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Gray R, Pradhan PM, Hoffmeister J, Misono S, Cho R, Tignanelli C. Risk of Post-Intubation Laryngotracheal Stenosis With Respect to COVID-19 Status in a Large Multicenter Cohort Cross-Sectional Study. Crit Care Explor 2024; 6:e1081. [PMID: 38638181 PMCID: PMC11025709 DOI: 10.1097/cce.0000000000001081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2024] Open
Abstract
OBJECTIVES Occurrence of post-intubation laryngotracheal stenosis (LTS) with respect to COVID-19 status. DESIGN Retrospective cross-sectional inpatient database. SETTING Eleven Midwest academic and community hospitals, United States. PATIENTS Adults, mechanically ventilated, from January 2020 to August 2022, who were subsequently readmitted within 6 months with a new diagnosis of LTS. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Six thousand eight hundred fifty-one COVID-19 negative and 1316 COVID-19 positive patients were intubated and had similar distribution by age (median 63.77 vs. 63.16 yr old), sex (male, 60.8%; n = 4173 vs. 60%; n = 789), endotracheal tube size (≥ 7.5, 75.8%; n = 5192 vs. 75.5%; n = 994), and comorbidities. The ICU length of stay (median [interquartile range (IQR)], 7.23 d [2.13-16.67 d] vs. 3.95 d [1.91-8.88 d]) and mechanical ventilation days (median [IQR], 5.57 d [1.01-14.18 d] vs. 1.37 d [0.35-4.72 d]) were longer in the COVID-19 positive group. The occurrence of LTS was double in the COVID-19 positive group (12.7%, n = 168 vs. 6.4%, n = 440; p < 0.001) and was most commonly diagnosed within 60 days of intubation. In multivariate analysis, the risk of LTS increased by 2% with each additional ICU day (hazard ratio [HR], 1.02; 95% CI, 1.02-1.03; p < 0.001), by 3% with each additional day of ventilation (HR, 1.03; 95% CI, 1.02-1.04; p < 0.001), and by 52% for each additional reintubation (HR, 1.52; 95% CI, 1.36-1.71; p < 0.001). We observed no significant association COVID-19 status and risk of LTS. CONCLUSIONS The occurrence of post-intubation LTS was double in a COVID-19 positive cohort, with higher risk with increasing number of days intubated, days in the ICU and especially with the number of reintubations. COVID-19 status was not an independent risk factor for LTS.
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Affiliation(s)
- Raluca Gray
- Department of Otolaryngology, Head and Neck Surgery, University of Minnesota, Minneapolis, MN
| | | | - Jesse Hoffmeister
- Department of Otolaryngology, Head and Neck Surgery, University of Minnesota, Minneapolis, MN
| | - Stephanie Misono
- Department of Otolaryngology, Head and Neck Surgery, University of Minnesota, Minneapolis, MN
| | - Roy Cho
- Department of Medicine, Division of Interventional Pulmonology, University of Minnesota, Minneapolis, MN
| | - Christopher Tignanelli
- Department of Surgery, Division of Critical Care/Acute Care Surgery, University of Minnesota, Minneapolis, MN
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Kaur T, Baijal N, Jana M, Manchanda S, Naranje P, Bhalla AS. Ultrasound in Causes of Stridor in Children. J Ultrasound Med 2024; 43:801-806. [PMID: 38205904 DOI: 10.1002/jum.16390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 08/27/2023] [Accepted: 12/03/2023] [Indexed: 01/12/2024]
Abstract
Airway ultrasound (US) is an easily available, portable, radiation-free imaging modality for quick, non-invasive, dynamic evaluation of the airway without sedation. This is useful in children with stridor, which is an emergency due to upper airway obstruction requiring immediate management. Several causes of stridor including laryngomalacia, laryngeal cyst, subglottic hemangioma, vocal cord palsy, and lymphatic malformations can be evaluated accurately. Thin musculature and unossified cartilages in children provide a good acoustic window. Thus, airway US is valuable, but underutilized for the evaluation of children with stridor. In this case-based review, we describe the technique, indications, anatomy, and pathologies on airway US.
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Affiliation(s)
- Tejinder Kaur
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Neha Baijal
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Manisha Jana
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Smita Manchanda
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Priyanka Naranje
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Ashu Seith Bhalla
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
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Muslim NN, Mohd Shakri N, Kalimuthu S, Gopalan S, Zainal Abidin PNB. Vallecular Cysts in Newborns: A Case Series Demystifying the Obscured Anomaly. Cureus 2024; 16:e57626. [PMID: 38707170 PMCID: PMC11070219 DOI: 10.7759/cureus.57626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2024] [Indexed: 05/07/2024] Open
Abstract
A vallecular cyst is a rare diagnosis in newborns presented with stridor, which poses a significant threat to the well-being of infants. This potentially life-threatening condition is associated with a range of complications, including respiratory distress, feeding difficulties, and failure to thrive. Through this case series, we aim to shed light on the suspicion of vallecular cysts in newborns presenting with stridor and the complexities encountered during their management, highlighting the importance of early recognition and intervention. We presented a case series consisting of three newborns who presented with stridor and respiratory distress symptoms to our center. All three cases were diagnosed using a flexible laryngoscope, and surgical intervention was done. The vallecular cyst was removed, and subsequent follow-up showed no recurrence of the lesion. This case series highlights the importance of early suspicion and recognition of vallecular cysts in newborns, emphasizing the thorough examination during diagnostic evaluations. Proper surgical planning and appropriate ventilation strategies are essential for the successful management and resolution of symptoms.
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Affiliation(s)
- Noorain Nadhrah Muslim
- Otolaryngology - Head and Neck Surgery, Universiti Kebangsaan Malaysia (UKM), Kuala Lumpur, MYS
| | - Nadhirah Mohd Shakri
- Otolaryngology - Head and Neck Surgery, Universiti Kebangsaan Malaysia (UKM), Kuala Lumpur, MYS
| | - Santhi Kalimuthu
- Otolaryngology - Head and Neck Surgery, Hospital Tengku Ampuan Rahimah, Klang, MYS
| | - Shashi Gopalan
- Otolaryngology - Head and Neck Surgery, Hospital Tengku Ampuan Rahimah, Klang, MYS
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4
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Puri S, Jafra A, Dogra N, Sen IM, Solanki S. Anesthetic Management of a Massive Cystic Hygroma of the Neck in a Neonate. J Indian Assoc Pediatr Surg 2024; 29:183-185. [PMID: 38616834 PMCID: PMC11014163 DOI: 10.4103/jiaps.jiaps_197_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 12/11/2023] [Accepted: 12/27/2023] [Indexed: 04/16/2024] Open
Abstract
Cystic hygroma of the neck, a congenital benign tumor of the lymphatic system, is a potential cause of neonatal airway obstruction leading to stridor. Meticulous airway evaluation, case appropriate preparation, and use of advanced technology, including videolaryngoscope and ultrasonography, can facilitate the safe management of the difficult airway.
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Affiliation(s)
- Sunaakshi Puri
- Department of Anaesthesia, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anudeep Jafra
- Department of Anaesthesia, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Neeti Dogra
- Department of Anaesthesia, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Indu Mohini Sen
- Department of Anaesthesia, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shailesh Solanki
- Department of Pediatric Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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5
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Pan C, Chen C. Stridor caused by endobronchial lymphoma in a middle-aged woman. Respirol Case Rep 2024; 12:e01335. [PMID: 38528949 PMCID: PMC10963131 DOI: 10.1002/rcr2.1335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 03/13/2024] [Indexed: 03/27/2024] Open
Abstract
Diffuse large B-cell lymphoma, primarily nodal in nature, can present with rare endobronchial involvement, underscoring the importance of considering it in the differential diagnoses of endobronchial lesions.
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Affiliation(s)
- Chih‐hsi Pan
- Division of Pulmonary and Critical Care Medicine, Department of Internal MedicineTri Service General Hospital, National Defense Medical CenterTaipei CityTaiwan
| | - Chien‐wen Chen
- Division of Pulmonary and Critical Care Medicine, Department of Internal MedicineTri Service General Hospital, National Defense Medical CenterTaipei CityTaiwan
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6
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Kanotra SP, Rand D, Mulanax C. Transcervical Epiglottopexy: A versatile technique for managing epiglottic prolapse. Otolaryngol Head Neck Surg 2024; 170:380-390. [PMID: 37622519 DOI: 10.1002/ohn.488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/23/2023] [Accepted: 07/29/2023] [Indexed: 08/26/2023]
Abstract
OBJECTIVE Epiglottic prolapse (EP) presents a unique management challenge. The objective of the present case series is to present clinical outcomes using a novel technique of transcervical epiglottopexy (TCE) in etiologically diverse cases of EP and to discuss the evolution of the surgical technique with technical modifications to optimize the surgical procedure. STUDY DESIGN A retrospective case series review. SETTING Tertiary care academic setting. METHODS Pediatric cases with EP over a 3-year period. Demographic data including age, sex, presenting symptoms, operative details, and polysomnographic indices were collected. RESULTS A total of 18 patients with a mean age of 48.88 ± 37.3 months underwent TCE. Sixty-seven percent of patients had high-grade EP (grades 3 and 4). A previous endolaryngeal epiglottopexy had been performed in 5 (28%) patients. Fourteen (78%) patients had a concurrent airway procedure performed including 4 undergoing single-stage laryngotracheal reconstruction. The mean suspension time only for the TCE part ranged from 8 to 17 minutes with a mean of 11.23 ± 3.4 minutes. A stable EP defined as a healed glossoepiglottic adhesion was achieved in all but 1 case with an overall success rate of 95%. All cases with previous failed endoscopic epiglottopexy had a stable epiglottopexy. No immediate complications were noticed. Among the late complications, the most common was the formation of granulation tissue at the site of silastic disc placement which was seen in 3 patients. CONCLUSION TCE using an exo-endolaryngeal technique can achieve stable epiglottopexy in children with EP and can be adapted for any kind of EP.
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Affiliation(s)
- Sohit Paul Kanotra
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals & Clinics, Iowa City, Iowa, USA
| | - Dayton Rand
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals & Clinics, Iowa City, Iowa, USA
| | - Catalina Mulanax
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals & Clinics, Iowa City, Iowa, USA
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7
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Ezeh UC, Ben-Dov T, Taufique ZM, Gaffey MM, Blei F, April MM. A New Approach for Diagnosis and Surveillance of Infantile Subglottic Hemangioma in the Era of Propranolol Use: A Case Series. Ann Otol Rhinol Laryngol 2024; 133:145-151. [PMID: 37551026 DOI: 10.1177/00034894231191831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
OBJECTIVE To report our institutional experience in diagnosing and surveilling patients with infantile subglottic hemangioma (SGH) using in-office flexible fiberoptic laryngoscopy (FFL) with video technology, without requiring operative endoscopy in the era of propranolol use. METHODS A retrospective case series was conducted on 4 children diagnosed with SGH between 2016 and 2022 at our institution. RESULTS Awake FFL with video technology provided adequate visualization of SGH lesions for diagnosis, without any complications. Serial examinations of the airway were performed in the outpatient setting and each SGH gradually regressed, with marked improvement in respiratory symptoms within 48 hours of oral propranolol initiation. CONCLUSION Our findings showed that in select patients, FFL with video technology can successfully identify SGH lesions without general anesthesia exposure. FFL may be used as a low-risk screening tool for propranolol therapy initiation in some patients, but operative endoscopy should remain the gold standard procedure for others. By utilizing FFL in this manner, it is possible to diagnose SGH lesions and start propranolol therapy without exposing all patients to the risks of operative endoscopy.
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Affiliation(s)
- Uche C Ezeh
- Division of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, NY, USA
| | - Tom Ben-Dov
- Division of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, NY, USA
| | - Zahrah M Taufique
- Division of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, NY, USA
| | - Megan M Gaffey
- Division of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, NY, USA
| | - Francine Blei
- Division of Pediatric Hematology/Oncology/Vascular Program, Hassenfeld Children's Hospital, NYU Langone, New York, NY, USA
| | - Max M April
- Division of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, NY, USA
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Alrashdan H, Alshugran K, Alshiyyab OM, Khasawneh JF, Ibrahim EN. An Uncommon Epiglottic Cyst Presentation in an Adolescent: A Case Report and Literature Review. Cureus 2024; 16:e54634. [PMID: 38524016 PMCID: PMC10959541 DOI: 10.7759/cureus.54634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2024] [Indexed: 03/26/2024] Open
Abstract
Epiglottic cysts are benign lesions of the larynx that are relatively rare beyond infancy age. A 17-year-old adolescent male patient presented to the outpatient specialized oropharyngeal clinic with inspiratory stridor, chronic sore throat, and progressive dyspnea symptoms over the past eight months. Examination by a headlight and a tongue depressor showed a large cystic lesion arising from the hypopharynx. A neck computed tomography (CT) scan revealed a 4 cm oval cyst attached to the lingual epiglottic surface. The relatively large epiglottic cyst was drained directly in the clinic and was later removed by microlaryngosurgery with traditional microinstrumentation in a follow-up visit. Subsequent recovery was uneventful. Regardless of the rarity of epiglottic cysts in adolescents, doctors should keep in mind this etiology as early diagnosis and management could spare the patient from life-threatening complications or tracheostomy and unneeded medical costs.
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9
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Nerurkar NK, Sarkar A. Correlation of narrow-band imaging findings using the Ni and European Laryngeal Society classification systems during in-office flexible laryngoscopy with histopathology. J Laryngol Otol 2024; 138:203-207. [PMID: 37332169 DOI: 10.1017/s0022215123001159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
OBJECTIVE This study used the European Laryngeal Society (2016) and Ni (2011 and 2019) classifications for narrow-band imaging and correlated the findings with histopathology. METHODS Retrospective analysis was conducted by retrieving data of patients who underwent micro-laryngoscopy for suspicious glottic lesions. The narrow-band imaging findings were classified using both classification systems. Retrieved histopathology report findings were correlated with narrow-band imaging data. RESULTS Using the European Laryngeal Society and Ni classifications, 37 (69.8 per cent) and 35 (66 per cent) patients, respectively, were suspected to have malignant lesions. Upon histopathology, 37 (69.8 per cent) lesions were malignant. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy using the European Laryngeal Society classification were 91.9 per cent, 81.3 per cent, 91.9 per cent, 81.3 per cent and 88.7 per cent, and using the Ni classification were 91.9 per cent, 93.8 per cent, 97.1 per cent, 83.3 per cent and 92.5 per cent, respectively. CONCLUSION The Ni classification had better specificity and accuracy. The European Laryngeal Society classification is simple to use and may serve as a useful screening tool. For optimum results, both European Laryngeal Society and Ni classifications may be used together, in that order.
