Subjective Evaluation of Voice Characteristics of School Aged Children in a Basket Ball Team

Abstract

Voice disorders have been estimated to be present in between 3 and 9% of general population. Sports children have vocal abusive behavior i.e. the extra effort which they put on their voice while playing, leading to voice disorders. It is imperative to find out the voice characteristics of children involved in sports activity. To assess voice characteristics of school aged children, who are active participants in a basket ball team. A group of twenty children (13 males and 7 females) were included in the study. He or she was member of school basket ball team and had participated in many events. The perceptual voice assessment was conducted using GRBAS scale, Buffalo III Voice Profile and Voice Handicap Index (VHI). Findings on GRBAS voice rating scale—In the first parameter i.e. grade 46.7% of the subjects reported slight hoarse component. In the second parameter i.e. Roughness 46.7% of the subjects showed slight roughness component. In another parameter i.e. the asthenia 20% % of the subjects reported slight asthenia component in their voice. In the next parameter i.e. strain in the voice, 26.7% of the subjects showed slight strain component in their voice. Finding on BUFFALO III voice screening profile—In the laryngeal tone, 46.7% of the subjects showed mild hoarse component. Findings on voice handicap index (VHI)—28% of the subjects had functional symptoms of voice problems. 43% of the subjects had some physical symptoms while 28% had affected emotional component. Present study is first of its kind to focus on voice disorders among school going children who are members of a basket ball team. During sport events players tend to scream in order to communicate among their team mates, to show their aggressiveness to their opponents and to show excitement of win or frustration of the lost match leading to various voice problems. There is a high probability of occurrence of voice disorders among children who are active participants of basket ball. Proper counselling of these children is required for preventive measures and to seek voice therapy when required.

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Genetically Diversity of Pseudomonas aeruginosa Isolated from Chronic Suppurative Otitis Media with Respect to Their Antibiotic Sensitivity Pattern

Abstract

Pseudomonas aeruginosa is an important chronic suppurative otitis media (CSOM) pathogen that exhibits multiple resistances to antibiotics with increasing frequency, making patient treatment more difficult. The aim of the study is to ascertain the genetically diversity of this clinically isolated P. aeruginosa with inter simple sequence repeat (ISSR) markers. All 25 P. aeruginosa were isolated from CSOM patients by taking their ear swabs and culturing on blood agar and MacConkey agar. All strains were identified with morphological characters and biochemical testing. The antimicrobial susceptibility testing was carried out according to National Committee for Clinical Laboratory Standards. ISSR was used to study the genetic diversity of P. aeruginosa. Clinically CSOM isolated 25 P. aeruginosa were 88% Ciprofloxacin resistant and similarly resistant to other antibiotics were documented. The study has been made using ISSR marker to find out the genomic relation among the strains/populations of P. aeruginosa. The result was shown that maximum similarity (80%) was between S-11 and S-13 and minimum (28.2%) was between S-4 and S-16 with an average similarity of 53.2%. The dendogram showed a distinct separation in between all the strains/populations of P. aeruginosa. The strains/populations were broken up into two main clusters in which small one bear two strains/populations (S-4 and S-9) and another cluster have another 23 strains/populations. These 23 strains were also separated to form subcluster by having different range of small clades. The genetically diversity of pathogenic P. aeruginosa present in CSOM at our hospital indicates the coexistence different strains due to different antibiotic sensitivity patterns. The conventional culture and sensitivity methods are time consuming whereas in PCR, it will detect within 4–6 h for effective antibiotic. Basing upon the banding pattern with ISSR primers, clinicians can prescribe the effective antibiotics accordingly for CSOM patients in the same day.

https://ift.tt/2qsLOmw

Intraosseous venous malformation of the zygomatico-orbital complex. Case report and literature review with focus on confusions in vascular lesion terms

Abstract

Intraosseous vascular malformations (VascM) of the facial skeleton are rare entities, raising difficulties even today in their treatment. We present a case for zygomatic intraosseous venous malformation of traumatic etiology with growth dynamics presentation and a multidisciplinary treatment approach, with intravascular embolization surgical ablation and primary reconstructruction using a titanium patient-specific implant (PSI), and a review of the literature for intraosseous vascular lesions of the facial skeleton focusing on the diagnostic syntagms used by the involved medical personnel, to shed light on the confusions over these terms.

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TX99 Is a Neutralizing Monoclonal Antibody Against Mouse TIGIT

Monoclonal Antibodies in Immunodiagnosis and Immunotherapy, Ahead of Print.


