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Ear, Nose, & Throat Journal 2016Bullous pemphigoid is an autoimmune bullous disease characterized by skin lesions, with or without oral lesions. The occurrence of pharyngolaryngeal lesions is very rare...
Bullous pemphigoid is an autoimmune bullous disease characterized by skin lesions, with or without oral lesions. The occurrence of pharyngolaryngeal lesions is very rare in affected patients. We conducted a study to investigate the characteristics of oral and pharyngolaryngeal lesions in bullous pemphigoid. Our study population was made up of 6 consecutively presenting outpatients-2 men and 4 women, aged 40 to 83 years (mean: 68.2)-who had been referred to our department over an 11-year period. Presenting symptoms included sore throat in all 6 patients and oral pain in 3. The sites of mucosal lesions included the soft palate, epiglottis, gingiva, hypopharynx, tongue, nasal cavity, and buccal mucosa. These lesions appeared as erosions, erosions with white coating, erythematous patches, and/or blisters. Mucosal lesions preceded skin lesions in 2 patients, appeared after skin lesions in 1 patient, and appeared simultaneously with skin lesions in 3 patients. We conclude that bullous pemphigoid sometimes involves the mucosa, such as that of the laryngopharynx and the oral cavity, and it can manifest as skin lesions. In the differential diagnosis of refractory pharyngolaryngeal lesions, bullous pemphigoid should be considered.
Topics: Adult; Aged; Aged, 80 and over; Blister; Female; Humans; Laryngeal Diseases; Laryngeal Mucosa; Male; Middle Aged; Mouth Diseases; Mouth Mucosa; Pemphigoid, Bullous; Pharyngeal Diseases; Retrospective Studies
PubMed: 27792825
DOI: No ID Found -
Anaesthesia Oct 2016This study compared two methods of controlling the intracuff pressure in laryngeal mask airways. One hundred and eighty patients were randomly assigned into two groups.... (Comparative Study)
Comparative Study Randomized Controlled Trial
This study compared two methods of controlling the intracuff pressure in laryngeal mask airways. One hundred and eighty patients were randomly assigned into two groups. In the first group (n = 90), after training, the intracuff pressure was controlled using digital palpation of the pilot balloon. In the second group (n = 90), continuous manometry was used to control the intracuff pressure. An upper pressure limit of 60 cmH2 O was set. The median (IQR [range]) intracuff pressure in the palpation group was 130 (125-130 [120-130]) cmH2 O compared with 29 (20-39 [5-60]) cmH2 O in the manometry group (p < 0.001). In the palpation group, 37% of patients experienced pharyngolaryngeal complications vs. 12% in the manometry group (p < 0.001). We conclude that the digital palpation technique is not a suitable alternative to manometry in controlling the intracuff pressure in laryngeal mask airways.
Topics: Double-Blind Method; Female; Humans; Laryngeal Masks; Male; Manometry; Middle Aged; Monitoring, Physiologic; Palpation; Postoperative Complications; Prospective Studies
PubMed: 27501056
DOI: 10.1111/anae.13566 -
Anesthesia, Essays and Researches 2016Endotracheal tube (ETT) has been associated with various pharyngolaryngeal morbidities (PLMs) following general anesthesia (GA). Laryngeal mask airway (LMA), currently...
INTRODUCTION
Endotracheal tube (ETT) has been associated with various pharyngolaryngeal morbidities (PLMs) following general anesthesia (GA). Laryngeal mask airway (LMA), currently the most commonly used supraglottic airway device, has several advantageous over the ETT but has been associated with varying results of PLM. The aim of our study was to compare the PLM between them and to know whether LMA is a better alternative.
MATERIALS AND METHODS
One hundred and seventy American Society of Anesthesiologists Grades 1 and 2 women scheduled for elective mastectomy were included in the study, 85 each in either group, E Group (intubated with ETT) and L Group (using LMA) on a random basis. All patients received GA with controlled ventilation using a muscle relaxant. PLMs such as hoarseness, pain on phonation, sore throat, and difficulty in swallowing were documented by an interview done postoperatively. Peroperative parameters such as intubation attempts, trauma during airway device insertion, and intraoperative incidents were also analyzed. A sample size of 85 patients in each group was calculated in order to achieve a study power of 0.8 and alpha level was taken as 0.05. Data were analyzed using SPSS version 16 using Chi-square test, Mann-Whitney U-test and Fisher's exact test were used as nonparametric tests. A two-tailed P< 0.05 was considered significant.
