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Ear, Nose, & Throat Journal Jun 2022The hemangioma is the most common vascular tumor, involving the head and neck in 60% of cases. It is rare in the larynx. In children, hemangiomas are more frequent on... (Review)
Review
INTRODUCTION
The hemangioma is the most common vascular tumor, involving the head and neck in 60% of cases. It is rare in the larynx. In children, hemangiomas are more frequent on the subglottis, whereas in adults the most common site is the supraglottis. Laryngeal hemangioma with cavernous features isolated to the free edge of the vocal fold is a very rare clinical finding. We present 2 cases of glottic hemangioma. Both patients reported severe hoarseness.
CASES
In the first patient, an extensive blue-purple mass was seen on the right vocal cord. The patient was posted for microlaryngeal surgery with carbon dioxide (CO) laser. Second patient had a large, smooth, flesh-colored polypoid mass emanating from the left vocal cord. The patient was posted for microlaryngeal surgery. After 2 months, both patients showed a considerable voice improvement.
DISCUSSION
Vocal cord hemangiomas are very rare, and they usually cause problem in the voice of the patient. A vascular lesion that may mimic a hemangioma may sometimes result from an organizing hematoma following a hemorrhage on the vocal cords due to voice abuse. Laryngeal hemangiomas also need to be distinguished pathologically from polypoidal vascular granulation tissue that may be produced by laryngeal biopsy, intubation, or trauma. Indirect endoscopy is enough to diagnosis. No active treatment is advised for adult laryngeal hemangiomas unless the lesions are symptomatic or show a tendency to involve other parts. There is no uniformly accepted treatment of head and neck hemangiomas. Surgical excision with laser CO microlaryngoscopic techniques gives satisfactory results.
Topics: Adult; Carbon Dioxide; Child; Hemangioma; Humans; Laryngeal Neoplasms; Lasers, Gas; Vocal Cords
PubMed: 32921178
DOI: 10.1177/0145561320952191 -
Stem Cells Translational Medicine Feb 2017Patients with laryngeal disorders may have severe morbidity relating to swallowing, vocalization, and respiratory function, for which conventional therapies are...
Patients with laryngeal disorders may have severe morbidity relating to swallowing, vocalization, and respiratory function, for which conventional therapies are suboptimal. A tissue-engineered approach would aim to restore the vocal folds and maintain respiratory function while limiting the extent of scarring in the regenerated tissue. Under Good Laboratory Practice conditions, we decellularized porcine larynges, using detergents and enzymes under negative pressure to produce an acellular scaffold comprising cartilage, muscle, and mucosa. To assess safety and functionality before clinical trials, a decellularized hemilarynx seeded with human bone marrow-derived mesenchymal stem cells and a tissue-engineered oral mucosal sheet was implanted orthotopically into six pigs. The seeded grafts were left in situ for 6 months and assessed using computed tomography imaging, bronchoscopy, and mucosal brushings, together with vocal recording and histological analysis on explantation. The graft caused no adverse respiratory function, nor did it impact swallowing or vocalization. Rudimentary vocal folds covered by contiguous epithelium were easily identifiable. In conclusion, the proposed tissue-engineered approach represents a viable alternative treatment for laryngeal defects. Stem Cells Translational Medicine 2017;6:677-687.
Topics: Animals; Biomechanical Phenomena; Bronchoscopy; Cell Proliferation; Cells, Cultured; Female; Humans; Larynx; Mesenchymal Stem Cell Transplantation; Mesenchymal Stem Cells; Phonation; Recovery of Function; Regeneration; Sus scrofa; Time Factors; Tissue Engineering; Tissue Scaffolds; Tomography, X-Ray Computed; Vocalization, Animal
PubMed: 28191770
DOI: 10.5966/sctm.2016-0130 -
Anesthesiology Jan 2005Previous reports indicate that detrimental laryngeal function persists over several hours after tracheal extubation even in patients who have regained full consciousness... (Clinical Trial)
Clinical Trial Comparative Study Randomized Controlled Trial
BACKGROUND
Previous reports indicate that detrimental laryngeal function persists over several hours after tracheal extubation even in patients who have regained full consciousness from anesthesia. The authors hypothesize that even after minor surgery, the presence of an endotracheal tube (ETT) impairs the receptors at the vocal cord and diminishes the defensive laryngeal function. The hypothesis was tested by comparing types of experimentally induced laryngeal airway reflexes before and after surgery in anesthetized patients with use of either an ETT or a Laryngeal Mask Airway.