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Animal models of acute otitis media – A review with practical implications for laboratory research

Publication date: Available online 12 April 2018
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): N.H. Davidoss, Y.K. Varsak, P.L. Santa Maria
Considerable animal research has focused on developing new strategies for the prevention and treatment of acute otitis media (AOM). Several experimental models of AOM have thus been developed. A PubMed search of the English literature was conducted from 1975 to July 2016 using the search terms "animal model" and "otitis media" from which 91 published studies were included for analysis, yielding 123 animal models. The rat, mouse and chinchilla are the preferred animals for experimental AOM models with their individual advantages and disadvantages. The most common pathogens used to create AOM are Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis. Streptococcus pneumoniae (types 3, 23 and 6A) and non-typeable Haemophilus influenzae (NTHi) are best options for inoculation into rat and mouse models. Adding viral pathogens such as RSV and Influenza A virus, along with creating ET dysfunction, are useful adjuncts in animal models of AOM. Antibiotic prophylaxis may interfere with the inflammatory response without a significant reduction in animal mortality.



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Perioperative management of transcatheter, aortic and mitral, double valve-in-valve implantation during pregnancy through left ventricular apical approach

Suresh Chengode, Rahul Vijaykumar Shabadi, Ram Narayan Rao, Nasser Alkemyani, Hilal Alsabti

Annals of Cardiac Anaesthesia 2018 21(2):185-188

Pregnant women with stenotic degeneration of bioprosthetic cardiac valves may require another valve replacement procedure when their symptoms deteriorate with progression of pregnancy, but fetal mortality is higher with cardiac surgery done on cardiopulmonary bypass. Transcatheter valve-in-valve implantation may help to improve the fetal and maternal outcomes in these situations. Double valve-in-valve implantation is rare and has not been reported in a pregnant patient. We report, for the first time, the case of a pregnant woman with stenotic bioprosthetic valves in the mitral and aortic positions, who underwent a successful concomitant, transcatheter, double valve-in-valve implantation through the left ventricular apical route during the second trimester of her precious pregnancy.

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Dishonesty in medical research and publication and the remedial measures

Praveen Kumar Neema

Annals of Cardiac Anaesthesia 2018 21(2):111-113



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Absent right superior vena cava and persistent left superior vena cava in a patient with bicuspid aortic valve with aortic stenosis

Kushant Gupta, Vijayakanth Bhuvana, Varun Bansal, Ruma Ray, Arkalgud Sampath Kumar

Annals of Cardiac Anaesthesia 2018 21(2):212-214

Persistent left superior vena cava (LSVC) with absent right SVC (RSVC) is a rare congenital anomaly. If undetected, the condition may pose difficulties in central venous catheter insertion, pacemaker electrode insertion, and cannulation during cardiopulmonary bypass. We describe a case of persistent LSVC with absent RSVC, who was diagnosed to have bicuspid aortic valve with aortic stenosis.

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Immediate extubation after cardiac surgery should be part of routine anesthesia practice for selected patients

Thomas M Hemmerling

Annals of Cardiac Anaesthesia 2018 21(2):114-115



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Anesthetic challenges of a patient with the communicating bulla coming for nonthoracic surgery

Bernice Theodare, Vinolia Victory Nissy, Raj Sahajanandan, Ramamani Mariappan

Annals of Cardiac Anaesthesia 2018 21(2):200-202

Management of a patient with a giant bulla coming for a nonthoracic surgery is rare, and its anesthetic management is very challenging. It is imperative to isolate only the subsegmental bronchus, in which the bulla communicates to avoid respiratory morbidities such as pneumothorax, emphysema or atelectasis of the surrounding lung parenchyma, and postoperative respiratory failure. Herewith, we want to report the anesthetic challenges of a patient with giant bulla communicating into one of the subsegmental right upper lobe bronchus for splenectomy.

https://ift.tt/2EI23RH

Pulmonary hypertension and cardiac anesthesia: Anesthesiologist's perspective

Manjula Sudeep Sarkar, Pushkar M Desai

Annals of Cardiac Anaesthesia 2018 21(2):116-122

Perioperative management of pulmonary hypertension remains one of the most challenging scenarios during cardiac surgery. It is associated with high morbidity and mortality due to right ventricular failure, arrhythmias, myocardial ischemia, and intractable hypoxia. Therefore, this review article is intended toward the anesthetic considerations in the perioperative period, with particular emphasis on the selection of technique and choice of anesthesia with maintenance, anesthetic drugs, and the recent intraoperative recommendations for prevention and treatment of pulmonary hypertensive crisis.