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Affiliation(s)
- Nupur Kapoor Nerurkar
- Bombay Hospital Voice and Swallowing Centre, Bombay Hospital and Medical Research Centre, Mumbai, India
| | - Asitama Sarkar
- Bombay Hospital Voice and Swallowing Centre, Bombay Hospital and Medical Research Centre, Mumbai, India
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10
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Kimpo J, Abu-Ghanem S, Chen L. New onset dyspnea and stridor in an adolescent with Urbach-Wiethe disease. Pediatr Pulmonol 2024. [PMID: 38265163 DOI: 10.1002/ppul.26868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/18/2023] [Accepted: 01/01/2024] [Indexed: 01/25/2024]
Affiliation(s)
- James Kimpo
- Department of Pediatrics, Maimonides Children's Hospital, Brooklyn, New York, USA
| | - Sara Abu-Ghanem
- Division of Otolaryngology, Maimonides Health, Brooklyn, New York, USA
| | - Linda Chen
- Department of Pediatrics, Maimonides Children's Hospital, Brooklyn, New York, USA
- Division of Pediatric Pulmonary, Maimonides Children's Hospital, Brooklyn, New York, USA
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11
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Zirek F, Özcan G, Tekin MN, Uçar Çİ, Kartal AT, Balaban B, Kendirli T, Teber ST, Çobanoğlu N. An infant with episodic stridor and respiratory crises since birth: A challenging diagnosis. Pediatr Pulmonol 2024. [PMID: 38251867 DOI: 10.1002/ppul.26866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 01/02/2024] [Accepted: 01/05/2024] [Indexed: 01/23/2024]
Affiliation(s)
- Fazılcan Zirek
- Department of Pediatrics, Division of Pediatric Pulmonology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Gizem Özcan
- Department of Pediatrics, Division of Pediatric Pulmonology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Merve Nur Tekin
- Department of Pediatrics, Division of Pediatric Pulmonology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Çiğdem İlter Uçar
- Department of Pediatrics, Division of Pediatric Neurology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Ayşe Tuğba Kartal
- Department of Pediatrics, Division of Pediatric Neurology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Burak Balaban
- Department of Pediatrics, Division of Pediatric Intensive Care Unit, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Tanıl Kendirli
- Department of Pediatrics, Division of Pediatric Intensive Care Unit, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Serap Tıraş Teber
- Department of Pediatrics, Division of Pediatric Neurology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Nazan Çobanoğlu
- Department of Pediatrics, Division of Pediatric Pulmonology, Faculty of Medicine, Ankara University, Ankara, Turkey
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12
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Hyland LD, Saville R, Dwiddar N, Sovani M. Bilateral Vocal Cord Palsy Secondary to Rheumatoid Arthritis. Cureus 2024; 16:e51958. [PMID: 38333461 PMCID: PMC10851048 DOI: 10.7759/cureus.51958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2024] [Indexed: 02/10/2024] Open
Abstract
Rheumatoid arthritis (RA) can cause a number of laryngeal manifestations; however, most of these do not cause an airway emergency. Airway obstruction due to vocal cord fixation of one or both vocal cords occurs late in the disease process of RA and can present as an inspiratory stridor. We report the case of an elderly lady who presented with acute stridor secondary to RA-induced bilateral vocal cord palsy and describe the various management options that were considered. An 85-year-old woman presented to A&E Resus with tachypnoea, stridor, and drowsiness. An arterial blood gas (ABG) was performed which showed hypercapnic respiratory failure on 60% oxygen with blood tests revealing moderately raised infective markers and a chest X-ray displaying right lower zone consolidation. A flexible nasendoscopy was performed which demonstrated bilaterally fixed and adducted vocal cords due to bilateral cricoarytenoid joint fixation, with a rima glottidis measurement of approximately 3 mm and evidence of paradoxical breathing. The patient had been admitted with a similar presentation 18 months before, however not as severe, and once again, the bilateral vocal cord palsy had been attributed to her longstanding RA. She was stabilised with non-invasive ventilation and transferred to the acute respiratory care unit. Long-term surgical options were thoroughly discussed including tracheostomy, vocal cord lateralisation, cordotomy, and arytenoidectomy, but ultimately, these options were all deemed unsuitable for the patient and so a palliative care approach was adopted following the withdrawal of bilevel positive airway pressure. Stridor is a late but life-threatening complication of RA that has viable surgical options of tracheostomy and static glottis enlarging procedures; however, the appropriateness of such procedures should always be correlated with the patient's current clinical status and the extent to which they may impact on the patient's quality of life.
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Affiliation(s)
- Liam D Hyland
- Otolaryngology, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, GBR
| | - Rachel Saville
- Respiratory Medicine, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, GBR
| | - Nada Dwiddar
- Otolaryngology, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, GBR
| | - Milind Sovani
- Respiratory Medicine, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, GBR
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Luhana M, Karim J. The Adult Epiglottitis Enigma: A Case Report. Cureus 2023; 15:e49984. [PMID: 38179346 PMCID: PMC10766345 DOI: 10.7759/cureus.49984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2023] [Indexed: 01/06/2024] Open
Abstract
Adult epiglottitis, once primarily associated with pediatric populations, has emerged as a distinctive clinical entity with potentially life-threatening implications. This condition is characterized by inflammation and swelling of the epiglottis, presenting initially as a seemingly benign sore throat and dysphagia but progressing rapidly to more severe symptoms such as drooling, severe odynophagia, hoarse voice, and acute upper airway obstruction. Timely diagnosis and intervention are paramount, as delayed presentation can result in fatal outcomes even in adults. The cornerstone of treatment involves securing the airway, providing supplemental oxygen, and administering intravenous antibiotics. In this report, we present a case of adult epiglottitis in a 20-year-old individual, discussing the clinical presentation, diagnostic considerations, and the essential components of its management. Recognition of adult epiglottitis as a distinct clinical entity is crucial for healthcare practitioners to ensure prompt intervention and optimize patient outcomes.
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Affiliation(s)
- Mitanshi Luhana
- Otolaryngology - Head and Neck Surgery, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, GBR
| | - Jumana Karim
- General Surgery, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, GBR
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Sun Y, Zhao H, Ma Y, An Y. Commentary: Comparative efficacies of various corticosteroids for preventing postextubation stridor and reintubation: a systematic review and network meta-analysis. Front Med (Lausanne) 2023; 10:1289321. [PMID: 38046411 PMCID: PMC10690941 DOI: 10.3389/fmed.2023.1289321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 11/01/2023] [Indexed: 12/05/2023] Open
Affiliation(s)
- Yao Sun
- Department of Critical Care Medicine, Peking University People's Hospital, Beijing, China
| | - Huiying Zhao
- Department of Critical Care Medicine, Peking University People's Hospital, Beijing, China
| | - Ye Ma
- Department of Anesthesiology, Peking University People's Hospital, Beijing, China
| | - Youzhong An
- Department of Critical Care Medicine, Peking University People's Hospital, Beijing, China
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15
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Poirier M, Walton RAL. The successful use of a subcutaneous catheter in the management of severe subcutaneous emphysema in a dog with laryngeal crush injury and tracheostomy tube placement. J Vet Emerg Crit Care (San Antonio) 2023; 33:710-714. [PMID: 37793056 DOI: 10.1111/vec.13322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 06/26/2022] [Accepted: 06/30/2022] [Indexed: 10/06/2023]
Abstract
OBJECTIVE To describe the placement of a subcutaneous catheter in a dog for the management of severe subcutaneous emphysema secondary to severe laryngeal crushing injury and temporary tracheostomy tube placement. CASE SUMMARY A 6-year-old male neutered Kelpie suffered a severe laryngeal crushing injury following a dog attack. Case management included the placement of a temporary tracheostomy tube due to severe respiratory compromise and inspiratory dyspnea associated with the crush injury. During hospitalization, the patient developed severe subcutaneous emphysema, pneumomediastinum, and a pneumothorax as a complication of the laryngeal crushing injury and temporary tracheostomy. A subcutaneous catheter was placed to manage the recurrent subcutaneous emphysema while the tracheostomy stoma healed. Five months posttrauma, the dog returned to normal with mild stridor during excitement and while panting. NEW OR UNIQUE INFORMATION PROVIDED This is the first report in veterinary medicine describing the use of a subcutaneous catheter for the management of subcutaneous emphysema secondary to laryngeal crush injury and temporary tracheostomy tube placement.
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Affiliation(s)
- Maude Poirier
- Department of Small Animal Emergency and Critical Care, College of Veterinary Medicine, Iowa State University, Ames, Iowa, USA
| | - Rebecca A L Walton
- Department of Small Animal Emergency and Critical Care, College of Veterinary Medicine, Iowa State University, Ames, Iowa, USA
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16
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Sabat S, Gonzalez L, Agarwal A. Pyolaryngocele Presenting with Acute-onset Stridor. Clin Pract Cases Emerg Med 2023; 7:266-267. [PMID: 38353199 PMCID: PMC10855277 DOI: 10.5811/cpcem.57238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 07/12/2023] [Accepted: 07/13/2023] [Indexed: 02/18/2024] Open
Abstract
Case presentation This case describes the classic imaging findings of pyolaryngocele and highlights the importance of prompt imaging for diagnosis of clinically occult airway lesions. The case also highlights how pyolaryngoceles can become large and present with acute-onset clinical symptoms, including stridor and dyspnea. Discussion Pyolaryngoceles represent an uncommon but life-threatening complication of laryngoceles. Laryngoceles are frequently seen as an incidental, abnormal, air-filled dilation of the laryngeal saccule related to various local pathologies of the larynx. They are often asymptomatic. Occasionally they can become secondarily infected, in which case they are called pyolaryngocele, and they can cause rapid-onset, life-threatening airway compromise.
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Affiliation(s)
- Shyam Sabat
- Mayo Clinic, Department of Radiology, Jacksonville, Florida
| | - Luis Gonzalez
- University of Florida, Department of Radiology, Gainesville, Florida
| | - Amit Agarwal
- University of Florida, Department of Radiology, Gainesville, Florida
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17
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Hazkani I, Stein E, Ghadersohi S, Ida J, Thompson DM, Valika T. Epiglottopexy in Infants Younger Than 6 Months Old: A Case Series. Ann Otol Rhinol Laryngol 2023; 132:1393-1399. [PMID: 36960699 DOI: 10.1177/00034894231160693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
BACKGROUND Severe laryngomalacia, characterized by apnea, hypoxia, and feeding difficulties, is an uncommon diagnosis that often requires surgical intervention with supraglottoplasty. Children who require surgery at a young age and those with additional comorbidities pose a special challenge and may require further surgical interventions. Posterior displacement of the epiglottis has been noted in some infants with congenital stridor and is commonly treated with epiglottopexy. The goal of our study is to review the outcomes of epiglottopexy combined with supraglottoplasty in our cohort of infants younger than 6 months old with severe laryngomalacia. METHODS A retrospective chart review of infants younger than 6 months old who underwent epiglottopexy combined with supraglottoplasty for severe laryngomalacia from January 2018 to July 2021 at a tertiary care children's hospital. RESULTS 13 patients (age 1.3 week-5.2 months) underwent supraglottoplasty and epiglottopexy for severe laryngomalacia and epiglottis retroflection. The patients were admitted to the intensive care unit and remained intubated for at least one night. All patients demonstrated subjective and objective improvement in upper airway respiratory signs and symptoms. Ten patients demonstrated aspiration immediately postoperatively, despite 4 of them having no concern for aspiration at preoperative evaluation. On follow-up, 1 patient required revision supraglottoplasty and epiglottopexy for persistent laryngomalacia, and 2 patients required tracheostomy tube placement due to cardiopulmonary comorbidities. CONCLUSION Infants younger than 6 months old with medical comorbidities undergoing epiglottopexy with supraglottoplasty may demonstrate significant improvement in respiratory symptoms. Worsening dysphagia may complicate the postoperative period, particularly among children with medical comorbidities.
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Affiliation(s)
- Inbal Hazkani
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Department of Otolaryngology-Head and Neck Surgery, Feinberg School of Medicine, Northwestern University, Chicago Illinois, IL, USA
| | - Eli Stein
- Department of Otolaryngology-Head and Neck Surgery, Feinberg School of Medicine, Northwestern University, Chicago Illinois, IL, USA
| | - Saied Ghadersohi
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Department of Otolaryngology-Head and Neck Surgery, Feinberg School of Medicine, Northwestern University, Chicago Illinois, IL, USA
| | - Jonathan Ida
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Department of Otolaryngology-Head and Neck Surgery, Feinberg School of Medicine, Northwestern University, Chicago Illinois, IL, USA
| | - Dana M Thompson
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Department of Otolaryngology-Head and Neck Surgery, Feinberg School of Medicine, Northwestern University, Chicago Illinois, IL, USA
| | - Taher Valika
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Department of Otolaryngology-Head and Neck Surgery, Feinberg School of Medicine, Northwestern University, Chicago Illinois, IL, USA
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18
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Bredun S, Kotowski M, Mezydlo J, Szydlowski J. Characteristics of Patients with Laryngomalacia: A Tertiary Referral Center Experience of 106 Cases. Diagnostics (Basel) 2023; 13:3180. [PMID: 37892001 PMCID: PMC10605856 DOI: 10.3390/diagnostics13203180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/10/2023] [Accepted: 10/05/2023] [Indexed: 10/29/2023] Open
Abstract
Laryngomalacia (LM) is the most common airway congenital anomaly and the main cause of stridor in infants. Some patients with severe airway symptoms or with feeding difficulties require surgical intervention. Synchronous airway lesions (SALs) may influence the severity and course of the disease. This study aimed to determine the prevalence of various types of LM and SALs and their influence on surgical intervention decisions and feeding difficulties. Moreover, the study focused on the interrelations between SALs and the type of LM or the presence of feeding difficulties. A retrospective analysis of 106 pediatric patients revealed a significant relationship between type 2 LM and the necessity of surgical treatment. We also found a significant effect of LM type 2 on feeding difficulty. Type 1 LM is significantly more characteristic in premature children. Among different comorbidities, SALs are suspected of modification of the course and severity of LM. This study did not find a significant effect of SALs on the incidence of supraglottoplasty or feeding difficulty.
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Affiliation(s)
| | - Michal Kotowski
- Department of Pediatric Otolaryngology, Poznan University of Medical Sciences, 27/33 Szpitalna Street, 60-572 Poznan, Poland
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19
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Alanzi O, Al-Faleh M, Alsheef H. Features and Associated Comorbidities of Laryngomalacia in Saudi Arabia. Cureus 2023; 15:e47432. [PMID: 38022359 PMCID: PMC10658749 DOI: 10.7759/cureus.47432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2023] [Indexed: 12/01/2023] Open
Abstract
Laryngomalacia (LM) is defined as the collapse of supraglottic structures during inspiration, resulting in intermittent airflow impedance and associated stridor. LM is the most prevalent cause of congenital stridor in newborns. The aim of this study is to determine the features and associated comorbidities of LM in Saudi Arabia and to delineate the diagnostic and therapeutic measures used, based on the severity of the case and related comorbidities. This is a three-year retrospective study of children diagnosed with LM and treated in the pediatric otorhinolaryngology outpatient clinic at Maternity and Children Hospital, Dammam, Saudi Arabia, between January 2018 and January 2022. The inclusion criteria were patients with signs and symptoms of LM who are younger than 14 years old. The diagnosis of LM was based on clinical evaluation and confirmed by nasopharyngolaryngoscopy in awake patients and/or direct laryngoscopy and scoping under general anesthesia with spontaneous ventilation for dynamic evaluation. The Olney classification was used for the morphological classification of LM. The exclusion criteria were patients lost to follow-ups. Follow-up duration was two years minimum. A total of 52 patients were included in the study. Among the participants, females accounted for 71% and males accounted for 29% of cases. Our results were in accordance with the relevant literature, except for the higher prevalence of LM in full-term neonates who were found to account for 69.2% of the cases. Understanding the patterns and characteristics of breathing may help clinicians distinguish the noisy breathing of LM from other illnesses because infants are frequently misdiagnosed with these conditions.
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Affiliation(s)
- Omar Alanzi
- Otorhinolaryngology, King Fahad Specialist Hospital, Dammam, SAU
| | - Moath Al-Faleh
- Otorhinolaryngology, King Fahad Specialist Hospital, Dammam, SAU
| | - Hussain Alsheef
- Pediatric Otorhinolaryngology, Maternity and Children Hospital, Dammam, SAU
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20
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So RJ, Franks Z, Espahbodi M, Ryan MA, Jenks C, Walsh J. Clinical Presentation of Pediatric Recurrent Croup: Implications for Diagnosis. Clin Pediatr (Phila) 2023; 62:871-878. [PMID: 37550866 DOI: 10.1177/00099228221150691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
Recurrent croup is a common clinical entity afflicting the pediatric population, but is not well-characterized in the literature. We describe the largest series of recurrent croup in North America from a single tertiary care academic center, and differentiate subpopulations based on demographic characteristics and clinical presentation. We identified 114 patients for inclusion. Common symptoms included barky cough (86.0%) and inspiratory stridor (60.5%). Many (26.3%) experienced full symptom resolution within a day, and 41.2% reported onset of symptoms at any time of the day. Male patients had a higher number of prior croup episodes at presentation compared with female patients (mean of 9.8 ± 8.0 in males vs 6.6 ± 4.8 in females, P = .03). On multivariate regression, racial/ethnic minority patients were at higher risk for dyspnea (odds ratio [OR]: 58.6; 95% confidence interval [CI]: 7.2-475.4) and upper respiratory infection prodrome (OR: 7.6; 95% CI: 1.6-35.3) compared with non-Hispanic white patients.
