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Revista Medica Del Instituto Mexicano... Oct 2022Chemical substances are important causes of gastrointestinal tract injuries and usually affect two groups of patients: children under 5 years of age and adults who...
INTRODUCTION
Chemical substances are important causes of gastrointestinal tract injuries and usually affect two groups of patients: children under 5 years of age and adults who attempt suicide. Its effects can range from necrosis to perforation of the digestive tract, which can affect the mouth, pharynx, esophagus and stomach. The main complication of accidental caustic ingestion is esophageal stricture. The frequency with which esophageal strictures appear ranges from 15% to 35% and is related to the degree of injury induced by the ingested agent. They may become symptomatic by the second or third week after a latent repair phase or, in other cases, months or years after ingestion. Different forms of treatment have been applied to treat caustic esophageal strictures, and endoscopic dilation is the first line, with successful results in 60% to 80% of patients. If these are not effective, surgical treatment for esophageal replacement is indicated.
CLINICAL CASE
A clinical case of a 48-year-old male patient with no chronic degenerative history is presented, who began suffering after accidental ingestion of caustic substance 4 months ago with dysphagia to liquids and solids, for which he is protocolized in our unit for definitive surgical resolution by gastric pull-up.
CONCLUSIONS
Although associated with high rates of anastomotic stricture, transhiatal esophagectomy and gastric pull-up with cervical anastomosis are safe procedures for the treatment of caustic esophageal strictures.
Topics: Child; Male; Adult; Humans; Child, Preschool; Middle Aged; Caustics; Constriction, Pathologic; Burns, Chemical; Esophageal Stenosis; Retrospective Studies
PubMed: 36283060
DOI: No ID Found -
Medicine Oct 2019Cerebral aneurysm surgery has significant mortality and morbidity rate. Inflammation plays a key role in the pathogenesis of intracranial aneurysms, their rupture,...
Effect of local anesthesia with lidocaine on perioperative proinflammatory cytokine levels in plasma and cerebrospinal fluid in cerebral aneurysm patients: Study protocol for a randomized clinical trial.
BACKGROUND
Cerebral aneurysm surgery has significant mortality and morbidity rate. Inflammation plays a key role in the pathogenesis of intracranial aneurysms, their rupture, subarachnoid hemorrhage and neurologic complications. Proinflammatory cytokine level in blood and cerebrospinal fluid (CSF) is an indicator of inflammatory response. Cytokines contribute to secondary brain injury and can worsen the outcome of the treatment. Lidocaine is local anesthetic that can be applied in neurosurgery as regional anesthesia of the scalp and as topical anesthesia of the throat before direct laryngoscopy and endotracheal intubation. Besides analgesic, lidocaine has systemic anti-inflammatory and neuroprotective effect.Primary aim of this trial is to determine the influence of local anesthesia with lidocaine on the perioperative levels of pro-inflammatory cytokines interleukin-1β, interleukin-6, and tumor necrosis factor-α in plasma and CSF in cerebral aneurysm patients.
METHODS
We will conduct prospective randomized clinical trial among patients undergoing craniotomy and cerebral aneurysm clipping surgery in general anesthesia. Patients included in the trial will be randomly assigned to the lidocaine group (Group L) or to the control group (Group C). Patients in Group L, following general anesthesia induction, will receive topical anesthesia of the throat before endotracheal intubation and also regional anesthesia of the scalp before Mayfield frame placement, both done with lidocaine. Patients in Group C will have general anesthesia only without any lidocaine administration. The primary outcomes are concentrations of cytokines interleukin-1β, interleukin-6 and tumor necrosis factor-α in plasma and CSF, measured at specific timepoints perioperatively. Secondary outcome is incidence of major neurological and infectious complications, as well as treatment outcome in both groups.
DISCUSSION
Results of the trial could provide insight into influence of lidocaine on local and systemic inflammatory response in cerebrovascular surgery, and might improve future anesthesia practice and treatment outcome. TRIAL IS REGISTERED AT CLINICALTRIALS.GOV:: NCT03823482.