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Retraction: Annals of cardiac anesthesia: Beacon journey toward excellence: 2015–2017

Annals of Cardiac Anaesthesia 2018 21(2):221-221



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Prophylactic preoperative levosimendan for off-pump coronary artery bypass grafting in patients with left ventricular dysfunction: Single-centered randomized prospective study

Pushkar Mahendra Desai, Manjula S Sarkar, Sanjeeta R Umbarkar

Annals of Cardiac Anaesthesia 2018 21(2):123-128

Background: Off-pump coronary artery bypass surgery (OPCAB) is often complicated by hemodynamic instability, especially in patients with prior left ventricular (LV) dysfunction and appropriate choice of inotrope plays a vital role in perioperative management of these patients. Aim and Objective: To study hemodynamic effects and immediate outcome of prophylactic infusion of levosimendan in patients with the LV dysfunction undergoing OPCAB surgery and whether this strategy helps in successful conduct of OPCAB surgery. Materials and Methods: After Institutional Ethics Committee approval, 60 patients posted for elective OPCAB surgery were randomly divided into two groups (n = 30 each). Patients with the LV ejection fraction <30% were included. Study group was started on injection levosimendan (@ 0.1 μg/kg/min) in the previous night before surgery and continued for 24 h including intraoperative period. Hemodynamic monitoring included heart rate, invasive blood pressure, cardiac index (CI), pulmonary capillary wedge pressure (PCWP), pulse oximetry, and arterial blood gases with serum lactates at as T0 (baseline), T1 (15 min after obtuse marginal and/or PDA anastomoses), T2 (at end of surgery), T3 (6 h after surgery in Intensive Care Unit [ICU]), T4 (12 h after surgery), and T5 (24 h after surgery in ICU). Vasopressor was added to maintain mean arterial pressure >60 mmHg. Chi-square/Fisher's exact/Mid P exact test and Student's t-tests were applied for categorical and continuous data. Results: CI was greater and PCWP reduced significantly in Group L during intraoperative and early postoperative period. Serum lactate concentration was lower in patients pretreated with levosimendan. Incidence of postoperative atrial fibrillation (POAF) (36.6 vs. 6.6%; P = 0.01), low cardiac output syndrome (LCOS) (30% vs. 6%; P = 0.02), and acute kidney injury (23.3% vs. 6.7%; P = 0.04) was less in Group L. Three patients (10%) in control group required conversion to cardiopulmonary bypass (CPB) as compared to none in the study group. There was no difference regarding ICU or hospital stay and mortality in both groups. Conclusion: Preoperative levosimendan helps in successful conduct of OPCAB and reduces the incidence of LCOS, POAF, conversion to CPB, and requirement of intra-aortic balloon pump.

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Inverted left atrial appendage during minimally invasive mitral valve repair

Kazuto Miyata, Sayaka Shigematsu

Annals of Cardiac Anaesthesia 2018 21(2):192-194

Inverted left atrial appendage (LAA) is a rare complication in cardiac surgery. The echocardiographic appearance often leads to misdiagnosis of thrombus or some other cardiac mass. Patients misdiagnosed in this way often undergo unnecessary anticoagulation or surgical treatment. Recently, minimally invasive mitral valve surgery (MIMVS) has become more widespread. However, as the incision for MIMVS through the right thoracotomy is very small, the inverted LAA is not within the surgical field of the cardiac surgeon. We present a case of inverted LAA during MIMVS and provide images from transesophageal echocardiography.

https://ift.tt/2v9gWNz

Comparison of immediate extubation versus ultrafast tracking strategy in the management of off-pump coronary artery bypass surgery