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Affiliation(s)
- Raymond J So
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Zechariah Franks
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mana Espahbodi
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Marisa A Ryan
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Carolyn Jenks
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jonathan Walsh
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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21
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Alotaibi FZ. Spontaneous epiglottic abscess: pathophysiology and airway management options. J Surg Case Rep 2023; 2023:rjad481. [PMID: 37614468 PMCID: PMC10444310 DOI: 10.1093/jscr/rjad481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 08/05/2023] [Indexed: 08/25/2023] Open
Abstract
Laryngeal abscesses are rare in the modern antibiotic era. This report presents a novel case of an epiglottic abscess in a patient with diabetes who developed respiratory distress and was managed by awake intubation in the emergency room followed by transoral incision and drainage of the abscess and tracheostomy. Full recovery after 1 week of intravenous antibiotic treatment was observed. Surgical intervention is necessary for treatment and culture-directed antimicrobial therapy. Poorly controlled diabetes is a newly described risk factor for spontaneous epiglottic abscess development.
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Affiliation(s)
- Fahad Z Alotaibi
- Department of Otolaryngology—Head and Neck Surgery, Imam Mohammad Ibn Saud Islamic University IMSIU, Riyadh 13317-4233, Saudi Arabia
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22
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Petreschi F, Coretti A, Porcaro F, Toscano A, Campanale CM, Trozzi M, Secinaro A, Allegorico A, Cutrera R, Carotti A. Pediatric airway compression in aortic arch malformations: a multidisciplinary approach. Front Pediatr 2023; 11:1227819. [PMID: 37547103 PMCID: PMC10401269 DOI: 10.3389/fped.2023.1227819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 07/05/2023] [Indexed: 08/08/2023] Open
Abstract
Background Aortic arch malformations (AAMs) should be suspected in the presence of persistent respiratory symptoms despite medical treatment or feeding problems at the pediatric age. Aim We report a descriptive cohort of patients with AAMs and the local management protocol applied. Methods A total of 59 patients with AAM were retrospectively reviewed. Three groups were identified: double aortic arch (DAA), group 1; complete vascular ring (non-DAA), group 2; and anomalous origin of the innominate artery (IA), group 3. Results Prenatal diagnosis was available for 62.7% of the patients. In all, 49.2% of children were symptomatic. There was a significantly different prevalence of respiratory symptoms within the three groups: 73.7% in group 1, 24.2% in group 2, and 100% in group 3 (p-value: <0.001). Surgery was considered in the presence of symptoms in patients with DAA and in those with reduction of the tracheal section area greater than 50%. A total of 52.5% of the patients underwent surgical repair (median age 6 months). The median follow-up interval was 21.9 months. Respiratory symptoms improved in most symptomatic patients. Conclusions No specific protocols are available for the management of patients with AAMs. Conservative treatment seems to be reasonable for asymptomatic patients or those with airway stenosis less than 50%. A close follow-up is necessary to identify early patients who become symptomatic.
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Affiliation(s)
- Francesca Petreschi
- Pediatric Pulmonology and Cystic Fibrosis Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Antonella Coretti
- Pediatric Pulmonology and Cystic Fibrosis Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Federica Porcaro
- Pediatric Pulmonology and Cystic Fibrosis Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Alessandra Toscano
- Perinatal Cardiology Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | | | - Marilena Trozzi
- Airway Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Aurelio Secinaro
- Advanced Cardiothoracic Imaging Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Annalisa Allegorico
- Pediatric Pulmonology and Cystic Fibrosis Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Renato Cutrera
- Pediatric Pulmonology and Cystic Fibrosis Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Adriano Carotti
- Unit of Complex Cardiac Surgery with Innovative Techniques, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
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23
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Sadidi H, Bahrami Taqanaki P, Amirfakhrian H, Rezaei R. Tracheal hemangioma: a case report and literature review. Ann Med Surg (Lond) 2023; 85:3615-3622. [PMID: 37427188 PMCID: PMC10328570 DOI: 10.1097/ms9.0000000000000850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 05/10/2023] [Indexed: 07/11/2023] Open
Abstract
Hemangiomas are the most common vascular tumors in children. Although hemangiomas are common, they are rarely seen in areas like the trachea and larynx.The most common clinical manifestations in tracheal hemangiomas are stridor and respiratory distress. The main diagnostic method is bronchoscopy. Other imaging techniques like computed tomography scans and MRIs are also helpful. Various treatment options are now used for treating the disease, including beta blockers like propranolol, local and systemic steroids, and surgical resection. Case presentation An 8-year-old boy with the chief complaint of severe progressive dyspnea and a history of neonatal postbreastfeeding cyanosis was admitted. On physical examination, he had tachypnea, and stridor was heard upon auscultation. There was no history of fever, chest pain, or coughing. He underwent a rigid bronchoscopy followed by a neck computed tomography scan. The results indicated a soft tissue mass with a vascular nature. An MRI of the neck confirmed the diagnosis of tracheal hemangioma. The mass was not resectable during surgery; hence, angioembolization was carried out. Treatment was successful and there was no recurrence on the follow-up. Clinical discussion Based on the findings in this literature review tracheal hemangiomas present with stridor, progressive respiratory distress, dyspnea, hemoptysis, and chronic coughs. Advanced tracheal hemangiomas commonly do not reduce in size by themselves and need treatment. A close follow-up ranging from 3 months to 1 year is recommended. Conclusion Although tracheal hemangiomas are rare they should be considered in the differential diagnosis of severe dyspnea and stridor.
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Affiliation(s)
- Hossein Sadidi
- Thoracic Surgery Department of Ghaem Hospital, Mashhad University of Medical Sciences
| | | | - Hamed Amirfakhrian
- Thoracic Surgery Department of Ghaem Hospital, Mashhad University of Medical Sciences
| | - Reza Rezaei
- Endoscopic and Minimally Invasive Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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24
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Lawrence A, Gener M, Jiang S, Arganbright J. Oropharyngeal Teratoma: Five-Month-Old Presenting With Failure to Thrive and Severe Obstructive Sleep Apnea. Cureus 2023; 15:e42578. [PMID: 37641749 PMCID: PMC10460287 DOI: 10.7759/cureus.42578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2023] [Indexed: 08/31/2023] Open
Abstract
Oropharyngeal teratomas are an extremely rare congenital tumor. They are often diagnosed prenatally and can cause significant airway obstruction and feeding difficulties at birth. We present a five-month-old female that was diagnosed with a palatal teratoma that presented with failure to thrive, difficulty feeding, and eventually with severe obstructive sleep apnea. We present a five-month-old term, otherwise healthy female who became stridulous after an episode of the respiratory syncytial virus at one month old. At three months old, an otolaryngologist diagnosed mild laryngomalacia with no mass identified, and no surgical intervention was recommended. Due to continued poor weight gain, at four months old, a nasogastric tube was placed. She was subsequently admitted for further workup. She had severe stridor, a failure to thrive, and was in the 0.07th percentile for weight. Workup revealed severe obstructive sleep apnea and a palatal mass obstructing her left oropharynx. A biopsy and debulking of the mass was performed in the operating room. Pathology resulted as a mature teratoma with evidence of glial and intestinal tissue. There are no pathognomonic characteristics found on imaging to diagnose teratomas, and diagnosis is made with pathologic identification of two of the three germ cell layers. Although most teratomas are benign, there is potential for malignant transformation involving any of the represented germ cell layers. Many teratomas are diagnosed prenatally and can be quite large, often requiring Ex Utero Intrapartum Treatment (EXIT) procedure at birth to establish a safe airway. Overall, this case highlights the importance of a thorough head and neck exam, including a bilateral flexible laryngoscopy, when evaluating an infant with airway obstruction. Providers evaluating these patients should consider oropharyngeal masses, such as teratoma, as part of the differential to ensure accurate and timely diagnosis.
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Affiliation(s)
- Anna Lawrence
- Otolaryngology - Head and Neck Surgery, Children's Mercy Hospital, Kansas City, USA
| | - Melissa Gener
- Pathology, Children's Mercy Hospital, Kansas City, USA
| | - Shao Jiang
- Plastic Surgery, Children's Mercy Hospital, Kansas City, USA
| | - Jill Arganbright
- Otolaryngology - Head and Neck Surgery, Children's Mercy Hospital, Kansas City, USA
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25
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Deb P, Ahmed J, Akhtar H, Dutta K, Yunus M. An Unusual Case of Post-Operative Functional Stridor After Emergence From General Anesthesia. Cureus 2023; 15:e41757. [PMID: 37575817 PMCID: PMC10416135 DOI: 10.7759/cureus.41757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2023] [Indexed: 08/15/2023] Open
Abstract
Post-anesthesia stridor due to laryngospasm, laryngeal edema, or any other organic cause is a life-threatening condition requiring immediate intervention. The very rare functional stridor or psychogenic stridor following emergence from general anesthesia may sometimes mimic stridor due to an organic cause, but it is neither fatal nor require immediate airway management. However, if the condition is not diagnosed timely, it may lead to unnecessary manipulation of the airway, such as endotracheal intubation or tracheostomy. We report herein a case of functional stridor in a 48-year-old woman who underwent abdominal-perineal resection for carcinoma rectum. The case was timely diagnosed by the attending anesthetist, and the patient recovered spontaneously, thus avoiding any unindicated airway handling and its associated complications.
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Affiliation(s)
- Prakash Deb
- Anesthesiology and Critical Care, All India Institute of Medical Sciences, Guwahati, Guwahati, IND
| | - Jabed Ahmed
- Critical Care Medicine, Christian Medical College, Vellore, Vellore, IND
| | - Hanifa Akhtar
- Otorhinolaryngology, All India Institute of Medical Sciences, Guwahati, Guwahati, IND
| | - Kaustuv Dutta
- Anesthesiology and Critical Care, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, IND
| | - Mohd Yunus
- Emergency Medicine and Trauma, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
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26
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Wang A, Okezue C, Chang L, Spira Y, Nabors C. A Case of "Anaphylaxis" to NovoSeven in a Hemophiliac Patient. Cureus 2023; 15:e40802. [PMID: 37485125 PMCID: PMC10362835 DOI: 10.7759/cureus.40802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2023] [Indexed: 07/25/2023] Open
Abstract
Anaphylaxis is a life-threatening emergency that may be confused with other less serious conditions. The onset of true anaphylaxis typically occurs within minutes following exposure to an offending agent, and it can variably include dyspnea/wheezing, hemodynamic compromise, rash, hives/pruritus, swelling, or gastrointestinal symptoms. The absence of an expected association between exposure(s) and classic symptoms should lead to the consideration of alternative diagnoses. Here, we describe the course of a patient with hemophilia B who developed stridor and wheezing after exposure to the recombinant factor VII, NovoSeven, and tranexamic acid (TXA) for the management of hematomas. Due to a reported prior history of anaphylaxis to multiple factor replacements, the patient's initial management included NovoSeven with steroid/antihistamine prophylaxes and close monitoring with epinephrine at the bedside. Despite the administration of prophylaxis, the patient developed significant stridor, was treated with epinephrine and nebulizers and additional steroids, and was transferred to the intensive care unit. There, a pattern of NovoSeven administration followed variably by wheezing and stridor continued for two days until the patient's respiratory condition was predictable and stable. The patient's subsequent clinical course following transfer to the general medical ward was not consistent with anaphylaxis. This case highlights the importance of evaluating for mimickers of anaphylaxis, especially where only select symptoms such as stridor and wheezing are present without other serious signs of anaphylaxis such as hypoxemia, hypotension, or significant tachycardia.
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Affiliation(s)
- Andy Wang
- Internal Medicine, Westchester Medical Center, Valhalla, USA
| | - Chisom Okezue
- Internal Medicine, Westchester Medical Center, Valhalla, USA
| | - Lillian Chang
- Internal Medicine, Westchester Medical Center, Valhalla, USA
| | - Yaakov Spira
- Internal Medicine, Westchester Medical Center, Valhalla, USA
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27
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De Rose DU, Ronci S, Caoci S, Maddaloni C, Diodato D, Catteruccia M, Fattori F, Bosco L, Pro S, Savarese I, Bersani I, Randi F, Trozzi M, Meucci D, Calzolari F, Salvatori G, Solinas A, Dotta A, Campi F. Vocal Cord Paralysis and Feeding Difficulties as Early Diagnostic Clues of Congenital Myasthenic Syndrome with Neonatal Onset: A Case Report and Review of Literature. J Pers Med 2023; 13:jpm13050798. [PMID: 37240968 DOI: 10.3390/jpm13050798] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 04/21/2023] [Accepted: 05/04/2023] [Indexed: 05/28/2023] Open
Abstract
Herein, we present a newborn female with congenital vocal cord paralysis who required a tracheostomy in the neonatal period. She also presented with feeding difficulties. She was later diagnosed with a clinical picture of congenital myasthenia, associated with three variants of the MUSK gene: the 27-month follow-up was described. In particular, the c.565C>T variant is novel and has never been described in the literature; it causes the insertion of a premature stop codon (p.Arg189Ter) likely leading to a consequent formation of a truncated nonfunctioning protein. We also systematically collected and summarized information on patients' characteristics of previous cases of congenital myasthenia with neonatal onset reported in the literature to date, and we compared them to our case. The literature reported 155 neonatal cases before our case, from 1980 to March 2022. Of 156 neonates with CMS, nine (5.8%) had vocal cord paralysis, whereas 111 (71.2%) had feeding difficulties. Ocular features were evident in 99 infants (63.5%), whereas facial-bulbar symptoms were found in 115 infants (73.7%). In one hundred sixteen infants (74.4%), limbs were involved. Respiratory problems were displayed by 97 infants (62.2%). The combination of congenital stridor, particularly in the presence of an apparently idiopathic bilateral vocal cord paralysis, and poor coordination between sucking and swallowing may indicate an underlying congenital myasthenic syndrome (CMS). Therefore, we suggest testing infants with vocal cord paralysis and feeding difficulties for MUSK and related genes to avoid a late diagnosis of CMS and improve outcomes.
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Affiliation(s)
| | - Sara Ronci
- Neonatal Intensive Care Unit, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Stefano Caoci
- Neonatal Intensive Care Unit, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Chiara Maddaloni
- Neonatal Intensive Care Unit, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Daria Diodato
- Neuromuscular and Neurodegenerative Disorders Unit, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Michela Catteruccia
- Neuromuscular and Neurodegenerative Disorders Unit, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Fabiana Fattori
- Laboratory of Medical Genetics, Translational Cytogenomics Research Unit, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy
| | - Luca Bosco
- Neuromuscular and Neurodegenerative Disorders Unit, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
- Department of Science, University Roma Tre, 00146 Rome, Italy
| | - Stefano Pro
- Developmental Neurology Unit, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Immacolata Savarese
- Neonatal Intensive Care Unit, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Iliana Bersani
- Neonatal Intensive Care Unit, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Franco Randi
- Neurosurgery Unit, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Marilena Trozzi
- Airway Surgery Unit, Pediatric Surgery Department, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Duino Meucci
- Airway Surgery Unit, Pediatric Surgery Department, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Flaminia Calzolari
- Neonatal Intensive Care Unit, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Guglielmo Salvatori
- Neonatal Intensive Care Unit, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Agostina Solinas
- Neonatal Intensive Care Unit, Sant'Anna Hospital of Ferrara, 44124 Ferrara, Italy
| | - Andrea Dotta
- Neonatal Intensive Care Unit, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Francesca Campi
- Neonatal Intensive Care Unit, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
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Salaouatchi MT, Spinato L, Sanoussi S, Mesquita MDCF. Tracheal stenosis following tracheotomy in a COVID‐19 patient. Respirol Case Rep 2023; 11:e01127. [PMID: 36994108 PMCID: PMC10040721 DOI: 10.1002/rcr2.1127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 03/13/2023] [Indexed: 03/29/2023] Open
Abstract
Hemodialyzed patients with COVID‐19 are at risk for severe complications from acute respiratory distress syndrome, requiring admission to the intensive‐care unit for invasive mechanical ventilation. Post tracheotomy stenosis can be a life‐threatening condition that commonly occurs after iatrogenic injury secondary to tracheotomy or tracheal intubation. We report a case of a 44‐year‐old female patient on maintenance haemodialysis who presented a COVID‐19‐related ARDS that required mechanical ventilation for 4 weeks, followed by a persistent stridor and finally succumbed, 1 month after being discharged from intensive care unit, from a severe respiratory distress due to a tracheal stenosis. Our aim is to highlight the importance of the early recognition and management of post tracheotomy stenosis in patients with persistent respiratory difficulty as stridor after prolonged intubation requiring tracheotomy, in order to improve the prognosis of these patients.
