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Publications and source records attributed to R Roedel.
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Congenital unilateral lower lip palsy (CULLP) with or without additional malformations is a well-known limited variation of congenital unilateral facial palsy. Some electromyographical studies referred to a hypoplasia or an aplasia of the depressor anguli oris muscle. However, no attempt has been made to investigate the cause for this mimical disorder by using imaging procedures. We examined the occurrence of the depressor anguli oris muscle in 7 patients presenting with congenital lower lip palsy by using B-scan sonography. In 6 of the patients, the muscle was well-developed on the affected side, but only in one patient the muscle seemed to be completely absent. Thus, in the majority of cases, hypoplasia or aplasia of the depressor anguli oris muscle is obviously not the reason for this mimical disorder. This observation may be important with regard to a possible therapeutic management.
OBJECTIVES: To determine the relationship between minimal stimulating current and success rate of interscalene brachial plexus block (IBPB), to assess the quality of anaesthesia and postoperative analgesia, and to evaluate the benefits and drawbacks of this technique in shoulder surgery. STUDY DESIGN: Prospective study of a continuous series of clinical cases. PATIENTS: Series of 167 patients undergoing shoulder surgery under IBPB, obtained with Winnie's technique, in 1995. METHODS: The plexus was located with a nerve stimulator and an insulated needle, 25 mm long and with a short 30 degrees bevel (Stimuplex, Braun). Data were collected with questionnaires, filled in by the anaesthetists, the surgeon and patients. RESULTS: Shoulder surgery was performed either under IBPB alone in 51.5% of cases (group A), or under IBPB associated with sedation (midazolam: 1-3 mg) in 31.7% (group B), or under IBPB associated with general anaesthesia either on the patient's request (11.4% = group C) or due to IBPB failure (5.4% = group D). The success rate was 94.6% and the efficiency of postoperative analgesia obtained in 100% of cases (no pain at admission in the recovery room). For the nerve location a minimal stimulating current of 0.08 to 1 mA (mean minimal stimulating current 0.42 +/- 0.17 mA) had been required, with a significant difference (P = 0.0001) between group A (0.38 +/- 0.14 mA) and the others (0.43 +/- 0.15 mA in group B, 0.50 +/- 0.21 mA in group C, 0.59 +/- 0.23 mA in group D). CONCLUSIONS: The correlation between minimal stimulating current and success rate has clearly shown the benefit of the nerve stimulation. IBPB, which provides a successful and efficient anaesthesia with minimal risk and satisfactory postoperative analgesia, has become the standard technique for shoulder surgery.
A survey presents the technical conditions and facilities of the computed tomographic virtual endoscopy. The inner surface of the upper airway was reconstructed from the data set of a helical CT. The anatomical structures were visualized in over 80 patients. 15 patients with a suspected tracheal stenosis were additional investigated. The virtual endoscopy allowed an identification of the anatomical structures. Pathological endoluminal findings, as stenosis, were investigated successfully. The virtual endoscopy combines the advantages of helical CT and the imaging of the endoluminal surface. Compared with the endoscopic examination the non-invasive technique offers additional indications, especially in high-risk patients or non-passable Stenosis.
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Our goal was to evaluate the influence of the scan parameters on the 3D virtual endoscopy of the larynx and trachea and the clinical assessment. Helical CT (HiSpeed Advantage; GE, Milwaukee, WI, U.S.A.) of a cadaver phantom was performed with increased collimation (1-10 mm) and pitch (0.5-3). Seventy-two patients with complaints of the upper airways were investigated by virtual endoscopy and their results were compared with the findings of regular endoscopy. Best correlation between virtual endoscopy and anatomical findings, diagnostic quality of the axial slices, and useful longitudinal coverage of the examination were obtained with a collimation of 3 mm and a pitch of 1.5. Space-occupying tumors and stenosis were detected correctly, but the mucous membrane could not be visualized. 3D virtual endoscopy proved to be a valuable method for displaying anatomical structures. For an optimal protocol, a collimation of 3 mm with a pitch of 1.5 is recommended.