Amarja Sachin Nagre, Nagesh P Jambures

Annals of Cardiac Anaesthesia 2018 21(2):129-133

Introduction: Ultrafast tracking of anesthesia (UFTA) is practiced routinely, whereas immediate on-table extubation after off-pump coronary artery bypass (OPCAB) grafting surgery has many concerns. The purpose of our study was to evaluate the safety and feasibility of immediate extubation (IE) versus UFTA. Methods: Sixty patients were enrolled who underwent OPCAB surgery. The two groups IE and UFTA had thirty patients each. Inclusion criteria were patients for OPCAB surgery including left main stenosis. Exclusion criteria were patients with Ejection Fraction(EF) <30%, with unstable hemodynamics, on intra-aortic balloon pump (IABP), with renal dysfunction, with associated valvular heart diseases, on inotropes, on temporary pacemaker, with intraoperative conversion to on-pump coronary artery bypass grafting (CABG), who are chronic smokers, and with chronic obstructive pulmonary disease. Statistical analysis was done with Minitab 15 software. Descriptive statistics were summarized as mean, standard deviation, and percentage. Student's t-test was used to determine the significance of normally distributed parametric values. Z-test was used for proportion. Statistical significance was accepted at P < 0.05. Results: OT extubation was found to be safe as no patient had reintubation or respiratory insufficiency. None of the patients in either group had postoperative myocardial infarction, stroke, low cardiac output, mediastinitis, and renal failure. Hypothermia, blood transfusion, atrial fibrillation, and re-exploration did not occur. Intensive Care Unit length of stay was similar in the two groups. Discharge day is statistically significant (P = 0.001), with 5.66 days in the IE group and 6.36 days in the UFTA group. Time spent in the operating room at the end of surgery is statistically significant, with 14.03 min in UFTA group and 33.9 min in IE group. Conclusion: IE appears to be safe and effective in OPCAB patients without any major complications. It can be achieved after fulfilling traditional extubation criteria but is confined to highly selective group of patients.

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Absent superior vena cava in tetralogy of fallot

Tejas R Shah, Channabasavaraj S Hiremath, Anitha Diwakar, Krishna Manohar Soman Rema

Annals of Cardiac Anaesthesia 2018 21(2):205-207

Absent superior vena cava (SVC) is an asymptomatic congenital systemic venous anomaly which is rarely detected and compatible with normal life. Undiagnosed absent SVC may cause problems during cardiac catheterization or cardiac surgery. We present our surgical experience in a patient with tetralogy of Fallot who had undiagnosed absent SVC.

https://ift.tt/2EH7znM

Assessment of the effect of two regimens of milrinone infusion in pediatric patients undergoing fontan procedure: A randomized study

Rabie Soliman, Adel Ragheb

Annals of Cardiac Anaesthesia 2018 21(2):134-140

Objective: The aim of the study was to compare the effect of two different regimens of milrinone on hemodynamics and oxygen saturation in pediatric patients undergoing Fontan procedure. Design: This was a randomized study. Setting: Cardiac centers. Patients: This study included 116 patients undergoing Fontan procedure. Material and Methods: Group E: Milrinone was started as infusion 0.5 μg/kg/min without a loading dose at the beginning of cardiopulmonary bypass (CPB) followed by infusion 0.5–0.75 μg/kg/min in the pediatric cardiac surgical intensive care unit (PSICU). Group L: Milrinone was started as a loading dose 50 μg/kg over 10 min before weaning from CPB followed by infusion 0.5–0.75 μg/kg/min in the PSICU. Measurements: Heart rate, mean arterial blood pressure, central venous pressure, transpulmonary pressure, cardiac index, pharmacological support, lactate level, urine output, oxygen saturation, ICU, and hospital length of stay. Main Results: There were no changes in the heart rate and mean arterial blood pressure (P > 0.05). The increase in the postoperative central venous pressure, transpulmonary pressure and lactate level was lower in Group E than Group L (P < 0.05). The increase in the postoperative cardiac index, oxygen saturation, and urine output was higher in Group E than Group L (P < 0.05). The requirement for pharmacological support was lower in the Group E (P < 0.05). The ICU and hospital length of stay were shorter in the Group E than Group L (P < 0.05). Conclusion: Early use of milrinone during Fontan procedure facilitated the weaning from CPB, decreased the elevation in the central venous pressure, transpulmonary gradient pressure, and the requirement for pharmacological support. Furthermore, it increased the cardiac index and arterial oxygen saturation.

https://ift.tt/2JGn5Ux

Radio-opaque tricuspid aortic valve seen in X-Ray chest as mercedes-benz sign

Gauranga Majumdar, Surendra Kumar Agarwal, Prabhat Tewari

Annals of Cardiac Anaesthesia 2018 21(2):218-219

We are presenting a very interesting X-ray image of the calcific aortic valve in a septuagenarian male patient who underwent successful aortic valve replacement.

https://ift.tt/2v9gtuN

Milrinone: is bolus bad?

Venugopal Kulkarni

Annals of Cardiac Anaesthesia 2018 21(2):141-142



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View point: Retraction is a pain but scientific misconduct is a crime!