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Affiliation(s)
| | - Linda Spinato
- Centre Hospitalier Universitaire Brugmann, Place A.Van Gehuchten 41020BruxellesBelgium
| | - Said Sanoussi
- Centre Hospitalier Universitaire Brugmann, Place A.Van Gehuchten 41020BruxellesBelgium
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Loberger JM, Manchikalapati A, Borasino S, Prabhakaran P. Prevalence, Risk Factors, and Outcomes of Airway Versus Non-Airway Pediatric Extubation Failure. Respir Care 2023; 68:374-383. [PMID: 36750258 PMCID: PMC10027148 DOI: 10.4187/respcare.10341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Pediatric extubation failure is associated with morbidity and mortality. The most common cause is upper-airway obstruction. Subglottic edema is common, but upper-airway obstruction can occur from the oral cavity to the trachea. Dichotomous categorization of extubation failure as airway versus non-airway may help identify risk factors as well as strategies that translate to lower extubation failure rates. METHODS This was as single-center, retrospective cohort study of invasive mechanical ventilation encounters within a quality improvement database between October 1, 2017-November 30, 2020. Utilizing a 3-physician adjudication process, all extubation failures were categorized as airway versus non-airway. Primary outcome was failure subtype prevalence. Secondary outcome was failure subtype risk factors. Clinical outcomes were explored. RESULTS The all-cause extubation failure rate was 10% in a cohort of 844 encounters. Airway and non-airway extubation failure represented 60.7% and 39.3%, respectively. Most airway failures were due to upper-airway obstruction (84.3%)-35.3% were supraglottic, 25.5% subglottic, and 23.5% mixed. Other causes of airway failure were airway patency/secretions (11.8%) and aspiration (3.9%). Non-airway failures were attributed to respiratory failure (75.8%), encephalopathy (15.2%), and other (9%). All-cause extubation failure was associated with dysgenetic/syndromic comorbidity (P = .005), ≥ 3 concurrent comorbid conditions (P = .007), indication for invasive ventilation (P < .001), and longer invasive mechanical ventilation duration (P < .001). Airway extubation failure was significantly associated with the presence of a respiratory comorbidity (P = .01) and Glasgow coma scale < 10 (P = .02). No significant non-airway failure risk factors were identified. Longer pediatric ICU (PICU) stay (P < .001) and PICU mortality (P < .001) were associated with all-cause extubation failure. No significant outcome associations with extubation failure subtype were identified. CONCLUSIONS Airway extubation failure prevalence was 1.5 times higher than non-airway failure. Potential risk factors for airway failure were identified. These findings are hypothesis generating for future study focused on key evidence gaps and pragmatic bedside application.
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Affiliation(s)
- Jeremy M Loberger
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
| | - Ananya Manchikalapati
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Santiago Borasino
- Department of Pediatrics, Division of Cardiology, Section of Cardiac Critical Care, University of Alabama at Birmingham, Birmingham, Alabama
| | - Priya Prabhakaran
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama
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30
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Di Scenza G, Mason K, Oikonomou G. Analysis of penetrating neck injuries at a South London Trauma Centre before and after the first national lockdown of the coronavirus pandemic. Clin Otolaryngol 2023; 48:259-263. [PMID: 36539942 DOI: 10.1111/coa.14024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/19/2022] [Accepted: 12/10/2022] [Indexed: 12/24/2022]
Affiliation(s)
| | - Katrina Mason
- Ear, Nose and Throat (ENT) Surgery Department, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Georgios Oikonomou
- Ear, Nose and Throat (ENT) Surgery Department, St George's University Hospitals NHS Foundation Trust, London, UK
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31
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Han SH, Kim M, Ji JY, Kwon SK. Analysis of clinical features and risk factors of subglottic cysts in children: a clinical experience using the spontaneous respiration technique. Clin Exp Otorhinolaryngol 2023; 16:177-183. [PMID: 36822198 DOI: 10.21053/ceo.2023.00031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 02/17/2023] [Indexed: 02/19/2023] Open
Abstract
Objective Subglottic cyst (SGC) is one of the rare causes of respiratory distress caused by upper airway obstruction in infants and young children. Risk factors other than prematurity with a history of endotracheal intubation have not yet been well elucidated. Therefore, we aimed to describe the clinical features and analyze the risk factors of SGC. Methods A retrospective review of medical records of pediatric patients who underwent marsupialization for SGCs between January 2017 and March 2022 was undertaken. These records were then compared with those of controls with a history of neonatal intubation with a case to control ratio of 1:3. Results Eleven patients (8 males and 3 females) diagnosed with SGCs and 33 control patients (26 males and 7 females) were included. All patients had a history of premature birth and neonatal intubation. Symptoms of SGC appeared at a mean age of 8.2 months (1-14 months) after extubation. The mean duration of intubation was 21.5 days (2-90 days), and the intubation period was longer in patients with SGC than in controls (21.5±24.8 days vs. 5.3±7.1 days; p<0.001). Furthermore, gestational age (28.3±4.2 weeks vs. 33.8±4.4 weeks; p=0.001) and birth weight (1134.1±515.1 g vs. 2178.2±910.1 g; p=0.001) were significantly lower in patients with SGC than in controls. In multivariable analysis, intubation period was identified as an independent risk factor. Conclusion This study showed that gestational age, birth weight, and intubation period were significantly associated with development of SGC. Pediatric patients presenting with progressive dyspnea with the corresponding risk factors should undergo early laryngoscopy for the differential diagnosis of SGC.
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Affiliation(s)
- Seung Hoon Han
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea, Hwaseong, Korea
| | - Minju Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea, Seoul, Korea
| | - Jeong-Yeon Ji
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea, Seoul, Korea
| | - Seong Keun Kwon
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea, Seoul, Korea
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Moore AE, Walker A, Kanotra SP. Endoscopic Versus Open Surgical Intervention for Congenital Laryngeal Webs: A Systematic Review and Meta-Analysis. Otolaryngol Head Neck Surg 2023. [PMID: 36939597 DOI: 10.1002/ohn.279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 12/29/2022] [Accepted: 01/16/2023] [Indexed: 02/10/2023]
Abstract
OBJECTIVES To examine and compare the outcomes of various surgical interventions for congenital laryngeal webs in terms of avoidance of tracheostomy, rate of decannulation, web recurrence, revision surgery, and mortality in children. DATA SOURCES Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic review was conducted on December 10, 2021, using a comprehensive search in PubMed, Web of Science, Cochrane library, and Embase with no date restriction. REVIEW METHODS Articles on surgical intervention for congenital laryngeal webs in pediatric (<18 years) patients were included in the analysis. Articles including acquired laryngeal webs, no surgical intervention, or exclusively adult population were excluded. RESULTS 9027 articles were reviewed, 24 articles met the inclusion criteria and 126 patients were included. In patients with Grades I and II webs, there was no significant difference in rates of tracheostomy or decannulation, between endoscopic (100%) versus open approach (100%). For Grades III and IV webs, 96% of patients who received open surgery were decannulated or avoided tracheostomy compared to 84% of those managed endoscopically (p = 0.081). There were significantly lower rates of revision surgery in the open group compared to the endoscopic group (77.8% vs 30.9%, p = 0.008). CONCLUSION This study showed no difference in rates of tracheostomy, decannulation, web recurrence, revision, or mortality between endoscopic and open approaches for the treatment of Grades I and II webs. For Grades III and IV, open surgical techniques achieved a lower revision rate. Results should be interpreted in light of associated increased morbidity with open procedures.
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Affiliation(s)
- Abigail E Moore
- Department of Otolaryngology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Austin Walker
- Department of Otolaryngology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.,Department of Anesthesiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Sohit Paul Kanotra
- Department of Otolaryngology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
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Rajasekaran V, McCaffer C, Bishop J, Van Der Meer G, Toll EC, Evans H. Late airway complications following pediatric liver transplantation: A case series. Pediatr Transplant 2023; 27:e14473. [PMID: 36694298 DOI: 10.1111/petr.14473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 12/09/2022] [Accepted: 01/09/2023] [Indexed: 01/26/2023]
Abstract
BACKGROUND Late airway complications, as consequence of immunosuppression following pediatric liver transplantation are uncommonly reported. METHODS In this retrospective case series, we describe two young children presenting with symptoms of airway obstruction, secondary to differing pathologies in the supraglottic airway, as a result of immunosuppression following liver transplantation. RESULTS Case 1, a 2-year-old girl who presented with stridor 12-months following liver transplantation, was found to have a proliferative soft tissue mass involving the supraglottic larynx. Biopsies were consistent with infiltrative eosinophilic laryngitis and associated eosinophilic esophagitis. Case 2, a 12-month-old female who presented with stridor 5-months following liver transplantation, was found to have an exophytic soft tissue mass involving the supraglottis and hypopharynx. Biopsies revealed polymorphic Epstein-Barr virus (EBV) driven post-transplant lymphoproliferative disease (PTLD). Case 1 was managed with local resection and high dose oral corticosteroids. Case 2 responded to debulking of the necrotic supraglottic mass, reduction of immunosuppression and rituximab. CONCLUSION A high index of suspicion needs to be maintained for complications of immunosuppression for appropriate diagnosis of airway presentations following pediatric liver transplantation. Further research is necessary to improve early detection and consolidate management strategies for these airway lesions.
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Affiliation(s)
- Vivek Rajasekaran
- Department of Paediatric Gastroenterology and Hepatology, Starship Child Health, Auckland, New Zealand.,Department of Paediatrics, Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Craig McCaffer
- Department of Paediatric Otolaryngology, Starship Child Health, Auckland, New Zealand
| | - Jonathan Bishop
- Department of Paediatric Gastroenterology and Hepatology, Starship Child Health, Auckland, New Zealand
| | - Graeme Van Der Meer
- Department of Paediatric Otolaryngology, Starship Child Health, Auckland, New Zealand
| | - Edward C Toll
- Department of Paediatric Otolaryngology, Starship Child Health, Auckland, New Zealand
| | - Helen Evans
- Department of Paediatric Gastroenterology and Hepatology, Starship Child Health, Auckland, New Zealand.,Department of Paediatrics, Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Subbotina MV. [Diagnostic efficiency of transcutaneous ultrasound scanning and Dopplerography in laryngeal pathology]. Vestn Otorinolaringol 2023; 88:27-33. [PMID: 37970767 DOI: 10.17116/otorino20238805127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
OBJECTIVE To assess the efficiency and the place of grey scale ultrasound and color Doppler sonography of the larynx in the diagnosis of laryngeal pathology. MATERIAL AND METHODS A prospective blind cohort examination in B-mode laryngeal ultrasound (LUS) and color Doppler imaging (CDI) with linear scanning transducer 7-15 MHz was performed in 120 patients aged from 6 months to 52 years (average age 7.6±5.8 years, Me 6 year) and in 40 patients without laryngeal pathology (average age 7.0±5.0 years). The patients presented with complaints of voice and/or stridor. The diagnosis was verified by followed laryngoscopy. RESULTS Laryngeal papillomas, hemangiomas, scarring and vocal fold's nodules were identified as hyperechoic formations. Color Doppler sonography made it possible to visualize them better: small formations were highlighted in color and the space around the large ones was colored. There were paradoxical movements of the hyperechoic arytenoid cartilages during inspiration to the anterior commissure in patients with laryngomalacia. Color Doppler ultrasonography revealed changes during phonation in patients with functional dysphonia. The sensitivity and specificity of LUS were 58% (95% CI 48-66) and 98% (95% CI 87-99) compared with laryngoscopy in the detection of laryngeal pathology, but laryngeal CDI - 81% (95% CI 72-87) and 98% (95% CI 87-99) respectively. CONCLUSION Ultrasound of the larynx in B-mode has a diagnostic efficiency of 67.5%, and in CDI mode - 85% for ruling in laryngeal pathologies compared to laryngoscopy. So, this method is a modern affordable, non-invasive and informative diagnostic tool for the detection of laryngeal diseases, especially in those cases, when it is impossible to carry out a laryngoscopy.
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Affiliation(s)
- M V Subbotina
- Irkutsk State Medical University Ministry of Healthcare of Russia, Irkutsk, Russia
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35
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Slater A, del Solar R, Raj J. Nasopharyngeal abscess causing inspiratory dyspnoea in a domestic cat. JFMS Open Rep 2023; 9:20551169231178448. [PMID: 37441537 PMCID: PMC10333994 DOI: 10.1177/20551169231178448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2023] [Indexed: 07/15/2023] Open
Abstract
Case summary An 11-month-old female domestic shorthair cat presented with a 24 h history of inspiratory dyspnoea, abnormal upper respiratory tract sounds, gagging, retching and making exaggerated swallowing motions. Retroflexed nasopharyngoscopy revealed a large, right-sided nasopharyngeal mass that was seen to exude purulent material and a possible small foreign body when pressure was applied with forceps. Thorough expression of the mass alleviated clinical signs. Cytology revealed septic neutrophilic inflammation, and a Pasteurella species with no noted antimicrobial resistance was cultured. The cat was discharged with oral antibiotics and analgesia and made a full recovery, with no recurrence of clinical signs at the 6-month follow-up. Relevance and novel information Abscess formation in the nasopharyngeal region has not been previously reported in cats, to the authors' knowledge. The cause of the abscess was suspected to be a foreign body, but other aetiologies could not be fully excluded. This case demonstrates that nasopharyngeal abscesses are a rare but potentially significant differential diagnosis for upper respiratory tract obstruction in cats.
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Affiliation(s)
- Annie Slater
- Annie Slater MA, VetMB, MRCVS, Southfields
Veterinary Specialists (part of Linnaeus Veterinary), Cranes Point, Gardiners Ln S,
Basildon SS14 3AP, UK
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Muacevic A, Adler JR, Gopal P. Post-extubation Stridor in a Case of Intracranial Bleed: Assessing Airway Patency Prior to Extubation Using Cuff Leak Test. Cureus 2023; 15:e33632. [PMID: 36788840 PMCID: PMC9918331 DOI: 10.7759/cureus.33632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2023] [Indexed: 01/12/2023] Open
Abstract
Laryngeal edema is a common complication of endotracheal intubation. It may range from mild and asymptomatic to respiratory distress and severe stridor leading to subsequent reintubation. It is crucial to assess the patency of the airway before extubation to identify patients with a risk of developing laryngeal edema. To prevent post-extubation laryngeal edema (PLE), intravenous corticosteroids or nebulized corticosteroids appear to be reasonably effective, reducing the need for reintubation by more than half. We present a case of a 59-year-old male who presented with an intracranial bleed and aspiration pneumonia. The patient developed PLE and was reintubated due to respiratory distress and treated with intravenous and nebulized corticosteroids. The patient was extubated two days later after adequate cuff leak test (CLT) results. If PLE causes respiratory distress, reintubation is the only definitive treatment and should not be delayed.