RESULTS
Patients in E Group had statistically significant increased incidence of a sore throat and voice complaints whereas L Group showed a statistically significant increase of swallowing problems. There was also a significant correlation between traumatic insertion and sore throat, pain on swallowing in the L Group, which could be due to direct trauma.
CONCLUSIONS
ETT was associated with an increased incidence of voice problems and sore throat whereas LMA had an increased incidence of dysphagia and odynophagia. Use of LMA changes the pharyngolaryngeal profile to a more acceptable one.
PubMed: 27212745
DOI: 10.4103/0259-1162.174466 -
British Journal of Anaesthesia Feb 2016Cervical epidural analgesia (CEA) is an analgesic technique, potentially useful for surgeries involving the upper body. Despite the inherent technical risks and systemic... (Review)
Review
Cervical epidural analgesia (CEA) is an analgesic technique, potentially useful for surgeries involving the upper body. Despite the inherent technical risks and systemic changes, it has been used for various surgeries. There have been no previously published systematic reviews aimed at assessing its clinical utility. This systematic review was performed to explore the perioperative benefits of CEA. The review was also aimed at identifying the rationale of its use, reported surgical indications and the method of use. We performed a literature search involving PubMed and Embase databases, to identify studies using CEA for surgical indications. Out of 467 potentially relevant articles, 73 articles were selected. Two independent investigators extracted data involving 5 randomized controlled trials, 17 observational comparative trials, and 51 case reports (series). The outcomes studied in most comparative studies were on effects of local anaesthetics and other agents, systemic effects, and feasibility of CEA. In one randomized controlled study, CEA was observed to decrease the resting pain scores after pharyngo-laryngeal surgeries. In a retrospective study, CEA was shown to decrease the cancer recurrence after pharyngeal-hypopharyngeal surgeries. The limited evidence, small studies, and the chosen outcomes do not allow for any specific recommendations based on the relative benefit or harm of CEA. Considering the potential for significant harm, in the face of better alternatives, its use must have a strong rationale mostly supported by unique patient and surgical demands. Future studies must aim to assess analgesic comparator effectiveness for clinically relevant outcomes.
Topics: Analgesia, Epidural; Humans; Pain, Postoperative
PubMed: 26787789
DOI: 10.1093/bja/aev453 -
The Cochrane Database of Systematic... Oct 2015Several agents are used to clear secretions from the airways of people with cystic fibrosis. Inhaled dry powder mannitol is now available in Australia and some countries... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Several agents are used to clear secretions from the airways of people with cystic fibrosis. Inhaled dry powder mannitol is now available in Australia and some countries in Europe. The exact mechanism of action of mannitol is unknown, but it increases mucociliary clearance. Phase III trials of inhaled dry powder mannitol for the treatment of cystic fibrosis have been completed. The dry powder formulation of mannitol may be more convenient and easier to use compared with established agents which require delivery via a nebuliser.
OBJECTIVES
To assess whether inhaled dry powder mannitol is well tolerated, whether it improves the quality of life and respiratory function in people with cystic fibrosis and which adverse events are associated with the treatment.
SEARCH METHODS
We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register which comprises references identified from comprehensive electronic databases, handsearching relevant journals and abstracts from conferences.Date of last search: 16 April 2015.
SELECTION CRITERIA
All randomised controlled studies comparing mannitol with placebo, active inhaled comparators (for example, hypertonic saline or dornase alfa) or with no treatment.
DATA COLLECTION AND ANALYSIS
Authors independently assessed studies for inclusion, carried out data extraction and assessed the risk of bias in included studies.