Prabhat Tewari

Annals of Cardiac Anaesthesia 2018 21(2):109-110



https://ift.tt/2vfsuyM

Dexmedetomidine versus ketofol sedation for outpatient diagnostic transesophageal echocardiography: A randomized controlled study

S Sruthi, Banashree Mandal, Manoj K Rohit, Goverdhan Datt Puri

Annals of Cardiac Anaesthesia 2018 21(2):143-150

Background: Moderate sedation is required for out-patient transesophageal echocardiography (TEE). Our objective was to compare the effect of Ketofol and dexmedetomidine for outpatient procedural sedation in diagnostic TEE with a hypothesis that Ketofol would be as effective as dexmedetomidine. Patients and Methods: Fifty adult patients of age group 18-60 years with atrial septal defect, rheumatic valvular heart disease undergoing diagnostic TEE in the outpatient echocardiography laboratory were randomized into two groups, group D and group KF. GROUP D: Dexmedetomidine infusion -200 μg in 20 ml normal saline. GROUP KF: Ketofol infusion: (ketamine: propofol, 1mg: 3 mg in 20 ml syringe). Loading dose of drug at 1ml/kg/hour IV till Ramsay sedation score (RSS) ≥ 3 achieved followed by maintenance infusion at 0.05 ml/kg/hour till end of procedure. Results: The primary outcome - time to achieve Ramsay sedation score ≥ 3 was significantly lesser with Ketofol as compared to Dexmedetomidine 260[69] seconds vs 460 [137], (p value<0.05).Conclusion: In out-patient setting, ketofol is favourable over dexmedetomidine for sedation regimen for diagnostic TEE as lesser time is taken to achieve optimal sedation with lesser hemodynamic perturbations, post procedure complications and better cardiologist satisfaction.

https://ift.tt/2JDWU0y

Mitral valve repair in infective endocarditis during pregnancy

Takahiro Tamura, Shuichi Yokota

Annals of Cardiac Anaesthesia 2018 21(2):189-191

Infective endocarditis (IE) during pregnancy and subsequent cardiac surgery are rare and associated with a high risk of mortality for the mother and fetus. It is difficult to determine the right time for cardiac intervention when IE is diagnosed early in pregnancy. A 33-year-old previously healthy woman in the 11th week of pregnancy was diagnosed with IE and underwent surgical intervention. The cardiopulmonary bypass settings and the anesthetic drugs were carefully chosen. Although she was in good health, while being discharged, the fetus did not survive. Anesthesiologists prioritizing the mother's survival should aim to improve fetal outcomes in such cases.

https://ift.tt/2v9gmiR

Utility of thromboelastography versus routine coagulation tests for assessment of hypocoagulable state in patients undergoing cardiac bypass surgery

Seema Sharma, Sujeet Kumar, Prabhat Tewari, Shantanu Pande, Manjula Murari

Annals of Cardiac Anaesthesia 2018 21(2):151-157

Introduction: Peri-operative monitoring of coagulation is important to diagnose potential cause of hemorrhage, to manage coagulopathy and guide treatment with blood products in patients undergoing cardiac surgery with cardiopulmonary bypass. This study was done to evaluate usefulness of Thromboelastography (TEG) and routine coagulation tests (RCT) in assessing hemostatic changes and predicting postoperative bleeding in patients undergoing cardiac surgery with cardiopulmonary bypass. Methods: Fifty adult patients undergoing cardiac surgery with cardiopulmonary bypass were enrolled in this prospective study. Preoperative and post-operative samples were collected for routine coagulation tests and TEG. Regression analysis and test of significance using Pearson's correlation coefficient was performed to assess correlation between routine coagulation tests and corresponding TEG parameters .Regression analysis was done to study relation between blood loss at 24 hours and various coagulation parameters. Results: The Routine coagulation test i.e. PT, INR, APTT showed no significant correlation with corresponding TEG parameters in pre-operative samples. However platelet count significantly correlated (p = 0.004) with MA values in postoperative samples. A significant correlation (p = 0.001) was seen between fibrinogen levels and alpha angles as well as with MA in both baseline preoperative and postoperative samples. TEG parameters R time and MA in postoperative samples were the only parameters that predicted bleeders with fair accuracy. Conclusion: Though the techniques of RCT and TEG are different, a few RCT e.g. platelet count and fibrinogen correlated with corresponding TEG parameters i.e. MA and Alpha angle. TEG parameters (R time and MA in postoperative samples) were able to predict blood loss better than RCT.

