1,721,181 research outputs found
Chirurgia della roncopatia
No full textDiagnosi e trattamenti più attuali del russamento abituale e della sindrome delle apnee del sonn
Effectiveness indices in "Particle Repositioning Maneuver" by Parnes and Price-Jones | [Indicatori di efficacia nella "Particle Repositioning maneuver" di Parnes e Price-Jones.]
No full textThe Parnes and Price-Jones "Particle Repositioning Maneuver" (PRM) was used to treat Paroxysmal Positional Vertigo (VPP) in 36 consecutive cases, studying both any induced secondary nystagmus and any persistent Paroxysmal Positional Nystagmus (PPNy) upon repetition of the Hallpike positioning after 15 minutes (re-test). The purpose of the study was to evaluate the ability to use secondary Ny and the retest to predict maneuver effectiveness. Although the PRM was quite effective (PPNy disappeared in 86% of the cases after a single session), the low observation frequency reduced the feasibility of using secondary Ny. On the other hand the systematic introduction of the Hallpike re-test into clinical practice does not offer the desired cost/benefit ratio because of the time required to prevent false negatives due to PPNy fatigue. In fact, secondary Ny was only evoked in 12 out of 36 cases (33%) and of these only 9 out of 36 (25%) presented direction congruous with canalolith release (liberating Ny). The predictive value of evoked liberating Ny appeared further reduced by the persistence of PPNy upon subsequent re-testing in two cases and in one case by the persistence of the disorder upon follow-up. The Hallpike test appears a more reliable indicator of effectiveness as it proved in agreement with subsequent clinical findings in 80% of the cases. The present results lead one to conclude that, when using PRM in cases where no secondary liberating Ny was found (75%), we should rely on the high effectiveness of this procedure (86% of the cases resolved in a single session) rather than perform a Hallpike retest. Thus it is possible to select a small number of patients (22%) still presenting PPNy (positive retest) and requiring repetition of the therapeutic maneuver
Transoral Robotic Surgery for Obstructive Sleep Apnea: Past, Present, and Future
No full textNocturnal upper airway collapse often involves the obstruction at the tongue base. Several surgical procedures have been developed in recent years to address this area in continuous positive airway pressure-nonadherent patients and include hyolingual advancement, tongue suture suspension, and various lingual resection techniques. Traditional tongue base resection is generally done either via a transcervical technique or transorally with an endoscope for visualization. Each of these approaches has significant potential limitations. The unsurpassed visualization, dexterity, and control provided by the Da Vinci Surgical System offer many benefits for the surgeon compared with the other technologies
Semont maneuver vs. particle repositioning maneuver: comparative study | [Manovra di Semont vs. Particle Repositioning Maneuver: studio comparativo.]
No full textIn the present study 80 consecutive cases of PPV of the posterior semicircular canal are presented, with the purpose to evaluate the effectiveness of the treatment and to analyze the secondary Ny and re-test as indicators of the effectiveness of the therapeutic maneuver. The patients were treated in 40 cases with Particle Repositioning Maneuver (PRM) and in the other 40 with the Semont Maneuver, in an attempt to determine the secondary Nystagmus induced during treatment and any residual Paroxysmal Positional Nystagmus (PPNy) upon repetition of the Hallpike positioning after 15 minutes (re-test). Recovery was achieved in 80% of cases after the first session and in 95% of cases with the third session. PRM seemed to be slightly more effective. Secondary liberating Ny was frequently evoked (80%) and was reliable (75%) with the Semont Maneuver, while PRM yielded the liberating Ny in only 25% of cases, with lower reliability (70%). Reliability of the re-test with the Hallpike maneuver was high (80%) and the difference between the two techniques was negligible (78% in PRM and 85% in Semont). In conclusion, in terms of indicators of effectiveness, the Semont liberating Maneuver appears better in that it combines high therapeutic effectiveness (75% recovery in a single session) with a like percentage of liberating Ny (80%): this makes it possible to reserve the re-test and repetition of the therapeutic maneuver, performed during the same session, only in those cases that do not present liberating Ny (20% of cases). On the other hand, when the PRM is used, it appears better to rely on the high likelihood of effectiveness (85% in a single session) and then review the case directly at the next check-up rather than perform the Hallpike re-test in all cases that did not present the liberating secondary Ny (75%). In this way it is possible to select a small number of patients (22%) that still show PPNy (positive re-test) and for whom the therapeutic maneuver must be repeated
Algoritmo operativo nell'epistassi in atto: aspetti tecnici, organizzativi e decisionali
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