Topics: Adolescent; Adult; Aged; Anesthesia, Conduction; Anesthesia, General; Anesthesia, Local; Anesthetics, Local; Craniotomy; Cytokines; Female; Humans; Intracranial Aneurysm; Intubation, Intratracheal; Laryngoscopy; Lidocaine; Male; Middle Aged; Pharynx; Postoperative Complications; Prospective Studies; Randomized Controlled Trials as Topic; Scalp; Treatment Outcome; Young Adult
PubMed: 31626100
DOI: 10.1097/MD.0000000000017450 -
Anaesthesiology Intensive Therapy 2019To the Editor, Nasotracheal intubation is a widely used technique in anaesthesia management for procedures including oropharyngeal, dental, and maxillofacial...
To the Editor, Nasotracheal intubation is a widely used technique in anaesthesia management for procedures including oropharyngeal, dental, and maxillofacial surgeries[1-3]. It provides an uninhibited access to the mouth and plays an important role when dealing with difficult airways[4-6]. It is also used in patients with cervical spine instability owing to injury[7] or in patients with a cervical spine fixation owing to a disease or previous operation[8]. Moreover, it is selected for patients who require prolonged intubation for intensive care[9]. However, nasotracheal intubation may lead to certain complications, with epistaxis being the most common. Epistaxis generally occurs due to damage of the Kiesselbach's plexus in the anterior part of the nasal septum[10-12] where branches from several arteries, including branches of the ophthalmic, maxillary, and facial arteries, anastomose to form a vascular plexus. To avoid this complication, the tracheal tube should be inserted into the nasal cavity such that its bevel tip comes to the lateral side of naris. However, if the bleeding occurs on insertion of the tube, the nasotracheal intubation should be completed to chiefly protect the airway and also to tamponade the bleeding point. Risk of sinusitis is another disadvantage associated with nasotracheal intubation[13]. Sinusitis can induce oedema around the opening of the maxillary sinus. Mucosal oedema in the nasopharynx can also result in the middle-ear problem. Superficial necrosis of the nasal ala is another common complication associated with the nasotracheal intubation[3,9,14,15]. Several measures have been suggested to avoid this necrosis problem [15-18]; however, these measures cannot always be applied in paediatric patients as their naris do not provide enough space for them. Nasotracheal intubation has also been reported to cause bacteraemia owing to abrasion of the nasal mucosa [19,20]. The nasotracheal intubation-related carriage of bacteria into the trachea should be also avoided. It is reported that prior treatment of nostrils and anterior nasal septum with mupirocin is effective to avoid this complication[21,22]. However, the cheapest and easiest countermeasure to avoid such a complication during the nasotracheal intubation for inducing anaesthesia involves removal of the nasal dirt from the tip of the tracheal tube; in short, the tracheal tube should be pulled out with the aid of Magill forceps through the patient's mouth and the dirt should be wiped with a clean cotton (Figure 1). Additionally, dirt from the pharynx should be completely sucked under direct vision laryngoscope if required, before advancing the tracheal tube into the larynx. Once the tube tip and the pharynx are cleaned, the tube should be pulled again into the oral cavity by pulling the proximal side of the tube near the patient's nostril. Subsequently, the tube tip can be advanced into the larynx with the aid of Magill forceps. This series of treatment does not take longer than 10 seconds to perform once the anaesthesiologist and nurse anaesthetist get accustomed to it, thereby preventing an extreme fall in the peripheral capillary oxygen saturation (SpO2), even in paediatric patients. If the SpO2 value goes below the permissible range during the procedure, the patient can be easily ventilated by connecting the ventilation hose from the anaesthesia machine to the tracheal tube thereby completely closing the nose and mouth of patient (Figure 2), whereas some anaesthesiologists believe that the tracheal tube should be completely drawn from the patient's nose again to ventilate the patient with a mask On the other hand, some anaesthesiologists advance the tracheal tube further into the trachea in almost a panic condition, even when they have recognised the nose dirt on its tip (Figure 3), to prevent SpO2 fall, especially in paediatric patients. Therefore, knowledge of the ventilation technique via the tracheal tube inserted in the patient's nostril can be of great advantage while performing nasotracheal intubation. It can allow anaesthesiologists to calmly pull out the tip of tracheal tube using Magill forceps through the patient's mouth, when they recognise the nose dirt on it, to advance a cleaned tracheal tube into the trachea, even in paediatric patients. In conclusion, we suggest a simple countermeasure to avoid possible complications of nasotracheal intubation. It involves movement of a cleaned tracheal tube into the trachea of patient. Moreover, we suggest a possible ventilation technique in case the SpO2 falls beyond the permissible range during the nasotracheal intubation.