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Tricuspid stenosis: A rare and potential complication of ventricular septal occluder device

Ganesh Kumar Munirathinam, Bhupesh Kumar, Anand Kumar Mishra

Annals of Cardiac Anaesthesia 2018 21(2):195-199

Asymmetrical septal occluder device (ASOD) has made percutaneous closure of ventricular septal defect an easy and effective management option. Although there are reports of aortic and tricuspid valvular regurgitation after deployment of ASOD, only few cases of tricuspid stenosis (TS) has been reported so far in the literature. We report a case of malaligned ASOD that occurred after successful device closure resulting in TS along with mild tricuspid and aortic regurgitation requiring surgical retrieval. Transesophageal echocardiography played crucial role in detecting the cause of tricuspid valve dysfunction besides providing continuous monitoring during the procedure. We intend to emphasize the need of echocardiographic evaluation of the tricuspid valvular apparatus and aortic valve during and after the device deployment even after the successful device closure to prevent this rare complication.

http://www.annals.in/text.asp?2018/21/2/195/229929

Factors associated with delayed cardiac tamponade after cardiac surgery

Edgar Hernández Leiva, Marisol Carreño, Fernando Rada Bucheli, Alberto Cadena Bonfanti, Juan Pablo Umaña, Rodolfo José Dennis

Annals of Cardiac Anaesthesia 2018 21(2):158-166

Context: Cardiac tamponade (CT) following cardiac surgery is a potentially fatal complication and the cause of surgical reintervention in 0.1%–6% of cases. There are two types of CT: acute, occurring within the first 48 h postoperatively, and subacute or delayed, which occurs more than 48 h postoperatively. The latter does not show specific clinical signs, which makes it more difficult to diagnose. The factors associated with acute CT (aCT) are related to coagulopathy or surgical bleeding, while the variables associated with subacute tamponade have not been well defined. Aims: The primary objective of this study was to identify the factors associated with the development of subacute CT (sCT). Settings and Design: This report describes a case (n = 80) and control (n = 160) study nested in a historic cohort made up of adult patients who underwent any type of urgent or elective cardiac surgery in a tertiary cardiovascular hospital. Methods: The occurrence of sCT was defined as the presence of a compatible clinical picture, pericardial effusion and confirmation of cardiac tamponade during the required emergency intervention at any point between 48 hours and 30 days after surgery. All factors potentially related to the development of sCT were taken into account. Statistical Analysis Used: For the adjusted analysis, a logistical regression was constructed with 55 variables, including pre-, intra-, and post-operative data. Results: The mortality of patients with sCT was 11% versus 0% in the controls. Five variables were identified as independently and significantly associated with the outcome: pre- or post-operative anticoagulation, reintervention in the first 48 h, surgery other than coronary artery bypass graft, and red blood cell transfusion. Conclusions: Our study identified five variables associated with sCT and established that this complication has a high mortality rate. These findings may allow the implementation of standardized follow-up measures for patients identified as higher risk, leading to either early detection or prevention.

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Mass cytometry: a powerful tool for dissecting the immune landscape

Yannick Simoni | Melissa Hui Yen Chng | Shamin Li | Michael Fehlings | Evan W Newell

https://ift.tt/2qpd9G6

Obesity induced T cell dysfunction and implications for cancer immunotherapy

Ethan G Aguilar | William J Murphy

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Early intensive rehabilitation after oral cancer treatment

Publication date: Available online 12 April 2018
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Maximilian Bschorer, Daniel Schneider, Matthias Hennig, Bernd Frank, Gerhard Schön, Max Heiland, Reinhard Bschorer
PurposeThe treatment of oral cancer requires an effective rehabilitation strategy such as an early intensive rehabilitation (EIR) program.Materials and MethodsThe medical records and data of 41 patients who participated in an EIR program and 20 control group patients were analyzed. These patients all underwent surgical resection of the primary tumor followed by microsurgical reconstruction using free flaps. The length of stay (LOS) at the acute care hospital was compared between the two groups. Four indexes were used to evaluate the effectiveness of the EIR program.ResultsEIR patients stayed an average of 11.6 fewer days at the acute care hospital. All indexes showed significant improvements (p < 0.001). The Barthel Index (BI) and the Early Intensive Rehabilitation Barthel Index (EIR-BI) improved by 36.0 and 103.6 points, respectively. At discharge, the Bogenhausener Dysphagia Score (BODS) had improved to a score of 11.0 compared to the 13.9 at admission. EIR patients had a Work Ability Index (WAI) score of 25.7.ConclusionLength of stay at the acute care hospital can be reduced using early intensive rehabilitation if patients are transferred to an intensive rehabilitation clinic early.