METHODS
Twenty adult patients undergoing elective minor surgeries were randomly allocated into two groups, the ETT and Laryngeal Mask Airway groups, depending on the airway management method used during surgery. While maintaining sevoflurane at 1 minimum alveolar concentration, laryngeal and respiratory responses were elicited by instillation of distilled water on the vocal cords immediately before and after surgery. Furthermore, the vocal cord angles were endoscopically measured under complete paralysis.
RESULTS
Some laryngeal reflex responses of both groups, particularly the cough reflex, were significantly attenuated after minor surgery. Significant narrowing of the glottic aperture was evident in patients with ETT placement but not in patients with Laryngeal Mask Airway placement.
CONCLUSIONS
With either airway intervention, laryngeal defensive reflexes are depressed immediately after surgery even without visible laryngeal swelling. The sensory impairment attributable to the presence of an ETT cannot be the solo factor responsible for the modification of the defensive airway reflexes elicited from the larynx.
Topics: Adult; Aged; Blood Gas Analysis; Electrophysiology; Female; Humans; Intubation, Intratracheal; Laryngeal Masks; Larynx; Male; Middle Aged; Physical Stimulation; Reflex; Respiratory Mechanics; Vocal Cords
PubMed: 15618782
DOI: 10.1097/00000542-200501000-00007 -
Fa Yi Xue Za Zhi Jun 2018To study the main features of mechanical asphyxia--the pathological characteristics of petechial hemorrhage after high temperature effect (roasted, boiled) and its...
OBJECTIVES
To study the main features of mechanical asphyxia--the pathological characteristics of petechial hemorrhage after high temperature effect (roasted, boiled) and its changing rules.
METHODS
Rabbit model of mechanical asphyxia death with choking neck and death from anteposition hanging was established. The experimental rabbits were randomly divided into roasted group and boiled group (=4, in each group). The laryngeal ventricles and cardiopulmonary tissues in the roasted group were roasted for 3, 6 and 10 min, and the positions of petechial hemorrhage were observed and photographed. The same organs and tissues in the boiled group were heated in boiling water (100 ℃), and were observed and photographed at 30 and 60 s. Then histopathological examination was performed on all the laryngeal ventricles and cardiopulmonary tissues.
RESULTS
The petechial hemorrhage originating from laryngeal ventricle, trachea and lung did not disappear after high temperature treatment in the eight rabbits. The deepened color was visible to naked eyes and distinct from the surrounding normal tissues, with bleeding under the microscope.
CONCLUSIONS
Petechial hemorrhage caused by mechanical asphyxia would not disappear under high temperature, which might be related to the manner of death, the intensity and time of action, and the individual differences.
Topics: Animals; Asphyxia; Fever; Hemorrhage; Purpura; Rabbits; Temperature
PubMed: 30896101
DOI: 10.12116/j.issn.1004-5619.2018.06.011 -
The Laryngoscope Feb 2021Idiopathic subglottic stenosis (iSGS) is a chronic inflammatory condition that causes dyspnea and affects middle-aged women of White race and non-Latino or Hispanic...
OBJECTIVE
Idiopathic subglottic stenosis (iSGS) is a chronic inflammatory condition that causes dyspnea and affects middle-aged women of White race and non-Latino or Hispanic ethnicity. To better characterize its phenotype and pathogenesis, we assessed the proteomic and genomic methylation signatures of subglottic tissue collected from iSGS patients compared to controls.
STUDY DESIGN
Molecular analysis of clinical biospecimens.
METHODS
We collected subglottic tissue biopsies from 12 patients during direct laryngoscopy, immediately prior to surgical treatment of iSGS; as well as from 4 age-, sex-, and race/ethnicity-matched control patients undergoing other direct laryngoscopic procedures. We isolated protein and genomic DNA, acquired proteomic data using label-free quantitative mass spectrometry techniques, and acquired genome-wide methylation data using bisulfite conversion and a microarray platform. We compared molecular profiles across the iSGS and control groups, and with respect to clinical course in the iSGS group. Eight of the 12 iSGS patients underwent subsequent blood collection and plasma isolation for further assessment.
RESULTS
Proteomic analysis revealed 42 differentially abundant proteins in the iSGS biopsies compared to controls, inferring enrichment of biological pathways associated with early wound healing, innate immunity, matrix remodeling, and metabolism. Proteome-based hierarchical clustering organized patients into two iSGS and one control subgroups. Methylation analysis revealed five hypermethylated genes in the iSGS biopsies compared to controls, including the biotin recycling enzyme biotinidase (BTD). Follow-up analysis showed elevated plasma BTD activity in iSGS patients compared to both controls and published normative data.
CONCLUSION
iSGS exhibits distinct proteomic and genomic methylation signatures. These signatures expand current understanding of the iSGS phenotype, support the possibility of disease subgroups, and should inform the direction of future experimental studies.