Topics: Bacteremia; Epistaxis; Humans; Intubation, Intratracheal; Nasal Mucosa; Necrosis; Sinusitis
PubMed: 30723887
DOI: 10.5603/AIT.a2019.0002 -
PloS One 2020Memory B cell (mBC) induction and maintenance is one of the keys to long-term protective humoral immunity. MBCs are fundamental to successful medical interventions such...
Human CD27+ memory B cells colonize a superficial follicular zone in the palatine tonsils with similarities to the spleen. A multicolor immunofluorescence study of lymphoid tissue.
BACKGROUND
Memory B cell (mBC) induction and maintenance is one of the keys to long-term protective humoral immunity. MBCs are fundamental to successful medical interventions such as vaccinations and therapy in autoimmunity. However, their lifestyle and anatomic residence remain enigmatic in humans. Extrapolation from animal studies serves as a conceptual basis but might be misleading due to major anatomical distinctions between species.
METHODS AND FINDINGS
Multicolor immunofluorescence stainings on fixed and unfixed frozen tissue sections were established using primary antibodies coupled to haptens and secondary signal amplification. The simultaneous detection of five different fluorescence signals enabled the localization and characterization of human CD27+CD20+Ki67- mBCs for the first time within one section using laser scanning microscopy. As a result, human tonsillar mBCs were initially identified within their complex microenvironment and their relative location to naïve B cells, plasma cells and T cells could be directly studied and compared to the human splenic mBC niche. In all investigated tonsils (n = 15), mBCs appeared to be not only located in a so far subepithelial defined area but were also follicle associated with a previous undescribed gradual decline towards the follicular mantle comparable to human spleen. However, mBC areas around secondary follicles with large germinal centers (GCs) in tonsils showed interruptions and a general widening towards the epithelium while in spleen the mBC-containing marginal zones (MZ) around smaller GCs were relatively broad and symmetrical. Considerably fewer IgM+IgD+/- pre-switch compared to IgA+ or IgG+ post-switch mBCs were detected in tonsils in contrast to spleen.
CONCLUSIONS
This study extends existing insights into the anatomic residence of human mBCs showing structural similarities of the superficial follicular area in human spleen and tonsil. Our data support the debate of renaming the human splenic MZ to 'superficial zone' in order to be aware of the differences in rodents and, moreover, to consider this term equally for the human palatine tonsil.
Topics: Adolescent; Adult; Aged; B-Lymphocytes; Cellular Microenvironment; Child; Germinal Center; Humans; Middle Aged; Palatine Tonsil; Spleen; Tumor Necrosis Factor Receptor Superfamily, Member 7
PubMed: 32187186
DOI: 10.1371/journal.pone.0229778 -
Brazilian Journal of Otorhinolaryngology 2019The pectoralis major flap is a reconstructive option to consider in the treatment of pharyngocutaneous fistula after a total laryngectomy. There are not large studies...
INTRODUCTION
The pectoralis major flap is a reconstructive option to consider in the treatment of pharyngocutaneous fistula after a total laryngectomy. There are not large studies assessing variables related to pharyngocutaneous fistula recurrence after removal of the larynx. Our objectives were to review the results obtained with this type of treatment when pharyngocutaneous fistula appears in laryngectomized patients, and to evaluate variables related to the results.
METHODS
We retrospectively reviewed our results using either a myocutaneous or fasciomuscular pectoralis major flap to repair pharyngocutaneous fistula in 50 patients.