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37
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Muacevic A, Adler JR, R F, Abu Bakar S. Congenital Laryngeal Cyst as a Rare Cause of Stridor in Infants: Two Case Reports. Cureus 2023; 15:e33867. [PMID: 36819299 PMCID: PMC9933415 DOI: 10.7759/cureus.33867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2023] [Indexed: 01/19/2023] Open
Abstract
Congenital laryngeal cysts are a rare cause of stridor in infants. These cysts may have serious clinical implications if not promptly recognized. A small laryngeal cyst may remain asymptomatic. However, if large, it can block the laryngeal inlet leading to acute airway obstruction, which is potentially life-threatening. In pediatric patients presenting with respiratory distress, prompt diagnosis and surgical management are crucial to avoid infant morbidity and mortality. We describe two cases of laryngeal vallecular cysts in infants and their management in our clinical practice.
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Kobayashi T, Iwatani S, Morita K, Hatakeyama T, Yoshimoto S. Rigid laryngoscopy for subglottic stenosis in an extremely premature infant. Pediatr Int 2023; 65:e15688. [PMID: 37888202 DOI: 10.1111/ped.15688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 08/10/2023] [Accepted: 09/14/2023] [Indexed: 10/28/2023]
Affiliation(s)
- Takao Kobayashi
- Department of Neonatology, Hyogo Prefectural Kobe Children's Hospital Perinatal Center, Kobe, Hyogo, Japan
| | - Sota Iwatani
- Department of Neonatology, Hyogo Prefectural Kobe Children's Hospital Perinatal Center, Kobe, Hyogo, Japan
| | - Keiichi Morita
- Department of Pediatric Surgery, Hyogo Prefectural Kobe Children's Hospital, Kobe, Hyogo, Japan
| | - Tadashi Hatakeyama
- Department of Pediatric Surgery, Hyogo Prefectural Kobe Children's Hospital, Kobe, Hyogo, Japan
| | - Seiji Yoshimoto
- Department of Neonatology, Hyogo Prefectural Kobe Children's Hospital Perinatal Center, Kobe, Hyogo, Japan
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Jaworski J, Harper A, Crosby-Durrani H, Hall J. Primary retropharyngeal leiomyosarcoma in a young cat. JFMS Open Rep 2023; 9:20551169231164612. [PMID: 37101755 PMCID: PMC10123895 DOI: 10.1177/20551169231164612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023] Open
Abstract
Case summary An Oriental Shorthair cat, aged 1 year and 6 months, developed progressive stridor and a palpable right ventral cervical mass. Fine-needle aspiration of the mass was inconclusive, while thoracic radiography and CT showed no evidence of metastasis. There was initial improvement in stridor with oral doxycycline and prednisolone treatment, but it recurred 4 weeks later and excisional biopsy was performed. Histopathology with immunohistochemistry diagnosed leiomyosarcoma with incomplete surgical margins. Adjunctive radiation therapy was declined. Repeated physical examination and CT 7 months postoperatively documented no evidence of mass recurrence. Relevance and novel information This is the first reported case of retropharyngeal leiomyosarcoma in a young cat with no evidence of local reoccurrence 7 months following an excisional biopsy.
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Affiliation(s)
- Janusz Jaworski
- Wear Referrals Veterinary Specialists, Bradbury, Stockton-on-Tees, UK
- Janusz Jaworski DVM, CertAVP, BSAVA PGCertSAS, GPCert(DI), MRCVS, Wear Referrals Veterinary Specialists, Bradbury, Stockton-on-Tees TS21 2ES, UK
| | - Aaron Harper
- Wear Referrals Veterinary Specialists, Bradbury, Stockton-on-Tees, UK
| | - Hayley Crosby-Durrani
- Department of Veterinary Anatomy, Physiology and Pathology, University of Liverpool, Neston, Wirral, UK
| | - Jon Hall
- Wear Referrals Veterinary Specialists, Bradbury, Stockton-on-Tees, UK
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Kökoğlu K, Ketenci İ. A Unique Cause of Upper Airway Obstruction in a Child: Laryngeal Lipoma. Turk Arch Otorhinolaryngol 2022; 60:231-233. [PMID: 37456604 PMCID: PMC10339263 DOI: 10.4274/tao.2022.2022-11-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 12/29/2022] [Indexed: 07/18/2023] Open
Abstract
There are lots of diseases causing pediatric upper airway obstruction and stridor. They can be both congenital or acquired. While congenital causes are laryngomalacia, vocal cord palsy, congenital subglottic stenosis, acquired ones range from infections to foreign bodies or neoplasms. Laryngeal neoplasms develop almost epithelial in origin. Non-epithelial tumors consist 1% of laryngeal neoplasms. Although lipoma is the most common soft tissue tumor, laryngeal involvement is very rare and seen in the ages between 40-60 years. A 13-month-old child who had laryngeal lipoma and upper airway obstruction was aimed to present in this paper.
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Affiliation(s)
- Kerem Kökoğlu
- Department of Otolaryngology, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - İbrahim Ketenci
- Department of Otolaryngology, Erciyes University Faculty of Medicine, Kayseri, Turkey
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Farrell J, Hogan P, Sebaratnam DF. About PHACE. J Pediatr 2022; 255:256-257. [PMID: 36328192 DOI: 10.1016/j.jpeds.2022.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 10/19/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022]
Affiliation(s)
| | - Peter Hogan
- The Children's Hospital at Westmead, Westmead, NS
| | - Deshan Frank Sebaratnam
- The Children's Hospital at Westmead, Westmead, NS; South West Sydney Clinical Campuses, University of New South Wales, Liverpool, NS
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McCarter SJ, Mansukhani MP, Herold DL, Kolla BP. Delayed onset sleep-related stridor due to radiation for thyroid cancer. J Clin Sleep Med 2022; 18:2327-2329. [PMID: 35713170 PMCID: PMC9435334 DOI: 10.5664/jcsm.10128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 05/24/2022] [Accepted: 05/26/2022] [Indexed: 11/13/2022]
Abstract
Radiation therapy is the mainstay of treatment for head and neck cancers with both acute and delayed complications. While obstructive sleep apnea is common in the few series of patients undergoing radiation therapy to the neck, the development of sleep-related stridor is exceedingly rare and has typically been reported in the acute treatment setting. We describe a 65-year-old female with 1 year of nocturnal groaning beginning 2 years after radiation therapy for thyroid carcinoma. Polysomnography revealed mild obstructive sleep apnea and sleep-related stridor responsive to nasal continuous positive airway pressure. Our case highlights the importance of screening patients with a history of head and neck radiation for sleep-related breathing complaints at each follow-up visit and consideration of both obstructive sleep apnea and stridor in these patients. Identification of sleep-disordered breathing in these patients may lead to timely treatment and improvement in quality of life. CITATION McCarter SJ, Mansukhani MP, Herold DL, Kolla BP. Delayed onset sleep-related stridor due to radiation for thyroid cancer. J Clin Sleep Med. 2022;18(9):2327-2329.
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Affiliation(s)
| | | | | | - Bhanu Prakash Kolla
- Center for Sleep Medicine, Mayo Clinic, Rochester, Minnesota
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
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Miller EJ, Huning EYS. Subglottic tracheal stenosis complicating pregnancy: A case report. Obstet Med 2022; 15:205-207. [PMID: 36262817 PMCID: PMC9574454 DOI: 10.1177/1753495x21990220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 11/22/2020] [Accepted: 12/30/2020] [Indexed: 09/03/2023] Open
Abstract
The case presented details an uncommon case of subglottic tracheal stenosis exacerbated by pregnancy. We outine the multidisciplinary management involved and the outcomes for the pregnancy. The case serves as a reminder that shortness of breath in pregnancy has a broad differential diagnosis, and stridor is always abnormal.
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Cuestas G, Rodríguez H. [Algorithm for the management of laryngeal obstruction in pediatrics]. ARCH ARGENT PEDIATR 2022; 120:209-216. [PMID: 35533130 DOI: 10.5546/aap.2022.209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 09/20/2021] [Indexed: 11/12/2022]
Abstract
The larynx is at the aerodigestive crossroads; any pathology that involves it will have an impact on breathing, swallowing and/or the voice. It`s divided into three regions: supraglottis (includes epiglottis, ventricular bands and laryngeal ventricles), glottis (space limited by the vocal cords) and subglottis (narrowest area of pediatric airway and the only point of larynx completely surrounded by cartilage: the cricoid ring). Laryngeal obstruction can present as a potentially fatal acute condition or as a chronic process. The main symptom is inspiratory or biphasic stridor. The etiology varies widely according to age and it may be of congenital, inflammatory, infectious, traumatic, neoplastic or iatrogenic origin. We describe the pathologies that cause laryngeal obstruction, either those that occur very often or those which are important for their severity, their guiding symptoms to the presumptive diagnosis, additional studies and treatment.
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Affiliation(s)
- Giselle Cuestas
- Sección de Endoscopia Respiratoria, División de Otorrinolaringología, Hospital General de Niños Dr. Pedro de Elizalde, Ciudad Autónoma de Buenos Aires, Argentina.
| | - Hugo Rodríguez
- Servicio de Endoscopia Respiratoria, Hospital de Pediatría S.A.M.I.C. "Prof. Dr. Juan P. Garrahan", Ciudad Autónoma de Buenos Aires, Argentina
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Apuy M, Yock-Corrales A, Moreno AM, Gutierrez A. Streptococcus Pyogenes Epiglottitis in a Child: A Case Report. Cureus 2022; 14:e24123. [PMID: 35573512 PMCID: PMC9106533 DOI: 10.7759/cureus.24123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2022] [Indexed: 11/22/2022] Open
Abstract
Acute epiglottitis in children is a rare entity since the introduction of the vaccine against Haemophilus influenzae; however, it should be considered as part of the differential diagnosis when facing a patient with evidence of upper airway obstruction. This study describes the case of a three-year-old child who arrived at the emergency department with fever, respiratory distress, and stridor. After ventilatory failure, the patient was intubated and antibiotics were initiated. The results of the bacteria culture confirmed Streptococcus pyogenes infection. This case report intends to describe and review the differential diagnoses of epiglottitis, as well as its management and prognosis.
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Affiliation(s)
- Massiel Apuy
- Pediatrics, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", San Jose, CRI
| | - Adriana Yock-Corrales
- Pediatric Emergency Medicine, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", San Jose, CRI
| | - Ana Maria Moreno
- Pediatrics, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", San Jose, CRI
| | - Andrea Gutierrez
- Pediatrics, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", San Jose, CRI
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Al Omari A, Al-Qarqaz W, Khresat M, Sataloff RT. Tracheobronchopathia osteochondroplastica in the setting of COVID-19. Ear Nose Throat J 2022:1455613221083822. [PMID: 35324341 PMCID: PMC8960750 DOI: 10.1177/01455613221083822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Tracheobronchopathia osteoplastica (TO) is a rare, benign disease of unknown etiology, primarily affecting the major tracheobronchial tree, characterized by irregular nodular calcifications of the cartilaginous component of the inner wall of the tracheobronchial tree while sparing the posterior wall, leading to progressive narrowing of the airway. We report the case of a 60-year-old male otherwise healthy nonsmoker, who complained of chronic breathing discomfort and recurrent chest infections and was found to have TO according to radiographic, microlaryngoscopic, and biopsy findings. He experienced a flare up with worsening of disease progression after years of being in stable condition, after his infection with SARS-CoV-2.
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Affiliation(s)
- Ahmad Al Omari
- Department of Special Surgery,
Jordan
University of Science and Technology,
Irbid, Jordan
- Department of Otolaryngology - Head
and Neck Surgery, Drexel University College of
Medicine, Philadelphia, PA, USA
| | - Wisam Al-Qarqaz
- Department of Special Surgery,
Jordan University of Science and Technology, Irbid, Jordan
| | - Mohammd Khresat
- Department of Special Surgery,
Jordan University of Science and Technology, Irbid, Jordan
| | - Robert T. Sataloff
- Department of Otolaryngology - Head
and Neck Surgery, Drexel University College of
Medicine, Philadelphia, PA, USA
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Jazdarehee A, Huget-Penner S, Pawlowska M. Pseudo-pheochromocytoma due to obstructive sleep apnea: a case report. Endocrinol Diabetes Metab Case Rep 2022; 2022:21-0100. [PMID: 35212265 PMCID: PMC8897593 DOI: 10.1530/edm-21-0100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 02/02/2022] [Indexed: 11/11/2022] Open
Abstract
SUMMARY Obstructive sleep apnea (OSA) is a condition of intermittent nocturnal upper airway obstruction. OSA increases sympathetic drive which may result in clinical and biochemical features suggestive of pheochromocytoma. We present the case of a 65-year-old male with a 2.9-cm left adrenal incidentaloma on CT, hypertension, symptoms of headache, anxiety and diaphoresis, and persistently elevated 24-h urine norepinephrine (initially 818 nmol/day (89-470)) and normetanephrine (initially 11.2 µmol/day (0.6-2.7)). He was started on prazosin and underwent left adrenalectomy. Pathology revealed an adrenal corticoadenoma with no evidence of pheochromocytoma. Over the next 2 years, urine norepinephrine and normetanephrine remained significantly elevated with no MIBG avid disease. Years later, he was diagnosed with severe OSA and treated with continuous positive airway pressure. Urine testing done once OSA was well controlled revealed complete normalization of urine norepinephrine and normetanephrine with substantial symptom improvement. It was concluded that the patient never had a pheochromocytoma but rather an adrenal adenoma with biochemistry and symptoms suggestive of pheochromocytoma due to untreated severe OSA. Pseudo-pheochromocytoma is a rare presentation of OSA and should be considered on the differential of elevated urine catecholamines and metanephrines in the right clinical setting. LEARNING POINTS Obstructive sleep apnea (OSA) is a common condition among adults. OSA may rarely present as pseudo-pheochromocytoma with symptoms of pallor, palpitations, perspiration, headache, or anxiety. OSA should be considered on the differential of elevated urine catecholamines and metanephrines, especially in patients with negative metaiodobenzylguanidine (MIBG) scan results.
