The size and location of suppurated lymph nodes are not absolute determinants for surgical drainage in the stable pediatric ASCL patients. If patients show no clinical improvements despite appropriate second- and third-line antibiotics, patients should be carefully reevaluated and image-guided aspiration considered.
ObjectivePostoperative delirium is known to have various adverse effects on head and neck surgery patients. This study was designed to identify possible risk factors of delirium following long periods of head and neck cancer surgery and to help prevent postoperative delirium.MethodsWe enrolled 197 patients who underwent long-time (>6 h) head and neck surgery at the Asan Medical Center from January 2017 to December 2018 in this study. Clinical covariates that may be associated with delirium were analyzed retrospectively using univariate and multivariate analyses.ResultsDelirium occurred in 18 patients (9.1%). Within the first 7 days, 16 patients (88.9%) experienced delirium. Upon univariate analysis, delirium was associated with old age (≥75, p = 0.001), past neurological history (p = 0.019), time to ambulation (p = 0.014), and postoperative hospital day (p = 0.048). In multivariate analysis, old age (≥75, odds ratios (OR) 6.16, CI 2.00–19.00, p = 0.002), time to ambulation (OR 1.04, CI 1.01–1.07, p = 0.017), and past neurological history (OR 5.26, CI 1.09–25.37, p = 0.039) were significant risk factors associated with postoperative delirium.ConclusionsOlder patients or patients with neurologic history must be attended with care, especially early after surgery. Encouraging early ambulation might lower the incidence of postoperative delirium and, subsequently, reduce adverse effects. This result could benefit patients by helping them avoid undesirable outcomes.
Hyperparathyroidism is a common endocrine disorder, but intrathyroidal parathyroid adenoma is extremely rare. We report a on a case of hyperparathyroidism caused by intrathyroidal parathyroid adenoma. This case is important in that it affects an effective test for the diagnosis of intrathyroidal parathyroid adenoma, and shows the decision of the treatment process and the results.
Previous pathophysiologic studies have revealed that the upper airway dimension reaches a minimal value at the end of expiration, and pharyngeal negative pressure is not an essential prerequisite for upper airway collapse. Furthermore, pharyngeal collapse occurs in spite of increased activity of upper airway dilator muscles in patients with obstructive sleep apnea (OSA) compared with normal subjects. Pharyngeal sensory threshold is elevated in patients with OSA, which contributes to inadequate activity of upper airway dilator muscles. Pharyngeal narrowing results in several types of airflow limitation, of whom the mechanisms are mainly explained using Starling resistor model and negative effort dependence. Several studies have been conducted over the past years to validate polysomnographic surrogate markers which indicate specific pathophysiologic phenotypes, and such attempts may be able to lead us to personalized treatment for OSA.
Laryngopharyngeal or cervical pain following ingestion of foreign bodies is one of the most frequently encountered emergencies in otolaryngologic practice. Although most of these foreign bodies can be easily removed under laryngoscopic examination without any complications, surgical removal may be required when foreign bodies migrate extraluminally. This report describes two rare cases of ingested fishbones that had migrated, one each to the thyroid gland and submandibular gland. Extraluminal migration fishbones should always be considered in otolaryngologic clinics.
Solitary Fibrous tumor is usually arising in the pleura of the thoracic cavity and it has been described in a variety of extrapleural sites including the abdominal cavity, soft tissue, upper respiratory tract and rarely in head and neck region. We experienced a rare case of solitary fibrous tumor in the parotid gland. A 49-year-old woman presented with a painless mass in the left parotid. The mass was well-demarcated and easily dissected, and it showed a patternless arrangement of potential malignant spindle cells in a fibrotic background and prominent vascular structures. In immunochemistry, the mass cells were positive for CD34, vimentin, and negative for actin, S-100 protein, and cytokeratins. Therefore, the parotid mass diagnosed as SFT. During the 24 months of follow-up, there was no recurrence of tumor growth.
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