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Bilateral Interdigitated Pacman Flap for Round and Oval Facial Defects

Publication date: Available online 12 April 2018
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Sang- Ha Oh, Hyeokjae Kwon, Sun Je Kim, Hyunwoo Kyung, Young Joon Seo, Dae Hyun Lew, Seung Han Song
BackgroundSkin texture and color are important considerations during the reconstruction of facial defects, and anatomical borders should be preserved. Therefore, a local flap is a better option. In these cases, the authors repaired facial defects using a bilateral interdigitated V-Y flap.ObjectiveWe aim to present a modified bilateral Pacman flap technique for the reconstruction of round and oval facial defects.Materials and MethodsWe performed a retrospective chart review of 25 patients (26 cases) who underwent bilateral interdigitated Pacman flap repair of round and oval facial defects after Mohs surgery for skin cancer from January 2012 to December 2017. The defect sizes ranged from 0.7 to 8.4 cm² (mean 3.1 cm²).ResultsAll defects were covered successfully and the flaps survived in all cases. One patient had partial flap necrosis that resolved spontaneously. No flap contraction, distortion, or severe scar formation was observed in any patient during the 12-month follow-up period.ConclusionThe bilateral interdigitated Pacman flap can cover round and oval facial defects without distortion or central dog-ear deformity. This method is a useful option for facial restoration in selected cases.



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Sentinel lymph node biopsy in malignant melanoma of the head and neck

Publication date: Available online 12 April 2018
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Roman Kia Rahimi-Nedjat, Bilal Al-Nawas, Andrea Tuettenberg, Keyvan Sagheb, Stephan Grabbe, Christian Walter
BackgroundThe aim of this retrospective study was to investigate sentinel lymph node biopsy in patients with head and neck melanoma.Materials and MethodsPatients who underwent SLNB between 2010 and 2016 were comprised. Epidemiological, radiological, and surgical data were collected and compared to histological findings. Patients who underwent primary complete lymph node dissection were excluded.Results74 patients underwent SLNB during this period. The most common tumor localizations were the cheek (20.4%) and ears (20.4%). Overall, 256 sentinel lymph nodes (SLN) were detected and removed, most frequently in Robbins-levels IIA and IIB as well as in the surrounding of the parotid gland. 12.3% of the SLN showed a microscopic or macroscopic metastasis. In preoperative imaging all lymph nodes with macroscopic metastasis were described as suspect but only 4 of 11 lymph nodes with microscopic metastases were described as such.ConclusionsSLNB is an especially good procedure for the diagnosis of microscopically metastases as disease status is an important diagnostic and prognostic factor in early-stage melanoma patients. However, due to the complex lymphatic system in head and neck melanoma, a short follow-up interval is necessary in order to prevent delayed diagnosis of a nodal recurrence due to a false-negative SLN.



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The influence of insurance status on treatment and outcomes in oral cavity cancer: an analysis on 46,373 patients

The purpose of this study was to determine the influence of insurance status on treatment and outcomes in oral cavity cancer. Patients were identified in the National Cancer Database (NCDB). Data were collected and analyzed using χ2 tests, Kaplan–Meier methods, and multivariable Cox regression models. Those uninsured or on Medicaid were more likely to be younger (P<0.001), minority race (P<0.001), have a lower median household income (P<0.001), lower educational attainment (P<0.001), not undergo primary resection (P<0.001), present with higher T (P<0.001),N (P<0.001), and M (P<0.001) stage of disease, and have a higher tumor grade (P<0.001).

https://ift.tt/2HlqwBy

The influence of insurance status on treatment and outcomes in oral cavity cancer: an analysis on 46,373 patients

Publication date: Available online 12 April 2018
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): J.Y. Shin, J.K. Yoon, A.K. Shin, A.Z. Diaz
The purpose of this study was to determine the influence of insurance status on treatment and outcomes in oral cavity cancer. Patients were identified in the National Cancer Database (NCDB). Data were collected and analyzed using χ² tests, Kaplan–Meier methods, and multivariable Cox regression models. Those uninsured or on Medicaid were more likely to be younger (P<0.001), minority race (P<0.001), have a lower median household income (P<0.001), lower educational attainment (P<0.001), not undergo primary resection (P<0.001), present with higher T (P<0.001),N (P<0.001), and M (P<0.001) stage of disease, and have a higher tumor grade (P<0.001). On univariate analysis, those with private insurance had significantly better overall survival than those uninsured (hazard ratio (HR) 1.481), under Medicaid (HR 2.006), or on Medicare (HR 1.921). On multivariable Cox regression analysis, insurance status remained an independent prognosticator even after accounting for multiple demographic, socioeconomic, treatment, and clinicopathological factors. These data suggest that insurance status is associated with treatment and outcomes in patients with oral cavity cancer. Being uninsured or on Medicaid was found to be associated with a higher risk of a poorer prognosis when compared to private insurance, and the data suggest the need to expand comprehensive medical coverage and optimize access to adequate medical care in vulnerable patient populations.



