Tonsillotomy with the argon-supported monopolar needle--first clinical results

BACKGROUND: Primary management of tonsillar hyperplasia in children is tonsillectomy. Recent data from clinical case-series are clearly in support of the hypothesis that tonsillotomy with the CO2-laser seems to be effective and is noted to have less postoperative bleeding and less pain as compared to tonsillectomy. For the first time we used a monopolar argon-supported needle for tonsillotomy in the following study. METHODS: Fifty patients (age: 4.58 years; SD +/- 2.33) with benign tonsillar hyperplasia were recruited. For tonsillotomy we used the monopolar argon-supported needle. The outcome measures were postoperative pain, capability of oral intake, consumption of analgesics and postoperative bleeding. RESULTS: No postoperative bleeding occurred. Post-operative pain hardly occurred and could easily be controlled. The third postoperative day analgesics intake was under one portion per day (mean: 0.91; SD +/- 1.26). Capability of oral intake and swallowing was normal on the seventh postoperative day. CONCLUSION: It was concluded that tonsillotomy, using the monopolar argon-supported needle, is a valid treatment for benign tonsillar hyperplasia in children, which can be performed with slight post-operative pain and a low risk for postoperative bleeding. It offers good dissection and haemostasis abilities. Compared to the CO2-laser the monopolar argon-supported needle does not require any laser safety precautions.     

Soft palate implants: a new option for treating habitual snoring

One hundred six patients with proven habitual snoring were each treated with three implants consisting of a cylindrical-shaped segment of braided polyester filaments (18 mm in length with an outer diameter of 1.5 mm) in the soft palate. The implants, pre-loaded in a single-use delivery tool, were inserted into the soft palate under local anesthesia. Along with the initial examination, follow-up exams were done after the treatment to test the safety and efficacy of the procedure. Snoring post treatment was reported as no snoring or slight/occasional in the majority of the cases after treatment. The results indicate there were no serious adverse events reported. The most frequent minor adverse events were partial extrusions in which the patient often presented a minor foreign body sensation along with mild transient pain. This data has demonstrated the procedure as a minimally invasive, relatively painless, simple procedure that has been shown to be safe and effective.     

Survey of regional health care providers on selection of treatment for bulimia nervosa

OBJECTIVE: To determine which treatments clinicians currently recommend for patients with bulimia nervosa (BN), to find out if they recommended evidence-based treatments, and to assess availability and clinician satisfaction with treatment options. METHODS: Surveys were sent to 1,263 health care providers in Minnesota, Iowa, and Wisconsin who were likely to encounter patients with BN. These health care providers comprised all primary care clinicians, physician assistants, advanced practice nurses, and all mental health/chemical dependency clinicians (MDs, Clinical Nurse Specialist (CNS), social workers, doctoral and masters-level therapists, and chemical dependency (CD) counselors) affiliated with the Mayo Clinic in Rochester, Minnesota. RESULTS: Evidence-based treatments for BN are recommended consistently and are generally perceived to be available, at least to practitioners affiliated with a large medical center in the Midwest. Clinician satisfaction with treatment options is modest. DISCUSSION: Clinicians are recommending evidence-based treatments for BN patients and find them to be generally available. Modest satisfaction with available treatments may reflect a realistic understanding of treatment options, which need further development.     

Self-hypnosis relapse prevention training with chronic drug/alcohol users: effects on self-esteem, affect, and relapse

This study evaluated the effectiveness of a self-hypnosis protocol with chronic drug and alcohol patients in increasing self-esteem, improving affect, and preventing relapse against a control, a transtheoretical cognitive-behavioral (TCB), and a stress management (attention-placebo) group. Participants were 261 veterans admitted to Substance Abuse Residential Rehabilitation Treatment Programs (SARRTPs). Participants were assessed pre- and postintervention, and at 7-week follow-up. Relapse rates did not significantly differ across the 4 groups at follow-up; 87% of those contacted reported abstinence. At follow-up, the participants in the 3 treatment conditions were asked how often they practiced the intervention materials provided them. Practicing and minimal-practicing participants were compared against the control group for each of the 3 interventions via MANOVAs/ANOVAs. Results revealed a significant Time by Groups interaction for the hypnosis intervention, with individuals who played the self-hypnosis audiotapes "at least 3 to 5 times a week" at 7-week follow-up reporting the highest levels of self-esteem and serenity, and the least anger/impulsivity, in comparison to the minimal-practice and control groups. No significant effects were found for the transtheoretical or stress management interventions. Regression analyses predicted almost two-thirds of the variance of who relapsed and who did not in the hypnosis intervention group. Hypnotic susceptibility predicted who practiced the self-hypnosis audiotapes. The results suggest that hypnosis can be a useful adjunct in helping chronic substance abuse individuals with their reported self-esteem, serenity, and anger/impulsivity.     

Zerebrale Mikrodialyse beim Schlaganfall

Zusammenfassung Die zerebrale Mikrodialyse ist ein invasives Verfahren zum neurochemischen Monitoring des Gehirns, das bei intensivmedizinisch zu überwachenden Patienten mit Subarachnoidalblutungen oder schweren Schädel-Hirn-Traumen etabliert ist. Wir stellen die an 50 Schlaganfallpatienten gewonnenen Ergebnisse der Projektgruppen Zerebrale Mikrodialyse des Kompetenznetzes Schlaganfall vor, die wegen einer großen, potenziell raumfordernden Ischämie im Territorium der A. cerebri media intensivmedizinisch behandelt werden mussten. Durch Korrelation von Mikrodialysedaten mit computertomographischen Verlaufsuntersuchungen konnten wir die neurochemischen Charakteristika von nicht infarziertem Hirngewebe, an die Infarktzone angrenzendem Hirngewebe sowie den Infarktkern definieren. Ferner lassen sich zeitgemittelte Messwerte mit initialen PET-Untersuchungen korrelieren und so neurochemische Prädiktoren für einen malignen Verlauf des Schlaganfalls beschreiben. Wir diskutieren die Wertigkeit und Vorhersagekraft der Methode bezüglich des klinischen Langzeitergebnisses im Kontext mit anderen Anwendungsgebieten der zerebralen Mikrodialyse und erörtern die Vor- und Nachteile dieser Methode als Monitoringverfahren.Diese Arbeit wurde durch das Bundesministerium für Bildung und Forschung (BMBF) im Rahmen des Kompetenznetzwerks Schlaganfall, Projektgruppen B2 (Heidelberg), B6 (Köln) und B7 (Heidelberg) gefördert.     

Unintentional arterial puncture during cephalic vein cannulation: case report and anatomical study

Background. The cephalic antebrachial vein is often used forvenous access. However, superficial radial arteries of the forearmare known and unintentional arterial puncture can result fromattempts to cannulate the lateral veins of the arm. Methods. Accidental puncture of a superficial radial arteryduring peripheral venous cannulation prompted us to study theanatomy of 26 specimens and to assess the relationship betweenthe radial artery and the cephalic vein in the forearm. Results. In two cases, we found accessory branches of the radialartery close to the cephalic forearm vein. Venous cannulationat the lateral wrist carries a small risk of arterial punctureif arterial anomalies are present. Conclusions. If venous cannulation is attempted at the radialside of the wrist, palpation for pulsation should reduce thedanger of arterial puncture. Br J Anaesth 2004: 92: 740–2