconstruct the orbital axis, while the body and lateral border were used to reconstruct the nasofacial axis. Patients had successful oronasal separation, healed wounds withstanding adjuvant therapy, satisfactory orbital positioning and facial projection, preserved masticatory surfaces and opportunity for dental implants.