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Key Words
- adolescent/young adult
- adult
- geriatric
- neonatal
- paediatric
- pregnant adult
- female
- male
- american indian or alaska native
- asian - bangladeshi
- asian - chinese
- asian - filipino
- asian - indian
- asian - japanese
- asian - korean
- asian - pakistani
- asian - vietnamese
- asian - other
- black - african
- black - caribbean
- black - other
- hispanic or latino - central american or south american
- hispanic or latino - cuban
- hispanic or latino - dominican
- hispanic or latino - mexican, mexican american, chicano
- hispanic or latino - puerto rican
- hispanic or latino - other
- native hawaiian/other pacific islander
- white
- other
- afghanistan
- aland islands
- albania
- algeria
- american samoa
- andorra
- angola
- anguilla
- antarctica
- antigua and barbuda
- argentina
- armenia
- aruba
- australia
- austria
- azerbaijan
- bahamas
- bahrain
- bangladesh
- barbados
- belarus
- belgium
- belize
- benin
- bermuda
- bhutan
- bolivia
- bosnia and herzegovina
- botswana
- bouvet island
- brazil
- british indian ocean territory
- brunei darussalam
- bulgaria
- burkina faso
- burundi
- cambodia
- cameroon
- canada
- cape verde
- cayman islands
- central african republic
- chad
- chile
- china
- christmas island
- cocos (keeling) islands
- colombia
- comoros
- congo
- congo, the democratic republic of the
- cook islands
- costa rica
- côte d'ivoire
- croatia
- cuba
- cyprus
- czech republic
- denmark
- djibouti
- dominica
- dominican republic
- ecuador
- egypt
- el salvador
- equatorial guinea
- eritrea
- estonia
- ethiopia
- falkland islands (malvinas)
- faroe islands
- fiji
- finland
- france
- french guiana
- french polynesia
- french southern territories
- gabon
- gambia
- georgia
- germany
- ghana
- gibraltar
- greece
- greenland
- grenada
- guadeloupe
- guam
- guatemala
- guernsey
- guinea
- guinea-bissau
- guyana
- haiti
- heard island and mcdonald islands
- holy see (vatican city state)
- honduras
- hong kong
- hungary
- iceland
- india
- indonesia
- iran, islamic republic of
- iraq
- ireland
- isle of man
- israel
- italy
- jamaica
- japan
- jersey
- jordan
- kazakhstan
- kenya
- kiribati
- korea, democratic people's republic of
- korea, republic of
- kuwait
- kyrgyzstan
- lao people's democratic republic
- latvia
- lebanon
- lesotho
- liberia
- libyan arab jamahiriya
- liechtenstein
- lithuania
- luxembourg
- macao
- macedonia, the former yugoslav republic of
- madagascar
- malawi
- malaysia
- maldives
- mali
- malta
- marshall islands
- martinique
- mauritania
- mauritius
- mayotte
- mexico
- micronesia, federated states of
- moldova, republic of
- monaco
- mongolia
- montenegro
- montserrat
- morocco
- mozambique
- myanmar
- namibia
- nauru
- nepal
- netherlands
- netherlands antilles
- new caledonia
- new zealand
- nicaragua
- niger
- nigeria
- niue
- norfolk island
- northern mariana islands
- norway
- oman
- pakistan
- palau
- palestinian territory, occupied
- panama
- papua new guinea
- paraguay
- peru
- philippines
- pitcairn
- poland
- portugal
- puerto rico
- qatar
- réunion
- romania
- russian federation
- rwanda
- saint barthélemy
- saint helena
- saint kitts and nevis
- saint lucia
- saint martin
- saint pierre and miquelon
- saint vincent and the grenadines
- samoa
- san marino
- sao tome and principe
- saudi arabia
- senegal
- serbia
- seychelles
- sierra leone
- singapore
- slovakia
- slovenia
- solomon islands
- somalia
- south africa
- south georgia and the south sandwich islands
- spain
- sri lanka
- sudan
- suriname
- svalbard and jan mayen
- swaziland
- sweden
- switzerland
- syrian arab republic
- taiwan, province of china
- tajikistan
- tanzania, united republic of
- thailand
- timor-leste
- togo
- tokelau
- tonga
- trinidad and tobago
- tunisia
- turkey
- turkmenistan
- turks and caicos islands
- tuvalu
- uganda
- ukraine
- united arab emirates
- united kingdom
- united states
- united states minor outlying islands
- uruguay
- uzbekistan
- vanuatu
- vatican city state
- venezuela
- viet nam
- virgin islands, british
- virgin islands, u.s.
- wallis and futuna
- western sahara
- yemen
- zambia
- zimbabwe
- maylaysia
- adipose tissue
- adrenal
- bone
- duodenum
- heart
- hypothalamus
- kidney
- liver
- ovaries
- pancreas
- parathyroid
- pineal
- pituitary
- placenta
- skin
- stomach
- testes
- thymus
- thyroid
- andrology
- autoimmunity
- cardiovascular endocrinology
- developmental endocrinology
- diabetes
- emergency
- endocrine disruptors
- endocrine-related cancer
- epigenetics
- genetics and mutation
- growth factors
- gynaecological endocrinology
- immunology
- infectious diseases
- late effects of cancer therapy
- mineral
- neuroendocrinology
- obesity
- ophthalmology
- paediatric endocrinology
- puberty
- tumours and neoplasia
- vitamin d
- 17ohp
- acth
- adiponectin
- adrenaline
- aldosterone
- amh
- androgens
- androstenedione
- androsterone
- angiotensin
- antidiuretic hormone
- atrial natriuretic hormone
- avp
- beta-endorphin
- big igf2
- brain natriuretic peptide
- calcitonin
- calcitriol
- cck
- corticosterone
- corticotrophin
- cortisol
- cortisone
- crh
- dehydroepiandrostenedione
- deoxycorticosterone
- deoxycortisol
- dhea
- dihydrotestosterone
- dopamine
- endothelin
- enkephalin
- epitestosterone
- epo
- fgf23
- fsh
- gastrin
- gh
- ghrelin
- ghrh
- gip
- glp1
- glp2
- glucagon
- glucocorticoids
- gnrh
- gonadotropins
- hcg
- hepcidin
- histamine
- human placental lactogen
- hydroxypregnenolone
- igf1
- igf2
- inhibin
- insulin
- kisspeptin
- leptin
- lh
- melanocyte-stimulating hormone
- melatonin
- metanephrines
- mineralocorticoids
- motilin
- nandrolone
- neuropeptide y
- noradrenaline
- normetanephrine
- oestetrol (e4)
- oestradiol (e2)
- oestriol (e3)
- oestrogens
- oestrone (e1)
- osteocalcin
- oxyntomodulin
- oxytocin
- pancreatic polypeptide
- peptide yy
- pregnenolone
- procalcitonin
- progesterone
- prolactin
- prostaglandins
- pth
- relaxin
- renin
- resistin
- secretin
- somatostatin
- testosterone
- thpo
- thymosin
- thymulin
- thyroxine (t4)
- trh
- triiodothyronine (t3)
- tsh
- vip
- 17-alpha hydroxylase/17,20 lyase deficiency
- 17-beta-hydroxysteroid dehydrogenase type 3 deficiency
- 3-m syndrome
- 22q11 deletion syndrome
- 49xxxxy syndrome
- abscess
- acanthosis nigricans
- acromegaly
- acute adrenocortical insufficiency
- addisonian crisis
- addison's disease
- adenocarcinoma
- aip gene mutation
- adrenal insufficiency
- adrenal salt-wasting crisis
- adrenarche
- adrenocortical adenoma
- adrenocortical carcinoma
- adrenoleukodystrophy
- aip gene variant
- amenorrhoea (primary)
- amenorrhoea (secondary)
- amyloid goitre
- amyloidosis
- anaplastic thyroid cancer
- anaemia
- aneuploidy
- androgen insensitivity syndrome
- anti-phospholipid antibody syndrome
- asthma
- autoimmune disorders
- autoimmune polyendocrine syndrome 1
- autoimmune polyendocrine syndrome 2
- autoimmune polyglandular syndrome
- autoimmune hypophysitis
- autosomal dominant hypophosphataemic rickets
- autosomal dominant osteopetrosis
- bardet-biedl syndrome
- bartter syndrome
- bilateral adrenal hyperplasia
- biliary calculi
- breast cancer
- brenner tumour
- brown tumour
- burkitt's lymphoma
- casr gene mutation
- catecholamine secreting carotid body paraganglionoma
- cancer-prone syndrome
- carcinoid syndrome
- carcinoid tumour
- carney complex
- carotid body paraganglioma
- c-cell hyperplasia
- cerebrospinal fluid leakage
- chronic fatigue syndrome
- circadian rhythm sleep disorders
- congenital adrenal hyperplasia
- congenital hypothyroidism
- congenital hyperinsulinism
- conn's syndrome
- corticotrophic adenoma
- craniopharyngioma
- cretinism
- crohn's disease
- cryptorchidism
- cushing's disease
- cushing's syndrome
- cystolithiasis
- de quervain's thyroiditis
- denys-drash syndrome
- desynchronosis
- developmental abnormalities
- diabetes - lipoatrophic
- diabetes - mitochondrial
- diabetes - steroid-induced
- diabetes insipidus - dipsogenic
- diabetes insipidus - gestational
- diabetes insipidus - nephrogenic
- diabetes insipidus - neurogenic/central
- diabetes mellitus type 1
- diabetes mellitus type 2
- diabetic foot syndrome
- diabetic hypoglycaemia
- diabetic ketoacidosis
- diabetic muscle infarction
- diabetic nephropathy
- diverticular disease
- donohue syndrome
- down syndrome
- eating disorders
- ectopic acth syndrome
- ectopic cushing's syndrome
- ectopic parathyroid adenoma
- empty sella syndrome
- endometrial cancer
- endometriosis
- eosinophilic myositis
- euthyroid sick syndrome
- familial hypocalciuric hypercalcaemia
- familial dysalbuminaemic hyperthyroxinaemia
- familial euthyroid hyperthyroxinaemia
- fat necrosis
- female athlete triad syndrome
- fetal demise
- fetal macrosomia
- follicular thyroid cancer
- fractures
- frasier syndrome
- friedreich's ataxia
- functional parathyroid cyst
- galactorrhoea
- gastrinoma
- gastritis
- gastrointestinal perforation
- gastrointestinal stromal tumour
- gck mutation
- gender identity disorder
- gestational diabetes mellitus
- giant ovarian cysts
- gigantism
- gitelman syndrome
- glucagonoma
- glucocorticoid remediable aldosteronism
- glycogen storage disease
- goitre
- goitre (multinodular)
- gonadal dysgenesis
- gonadoblastoma
- gonadotrophic adenoma
- gorham's disease
- granuloma
- granulosa cell tumour
- graves' disease
- graves' ophthalmopathy
- growth hormone deficiency (adult)
- growth hormone deficiency (childhood onset)
- gynaecomastia
- hamman's syndrome
- haemorrhage
- hajdu-cheney syndrome
- hashimoto's disease
- hemihypertrophy
- hepatitis c
- hereditary multiple osteochondroma
- hirsutism
- histiocytosis
- huntington's disease
- hürthle cell adenoma
- hyperaldosteronism
- hyperandrogenism
- hypercalcaemia
- hypercalcaemic crisis
- hyperglucogonaemia
- hyperglycaemia
- hypergonadotropic hypogonadism
- hypergonadotropism
- hyperinsulinaemia
- hyperinsulinaemic hypoglycaemia
- hyperkalaemia
- hyperlipidaemia
- hypernatraemia
- hyperosmolar hyperglycaemic state
- hyperparathyroidism (primary)
- hyperparathyroidism (secondary)
- hyperparathyroidism (tertiary)
- hyperpituitarism
- hyperprolactinaemia
- hypersexuality
- hypertension
- hyperthyroidism
- hypoaldosteronism
- hypocalcaemia
- hypoestrogenism
- hypoglycaemia
- hypoglycaemic coma
- hypogonadism
- hypogonadotrophic hypogonadism
- hypoinsulinaemia
- hypokalaemia
- hyponatraemia
- hypoparathyroidism
- hypophosphataemia
- hypophosphatasia
- hypophysitis
- hypopituitarism
- hypothyroidism
- iatrogenic disorder
- idiopathic bilateral adrenal hyperplasia
- idiopathic pituitary hyperplasia
- igg4-related systemic disease
- inappropriate tsh secretion
- incidentaloma
- infertility
- insulin autoimmune syndrome
- insulin resistance
- insulinoma
- intracranial vasospasm
- intrauterine growth retardation
- iodine allergy
- ischaemic heart disease
- kallmann syndrome
- ketoacidosis
- klinefelter syndrome
- kwashiorkor
- kwashiorkor (marasmic)
- leg ulcer
- laron syndrome
- latent autoimmune diabetes of adults (lada)
- laurence-moon syndrome
- left ventricular hypertrophy
- leukocytoclastic vasculitis
- leydig cell tumour
- lipodystrophy
- lipomatosis
- liver failure
- lung metastases
- luteoma
- lymphadenopathy
- macronodular adrenal hyperplasia
- macronodular hyperplasia
- macroprolactinoma
- marasmus
- maturity onset diabetes of young (mody)
- mccune-albright syndrome
- mckittrick-wheelock syndrome
- medullary thyroid cancer
- meigs syndrome
- membranous nephropathy
- men1
- men2a
- men2b
- men4
- menarche
- meningitis
- menopause
- metabolic acidosis
- metabolic syndrome
- metastatic carcinoma
- metastatic chromaffin cell tumour
- metastatic gastrinoma
- metastatic melanoma
- metastatic tumour
- microadenoma
- microprolactinoma
- motor neurone disease
- myasthenia gravis
- myelolipoma
- myocardial infarction
- myositis
- myotonic dystrophy type 1
- myotonic dystrophy type 2
- myxoedema
- myxoedema coma
- nelson's syndrome
- neonatal diabetes
- nephrolithiasis
- neuroblastoma
- neuroendocrine tumour
- neurofibromatosis
- nodular hyperplasia
- non-functioning pituitary adenoma
- non-hodgkin lymphoma
- non-islet-cell tumour hypoglycaemia
- noonan syndrome
- oculocerebrorenal syndrome
- osteogenesis imperfecta
- osteomalacia
- osteomyelitis
- osteoporosis
- osteoporosis (pregnancy/lactation-associated)
- osteosclerosis
- ovarian cancer
- ovarian dysgenesis
- ovarian hyperstimulation syndrome
- ovarian tumour
- paget's disease
- paget's disease (juvenille)
- pancreatic neuroendocrine tumour
- pancreatitis
- panhypopituitarism
- papillary thyroid cancer
- paraganglioma
- paranasal sinus lesion
- paraneoplastic syndromes
- parasitic thyroid nodules
- parathyroid adenoma
- parathyroid adenoma (ectopic)
- parathyroid carcinoma
- parathyroid cyst
- parathroid hyperplasia
- pcos
- periodontal disease
- phaeochromocytoma
- phaeochromocytoma crisis
- pickardt syndrome
- pituitary abscess
- pituitary adenoma
- pituitary apoplexy
- pituitary carcinoma
- pituitary cyst
- pituitary haemorrhage
- pituitary hyperplasia
- pituitary hypoplasia
- pituitary tumour (malignant)
- plurihormonal pituitary adenoma
- poems syndrome
- polycythaemia
- porphyria
- pneumonia
- posterior reversible encephalopathy syndrome
- post-prandial hypoglycaemia
- prader-willi syndrome
- prediabetes
- pre-eclampsia
- pregnancy
- premature ovarian failure
- premenstrual dysphoric disorder
- premenstrual syndrome
- primary hypertrophic osteoarthropathy
- prolactinoma
- prostate cancer
- pseudohypoaldosteronism type 1
- pseudohypoaldosteronism type 2
- pseudohypoparathyroidism
- psychosocial short stature
- puberty (delayed or absent)
- puberty (precocious)
- pulmonary oedema
- quadrantanopia
- rabson-mendenhall syndrome
- rhabdomyolysis
- rheumatoid arthritis
- rickets
- schwannoma
- sellar reossification
- sertoli cell tumour
- sertoli-leydig cell tumour
- sexual development disorders
- sheehan's syndrome
- short stature
- siadh
- small-cell carcinoma
- small intestine neuroendocrine tumour
- solitary fibrous tumour
- solitary sellar plasmacytoma
- somatostatinoma
- somatotrophic adenoma
- squamous cell thyroid carcinoma
- stiff person syndrome
- struma ovarii
- subcutaneous insulin resistance
- systemic lupus erythematosus
- takotsubo cardiomyopathy
- tarts
- testicular cancer
- thecoma
- thyroid adenoma
- thyroid carcinoma
- thyroid cyst
- thyroid dysgenesis
- thyroid fibromatosis
- thyroid hormone resistance syndrome
- thyroid lymphoma
- thyroid nodule
- thyroid storm
- thyroiditis
- thyrotoxicosis
- thyrotrophic adenoma
- traumatic brain injury
- tuberculosis
- tuberous sclerosis complex
- tumour-induced osteomalacia
- turner syndrome
- unilateral adrenal hyperplasia
- ureterolithiasis
- urolithiasis
- von hippel-lindau disease
- wagr syndrome
- waterhouse-friderichsen syndrome
- williams syndrome
- wolcott-rallison syndrome
- wolfram syndrome
- xanthogranulomatous hypophysitis
- xlaad/ipex
- zollinger-ellison syndrome
- abdominal adiposity
- abdominal distension
- abdominal cramp
- abdominal discomfort
