S. A. Reza Nouraei

Botulinum toxin in the management of sialorrhoea: a systematic review

• Sialorrhoea can be a significant problem in both adults and children and can cause both physical and psychosocial problems.

Outcome of Endoscopic Sphenopalatine Artery Occlusion for Intractable Epistaxis: A 10‐Year Experience

Objective/Hypothesis: To evaluate the efficacy of surgical sphenopalatine artery occlusion (SAO) for treating intractable epistaxis, and identify factors associated with long‐term success or failure of this procedure.

A novel approach to the diagnosis and management of meralgia paresthetica.

OBJECTIVETo review the results of conservative and surgical treatment of meralgia paresthetica (MP), with particular reference to the use of a simple clinical test for diagnosing this condition and the outcome of primary nerve decompression surgery. METHODSRecords of all patients with a diagnosis of MP were reviewed. Information was obtained about clinical presentation and risk factors, diagnostic evaluation, management, and outcome. Actuarial analysis was used to determine the intervention-free interval after surgical decompression. RESULTSBetween 2000 and 2005, MP was diagnosed in 45 patients. There were 27 men and 18 women, and the average age at presentation and duration of symptoms were 47 and 1.9 years, respectively. The pelvic compression test had a sensitivity of 95% and a specificity of 93.3% for this condition. Twenty-five patients were managed conservatively and 20 required operative intervention, which was bilateral in two patients. The average follow-up period was 25 months, and the actuarial 2- and 5-year intervention-free rates were 91 and 78%, respectively, with no specific risk factors for revision surgery. CONCLUSIONThe pelvic compression test is a sensitive and specific test for MP, helping to distinguish it from lumbosacral radicular pain. Most patients with this condition can be managed successfully with conservative measures, and those requiring surgery can be treated effectively with nerve decompression.

ANALYSIS OF COMPLICATIONS FOLLOWING SURGICAL TREATMENT OF BENIGN PAROTID DISEASE

Background:  The objective of the study was to study the incidence of, and risk factors for developing complications following parotidectomy for benign disease, to improve preoperative patient counselling and better inform future surgical management.

Outcome of endoscopic treatment of adult postintubation tracheal stenosis.

Objectives/Hypothesis: To assess the results of primary endoscopic treatment of adult postintubation tracheal stenosis, to identify predictors of a successful outcome, and better define the scope and limitations of minimally‐invasive surgery for this condition.

Early endoscopic treatment of acute inflammatory airway lesions improves the outcome of postintubation airway stenosis

Objectives/Hypothesis: The objective of this study was to compare the results of treating acute postintubation stenotic airway lesions with the results of treating mature lesions and to assess whether early intervention improves the outcome.

Role of Planned Postchemoradiotherapy Selective Neck Dissection in the Multimodality Management of Head and Neck Cancer

Objective/Hypothesis: To assess the oncologic efficacy and functional outcome of selective postchemoradiotherapy neck dissection for stage IV head and neck squamous cell carcinoma.

Objective assessment of keloid scars with three-dimensional imaging: quantifying response to intralesional steroid therapy.

Background: Treatment of keloid scars poses a significant challenge. Assessment of treatment response and research in this area depend on the availability of objective, accurate, and reproducible outcome measures. At present, scars are assessed using subjective grading systems, or with cumbersome investigations such as direct casting. The authors assessed the feasibility of objectively monitoring response to intralesional steroid treatment in routine clinical practice with quantitative three-dimensional imaging. Methods: Scar volume was quantified using a validated three-dimensional speckle-pattern stereophotogrammetry before and for a minimum of 8 weeks after intralesional steroid therapy in 12 patients with keloid scars. Results: Mean scar volume at the start of treatment was 0.73 ± 0.701 cc (range, 0.12 to 2.15 cc); this was reduced to 0.14 ± 0.302 cc (range, 0.007 to 1.08 cc) after monthly intralesional injections of triamcinolone acetate (p < 0.001; analysis of variance). The majority of patients achieved a greater than 50 percent response within 8 weeks of the start of therapy, but poor treatment response was noted and quantified in a minority of patients. Conclusions: Three-dimensional stereophotogrammetry is a rapid and noninvasive method of scar volume assessment that could allow accurate and objective monitoring of treatment response to be incorporated into clinical practice. Therefore, it can be of considerable value in assessing treatment efficacy and evaluating new therapeutic strategies.

Quantifying the physiology of laryngotracheal stenosis: changes in pulmonary dynamics in response to graded extrathoracic resistive loading.

Objectives/Hypothesis: A model of airway obstruction was developed to study the impact of changes in airway resistance on ventilatory mechanics. This was used to derive quantitative indices of airway obstruction to aid in the objective diagnosis and physiological monitoring of adult patients with laryngotracheal stenosis (LTS).

Subclavian Cannulation Improves Outcome of Surgery for Type a Aortic Dissection

Acute type A aortic dissection is a major emergency that continues to cause significant morbidity and mortality. Given the anatomy of the lesion, different circulatory configurations achieved during cardiopulmonary bypass using different arterial inflow sites can influence outcome. Patients who had subclavian artery cannulation were compared with those who had femoral artery cannulation. Forty-nine consecutive patients (mean age, 60 ± 14 years) undergoing emergency surgery for acute type A aortic dissection between 1999 and 2004 were reviewed. Data on presentation, preoperative characteristics, operative details, hospital mortality, and neurological outcome were analyzed. Twenty-nine patients had femoral artery cannulation, and 20 had subclavian artery cannulation. The groups were comparable in terms of preoperative characteristics. The mean follow-up was 29 months. Subclavian artery cannulation conferred significant advantages in respect of hospital death (10% vs. 44%) and neurological impairment. Significantly fewer patients required re-operation following subclavian artery cannulation.