Background Deep-brain stimulation through an electrode implanted in the thalamus was developed as an alternative to thalamotomy for the treatment of drug-resistant tremor. Stimulation is thought to be as effective as thalamotomy but to have fewer complications. We examined the effects of these two procedures on the functional abilities of patients with drug-resistant tremor due to Parkinson's disease, essential tremor, or multiple sclerosis. Methods Sixty-eight patients (45 with Parkinson's disease, 13 with essential tremor, and 10 with multiple sclerosis) were randomly assigned to undergo thalamotomy or thalamic stimulation. The primary outcome measure was the change in functional abilities six months after surgery, as measured by the Frenchay Activities Index. Scores for this index can range from 0 to 60, with higher scores indicating better function. Secondary outcome measures were the severity of tremor, the number of adverse effects, and patients' assessment of the outcome. Results Functional status ...

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A comparison of continuous thalamic stimulation and thalamotomy for suppression of severe tremor

Background
Wound healing is a complex and dynamic process and a thorough knowledge of the basics of physiology of wound healing is a must to implement principles of chronic wound care. Understanding wound healing at multiple levels—biochemical, physiologic, cellular and molecular provides the surgeon with a framework for basing clinical decisions aimed at optimizing the healing response.

Wound Healing Concepts in Clinical Practice of OMFS.

OBJECTIVE: This study examined the advantages and disadvantages of internal maxillary artery (IMA) ligation versus embolization for the treatment of refractory posterior epistaxis.

METHODS: Thirty-nine patients underwent 42 procedures for treatment of posterior epistaxis at the University of Cincinnati Medical Center between 1986 and 1994. Complication rates, failure rates, demographics, and the costs of IMA ligation and embolization were compared. A review of 20 studies published between 1973 and 1995 was done to determine the complication and failure rates of IMA ligation and embolization. Finally, a mail survey was used to determine the availability and use of IMA ligation and embolization by urban and rural otolaryngologists in Ohio.

RESULTS: Complication and failure rates of IMA ligation and embolization were similar at our institution. In the literature review, IMA ligation had a higher complication rate, but fewer failures. Although the major complication rates were not significantly different, those associated with embolization were often more serious than those associated with IMA ligation. At our institution, the cost of IMA embolization was significantly lower than the cost of IMA ligation. Only 11% of Ohio otolaryngologists in nonurban areas have embolization available to treat posterior epistaxis.

CONCLUSION: IMA ligation is more effective than IMA embolization but may be associated with a higher minor complication rate. The major complications that occur with IMA embolization are often more serious. Although IMA embolization was less expensive at our institution, it is unavailable in most nonurban regions in Ohio. Training in the use of IMA ligation for refractory posterior epistaxis should continue in otolaryngology residency training programs despite the increasing availability of embolization at university training centers. (Otolaryngol Head Neck Surg 1998;118:636-42.)

Comparison of internal maxillary artery ligation versus embolization for refractory posterior epistaxis

Objectives: A prospective non-blinded randomized controlled trial to compare the efficacy of Merocel® and RapidRhino® nasal packs in the treatment of anterior epistaxis.



Methods:  Fifty-two consecutive participants admitted with anterior epistaxis refractory to digital pressure or nasal cautery were randomized to treatment using one or other of the nasal packs. Patients who required repacking because of continued bleeding, only the first packs were included in the analysis. Haemostatic properties of the packs were measured by grading bleeding during and after removal of the pack (0–4, where four is uncontrollable) and by noting if the nose was re-packed or not. The difficulty of insertion and removal (graded 0–3 by clinician where 3 is the most difficult) and the participant's perception of discomfort (graded 0–10, where 10 is the worst pain) during insertion and removal of the pack were also measured.



Results:  For bleeding, the mean values for Merocel® and RapidRhino® during packing and after pack removal were not significant (P = 0.38 and 0.82 respectively). The mean values of patient discomfort on insertion were 6.9 and 5.0 (P = 0.01), and for discomfort on removal were 4.6 and 3.4 (P = 0.05) respectively. The mean values of insertion graded by the clinician were 1.7 and 0.9 (P = 0.0003), and for removal were 1.4 and 0.4 (P < 0.0001).



Conclusions:  RapidRhino® and Merocel® are equally effective in the control of anterior epistaxis but RapidRhino® is significantly more comfortable for the patient and easier for the healthcare worker during insertion and removal.

Randomized controlled trial comparing Merocel and RapidRhino packing in the management of anterior epistaxis.

Purpose of reviewThis article reviews the literature on epistaxis, with a focus on the past 12–18 month, and aims to classify the literature available for this very common otolaryngology emergency.Recent findingsEpistaxis can be classified into primary or secondary epistaxis based on cause. It can a

Epistaxis: update on management.

A survey to assess variations in management and outcome of patients admitted with epistaxis was conducted. A questionnaire was sent to all consultant otolaryngologists working at NHS hospitals in England and Wales requesting information about management of patients admitted with epistaxis over a 3 month period. Data analysis of information provided by 102 consultants for a total of 933 patients was performed. The average number of patients admitted with epistaxis over a period of 3 months per consultant was 10.2. More than 70% of the patients were aged 60 years or over. Approximately 75% of the patients required nasal packing; the most common pack used was BIPP (Bismuth Iodine Paraffin Paste). Of the patients, 5.6% required general anaesthesia, with less than 1% requiring formal arterial ligation. The mean duration of stay in hospital was 2.9 days. Few complications were reported. Patients admitted with epistaxis were generally managed conservatively, with very few requiring surgical intervention. There was remarkable consensus in various aspects of management of patients admitted with epistaxis.

Management of epistaxis: a national survey.

This system for interdepartmental collection of data on surgical complications should, though designed for otolaryngology, be applicable to any surgical specialty. The system under which data are collected prospectively on a coded proforma has been shown to document considerably higher complication rates than retrospective, uncoded data collection and, as consultants are unlikely to report non-existent complications, we assume that the higher rates are more valid. The system also provides a list of factors which must be standardised before data on complication rates from different units can usefully be pooled or comparisons made between them.

Complication data collection: a prospective, standardised, coded system for otolaryngology or other branches of surgery.

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Management of epistaxis: a national survey.

Complication data collection: a prospective, standardised, coded system for otolaryngology or other branches of surgery.