- abdominal guarding
- abdominal lump
- abdominal pain
- abdominal tenderness
- abnormal posture
- abdominal wall defects
- abrasion
- acalculia
- accelerated growth
- acne
- acrochorda
- acroosteolysis
- acute stress reaction
- adverse breast development
- aggression
- agitation
- agnosia
- akathisia
- akinesia
- albuminuria
- alcohol intolerance
- alexia
- alopecia
- altered level of consciousness
- amaurosis
- amaurosis fugax
- ambiguous genitalia
- amblyopia
- amenorrhoea
- ameurosis
- amnesia
- amusia
- anasarca
- angiomyxoma
- anhedonia
- anisocoria
- ankle swelling
- anorchia
- anorectal malformations
- anorexia
- anosmia
- anosognosia
- anovulation
- antepartum haemorrhage
- anuria
- anxiety
- apathy
- aphasia
- aphonia
- apnoea
- appendicitis
- appetite increase
- appetite reduction/loss
- apraxia
- aqueductal stenosis
- arteriosclerosis
- arthralgia
- articulation impairment
- ascites
- asperger syndrome
- asphyxia
- asthenia
- astigmatism
- asymptomatic
- ataxia
- atrial fibrillation
- atrial myxoma
- atrophy
- adhd
- autism
- autonomic neuropathy
- avulsion
- babinski's sign
- back pain
- bacteraemia
- behavioural problems
- belching
- bifid scrotum
- biliary colic
- bitemporal hemianopsia
- blindness
- blistering
- bloating
- bloody show
- boil(s)
- bone cyst
- bone fracture(s)
- bone lesions
- bone pain
- bony metastases
- borborygmus
- bowel movements - bleeding
- bowel movements - increased frequency
- bowel movements - pain
- bowel obstruction
- bowel perforation
- brachycephaly
- brachydactyly
- bradycardia
- bradykinesia
- bradyphrenia
- bradypnea
- breast contour change
- breast enlargement
- breast lump
- breast reduction
- breast tenderness
- breastfeeding difficulties
- breathing difficulties
- bronchospasms
- brushfield spots
- bruxism
- buffalo hump
- cachexia
- calcification
- cardiac fibrosis
- cardiac malformations
- cardiac tamponade
- cardiogenic shock
- cardiomegaly
- cardiomyopathy
- cardiopulmonary arrest
- carpal tunnel syndrome
- caruncle - inflammation
- cataplexy
- cataract(s)
- catathrenia
- central obesity
- cerebrospinal fluid rhinorrhoea
- cervical pain
- cheeks - full
- cheiloschisis
- chemosis
- chest pain
- chest pain (pleuritic)
- chest pain (precordial)
- cheyne-stokes respiration
- chills
- cholecystitis
- cholestasis
- chondrocalcinosis
- chordee
- chorea
- choroidal atrophy
- chronic pain
- circulatory collapse
- cirrhosis
- citraturia
- claudication
- clitoromegaly
- cloacal exstrophy
- clonus
- club foot
- clumsiness
- coagulopathy
- coarctation
- coeliac disease
- cognitive problems
- cold intolerance
- collapse
- colour blindness
- coma
- concentration difficulties
- confusion
- congenital heart defect
- conjunctivitis
- constipation
- convulsions
- coordination difficulties
- coughing
- crackles
- cramps
- craniofacial abnormalities
- craniotabes
- cutaneous ischaemia
- cutaneous myxoma
- cutaneous pigmentation
- cyanosis
- dalrymple's sign
- deafness
- deep vein thrombosis
- dehydration
- delayed puberty
- delirium
- dementia
- dental abscess(es)
- dental problems
- depression
- diabetes insipidus
- diabetic neuropathy
- diabetic foot infection
- diabetic foot neuropathy
- diabetic foot ulceration
- diarrhoea
- diplopia
- dizziness
- duodenal atresia
- duplex kidney(s)
- dysarthria
- dysdiadochokinesia
- dysgraphia
- dyslexia
- dyslipidaemia
- dysmenorrhoea
- dyspareunia
- dyspepsia
- dysphagia
- dysphonia
- dysphoria
- dyspnoea
- dystonia
- dysuria
- ear, nose and/or throat infection
- early menarche
- ears - low set
- ears - pinna abnormalities
- ears - small
- ecchymoses
- ectopic ureter
- emotional immaturity
- encopresis
- endometrial hyperplasia
- enlarged bladder
- enlarged prostate
- eosinophilia
- epicanthic fold
- epilepsy
- epistaxis
- erectile dysfunction
- erythema
- euphoria
- eyebrows - bushy
- eyelid retraction
- eyelid swelling
- eyelids - redness
- eyes - almond-shaped
- eyes - dry
- eyes - feeling of grittiness
- eyes - inflammation
- eyes - irritation
- eyes - itching
- eyes - pain (gazing down)
- eyes - pain (gazing up)
- eyes - redness
- eyes - watering
- face - change in appearance
- face - coarse features
- face - numbness
- facial fullness
- facial palsy
- facial plethora
- facial weakness
- facies - abnormal
- facies - hippocratic
- facies - moon
- faecal incontinence
- failure to thrive
- fallopian tube hyperplasia
- fasciculation
- fatigue
- fatigue (post-exertional)
- feet - cold
- feet - increased size
- feet - large
- feet - pain
- feet - small
- fingers - thick
- flaccid paralysis
- flatulence
- flushing
- fontanelles - enlarged
- frontal bossing
- fungating lesion
- fungating mass
- funny turns
- gait abnormality
- gait unsteadiness
- gallbladder calculi
- gallstones
- gangrene
- gastro-oesophageal reflux
- genital oedema
- genu valgum
- genu varum
- gestational diabetes
- glaucoma
- glucose intolerance
- glucosuria
- growth hormone deficiency
- growth retardation
- haematemesis
- haematochezia
- haematoma
- haematuria
- haemoglobinuria
- haemoptysis
- hair - coarse
- hair - dry
- hair - temporal balding
- hairline - low
- hallucination
- hands - enlargement
- hands - large
- hands - single palmar crease
- hands - small
- head - large
- headache
- hearing loss
- heart failure
- heart murmur
- heat intolerance
- height loss
- hemiballismus
- hemianopia
- hemiparesis
- hemispatial neglect
- hepatic cysts
- hepatic metastases
- hepatomegaly
- hidradenitis suppurativa
- high-arched palate
- hip dislocation
- hippocampal dysgenesis
- hirschsprung's disease
- hot flushes
- hydronephrosis
- hypolipidaemia
- hyperactivity
- hyperacusis
- hyperandrogenaemia
- hypercalciuria
- hypercapnea
- hypercholesterolaemia
- hypercortisolaemia
- hyperflexibility
- hyperglucagonaemia
- hyperhidrosis
- hyperhomocysteinaemia
- hypernasal speech
- hyperopia
- hyperoxaluria
- hyperpigmentation
- hyperplasia
- hyperpnoea
- hypersalivation
- hyperseborrhea
- hypersomnia
- hyperthermia
- hypertrichosis
- hypertrophy
- hyperuricaemia
- hyperventilation
- hypoadrenalism
- hypoalbuminaemia
- hypocalciuria
- hypocitraturia
- hypomagnesaemia
- hypopigmentation
- hypoplastic scrotum
- hypopotassaemia
- hypoprolactinaemia
- hyporeflexia
- hyposmia
- hypospadias
- hypotension
- hypothermia
- hypotonia
- hypoventilation
- hypovitaminosis d
- hypovolaemia
- hypovolaemic shock
- hypoxia
- immunodeficiency
- impulsivity
- inattention
- infections
- inflexibility
- insomnia
- instability
- intussusception
- irritability
- ischaemia
- ischuria
- itching
- jaundice
- keratoconus
- ketonuria
- ketotic odour
- kidney dysplasia
- kidney stones
- kyphoscoliosis
- kyphosis
- labioscrotal fold abnormalities
- laceration
- late dentition
- learning difficulties
- leg pain
- legs - increased length
- leukaemia
- leukocytosis
- libido increase
- libido reduction/loss
- lichen sclerosus
- lips - dry
- lips - thin
- little finger - in-curved
- little finger - short
- liver masses
- lordosis
- lordosis (loss of)
- lymphadenectomy
- lymphadenitis
- lymphocytosis
- lymphoedema
- macroglossia
- malaise
- malaise (post-exertional)
- malodorous perspiration
- mania
- marcus gunn pupil
- mastalgia
- meckel's diverticulum
- melena
- menorrhagia
- menstrual disorder
- mesenteric ischaemia
- metabolic alkalosis
- microalbuminuria
- microcephaly
- micrognathia
- micropenis
- milk-alkali syndrome
- miscarriage
- mood changes/swings
- mouth - down-turned
- mouth - small
- movement - limited range of
- mucosal pigmentation
- muscle atrophy
- muscle freezing
- muscle hypertrophy
- muscle rigidity
- myalgia
- myasthaenia
- mydriasis
- myelodysplasia
- myeloma
- myoclonus
- myodesopsia
- myokymia
- myopathy
- myopia
- myosis
- nail clubbing
- nail dystrophy
- nasal obstruction
- nausea
- neck - loose skin (nape)
- neck - short
- neck mass
- neck pain/discomfort
- necrolytic migratory erythema
- necrosis
- nephrocalcinosis
- nephropathy
- neurofibromas
- night terrors
- nipple change
- nipple discharge
- nipple inversion
- nipple retraction
- nipples widely spaced
- nocturia
- normochromic normocytic anaemia
- nose - depressed bridge
- nose - flat bridge
- nose - thickening
- nystagmus
- obsessive-compulsive disorder
- obstetrical haemorrhage
- obstructive sleep apnoea
- odynophagia
- oedema
- oesophageal atresia
- oesophagitis
- oligomenorrhoea
- oliguria
- onychauxis
- oophoritis
- ophthalmoplegia
- optic atrophy
- orbital fat prolapse
- orbital hypertelorism
- orthostatic hypotension
- osteoarthritis
- osteopenia
- otitis media
- ovarian cysts
- ovarian hyperplasia
- palatoschisis
- pallor
- palmar erythema
- palpebral fissure (downslanted)
- palpebral fissure (extended)
- palpebral fissure (reduced)
- palpebral fissure (upslanted)
- palpitations
- pancreatic fibrosis
- pancytopaenia
- panic attacks
- papilloedema
- paraesthesia
- paralysis
- paranoia
- patellar dislocation
- patellar subluxation
- pedal ulceration
- pellagra
- pelvic mass
- pelvic pain
- penile agenesis
- peptic ulcer
- pericardial effusion
- periodontitis
- periosteal bone reactions
- peripheral oedema
- personality change
- pes cavus
- petechiae
- peyronie's disease
- pharyngitis
- philtrum - long
- philtrum - short
- phosphaturia
- photophobia
- photosensitivity
- pleurisy
- poikiloderma
- polydactyly
- polydipsia
- polyphagia
- polyuria
- poor wound healing
- postmenopausal bleeding
- post-nasal drip
- postprandial fullness
- postural instability
- prehypertension
- premature birth
- premature labour
- prenatal growth retardation
- presbyopia
- pretibial myxoedema
- proctalgia fugax
- prognathism
- proptosis
- prosopagnosia
- proteinuria
- pruritus
- pruritus scroti
- pruritus vulvae
- pseudarthrosis
- psoriatic arthritis
- psychiatric problems
- psychomotor retardation
- psychosis
- pterygium colli
- ptosis
- puberty (delayed/absent)
- puberty (early/precocious)
- puffiness
- pulmonary embolism
- purpura
- pyelonephritis
- pyloric stenosis
- pyrexia
- pyrosis
- pyuria
- rash
- rectal pain
- rectorrhagia
- refractory anemia
- reluctance to weight-bear
- renal agenesis
- renal clubbing
- renal colic
- renal cyst
- renal failure
- renal insufficiency
- renal phosphate wasting (isolated)
- renal tubular acidosis
- respiratory failure
- reticulocytosis
- retinitis pigmentosa
- retinopathy
- retrobulbar pain
- retrograde ejaculation
- retroperitoneal fibrosis
- salivary gland swelling
- salpingitis
- salt craving
- salt wasting
- sarcoidosis
- schizophrenia
- scoliosis
- scotoma
- seborrhoeic dermatitis
- seizures
- sensory loss
- sepsis
- septic arthritis
- septic shock
- shivering
- singultus
- sinusitis
- sixth nerve palsy
- skeletal deformity
- skeletal dysplasia
- skin - texture change
- skin infections
- skin necrosis
- skin pigmentation - spotty
- skin thickening
- skin thinning
- sleep apnoea
- sleep difficulties
- sleep disturbance
- sleep hyperhidrosis
- slow growth
- slurred speech
- social difficulties
- soft tissue swelling
- somnambulism
- somniloquy
- somnolence
- sore throat
- spasms
- spastic paraplegia
- spasticity
- speech delay
- spider naevi
- splenomegaly
- sputum production
- steatorrhoea
- stomatitis
- strabismus
- strangury
- striae
- stridor
- stroke
- subfertility
- suicidal ideation
- supraclavicular fat pads
- supranuclear gaze palsy
- sweating
- syncope
- syndactyly
- tachycardia
- tachypnoea
- teeth gapping
- telangiectasias
- telecanthus
- tetraparesis
- t-reflex (absent)
- t-reflex (depressed)
- tetany
- thermodysregulation
- thrombocytopenia
- thrombocytosis
- thrombophilia
- thrush
- tics
- tinnitus
- toe clubbing
- toe deformities
- toes - thick
- toes - widely spaced
- tongue - protruding
- tracheo-oesophageal compression
- tracheo-oesophageal fistula
- tremulousness
- tricuspid insufficiency
- umbilical hernia
- uraemia
- ureter duplex
- uricaemia
- urinary frequency
- urinary incontinence
- urogenital sinus
- urticaria
- uterine hyperplasia
- uterus duplex
- vagina duplex
- vaginal bleeding
- vaginal discharge
- vaginal dryness
- vaginal pain/tenderness
- vaginism
- ventricular fibrillation
- ventricular hypertrophy
- vertigo
- viraemia
- virilisation (abnormal)
- vision - acuity reduction
- vision - blurred
- visual disturbance
- visual field defect
- visual impairment
- visual loss
- vitiligo
- vocal cord paresis
- vomiting
- von graefe's sign
- weight gain
- weight loss
- wheezing
- widened joint space(s)
- xeroderma
- xerostomia
- 3-methoxy 4-hydroxy mandelic acid
- 17-hydroxypregnenolone (urine)
- 17-ketosteroids
- 25-hydroxyvitamin-d3
- 5hiaa
- aberrant adrenal receptors
- acid-base balance
- acth stimulation
- activated partial thromboplastin time
- acyl-ghrelin
- adrenal antibodies
- adrenal function
- adrenal scintigraphy
- adrenal venous sampling
- afp tumour marker
- alanine aminotransferase
- albumin
- albumin to creatinine ratio
- aldosterone (24-hour urine)
- aldosterone (blood)
- aldosterone (plasma)
- aldosterone (serum)
- aldosterone to renin ratio
- alkaline phosphatase
- alkaline phosphatase (bone-specific)
- alpha-fetoprotein
- ammonia
- amniocentesis
- amylase
- angiography
- anion gap
- anti-acetylcholine antibodies
- anticardiolipin antibody
- anti-insulin antibodies
- anti-islet cell antibody
- anti-gh antibodies
- antinuclear antibody
- anti-tyrosine phosphatase antibodies
- asvs
- barium studies
- basal insulin
- base excess
- apolipoprotein h
- beta-hydroxybutyrate
- bicarbonate
- bilirubin
- biopsy
- blood film
- blood pressure
- bmi
- body fat mass
- bone age
- bone biopsy
- bone mineral content
- bone mineral density
- bone mineral density test
- bone scintigraphy
- bone sialoprotein
- bound insulin
- brca1/brca2
- c1np
- c3 complement
- c4 complement
- ca125
- calcifediol
- calcium (serum)
- calcium (urine)
- calcium to creatinine clearance ratio
- carcinoembryonic antigen
- cardiac index
- catecholamines (24-hour urine)
- catecholamines (plasma)
- cd-56
- chemokines
- chest auscultation
- chloride
- chorionic villus sampling
- chromatography
- chromogranin a
- chromosomal analysis
- clomid challenge
- clonidine suppression
- collagen
- colonoscopy
- colposcopy
- continuous glucose monitoring
- core needle biopsy
- corticotropin-releasing hormone stimulation test
- cortisol (9am)
- cortisol (plasma)
- cortisol (midnight)
- cortisol (salivary)
- cortisol (serum)
- cortisol day curve
- cortisol, free (24-hour urine)
- c-peptide (24-hour urine)
- c-peptide (blood)
- c-reactive protein
- creatinine
- creatine kinase
- creatinine (24-hour urine)
- creatinine (serum)
- creatinine clearance
- crh stimulation
- ctpa scan
- ct scan
- c-telopeptide
- cytokines
- deoxypyridinoline
- dexa scan
- dexamethasone suppression
- dexamethasone suppression (high dose)
- dexamethasone suppression (low dose)
- dhea sulphate
- discectomy
- dldl cholesterol
- dmsa scan
- dna sequencing
- domperidone
- down syndrome screening
- ductal lavage
- echocardiogram
- eeg
- electrocardiogram
- electrolytes
- electromyography
- endoscopic ultrasound
- endoscopy
- endosonography
- enzyme immunoassay
- epinephrine (plasma)
- epinephrine (urine)
- erythrocyte sedimentation rate