MAIN RESULTS
The searches identified nine separate studies (45 publications), of which four studies (36 publications) were included with a total of 667 participants, one study (only available as an abstract) is awaiting assessment and two studies are ongoing. Duration of treatment in the included studies ranged from two weeks to six months with open-label treatment for an additional six months in two of the studies. Three studies compared mannitol with control (a very low dose of mannitol or non-respirable mannitol); two of these were parallel studies with a similar design and data could be pooled, where data for a particular outcome and time point were available; also, one short-term cross-over study supplied additional results. The fourth study compared mannitol to dornase alfa alone and to mannitol plus dornase alfa. There was generally a low risk of bias in relation to randomisation and blinding; evidence from the parallel studies was judged to be of low to moderate quality and from the cross-over studies was judged to be of low to very low quality. While the published papers did not provide all the data required for our analysis, additional unpublished data were provided by the drug's manufacturer and the author of one of the studies. There was an initial test to see if participants tolerated mannitol, with only those who could tolerate the drug being randomised to the studies; therefore the study results are not applicable to the cystic fibrosis population as a whole.For the comparison of mannitol and control, we found no consistent differences in health-related quality of life in any of the domains, except for burden of treatment, which was less for mannitol up to four months in the two pooled studies of a similar design; this difference was not maintained at six months. Up to and including six months, lung function in terms of forced expiratory volume at one second (millilitres) and per cent predicted were significantly improved in all three studies comparing mannitol to control. Beneficial results were observed in these studies in adults and in both concomitant dornase alfa users and non users. A significant reduction was shown in the incidence of pulmonary exacerbations in favour of mannitol at six months; however, the estimate of this effect was imprecise so it is unclear whether the effect is clinically meaningful. Cough, haemoptysis, bronchospasm, pharyngolaryngeal pain and post-tussive vomiting were the most commonly reported side effects on both treatments. Mannitol was not associated with any increase in isolation of bacteria over a six-month period.In the 12-week cross-over study (28 participants), no significant differences were found in the recorded domains of health-related quality of life or measures of lung function between mannitol versus dornase alfa alone and versus mannitol plus dornase alfa. There seemed to be a higher rate of pulmonary exacerbations in the mannitol plus dornase alfa arm compared with dornase alfa alone; although not statistically significant, this was the most common reason for stopping treatment in this arm. Cough was the most common side effect in the mannitol alone arm but there was no occurrence of cough in the dornase alfa alone arm and the most commonly reported reason of withdrawal from the mannitol plus dornase alfa arm was pulmonary exacerbations. Mannitol (with or without dornase alfa) was not associated with any increase in isolation of bacteria over the 12-week period.
AUTHORS' CONCLUSIONS
There is evidence to show that treatment with mannitol over a six-month period is associated with an improvement in some measures of lung function in people with cystic fibrosis compared to control. There is no evidence that quality of life is improved for participants taking mannitol compared to control; a decrease in burden of treatment was observed up to four months on mannitol compared to control but this difference was not maintained to six months. Randomised information regarding the burden of adding mannitol to an existing treatment is limited. There is no randomised evidence of improvement in lung function or quality of life comparing mannitol to dornase alfa alone and to mannitol plus dornase alfa.Mannitol as a single or concomitant treatment to dornase alfa may be of benefit to people with cystic fibrosis, but further research is required in order to establish who may benefit most and whether this benefit is sustained in the longer term.The clinical implications from this review suggest that mannitol could be considered as a treatment in cystic fibrosis; however, studies comparing its efficacy against other (established) mucolytic therapies need to be undertaken before it can be considered for mainstream practice.
Topics: Administration, Inhalation; Adult; Cystic Fibrosis; Deoxyribonuclease I; Humans; Mannitol; Mucociliary Clearance; Powders; Randomized Controlled Trials as Topic; Recombinant Proteins
PubMed: 26451533
DOI: 10.1002/14651858.CD008649.pub2 -
Journal of Ethnopharmacology Dec 2015Plants of the genus Mahonia Nuttall (Berberidaceae) have a long history of medical use in Traditional Chinese Medicine (TCM) for the treatment of a wide range of health... (Review)
Review
ETHNOPHARMACOLOGICAL RELEVANCE
Plants of the genus Mahonia Nuttall (Berberidaceae) have a long history of medical use in Traditional Chinese Medicine (TCM) for the treatment of a wide range of health disorders, such as tuberculosis, periodontitis, dysentery, pharyngolaryngitis, eczema, and wounds. In the theory of TCM, most Mahonia species exert the effects of relieving internal heat, eliminating dampness, removing toxins, suppressing pain, promoting blood circulation, inhibiting cough and alleviating inflammation. The aim of the review is to provide comprehensive summary on ethnopharmacology, phytochemistry, pharmacology, toxicology and clinical trials of Mahonia species used in TCM based on scientific literature. Available scientific evidence supporting the therapeutic effects of Mahonia species in TCM is demonstrated and opportunities for future research are discussed to highlight the scientific gaps in our knowledge that deserves further investigation.
METHODS
The available information on the ethnopharmacological uses in Chinese medicine, phytochemistry, pharmacology and clinical practice of the genus Mahonia was collected from Chinese Herbal Classics, published books, un-published resources, dissertations and various worldwide-accepted scientific databases: CNKI, PubMed, ScienceDirect, SpringerLink, Google Scholar, Wiley, TPL (www.theplantlist.org), SciFinder, and Embase.