LEVEL OF EVIDENCE
Not applicable Laryngoscope, 131:E540-E546, 2021.
Topics: Adult; Aged; Biomarkers; Biopsy; Biotin; Case-Control Studies; DNA Methylation; Female; Humans; Laryngostenosis; Larynx; Middle Aged; Proteomics
PubMed: 32619300
DOI: 10.1002/lary.28851 -
Medical Microbiology and Immunology Aug 2019Cytomegalovirus (CMV) infection has a profound impact on the host's immune system. Immunological imprinting by CMV is not restricted to immunity against CMV itself, but... (Review)
Review
Cytomegalovirus (CMV) infection has a profound impact on the host's immune system. Immunological imprinting by CMV is not restricted to immunity against CMV itself, but can affect immunity against other viral or non-viral infectious agents and also immunopathological responses. One category is heterologous immunity based on molecular mimicry, where antigen recognition receptors specific for a CMV antigen with broad avidity distribution also bind with some avidity to unrelated antigens and exert effector functions against target structures other than those linked to CMV. Another category is induction of cytokines by CMV infection that inhibit or drive immune responses to bystander antigens unrelated to CMV, and a third category is the activation of antigen-presenting cells by CMV from which unrelated antigens profit as "stowaways". A striking example of the "stowaway" category, actually one that is of medical importance, has been published recently and will be discussed here for the more general reader. Specifically, in a murine model, CMV airway infection and inhaled environmental antigen of poor intrinsic allergenic potential were found to sensitize for allergic airway disease (AAD) only when combined. As to the mechanism, viral activation of CD11b conventional dendritic cells (CD11b cDC) that localize to airway mucosa facilitates uptake and processing of inhaled antigen. Thus, CMV serves as a "door opener" for otherwise harmless environmental antigens that have no intrinsic property to activate DC. Antigen-laden CD11b cDC migrate selectively to the airway draining lymph nodes, where they prime type-2 CD4 T helper (Th-2) cells. Upon airway re-exposure to the inhaled antigen, Th-2 cells secrete interleukins (IL-4, IL-5, IL-9, and IL-25) known to induce goblet cell metaplasia, the lead histopathological manifestation of AAD that is characterized by thickening of airway epithelia and increased numbers of mucus-producing goblet cells, resulting in enhanced mucus secretion and airflow obstruction.
Topics: Animals; Asthma; Cell Differentiation; Cytokines; Cytomegalovirus Infections; Dendritic Cells; Disease Models, Animal; Goblet Cells; Mice; Mucus; Th2 Cells
PubMed: 31076879
DOI: 10.1007/s00430-019-00610-z -
Annals of Surgery May 2012The present review illustrates the state of the art of regenerative medicine (RM) as applied to surgical diseases and demonstrates that this field has the potential to... (Review)
Review
The present review illustrates the state of the art of regenerative medicine (RM) as applied to surgical diseases and demonstrates that this field has the potential to address some of the unmet needs in surgery. RM is a multidisciplinary field whose purpose is to regenerate in vivo or ex vivo human cells, tissues, or organs to restore or establish normal function through exploitation of the potential to regenerate, which is intrinsic to human cells, tissues, and organs. RM uses cells and/or specially designed biomaterials to reach its goals and RM-based therapies are already in use in several clinical trials in most fields of surgery. The main challenges for investigators are threefold: Creation of an appropriate microenvironment ex vivo that is able to sustain cell physiology and function in order to generate the desired cells or body parts; identification and appropriate manipulation of cells that have the potential to generate parenchymal, stromal and vascular components on demand, both in vivo and ex vivo; and production of smart materials that are able to drive cell fate.
Topics: Animals; Biocompatible Materials; Blood Vessel Prosthesis; Cell Transplantation; Chondroitin Sulfates; Collagen; Dermatologic Surgical Procedures; Gastrointestinal Tract; General Surgery; Heart Failure; Humans; Kidney Failure, Chronic; Larynx; Liver Transplantation; Regenerative Medicine; Respiratory Tract Diseases; Skin, Artificial; Tissue Scaffolds; Wound Healing; Wounds and Injuries
PubMed: 22330032
DOI: 10.1097/SLA.0b013e318243a4db -
BMJ Case Reports Dec 2021Laryngeal varices are rare and are usually associated with vocal cord trauma secondary to excessive use of voice. This report is the first documented case of laryngeal...