RESULTS
There were no cases of flap necrosis. Oral intake after fistula repair with a pectoralis major flap was restored in 94% of cases. Fistula recurrence occurred in 22 cases (44%), and it was associated with a lengthening of the hospital stay. Performing the flap as an emergency procedure was associated with a significantly higher risk of fistula recurrence. Hospital stay was significantly shorter when a salivary tube was placed.
CONCLUSIONS
The pectoralis major flap is a useful approach to repair pharyngocutaneous fistula. Placing salivary tubes during fistula repair significantly reduces hospital stay and complication severity in case of pharyngocutaneous fistula recurrence.
Topics: Aged; Cutaneous Fistula; Female; Humans; Laryngectomy; Male; Middle Aged; Pectoralis Muscles; Pharyngeal Diseases; Postoperative Complications; Retrospective Studies; Surgical Flaps; Treatment Outcome
PubMed: 29650373
DOI: 10.1016/j.bjorl.2018.03.002 -
European Annals of Otorhinolaryngology,... Apr 2015Reconstruction of the pharynx and upper esophagus uses various procedures, including pedicled or free flap. Pharyngoplasty with free forearm flap provides excellent...
Reconstruction of the pharynx and upper esophagus uses various procedures, including pedicled or free flap. Pharyngoplasty with free forearm flap provides excellent functional results. In radiation-related pharyngeal stenosis, recipient vascularization is often poor, especially in the venous system. The authors describe pharyngeal reconstruction with semi-free forearm flap, pedicled on the cephalic vein, to minimize the risk of venous thrombosis, which is the main factor of free forearm flap necrosis. Taking the case of a laryngectomy with complete pharyngeal stenosis after radiation therapy and iterative neck surgery, the technique of pharyngeal-esophageal reconstruction by semi-free forearm flap is described in a context of impaired vascularization.
Topics: Carcinoma, Squamous Cell; Esophagoplasty; Forearm; Free Tissue Flaps; Humans; Laryngeal Neoplasms; Laryngoplasty; Male; Middle Aged; Pharyngectomy; Plastic Surgery Procedures; Treatment Outcome
PubMed: 25482241
DOI: 10.1016/j.anorl.2014.09.002 -
Acta Otorhinolaryngologica Italica :... Jun 2020
Topics: Adult; Aged; Aged, 80 and over; Female; Free Tissue Flaps; Humans; Male; Middle Aged; Mouth; Myocutaneous Flap; Neck; Oropharynx; Plastic Surgery Procedures; Retrospective Studies; Superficial Musculoaponeurotic System
PubMed: 32773778
DOI: 10.14639/0392-100X-N0538 -
Cellular Immunology Jul 2019IgA nephropathy (IgAN) is a tonsil-related disease. We previously showed that oligodeoxynucleotides with CpG (CpG-ODN) and B-cell activation factor (BAFF) are involved...
IgA nephropathy (IgAN) is a tonsil-related disease. We previously showed that oligodeoxynucleotides with CpG (CpG-ODN) and B-cell activation factor (BAFF) are involved in hyperproduction of IgA from tonsillar mononuclear cells of patients with IgAN (IgAN-TMCs). In this study, we focused on a proliferation-inducing ligand (APRIL), homologous to BAFF. IgAN-TMCs produced more APRIL than non IgAN-TMCs in the presence of both CpG-ODN and control-ODN. TLR9 expression was higher in B-cells of IgAN-TMCs, and treatment with CpG-ODN enhanced transmembrane activator and CAML interactor (TACI) expression. IgA production from IgAN-TMCs was inhibited by APRIL neutralization antibody or TACI blocking antibody, and enhanced by co-treatment of APRIL and CpG-ODN. Serum APRIL levels were higher in patients with IgAN, and decreased after tonsillectomy. These findings suggest that APRIL is involved in the hyperproduction of IgA from IgAN-TMCs, and that CpG-ODN enhanced APRIL-induced IgA production by increasing TACI expression on B-cells of IgAN-TMCs.
