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Annals of Cardiac Anaesthesia 2017We report a patient who after an uneventful coronary artery bypass graft surgery and left ventricular aneurysmorrhaphy developed intracerebral hemorrhage and...
We report a patient who after an uneventful coronary artery bypass graft surgery and left ventricular aneurysmorrhaphy developed intracerebral hemorrhage and subsequently required minitracheostomy. Chest X-ray showed misdirected minitracheostomy tube facing upward toward the laryngeal opening which was repositioned using bronchoscope.
Topics: Bronchoscopy; Humans; Larynx; Male; Tracheostomy
PubMed: 28074805
DOI: 10.4103/0971-9784.197845 -
Canadian Medical Association Journal Apr 1963Laryngeal trauma may be obscured by associated injuries of the face and chest. An early assessment of these injuries should be made. Many cases may require observation...
Laryngeal trauma may be obscured by associated injuries of the face and chest. An early assessment of these injuries should be made. Many cases may require observation only. In patients with severe laryngeal fractures, preservation of the airway and control of hemorrhage must first be assured. Following this, splinting by external or internal means should be carried out. Three severe laryngeal injuries were splinted with open and closed plastic moulds, with satisfactory results. It is proposed that early recognition and proper management of severe cases of this nature would shorten the treatment and achieve the best results.
Topics: Female; Humans; Laryngostenosis; Larynx; Male; Neck Injuries; Prostheses and Implants
PubMed: 13953820
DOI: No ID Found -
Ear, Nose, & Throat Journal Dec 2022Reinke's edema and variceal hemorrhage are complex structural pathologies that affect the vocal cord mucosa. The vocal cords are highly susceptible to environmental... (Review)
Review
Reinke's edema and variceal hemorrhage are complex structural pathologies that affect the vocal cord mucosa. The vocal cords are highly susceptible to environmental stressors, such as smoking and vocal cord usage, thus, treatment involves their corresponding cessation. Here, we report a case of a patient with severe Reinke's edema and bilateral chronic vocal cord varices. The patient had a 30-pack-year history of cigarette smoking and was obstructed with intubation due to acute variceal hemorrhage and severe swelling of Reinke's edema. Moreover, a review of the literature regarding Reinke's edema and variceal hemorrhage treatment and their complications was performed.
Topics: Humans; Esophageal and Gastric Varices; Gastrointestinal Hemorrhage; Airway Obstruction; Vocal Cords; Varicose Veins; Edema
PubMed: 36052403
DOI: 10.1177/01455613221123825 -
American Journal of Veterinary Research Jun 2018OBJECTIVE To determine plasma concentrations of lidocaine after laryngeal administration or laryngeal and intratesticular administration in cats. ANIMALS 14 healthy...
OBJECTIVE To determine plasma concentrations of lidocaine after laryngeal administration or laryngeal and intratesticular administration in cats. ANIMALS 14 healthy adult sexually intact male cats (7 cats/treatment). PROCEDURES Cats were randomly allocated to receive 0.1 mL of 2% or 10% lidocaine hydrochloride solution (treatments L2 and L10, respectively) sprayed on the larynx for laryngeal desensitization, followed by endotracheal intubation and isoflurane anesthesia. After a 7-day washout period, cats were again randomly allocated to receive treatment L2 or L10, and castration was performed under isoflurane anesthesia following intratesticular administration of 2% lidocaine solution (0.1 mL/kg). In both experiments, a blood sample for measurement of plasma lidocaine concentration was obtained before (0 minutes) and 3, 5, 10, 15, 20, 30, 45, 60, and 75 minutes after laryngeal administration of lidocaine solution. Anesthesia was discontinued at 60 minutes. Plasma lidocaine concentrations were measured with high-performance liquid chromatography. RESULTS After treatments L2 and L10, median maximum plasma lidocaine concentrations were 34.1 ng/mL (range, 0 to 279.4 ng/mL) and 93.6 ng/mL (range, 79.3 to 182.2 ng/mL), respectively. Time to maximum plasma concentration was 10 minutes (range, 0 to 20 minutes) for each treatment. When cats received intratesticular lidocaine administration following L2 or L10 treatment, median maximum plasma concentration was 181.0 ng/mL (range, 103.7 to 600.2 ng/mL) and 301.2 ng/mL (range, 265.8 to 1,770.0 ng/mL), respectively. CONCLUSIONS AND CLINICAL RELEVANCE On the basis of these data, combined laryngeal and intratesticular administration of lidocaine solution at a total dose of approximately 5 mg/kg appears to be safe for use in healthy adult cats.