Laryngeal varices are rare and are usually associated with vocal cord trauma secondary to excessive use of voice. This report is the first documented case of laryngeal varices secondary to thyroid goitre. This is a report of an 83-year-old woman with a known retrosternal goitre chiefly with symptoms of globus. Retrosternal goitre was found to be compressing the pharyngeal venous plexus causing laryngeal venous structures bilaterally to be engorged along the aryepiglottic folds, arytenoids, posterior commissure and extending in to the postcricoid region. The presence of laryngeal varices carries a significant increased risk of haemorrhage. This case presents an atypical presentation of globus and the first reported case in the literature of laryngeal varices secondary to a thyroid goitre.
Topics: Aged, 80 and over; Arytenoid Cartilage; Female; Goiter, Substernal; Humans; Laryngeal Diseases; Larynx; Varicose Veins
PubMed: 34969797
DOI: 10.1136/bcr-2021-246413 -
Investigative Ophthalmology & Visual... Mar 2023Dry eye is closely related to the activation and proliferation of immune cells, especially T cells. However, the determination of the preferential T-cell clonotypes is...
PURPOSE
Dry eye is closely related to the activation and proliferation of immune cells, especially T cells. However, the determination of the preferential T-cell clonotypes is technically challenging. This study aimed to investigate the characterization of T-cell receptor (TCR) repertoire in the conjunctiva during dry eye.
METHODS
A desiccating stress animal model was established using C57/BL6 mice (8-10 weeks, female). After 7 days of stress stimulation, the slit-lamp image and Oregon-green-dextran staining were used to evaluate the ocular surface injury. Periodic acid-Schiff staining was used to measure the number of goblet cells. Flow cytometry was used to detect the activation and proliferation of T cells in the conjunctiva and cervical lymph nodes. Next-generation sequencing was used to detect the αβ TCR repertoire of the conjunctiva.
RESULTS
The αβ TCR diversity increased significantly in the dry eye group, including the higher CDR3 amino acid length, marked gene usage on TCR V and J gene segments, extensive V(D)J recombination, and distinct CDR3 aa motifs. More important, several T-cell clonotypes were uniquely identified in dry eye. Furthermore, these perturbed rearrangements were reversed after glucocorticoid administration.
CONCLUSIONS
A comprehensive analysis of the αβ TCR repertoire in the conjunctiva of the dry eye mouse model was performed. Data in this study contributed significantly to the research on dry eye pathogenesis by demonstrating the TCR gene distribution and disease-specific TCR signatures. This study further provided some potential predictive T-cell biomarkers for future studies.
Topics: Female; Animals; Mice; T-Lymphocytes; Conjunctiva; Goblet Cells; Disease Models, Animal; Eye Injuries; Povidone; Receptors, Antigen, T-Cell
PubMed: 36877515
DOI: 10.1167/iovs.64.3.14 -
International Journal of Surgery... Aug 2023Transoral endoscopic thyroidectomy vestibular approach (TOETVA) is a scarless alternative to open thyroidectomy (OT). This systematic review and meta-analysis aimed to... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Transoral endoscopic thyroidectomy vestibular approach (TOETVA) is a scarless alternative to open thyroidectomy (OT). This systematic review and meta-analysis aimed to synthesize evidence comparing the intraoperative and postoperative outcomes of TOETVA and OT.
METHODS
A systematic literature search of PubMed, Web of Science, the Cochrane Library, and Google Scholar was performed to identify studies comparing the outcomes of TOETVA and OT published before February 2023. The outcomes of interest were operative time, intraoperative blood loss, hospital stay, postoperative pain, number of central lymph nodes retrieved, number of metastatic central lymph nodes, and incidences of transient and permanent recurrent laryngeal nerve injury, transient and permanent hypocalcemia, hematoma, and infection.
RESULTS
Thirteen studies published between 2016 and 2022, involving a total of 2889 patients (TOETVA, n =1085; OT, n =1804) were included in this systematic review and meta-analysis. Meta-analysis showed that the TOETVA group had a significantly longer overall operative time (weighted mean difference [WMD] 55.19; 95% CI, 39.15, 71.23; P <0.001), longer hospital stay (WMD, 0.27; 95% CI, 0.14, 0.39; P <0.001), and lower pain scores on postoperative day 1 (WMD, -1.41; 95% CI, -2.79, -0.03; P =0.04) than the OT group. Other intraoperative and postoperative outcomes were not significantly different between the groups.
CONCLUSION
TOETVA has a similar safety profile to OT with less postoperative pain, making it an appropriate and more cosmetically appealing alternative to OT for select patients.
Topics: Humans; Thyroidectomy; Endoscopy; Pain, Postoperative; Operative Time; Blood Loss, Surgical; Natural Orifice Endoscopic Surgery; Thyroid Neoplasms
PubMed: 37161554
DOI: 10.1097/JS9.0000000000000444