RESULTS
A variety of ethnomedical usages of Mahonia have been recorded in ancient Chinese books and references. The phytochemical research of this genus has resulted in the identification of more than 150 chemical constituents, among which alkaloids are predominant. The isolated compounds and crude extracts have been shown to exhibit a wide spectrum of in vitro and in vivo pharmacological effects, including antimicrobial, anti-inflammatory, hepatoprotective, antioxidant, antimutagenic and analgesic properties. Preparations containing Mahonia species have been demonstrated to exert good efficacy for the clinical treatment of dysentery, internal and external hemorrhage, acne vulgaris and chronic pharyngitis, among other diseases.
CONCLUSIONS
The available scientific references demonstrate that the traditional medical uses of some important Mahonia species in TCM have been evaluated in modern pharmacological studies. Isoquinoline alkaloids may contribute to some of the activities shown by the plants of this genus. However, further studies employing scientific technologies and methods are warranted to reveal the phytochemistry of this genus, particularly to detail the active compounds and the underlying mechanisms.
Topics: Ethnopharmacology; Humans; Mahonia; Medicine, Chinese Traditional; Phytochemicals; Phytotherapy; Plant Preparations
PubMed: 26387740
DOI: 10.1016/j.jep.2015.09.013 -
Vestnik Otorinolaringologii 2015The objective of the present study was to estimate the influence of gastroesophageal reflux disease (GERD) on the pH values in the pharynx and nose. It included 87...
[pH values in the pharynx of the patients presenting with compromised nasal breathing of inflammatory and non-inflammatory genesis concomitant with gastroesophageal reflux disease].
The objective of the present study was to estimate the influence of gastroesophageal reflux disease (GERD) on the pH values in the pharynx and nose. It included 87 patients at the age varying from 18 to 81 years admitted to the Irkutsk-based Railway Clinical Hospital and allocated to four groups. Group 1 was comprised of 25 patients presenting with gastroesophageal reflux disease and chronic rhinosinusitis (CRS), group 2 consisted of 29 patients with CRS in the absence of GERD, group 3 included 22 patients with nasal septum deformations (NSD) and GERD, group 4 included 11 patients with NSD and motor rhinitis without GERD. The control group was formed from 10 volunteers. pH was measured by the contact method with the use ofEkokhim indicator paper. Gastroesophageal reflux disease was diagnosed following the recommendations of the Montreal consensus. It was shown that pH values in the pharynx of the patients with compromised nasal breathing of any origin in combination with GERD were lower than in the absence of GERD and in the healthy volunteers. The study groups did not differ in terms of pH values in the nasal cavity. It is concluded that pH values 4 or lower may serve as the criterion for pharyngo-laryngeal reflux (PLR) concomitant with HERD while pH 5 occurs more frequently in the patients with compromised nasal breathing of any etiology, regardless of the presence or absence of GERD.Disordered nasal breathing of any genesis in the patients presenting with gastroesophageal reflux disease was associated with the feeling of the lump in the throat, congestion of the respiratory tract and the nose, pain in the ears, cardialgia, and irregular heartbeat. It isrecommended to use pH measurements as a criterion for diagnostics of pharyngo-laryngeal reflux in the patients presenting with gastroesophageal reflux disease.
Topics: Adult; Chronic Disease; Female; Gastroesophageal Reflux; Humans; Hydrogen-Ion Concentration; Laryngopharyngeal Reflux; Male; Middle Aged; Nasal Obstruction; Nasopharynx; Reproducibility of Results; Rhinitis; Sinusitis
PubMed: 26288207
DOI: 10.17116/otorino201580335-39 -
PloS One 2015Neuromuscular block results in the loss of muscular tone in the upper airway, which might contribute to the increased postoperative airway morbidity followed by ProSeal... (Randomized Controlled Trial)
Randomized Controlled Trial
Neuromuscular block results in the loss of muscular tone in the upper airway, which might contribute to the increased postoperative airway morbidity followed by ProSeal laryngeal mask airway (PLMA) insertion. We compared the pharyngolaryngeal discomfort exerted by the PLMA according to the neuromuscular block. One hundred sixty patients undergoing surgery for breast disease or inguinal hernia were anesthetized with propofol and remifentanil by target controlled infusion. Rocuronium 0.6 mg/kg (NMBA group, n = 80) or normal saline (No-NMBA group, n = 80) was administered after the loss of consciousness, and one anesthesiologist inserted the PLMA. Postoperative pharyngolaryngeal discomfort was evaluated at postoperative 1 h. Traumatic event was recorded based on the blood trace on the surface of the PLMA cuff. Insertion time, insertion attempt number, sealing pressure, and fiberoptic brochoscopic grades were evaluated. Patients' characteristics and the PLMA insertion condition (insertion time, successful insertion attempt number, fiberoptic bronchoscopic grade, and sealing pressure) were similar between the two groups. The PLMA can be successfully inserted in non-paralyzed patients with less postoperative pharyngolaryngeal discomfort than when a neuromuscular blocking agent is used (13.8% vs. 30.0%, P = 0.021). The incidence of traumatic events is also reduced when no neuromuscular blocking agent is used (16.3% vs. 32.5%, P = 0.026). Regardless of whether or not a surgical procedure requires muscular relaxation, there is no need to administer neuromuscular blocking agents solely for the purpose of PLMA insertion.
