Objective: To review the effectiveness of intravenous tranexamic acid in reduction of blood loss, surgical time and field visualization among patients who underwent endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS). Methods: Data Sources: MEDLINE (PubMed), EMBASE, ScienceDirect, HERDIN, and the Cochrane Library. Eligibility Criteria: Randomized controlled trials (RCT) between 2005-2014 that evaluated the effects of tranexamic acid or placebo in patients undergoing ESS for CRS. Appraisal and Synthesis Methods: Articles were selected by 2 independent reviewers and methodological quality was blindly evaluated using a Jadad scale. Data were compiled in tables for analysis of outcome measures (estimated blood loss, length of surgery and intraoperative surgical field visualization). Results: Two trials were included in the study, enrolling 128 patients. One arm of the study had been given tranexamic acid while the other arm was given placebo (saline solution). Results varied for both studies. The summary of the observed difference for blood loss had a standardized mean difference of -51.20 (CI95 [-59.44, -42.95]) showing that the blood loss in milliliters was less in the tranexamic group compared to saline solution. The summary of the observed difference in surgical time had a standardized mean difference of -19.32 (CI95 [-24.21, -14.43]) showing that the surgical time in minutes was shorter in the tranexamic group compared to saline solution. The secondary outcome on surgical field visualization was not pooled together because the studies used different measurement scales. Limitations: The most important weaknesses of the 2 included studies were the differences in dose of tranexamic acid, scales of measurement of field visibility and age groups of the patients. Conclusion: Tranexamic acid reduced blood loss and shortened surgical time after ESS among patients with CRS. However, the additional benefit of tranexamic acid for better field visualization was not clear. Adverse effects were not considered in this study, however results support the use of intravenous tranexamic acid intraoperatively as an option for ESS with blood loss as a concern. Further randomized clinical trials and an update on the systematic review will strengthen the evidence on the effectivity of tranexamic acid for ESS. Keywords: tranexamic acid, endoscopic sinus surgery, bleeding time
Objective: To review cases of adult acute epiglottitis in a tertiary government hospital and describe the clinical presentations, diagnostics performed, management and outcomes. Methods: Study Design: Retrospective Chart Review Setting: Tertiary Government Hospital Subjects: Records of patients admitted by or referred to the Department of Otolaryngology Head and Neck Surgery with a diagnosis of acute epiglottitis from January 2008 to August 2014 were identified from the department census and charts were retrieved from the Hospital Record Section and evaluated according to inclusion and exclusion criteria. Information regarding demographic data, clinical features, laboratory and other diagnostic examinations, medical management, and length of hospital stay were collected. Results: There were 20 cases in seven years and eight months. Most were male, 18 to 37-years-old, presenting with dysphagia, odynophagia and a swollen epiglottis on laryngoscopy. Abnormal soft-tissue lateral radiographs of the neck and leukocytosis were seen in 73 % and 83% respectively. Intravenous antibiotics and corticosteroids were administered in all cases, and mean hospital stay was 11.2 days. Conclusion: Adult acute epiglottitis should be highly suspected in patients presenting with dysphagia, odynophagia, and muffling of the voice even with a normal oropharyngeal examination. History of respiratory infection, co-morbidities, smoking and alcohol intake, concomitant laryngeal pathology and supraglottic structure insults contribute to development of the disease. Laryngoscopy is still the gold standard in diagnosis. Airway protection is mandatory but prophylactic intubation or tracheostomy are not advised. Intravenous antibiotics are necessary and corticosteroids may be of benefit. Keywords: epiglottitis, supraglottitis, epiglottis, adult, Philippines
Objective: To present an atypical case of a live fish lodged in the throat of a pediatric patient and discuss its management. Methods: Study Design: Case Report Setting: Tertiary Government Hospital Subject: One Results: An 8-year-old girl swallowed a live fish when she accidentally fell in a body of water. Failed attempts to remove the live fish prompted consult in the emergency room of our hospital, where removal of the foreign body was successfully done using Mixter right angle forceps assisted with a gloved finger. Transient cyanosis and unresponsiveness during extraction was overcome with oxygen by mask, and she regained consciousness. She was allowed to go home as no other untoward events or complications were observed. Conclusion: All ingested foreign bodies, particularly in children, require immediate attention. The survival of patients with upper aerodigestive and airway foreign bodies depends on early recognition and prompt multidisciplinary management. Keywords: Foreign body, endoscopy, foreign body ingestion, impaction, oropharynx
Objective: To compare the postoperative complications (narrowing of the enlarged canal and perichondritis) of a meatoplasty without conchal cartilage removal and more raw skin area (modified meatoplasty) versus a meatoplasty with conchal cartilage removal and less raw skin area (Z meatoplasty) including other sequelae (hyperemia, formation of granulation tissue and discharge from the cavity) which may lead to complications in canal wall down post-auricular mastoidectomy. Methods: Design: Concealed, randomized controlled clinical trial Setting: Tertiary Public Hospital Patients: Twenty-one ears of 19 patients with chronic suppurative otitis media (CSOM) undergoing postauricular open mastoidectomy (radical or modified radical mastoidectomy) between February to July 2009 were randomly assigned to undergo modified meatoplasty (Group A: n=11 ) and Z meatoplasty (Group B:n=10). Main outcome measures were postoperative rates of meatoplasty complications and mastoidectomy sequelae that may lead to complications, on weeks 1, 2 and 4. Results: On the 1st postoperative week, the Z meatoplasty was associated with a higher incidence of hyperemia at the incision site [A: 36.4%, B: 90% (p <0.02)]. The specific complication of perichondritis or other sequelae (discharge from the cavity, granulation tissue) or were no different in both types of meatoplasty. On the second postoperative week, the modified meatoplasty was associated with a higher incidence of narrowing of the canal (73% vs 20%) P<0.02; [RR = 3.64 (CI:1.00,13.23)] The only factor associated with this complication was the modified meatoplasty procedure itself [RR = 3.64 (CI: 1.00, 13.23)]. Perichondritis, and the sequelae of mastoidectomy (discharge from the cavity, granulation tissue) were no different in both types of meatoplasty. Conclusion: Among CSOM patients who underwent postauricular open mastoidectomy, the Z meatoplasty was associated with a greater risk of hyperemia at the incision site than the modified meatoplasty in the 1st operative week. Compared to the Z meatoplasty, the modified meatoplasty was associated with greater risk of narrowing of the canal on the 2nd postoperative week. Keywords: meatoplasty; mastoidectomy; complications
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