Topics: Adolescent; Adult; Aged; Antibodies, Neutralizing; B-Cell Activating Factor; B-Lymphocytes; Gene Expression Regulation; Glomerulonephritis, IGA; Humans; Leukocytes, Mononuclear; Male; Middle Aged; Oligodeoxyribonucleotides; Palatine Tonsil; Signal Transduction; Toll-Like Receptor 9; Tonsillectomy; Transmembrane Activator and CAML Interactor Protein; Tumor Necrosis Factor Ligand Superfamily Member 13
PubMed: 31088610
DOI: 10.1016/j.cellimm.2019.103925 -
Frontiers in Immunology 2021In mucosa such as tonsil, antibody-producing plasmocytes (PCs) lie in sub-epithelium space, which is thought to provide a suitable environment for their survival. A...
In mucosa such as tonsil, antibody-producing plasmocytes (PCs) lie in sub-epithelium space, which is thought to provide a suitable environment for their survival. A proliferation inducing ligand (APRIL) is one key survival factor for PCs present in this area. According to staining, apical epithelial cells produced APRIL, and the secreted product had to migrate all through the stratified surface epithelium to reach basal cells. A similar process also occurred in the less-organized crypt epithelium. Tonsil epithelial cells captured secreted APRIL, thanks to their surface expression of the APRIL coreceptor, either syndecan-1 or -4 depending on their differentiation stage. In the most basal epithelial cells, secreted APRIL accumulated inside secretory lamp-1 vesicles in a polarized manner, facing the sub-epithelium. The tonsil epithelium upregulated APRIL production by apical cells and secretion by basal cells upon Toll-like receptor stimulation. Furthermore, LPS-stimulated epithelial cells sustained PC survival in a secreted APRIL-dependent manner. Taken together, our study shows that the tonsil epithelium responds to pathogen sensing by a polarized secretion of APRIL in the sub-epithelial space, wherein PCs reside.
Topics: Biomarkers; Cell Line; Cell Polarity; Epithelium; Heparan Sulfate Proteoglycans; Humans; Immunohistochemistry; Lysosomal-Associated Membrane Protein 1; Mucous Membrane; Palatine Tonsil; Toll-Like Receptors; Tumor Necrosis Factor Ligand Superfamily Member 13
PubMed: 34484218
DOI: 10.3389/fimmu.2021.715724 -
The American Journal of Case Reports Apr 2020BACKGROUND The prevalence of aberrant internal carotid artery (ICA) is extremely low in the general population. It commonly occurs in the neck. Close proximity of the... (Review)
Review
BACKGROUND The prevalence of aberrant internal carotid artery (ICA) is extremely low in the general population. It commonly occurs in the neck. Close proximity of the pulsatile submucosal mass of the aberrant ICA to the nasopharyngeal wall is dangerous. The complications include severe or fatal hemorrhage resulting from a missed diagnosis before intervention in this area, including tonsillectomy, adenoidectomy, eustachian tube dilation, oropharynx biopsy or resection, tracheal intubation, and neck surgery. We report the case of a 66-year-old woman who had a pulsatile mass of the kinked ICA in close proximity to the lateral nasopharyngeal wall, and provide a review of the literature. CASE REPORT The patient presented to our Ear, Nose, and Throat Clinic with persistent cough with phlegm. Endoscopic examination revealed an abnormal pulsatile mass in the lateral nasopharyngeal wall. Subsequent contrast-enhanced computed tomography angiography confirmed the presence of unilateral acute maxillary sinusitis, and a high-grade kinked submucosal mass of the ICA in the ipsilateral nasopharyngeal wall, concomitant with stenosis of the left ICA and left middle cerebral artery occlusion. CONCLUSIONS Pulsating and extremely high-grade kinking of the ICA in the lateral nasopharyngeal wall is a particularly dangerous condition. Clinicians must always consider the possibility of hemorrhage during surgery, especially in older women with arteriosclerosis. Otolaryngologists should perform comprehensive visual examinations before deciding on surgery or other medical interventions in the neck, to prevent severe or fatal hemorrhage as far as possible.
Topics: Aged; Carotid Artery, Internal; Carotid Stenosis; Computed Tomography Angiography; Cough; Female; Humans; Infarction, Middle Cerebral Artery; Nasopharynx
PubMed: 32282788
DOI: 10.12659/AJCR.921967