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Mechanical Obstruction (mechanical + obstruction)
Selected AbstractsLong-term frontal sinus patency after endoscopic frontal sinusotomy,THE LARYNGOSCOPE, Issue 6 2009Yvonne Chan MD Abstract Background: The frontal recess is the drainage pathway that connects the frontal sinus to the anterior ethmoid sinus. Mechanical obstruction is the primary cause of chronic frontal sinusitis with or without a secondary inflammatory process. Eosinophilic inflammation is one of the underlying causes for chronic rhinosinusitis. Objectives/Hyphothesis: To evaluate long-term frontal sinus patency after endoscopic frontal sinusotomy in chronic rhinosinusitis patients and to assess the effect of eosinophilic inflammation on frontal sinus patency. Study Design: Retrospective chart review. Symptom assessment and archived endoscopic photographs were prospectively collected on patients who underwent frontal sinusotomy between 7-1-1999 and 12-31-2000. Subjective symptom improvements were evaluated using the SNOT-20 = 20-item Sino-Nasal Outcome Test. Objective findings of endoscopic frontal sinus patency were documented by archived digital photography. Results: A total of 161 patients with 294 frontal sinuses who underwent endoscopic frontal sinus surgery in the 18 months had an average follow-up of 45.9 months. The patient population was divided into two groups: 58 patients had eosinophilic CRS (ECRS), and 103 patients had CRS without eosinophils (non-ECRS). The mean follow-up for patients with ECRS is 61.6 months and 37.0 months for non-ECRS patients. The non-ECRS patients had a documented endoscopic frontal sinus patency of 90%, and the ECRS patients had an endoscopic frontal sinus patency of 85%. The overall frontal ostium patency rate for all patients was 88.0%. Conclusions: Long-term endoscopic confirmation of frontal ostium patency demonstrates that endoscopic frontal sinusotomy can yield high quality, durable results. There was no significant difference in patency results between ECRS and non-ECRS patients. Laryngoscope, 2009 [source] Aspiration syndromes: 10 clinical pearls every physician should knowINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 5 2007H. S. Paintal Summary Aspiration syndromes are clinically and pathologically classified into three sets of disorders: (i) large airway mechanical obstruction caused by foreign bodies; (ii) aspiration pneumonitis; and (iii) aspiration pneumonia. In this article, we discuss the common clinical presentations, risk factors, radiographic features and methods of management of these disorders. We highlight recent recommendations and controversies surrounding the prevention of aspiration pneumonia in the critically ill patient. Finally, we review ethical dilemmas surrounding feeding and aspiration risk concerns in debilitated and demented patients. [source] Acute pseudo-obstruction of the colon (Ogilvie's syndrome) following instrumental vaginal deliveryINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 10 2006A. KAKARLA Summary Acute pseudo-obstruction of the colon (Ogilvie's syndrome) is an adynamic ileus without mechanical obstruction of the bowel. Predisposing factors include: abdominal and pelvic surgery, or trauma, or severe pre-existing systemic illness. In obstetrics, many cases have been reported after caesarean delivery, but none following a vaginal delivery. Conservative and pharmacological therapies are effective in many patients, but surgical intervention may be required. Early diagnosis and appropriate treatment is imperative to avoid caecal rupture, faecal peritonitis and the associated high maternal mortality. High index of clinical suspicion and proper assessment of the gastrointestinal system in the post-surgical patient are vital to the management of this uncommon but potentially serious condition met with in obstetrics practice. [source] Not just another case of nausea and vomiting: A review of postinfectious gastroparesisJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 3 2010Allison R. Thorn MSN, FNP-BC (Family Nurse Practitioner) Purpose: To review the epidemiology, pathophysiology, clinical presentation, diagnosis, and treatment of postinfectious gastroparesis (PIGP). Data sources: Review of literature using Medscape, the Internet, and PubMed. The following search terms were used: gastroparesis, postinfectious gastroparesis, postviral gastroparesis, and idiopathic gastroparesis. There was no limitation placed on publication year. Only articles in English were used. Conclusions: PIGP is a rare illness that can affect all ages and both genders, although more prominent in middle-aged women. It is defined as delayed gastric emptying after an acute self-limited viral infection in the absence of mechanical obstruction. Limited research is available on PIGP. It is a complicated disorder with an unclear pathogenesis and narrow treatment options, therefore