Topics: Bronchoscopy; Female; Humans; Laryngeal Masks; Larynx; Male; Middle Aged; Morbidity; Paralysis; Pharynx; Time Factors; Wounds and Injuries
PubMed: 26252522
DOI: 10.1371/journal.pone.0134130 -
Annals of Rehabilitation Medicine Apr 2015Spasmodic dysphonia is defined as a focal laryngeal disorder characterized by dystonic spasms of the vocal cord during speech. We described a case of a 22-year-old male...
Spasmodic dysphonia is defined as a focal laryngeal disorder characterized by dystonic spasms of the vocal cord during speech. We described a case of a 22-year-old male patient who presented complaining of idiopathic difficulty swallowing that suddenly developed 6 months ago. The patient also reported pharyngolaryngeal pain, throat discomfort, dyspnea, and voice change. Because laryngoscopy found no specific problems, an electrodiagnostic study and videofluoroscopic swallowing study (VFSS) were performed to find the cause of dysphagia. The VFSS revealed continuous twitch-like involuntary movement of the laryngeal muscle around the vocal folds. Then, he was diagnosed with spasmodic dysphonia by VFSS, auditory-perceptual voice analysis, and physical examination. So, we report the first case of spasmodic dysphonia accompanied with difficulty swallowing that was confirmed by VFSS.
PubMed: 25932430
DOI: 10.5535/arm.2015.39.2.313 -
Paediatric Anaesthesia Apr 2015Supraglottic airway devices with noninflatable cuff have advantages in omitting the cuff pressure monitoring and reducing potential pharyngolaryngeal complications.... (Comparative Study)
Comparative Study Randomized Controlled Trial
BACKGROUND
Supraglottic airway devices with noninflatable cuff have advantages in omitting the cuff pressure monitoring and reducing potential pharyngolaryngeal complications. Typical devices without cuff inflation available in children are the i-gel and the self-pressurized air-Q intubating laryngeal airway (air-Q SP). To date, there is no comparative study between these devices in pediatric patients.
AIM
The purpose of this randomized study was to compare the i-gel(™) and the self-pressurized air-Q(™) intubating laryngeal airway (air-Q SP) in children undergoing general anesthesia.
METHODS
Eighty children, 1-108 months of age, 7-30 kg of weight, and scheduled for elective surgery in which supraglottic airway devices would be suitable for airway management, were randomly assigned to either the i-gel or the air-Q SP. Oropharyngeal leak pressure and fiberoptic view were assessed three times as follows: after insertion and fixation of the device, 10 min after initial assessment, and after completion of surgery. We also assessed insertion parameters and complications.
RESULTS
Insertion of the i-gel was regarded as significantly easier compared to the air-Q SP (P = 0.04). Compared to the air-Q SP group, the i-gel group had significantly higher oropharyngeal leak pressures at all measurement points and significantly lower frequencies of gastric insufflation at 10 min after initial assessment and completion of surgery. The air-Q SP group had better fiberoptic views than the i-gel group at all measurement points.
CONCLUSION
Our results showed that the i-gel had easier insertion and better sealing function, and the air-Q SP provided improved fiberoptic views in children requiring general anesthesia.
Topics: Airway Management; Child; Child, Preschool; Compressed Air; Female; Humans; Infant; Infant, Newborn; Insufflation; Intubation, Intratracheal; Laryngeal Masks; Laryngoscopes; Laryngoscopy; Male
PubMed: 25559870
DOI: 10.1111/pan.12609