Topics: Anesthesia; Anesthetics, Local; Animals; Body Weight; Cats; Isoflurane; Larynx; Lidocaine; Male; Orchiectomy; Testis; Time Factors
PubMed: 30085855
DOI: 10.2460/ajvr.79.6.614 -
The Laryngoscope Apr 2017The larynx is a mucosal organ rich in lymphatic tissue that is regularly exposed to a multitude of inhaled, ingested, and refluxed microorganisms and irritants. The... (Comparative Study)
Comparative Study
OBJECTIVES/HYPOTHESIS
The larynx is a mucosal organ rich in lymphatic tissue that is regularly exposed to a multitude of inhaled, ingested, and refluxed microorganisms and irritants. The first line of mucosal immune defense is the barrier, including resident immune cells. T regulatory (Treg) cells are a specialized subset of CD4+ T cells that suppress or dampen immune responses to prevent damaging immunopathology. As Treg cells have been shown to preferentially accumulate at sites of infection, and Treg responses may contribute to persistence of infection by impairing antibacterial immunity, we sought to quantify these cells in laryngeal tissue exposed to smoking and reflux.
STUDY DESIGN
Cross-sectional study.
METHODS
Using an epigenetic assay, we quantified Treg and T cells and calculated the ratio of Treg to T cells (i.e., cellular ratio of immune tolerance [ImmunoCRIT]) in disease-free laryngeal biopsies representing four inflammatory states: 1) tobacco-exposed tissue, 2) refluxate and tobacco-exposed tissue, 3) refluxate-exposed tissue, and 4) unexposed tissue.
RESULTS
There was epigenetic evidence of Treg cells in all tissues, and we found no differences in Treg cell frequency relative to smoking and reflux in laryngeal tissue collected from 42 non-treatment-seeking participants. There was a decrease in total T cell frequency and an increase in ImmunoCRIT values in smokers regardless of reflux status.
CONCLUSIONS
In this study, laryngeal tissue from smokers show decreased overall T cells and increased ImmunoCRIT values. Our findings indicate that laryngeal inflammation is not directly mediated by loss of Treg cells in response to smoking and reflux in local tissue and increased ImmunoCRIT values in smokers implicate a role for this environmental exposure in modulating laryngeal immune homeostasis. More studies are indicated to explore Treg cell dysfunction in the pathophysiology of laryngeal disease.
LEVEL OF EVIDENCE
NA Laryngoscope, 127:882-887, 2017.
Topics: Adult; Age Factors; Aged; Cross-Sectional Studies; Female; Gastroesophageal Reflux; Homeostasis; Humans; Immune Tolerance; Immunity, Mucosal; Laryngeal Mucosa; Laryngopharyngeal Reflux; Linear Models; Male; Middle Aged; Risk Assessment; Sex Factors; Smoking; T-Lymphocytes, Regulatory; Young Adult
PubMed: 27653511
DOI: 10.1002/lary.26223 -
Ear, Nose, & Throat Journal Dec 2021To evaluate the efficacy of indirect laryngeal biopsy forceps in the treatment of epiglottic abscess (EA). (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
To evaluate the efficacy of indirect laryngeal biopsy forceps in the treatment of epiglottic abscess (EA).
METHODS
Twenty patients were diagnosed with EA in our department and were randomly divided into group A (indirect laryngeal biopsy forceps combined antibiotics) and group B (antibiotics only). Demographics, the degree of epiglottic and arytenoid swelling, and inflammatory cells were collected for analysis. The drainage of EA was performed under local anesthesia in conscious patients with indirect laryngeal biopsy forceps and 70° direct laryngoscopes. The length of symptomatic relief and length of hospitalization were assessed.
RESULTS
Ten patients were treated with indirect laryngeal biopsy forceps under the view of the 70° direct laryngoscopes combined with intravenous antibiotics, whereas the other 10 patients were treated with antibiotics only. The differences between the 2 groups had no statistical significance in age, gender, white blood cell count, neutrophils count, and the percent of neutrophils, abscess size, and scope classification at the time of diagnosis. The length of hospitalization and length of symptomatic relief was significantly lower in patients treated with indirect laryngeal biopsy forceps combined antibiotics than those treated with antibiotics only.