affecting the patient's quality of life significantly. Fortunately, the prognosis of PIGP is good, although in some instances it can take years to recover completely. Implications for practice: There is a huge lack of awareness of PIGP among primary care providers (PCPs). The importance of this illness is greatly underestimated. Educating PCPs about PIGP leads to quicker referrals and therefore faster treatment for patients, which in turn improves their health and quality of life, and thereby decreases healthcare costs as well. [source] Smooth muscle phenotypic plasticity in mechanical obstruction of the small intestineNEUROGASTROENTEROLOGY & MOTILITY, Issue 7 2008J. A. Macdonald Abstract, Chronic, partial obstruction of the small intestine can dramatically alter peristaltic contractile properties. Morphological studies have revealed hypertrophy of the circular smooth muscle cells in the constricted part of the intestine. In this issue of Neurogastroenterology and Motility, Chen et al. show that hyperplasia and hypertrophy of intestinal smooth muscle cells occur at distinct times in response to partial obstruction of the ileum. Furthermore, the first evidence is provided to link intestinal smooth muscle remodelling during mechanical obstruction with changes in serum response factor and two of its co-regulating factors, myocardin and Elk-1. [source] The use of mandibular nerve block to predict safe anaesthetic induction in patients with acute trismus*ANAESTHESIA, Issue 11 2009A. M. B. Heard Summary Acute trismus can be caused by pain, muscle spasm, swelling or mechanical obstruction. Unfortunately, the cause is not always obvious during pre-operative airway assessment. In this pilot study, we prospectively evaluated mandibular nerve block as a pre-operative tool to identify patients with reversible causes of trismus, namely pain or spasm, in order to allow safe anaesthetic induction. Six patients with unilateral fractured mandibles and trismus received a mandibular nerve block before induction of general anaesthesia. There was an increase in maximal inter-incisor gap after the blocks (median (range) distance: pre-block 16.5 (14,30) and post-block 34 (32,35) mm; p = 0.027), and no further improvement after induction of general anaesthesia (post-induction 37 (30,40) mm; p = 0.276 compared with post-block). There was an improvement in pain scores (p = 0.027), and no side-effects were detected. Pre-operative mandibular nerve blockade appears to reverse trismus caused by pain and muscle spasm, allowing the anaesthetist to decide whether awake intubation is genuinely indicated. [source] Ileovesicostomy for adults with neurogenic bladders: Complications and potential risk factors for adverse outcomes,,NEUROUROLOGY AND URODYNAMICS, Issue 3 2008Hung-Jui Tan Abstract Aims Risk factors for complications following ileovesicostomy have not been well defined. This study's purpose was to examine outcomes following ileovesicostomy in adults and identify possible risk factors that may contribute to post-operative complications. Methods Retrospective database review identified ileovesicostomy procedures from August 1999 to September 2003. Demographic, pre-operative, and post-operative data were extracted. Statistical analysis determined whether risk factors influenced outcomes of urethral continence, re-operation, and post-operative complications. Factors included age, tobacco use, diabetes, neurogenic bladder etiology, body mass index, pre-operative indwelling catheterization, or simultaneous procedures including pubovaginal sling/urethral closure. Results 50 adults status-post ileovesicostomy were identified. At last follow-up, 36 patients (72%) were continent per urethra. The incidence of complications decreased significantly from 3.38 per patient to 1.16 post-operatively (P,<,0.0001). Twenty-seven averaged 1.52 inflammatory or infectious post-operative complications per patient, 19 averaged 1.47 stomal complications, and 11 averaged 2.09 ileovesicostomy mechanical obstructions. Overall, 27 required 2.85 re-operations or additional procedures following ileovesicostomy. Sub-group analysis identified BMI (P,=,0.0569) as a possible risk factor. Differences in outcomes based on age, tobacco use, diabetes, neurogenic bladder etiology, pre-operative indwelling catheterization, or urethral closure were not significant. Conclusions Ileovesicostomy is a valuable management option for adults with neurogenic bladder unable to perform intermittent catheterization. The incidence of urinary tract comorbid events significantly decreased following ileovesicostomy though the onset of other complications should be considered. The morbidity associated with ileovesicostomy requires careful patient selection, close long-term follow-up, and potential subsequent interventions to address post-operative complications. Neurourol. Urodynam. 27:238,243, 2008. © 2007 Wiley-Liss, Inc. [source] | ||||||||||