- estimated glomerular filtration rate
- ethanol ablation
- ewing and clarke autonomic function
- exercise tolerance
- fbc
- ferritin
- fine needle aspiration biopsy
- flow cytometry
- fludrocortisone suppression
- fluticasone-propionate-17-beta carboxylic acid
- fmri
- folate
- ft3
- ft4
- gada
- gallium nitrate
- gallium scan
- gastric biopsy
- genetic analysis
- genitography
- gh day curve
- gh stimulation
- gh suppression
- glp-1
- glp-2
- glucose suppression test
- glucose (blood)
- glucose (blood, fasting)
- glucose (blood, postprandial)
- glucose (urine)
- glucose tolerance
- glucose tolerance (intravenous)
- glucose tolerance (oral)
- glucose tolerance (prolonged)
- gluten sensitivity
- gnrh stimulation
- gonadotrophins
- growth hormone-releasing peptide-2 test
- gut hormones (fasting)
- haematoxylin and eosin staining
- haemoglobin
- haemoglobin a1c
- hcg (serum)
- hcg (urine)
- hcg stimulation
- hdl cholesterol
- hearing test
- heart rate
- hepatic venous sampling with arterial stimulation
- high-sensitivity c-reactive protein
- histopathology
- hla genotyping
- holter monitoring
- homa
- homocysteine
- hyaluronic acid
- hydrocortisone day curve
- hydroxyproline
- hydroxyprogesterone
- hysteroscopy
- igfbp2
- igfbp3
- igg4/igg ratio
- immunocytochemistry
- immunohistochemistry
- immunoglobulins
- immunoglobulin g2
- immunoglobulin g4
- immunoglobulin a
- immunoglobulin m
- immunostaining
- inferior petrosal sinus sampling
- inhibin b
- insulin (fasting)
- insulin suppression
- insulin tissue resistance tests
- insulin tolerance
- intracranial pressure
- irm imaging
- ketones (plasma)
- ketones (urine)
- kidney function
- lactate
- lactate dehydrogenase
- laparoscopy
- laparoscopy and dye
- laparotomy
- ldl cholesterol
- leuprolide acetate stimulation
- leukocyte esterase (urine)
- levothyroxine absorption
- lipase (serum)
- lipid profile
- liquid-based cytology
- liquid chromatography-mass spectrometry
- liver biopsy
- liver function
- lumbar puncture
- lung function testing
- luteinising hormone releasing hormone test
- macroprolactin
- magnesium
- mag3 scan
- mammogram
- mantoux test
- metanephrines (plasma)
- metanephrines (urinary)
- methoxytyramine
- metoclopramide
- metyrapone cortisol day curve
- metyrapone suppression
- metyrapone test dose
- mibg scan
- microarray analysis
- molecular genetic analysis
- mri
- myocardial biopsy
- nerve conduction study
- neuroendocrine markers
- neuron-specific enolase
- norepinephrine
- ntx
- oct
- octreotide scan
- octreotide suppression test
- osmolality
- ovarian venous sampling
- p1np
- palpation
- pap test
- parathyroid scintigraphy
- pentagastrin
- perchlorate discharge
- percutaneous umbilical blood sampling
- peripheral blood film
- pet scan
- ph (blood)
- phosphate (serum)
- phosphate (urine)
- pituitary function
- plasma osmolality
- plasma viscosity
- platelet count
- pneumococcal antigen
- pneumococcal pcr
- polymerase chain reaction
- polysomnography
- porter-silber chromogens
- potassium
- pregnancy test
- proinsulin
- prostate-specific antigen
- protein electrophoresis
- protein fingerprinting
- protein folding analysis
- psychiatric assessment
- psychometric assessment
- pulse oximetry
- pyelography
- pyridinium crosslinks
- quicki
- plasma renin activity
- radioimmunoassay
- radionuclide imaging
- raiu test
- red blood cell count
- renal biopsy
- renin (24-hour urine)
- respiratory status
- renin (blood)
- renin plasma activity
- rheumatoid factor
- salt loading
- sdldl cholesterol
- secretin stimulation
- selective parathyroid venous sampling
- selective transhepatic portal venous sampling
- semen analysis
- serotonin
- serum osmolality
- serum free insulin
- sestamibi scan
- sex hormone binding globulin
- shbg
- skeletal muscle mass
- skin biopsy
- sleep diary
- sodium
- spect scan
- supervised 72-hour fast
- surgical biopsy
- sweat test
- synaptophysin
- systemic vascular resistance index
- tanner scale
- thoracocentesis
- thyroid transcription factor-1
- thyroglobulin
- thyroid antibodies
- thyroid function
- thyroid scintigraphy
- thyroid ultrasonography
- total cholesterol
- total ghrelin
- total t3
- total t4
- trabecular thickness
- transaminase
- transvaginal ultrasound
- trap 5b
- trh stimulation
- triglycerides
- triiodothyronine (t3) suppression
- troponin
- tsh receptor antibodies
- type 3 precollagen
- type 4 collagen
- ultrasound-guided biopsy
- ultrasound scan
- urea and electrolytes
- uric acid (blood)
- uric acid (urine)
- urinalysis
- urinary free cortisol
- urine 24-hour volume
- urine osmolality
- vaginal examination
- vanillylmandelic acid (24-hour urine)
- visual field assessment
- vitamin b12
- vitamin e
- waist circumference
- water deprivation
- water load
- weight
- western blotting
- white blood cell count
- white blood cell differential count
- x-ray
- zinc
- abscess drainage
- acetic acid injection
- adhesiolysis
- adrenalectomy
- amputation
- analgesics
- angioplasty
- arthrodesis
- assisted reproduction techniques
- bariatric surgery
- bilateral salpingo-oophorectomy
- blood transfusion
- bone grafting
- caesarean section
- cardiac transplantation
- cardiac pacemaker
- cataract extraction
- chemoembolisation
- chemotherapy
- chemoradiotherapy
- clitoroplasty
- continuous renal replacement therapy
- contraception
- cordotomy
- counselling
- craniotomy
- cryopreservation
- cryosurgical ablation
- debridement
- dialysis
- diazoxide
- diet
- duodenotomy
- endonasal endoscopic surgery
- exercise
- external fixation
- extracorporeal shock wave lithotripsy
- extraocular muscle surgery
- eye surgery
- eyelid surgery
- fasciotomy
- fluid repletion
- fluid restriction
- gamma knife radiosurgery
- gastrectomy
- gastrostomy
- gender reassignment surgery
- gonadectomy
- heart transplantation
- hormone replacement
- hormone suppression
- hypophysectomy
- hysterectomy
- inguinal orchiectomy
- internal fixation
- intra-cardiac defibrillator
- islet transplantation
- ivf
- kidney transplantation
- laparoscopic adrenalectomy
- laryngoplasty
- laryngoscopy
- laser lithotripsy
- light treatment
- liver transplantation
- lumpectomy
- lymph node dissection
- mastectomy
- molecularly targeted therapy
- neuroendoscopic surgery
- oophorectomy
- orbital decompression
- orbital radiation
- orchidectomy
- orthopaedic surgery
- osteotomy
- ovarian cystectomy
- ovarian diathermy
- oxygen therapy
- pancreas transplantation
- pancreatectomy
- pancreaticoduodenectomy
- parathyroidectomy
- percutaneous adrenal ablation
- percutaneous nephrolithotomy
- pericardiocentesis
- pericardiotomy
- physiotherapy
- pituitary adenomectomy
- plasma exchange
- plasmapheresis
- psychotherapy
- radiofrequency ablation
- radionuclide therapy
- radiotherapy
- reconstruction of genitalia
- resection of tumour
- right-sided hemicolectomy
- salpingo-oophorectomy
- small bowel resection
- speech and language therapy
- spinal surgery
- splenectomy
- stereotactic radiosurgery
- termination of pregnancy
- thymic transplantation
- thyroidectomy
- tracheostomy
- transcranial surgery
- transsphenoidal surgery
- transtentorial surgery
- vaginoplasty
- vagotomy
- 5-alpha-reductase inhibitors
- 17?-estradiol
- abiraterone
- acarbose
- acetazolamide
- acetohexamide
- adalimumab
- albiglutide
- alendronate
- alogliptin
- alpha-blockers
- alphacalcidol
- alpha-glucosidase inhibitors
- amiloride
- amlodipine
- amoxicillin
- anastrozole
- angiotensin-converting enzyme inhibitors
- angiotensin receptor antagonists
- anthracyclines
- antiandrogens
- antibiotics
- antiemetics
- antiepileptics
- antipsychotics
- antithyroid drugs
- antiseptic
- antivirals
- aripiprazole
- aromatase inhibitors
- aspirin
- astragalus membranaceus
- ativan
- atenolol
- atorvastatin
- avp receptor antagonists
- axitinib
- azathioprine
- bendroflumethiazide
- benzodiazepines
- beta-blockers
- betamethasone
- bexlosteride
- bicalutamide
- bisphosphonates
- bleomycin
- botulinum toxin
- bromocriptine
- cabergoline
- cabozantinib
- calcimimetics
- calcitonin (salmon)
- calcium
- calcium carbonate
- calcium chloride
- calcium dobesilate
- calcium edta
- calcium gluconate
- calcium-l-aspartate
- calcium polystyrene sulphonate
- canagliflozin
- capecitabine
- captopril
- carbimazole
- carboplatin
- carbutamide
- carvedilol
- ceftriaxone
- chlorothiazide
- chlorpropamide
- cholecalciferol
- cholinesterase inhibitors
- ciclosporin
- cinacalcet
- cisplatin
- clodronate
- clomifene
- clomiphene citrate
- clopidogrel
- co-cyprindiol
- codeine
- colonic polyps
- combined oral contraceptive pill
- conivaptan
- cortisone acetate
- continuous subcutaneous hydrocortisone infusion
- continuous subcutaneous insulin infusion
- coumadin
- corticosteroids
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- cardiology
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- insight into disease pathogenesis or mechanism of therapy
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- february
- 2022
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Affiliation(s)
- Aria Jazdarehee
- Department of Medicine and Faculty of Medicine, University of British Columbia, British Columbia, Canada
| | - Sawyer Huget-Penner
- Division of Endocrinology and Metabolism, Fraser Health Authority, British Columbia, Canada
| | - Monika Pawlowska
- Division of Endocrinology and Metabolism, University of British Columbia, British Columbia, Canada
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Loewen JM, Bach JF. Performing an upper airway examination in dogs. J Vet Emerg Crit Care (San Antonio) 2022; 32:16-21. [PMID: 35044069 DOI: 10.1111/vec.13124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 09/25/2017] [Accepted: 10/02/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Increased airway resistance due to upper airway obstruction is a common cause of respiratory distress. An upper airway exam is an inexpensive and quick diagnostic procedure that can serve to localize a disease process, confirm a definitive diagnosis, and offer therapeutic benefits. DESCRIPTION The upper airway examination consists of an external evaluation of the head and neck as well as a sedated examination of the oral cavity, the pharyngeal cavity, larynx, and nasal passages. SUMMARY An upper airway examination should be performed in patients with increased inspiratory effort or increased upper respiratory noise (eg, stertor or stridor). A complete, sedated upper airway examination should be considered for patients with clinical signs of upper airway disease for which a cause is not obvious from the physical examination. KEY POINTS Indications for an upper airway examination include sneezing, nasal discharge or epistaxis, reduced or absent nasal airflow, change in phonation, inspiratory difficulty, and audible respiratory sounds. Upper airway examination helps localize pathological processes and allows the clinician to confirm or exclude several differential diagnoses. Pre-oxygenation of the patient for 3-5 minutes prior to sedation will help increase the amount of time available before hypoxemia occurs, should complications arise. Upon completion of the upper airway examination, it is important to monitor the patient carefully and ensure a safe recovery. Careful planning to ensure the availability of necessary equipment and preparation of the team to react during and after the airway examination will minimize the risks of examination to patients with upper airway disease.
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Affiliation(s)
- Jennifer M Loewen
- School of Veterinary Medicine, Department of Medical Sciences, University of Wisconsin, Madison, Madison, Wisconsin, USA
| | - Jonathan F Bach
- School of Veterinary Medicine, Department of Medical Sciences, University of Wisconsin, Madison, Madison, Wisconsin, USA
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Grover T, Dayal V, Fourcin A, Milabo C, Limousin P, Foltynie T. Quantifying Stridor Associated with Parkinsonism and Deep Brain Stimulation-A Case Report. Mov Disord Clin Pract 2022; 9:91-94. [PMID: 35005071 DOI: 10.1002/mdc3.13368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 09/01/2021] [Accepted: 09/24/2021] [Indexed: 11/10/2022] Open
Affiliation(s)
- Timothy Grover
- Movement Disorders National Hospital for Neurology and Neurosurgery London United Kingdom
| | - Viswas Dayal
- Neurology Department Auckland City Hospital Auckland New Zealand
| | - Adrian Fourcin
- Department of Linguistics, Faculty of Brain Sciences University College London London United Kingdom
| | - Catherine Milabo
- Movement Disorders National Hospital for Neurology and Neurosurgery London United Kingdom
| | - Patricia Limousin
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology University College London London United Kingdom
| | - Thomas Foltynie
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology University College London London United Kingdom
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50
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Valjarevic S, Radaljac D, Miladinovic N. Life-Threatening Stridor due to Laryngeal Tuberculosis in the COVID-19 Era: Report of a Case. Ear Nose Throat J 2022:1455613211070896. [PMID: 34974770 DOI: 10.1177/01455613211070896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Laryngeal tuberculosis is the most frequent granulomatous disease of the larynx and it is prone to be diagnosed as cancer. COVID-19 pandemic caused considerable disruption in tuberculosis service provisions both in the primary care and hospital settings. This report describes a rare case of life-threatening stridor in a patient who presented with an ulceroproliferative laryngeal mass later confirmed as laryngeal tuberculosis. Urgent tracheostomy was performed. The patient's sputum and the computed tomography of the chest revealed a pulmonary, as well as laryngeal tuberculosis. The patient was commenced on a 24 week course of anti-tuberculous treatment which was interrupted because of a mild course of hospital-acquired coronavirus infection. 3 months after initial treatment for tuberculosis, his sputum cultures became negative. Flexible laryngoscopy was performed at our department 4 months after commencement of treatment, demonstrating complete regression of the lesion and symmetrical laryngeal mobility, hence the patient was successfully decannulated and discharged to be followed up to his community hospital. In the time of COVID-19 pandemic, we should never underestimate other severe infectious diseases.
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Affiliation(s)
- Svetlana Valjarevic
- Department of Otorhinolaryngology with Maxillofacial Surgery, Clinical Hospital Center "Zemun", Belgrade, Serbia
- University of Belgrade, Faculty of Medicine, Belgrade, Serbia
| | - Dejan Radaljac
- Department of Otorhinolaryngology with Maxillofacial Surgery, Clinical Hospital Center "Zemun", Belgrade, Serbia
| | - Nenad Miladinovic
- Department of Clinical Pathology, Clinical Hospital Center "Zemun", Belgrade, Serbia
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