CONCLUSIONS
Indirect laryngeal biopsy forceps are safe and effective method to treat EA, which shorten the hospitalization and has the advantages of cost savings and convenience.
Topics: Abscess; Adult; Anti-Bacterial Agents; Arytenoid Cartilage; Biopsy; Combined Modality Therapy; Epiglottis; Epiglottitis; Female; Humans; Laryngoscopy; Male; Middle Aged; Surgical Instruments; Treatment Outcome
PubMed: 32520602
DOI: 10.1177/0145561320930644 -
European Journal of Immunology Dec 2013Chronic asthma is an inflammatory disease of the airway wall that leads to bronchial smooth muscle hyperreactivity and airway obstruction, caused by inflammation, goblet... (Review)
Review
Chronic asthma is an inflammatory disease of the airway wall that leads to bronchial smooth muscle hyperreactivity and airway obstruction, caused by inflammation, goblet cell metaplasia, and airway wall remodeling. In response to allergen presentation by airway DCs, T-helper lymphocytes of the adaptive immune system control many aspects of the disease through secretion of IL-4, IL-5, IL-13, IL-17, and IL-22, and these are counterbalanced by cytokines produced by Treg cells. Many cells of the innate immune system such as mast cells, basophils, neutrophils, eosinophils, and innate lymphoid cells also play an important role in disease pathogenesis. Barrier epithelial cells are being ever more implicated in disease pathogenesis than previously thought, as these cells have in recent years been shown to sense exposure to allergens via pattern recognition receptors and to activate conventional and inflammatory-type DCs and other innate immune cells through the secretion of thymic stromal lymphopoietin, granulocyte-macrophage colony stimulating factor, IL-1, IL-33, and IL-25. Understanding this cytokine crosstalk between barrier epithelial cells, DCs, and immune cells provides important insights into the mechanisms of allergic sensitization and asthma progression as discussed in this review.
Topics: Allergens; Animals; Antigen Presentation; Asthma; Blood-Air Barrier; Cytokines; Dendritic Cells; Epithelial Cells; Goblet Cells; Humans; Inflammation; Mast Cells; Metaplasia; Respiratory Mucosa; T-Lymphocytes, Regulatory
PubMed: 24165907
DOI: 10.1002/eji.201343730 -
Journal of Forensic Sciences Sep 2020Finland has one of the highest homicide rates in Western Europe, and almost every tenth homicide is caused by asphyxiation. Reliable statistics, a strict legislation,...
Finland has one of the highest homicide rates in Western Europe, and almost every tenth homicide is caused by asphyxiation. Reliable statistics, a strict legislation, and an exceptionally high medico-legal autopsy rate formed a base for a nationwide analysis of asphyxia homicides (n = 383) during 30 years. The cases were identified through multiple records, and all the forensic pathology case files were studied in detail. In more than one out of five cases, there were indications of staging, and the homicide was revealed first at autopsy in close to one in ten cases. The vast majority of the homicides took place in private locations and involved persons known to each other. Every third victim was an intimate partner, and every tenth a child. Almost half of the victims died from manual strangulation, one in three from ligature strangulation. Smothering, choking, neck compression with a firm object, and thoracic compression were more rare methods. Drownings were excluded from this study material. Of all the victims, 7% had no observable external injuries. Petechiae were recorded in approximately in 61%, laryngohyoid fractures in 47%, and vocal cord hemorrhages in 16% of the cases. Every tenth female victim had genital injuries. Toxicological analyses were performed in close to all of the cases, and almost three out of four victims tested positive for blood alcohol. The various aspects of the demographics and autopsy findings covered in this study contribute reliable and accurate data to further strengthen the spectrum of observable medico-legal characteristics of asphyxia homicides.
Topics: Adolescent; Adult; Age Distribution; Aged; Aged, 80 and over; Asphyxia; Blood Alcohol Content; Child; Child, Preschool; Crime Victims; Female; Finland; Forensic Medicine; Fractures, Bone; Fractures, Cartilage; Genitalia, Female; Hemorrhage; Homicide; Humans; Hyoid Bone; Infant; Infant, Newborn; Laryngeal Cartilages; Male; Middle Aged; Motivation; Purpura; Retrospective Studies; Sex Distribution; Substance Abuse Detection; Vocal Cords; Young Adult
PubMed: 32602942
DOI: 10.1111/1556-4029.14458 -
Ear, Nose, & Throat Journal Sep 2021Type 1 thyroplasty is an established procedure for the treatment of vocal fold paralysis to improve voice and swallowing outcomes. At our institution, we commonly...
OBJECTIVE
Type 1 thyroplasty is an established procedure for the treatment of vocal fold paralysis to improve voice and swallowing outcomes. At our institution, we commonly perform this procedure on an outpatient basis in medically stable patients. With this study, we assess the safety of outpatient thyroplasty by examining complication and readmission rates, need for revision surgery, and predictors of these outcome measures.
METHODS
We performed a retrospective review of patients undergoing outpatient type 1 thyroplasty for vocal fold paralysis between 2013 and 2018 at our institution. We documented the etiology of paralysis, comorbidities, and demographic data. Our primary outcome measures were complications, need for readmission, and need for revision surgery.
RESULTS
During the study period, 160 patients met our inclusion criteria. Mean age at time of surgery was 62.1 ± 13.9 years; there were 82 (51%) males and 78 (49%) females. Nine (5.6%) patients experienced major complications after surgery and 7 (4.4%) patients required unplanned readmission. Mean time to complication was 6.9 ± 9.7 days. There were no instances of postoperative airway compromise requiring intervention. There were no mortalities. Of those who underwent primary surgery, 22 (14%) patients required revision surgery.
CONCLUSION
Given that complications tend to occur in a delayed fashion rather than in the acute postoperative period, same-day discharge seems reasonable as compared to overnight observation in medically stable patients undergoing type 1 thyroplasty.
LEVEL OF EVIDENCE
IV.
Topics: Adult; Aged; Aged, 80 and over; Ambulatory Surgical Procedures; Female; Hematoma; Humans; Incidence; Intraoperative Complications; Laryngoplasty; Male; Middle Aged; Postoperative Complications; Reoperation; Retrospective Studies; Vocal Cord Paralysis; Vocal Cords; Voice Quality
PubMed: 31903781
DOI: 10.1177/0145561319894414 -
Journal of Cardiothoracic Surgery Oct 2023To present clinical experiences regarding surgical treatment of patients with severe cicatricial tracheal stenosis.
OBJECTIVE
To present clinical experiences regarding surgical treatment of patients with severe cicatricial tracheal stenosis.
PATIENTS AND METHODS
From January 2008 to March 2020, 14 patients underwent tracheal resection and reconstruction under general anesthesia. Nine cases had cervical tracheal stenosis and five cases had thoracic tracheal stenosis. The mean diameter and length of strictured trachea was 0 - 8 mm with a mean of 4.5 ± 2.4 mm and 1 - 3 cm with a mean of 1.67 ± 0.63 cm, respectively. General anesthesia and mechanical ventilation were performed in ten cases and four patients underwent femoral arteriovenous bypass surgery due to severe stenosis. End-to-end anastomosis of trachea was performed in 13 cases and the anastomosis between trachea and cricothyroid membrane was performed in one case. Absorbable and unabsorbable sutures were used for the anterior and posterior anastomoses, respectively. Postoperative neck anteflexion was maintained by a suture between the chin and superior chest wall. The relevant data of the 14 patients were retrospectively reviewed, and the operation time, blood loss, postoperative hospital stay, postoperative complications and follow-up were retrieved.
RESULTS
There was no intraoperative death. The length of resected trachea ranged from 1.5 to 4.5 cm with a mean of 1.67 ± 0.63 cm. Operation time ranged from 50 - 450 min with a mean of 142.8 ± 96.6 min and intraoperative hemorrhage ranged from 10 - 300 ml with a mean of 87.8 ± 83.6 ml. Follow-up period ranged from 5 to 43 months with a mean of 17.9 ± 10.6 months. None of the patients had recurrent laryngeal nerve paralysis during postoperative follow-up. Ten cases were discharged uneventfully. Anastomosis stenosis occurred in three cases who received interventional therapies. Bronchopleurocutaneous fistula occurred in one patient after 6 days postoperatively and further treatment was declined.
CONCLUSION
The strategies of anesthesia, mechanical ventilation, identification of stenosis lesion, the "hybrid" sutures and postoperative anteflexion are critical to be optimized for successful postoperative recovery.
Topics: Humans; Tracheal Stenosis; Constriction, Pathologic; Retrospective Studies; Trachea; Larynx; Anastomosis, Surgical; Treatment Outcome
PubMed: 37833733
DOI: 10.1186/s13019-023-02369-0