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In vitro study of a modified sagittal split osteotomy fixation technique of the mandible: a mechanical test

Publication date: Available online 11 April 2018
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): C.L. Sonego, M.A.R. Scheffer, O.L. Chagas Júnior, B.M. Vetromilla, L.P. Fernandes, A. Ozkomur, A.N. Silva Júnior, S.A.Q. Miguens Júnior, P.A.G. Hernandez
This study was performed to evaluate the compressive mechanical strength of rigid internal fixation (RIF) using 1.5-mm L-shaped plates fixed with monocortical screws in sagittal split osteotomy (SSO). Thirty synthetic hemimandibles, which had all undergone a 5-mm advancement, were divided into three groups: three 12-mm bicortical titanium screws were placed in an inverted L pattern in group A; one straight 2.0-mm system spaced titanium plate fixed with four 5-mm monocortical screws was used in group B; two 1.5-mm system L-shaped titanium plates, each fixed with four 5-mm monocortical screws, were used in group C. The models were subjected to compressive and progressive mechanical tests with forces applied in the area between the second premolar and first molar to verify resistance in Newtons (N). A displacement speed of 1mm/min was applied, with a maximum 10mm displacement of the distal segment or until disruption of the fixation. The deformity and/or eventual rupture of the plates were evaluated, and consequently their technical stability was determined. The results showed that the modified fixation technique tested in this study on synthetic mandibles resulted in adequate stability and superior mechanical behaviour compared to simulated osteosynthesis with the use of a straight 2.0-mm titanium plate.



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Erratum

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Early intensive rehabilitation after oral cancer treatment

The treatment of oral cancer requires an effective rehabilitation strategy such as an early intensive rehabilitation (EIR) program.

https://ift.tt/2HuPQD0

Sentinel lymph node biopsy in malignant melanoma of the head and neck

The aim of this retrospective study was to investigate sentinel lymph node biopsy in patients with head and neck melanoma.

https://ift.tt/2GSXiXn

Bilateral Interdigitated Pacman Flap for Round and Oval Facial Defects

Skin texture and color are important considerations during the reconstruction of facial defects, and anatomical borders should be preserved. Therefore, a local flap is a better option. In these cases, the authors repaired facial defects using a bilateral interdigitated V-Y flap.

https://ift.tt/2GWatHc

SQ house dust mite sublingual immunotherapy tablet subgroup efficacy and local application site reaction duration

Allergic rhinitis with or without conjunctivitis (AR/C) is common, necessitating evaluation of SQ house dust mite (HDM) sublingual immunotherapy (SLIT)-tablet efficacy in various subgroups.

https://ift.tt/2JHwWcK

Short and long-term management of cases of venom induced anaphylaxis (via) is suboptimal

Venom induced anaphylaxis (VIA) accounts for severe reactions. However, little is known about the short and long-term management of VIA cases.

https://ift.tt/2vbYt2R

Re: Is a fractured mandible an emergency?

We the recent paper from Hammond et al with interest.1 It stated that "delay before definitive fixation caused no harm in either the short or the long term." While we agree that this retrospective review adds to the evidence that delay before fixation of a fractured mandible is not associated with adverse surgical outcomes, it does not explore non-surgical outcomes, and this conclusion is therefore unjustified.

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Appearance on face reading (cheek line) after orthognathic surgery

The cheek line (face reading) is an aesthetic element of the facial profile. The purpose of our study was to investigate the changes in the cheek line after mandibular setback surgery. Forty patients (20 female and 20 male, mean (SD) age 22 (5) years) were diagnosed with mandibular prognathism and treated by intraoral vertical ramus osteotomy alone. Cephalograms were obtained before operation (T1), at least a year postoperatively (T2), and final surgical changes over a year (T2-T1). The cheek line and landmarks (soft and hard tissues) were compared using the paired t test.

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An evidence based protocol for managing neonatal middle ear effusions in babies who fail newborn hearing screening

Publication date: Available online 12 April 2018
Source:American Journal of Otolaryngology
Author(s): Brittany C. Weber, Scott M. Whitlock, Kaidi He, Blake S. Kimbrell, Craig S. Derkay
ObjectivesTo evaluate the prevalence of middle ear disease in infants referred for failed newborn hearing screening (NBHS) and to review patient outcomes after intervention in order to propose an evidence-based protocol for management of newborns with otitis media with effusion (OME) who fail NBHS.Methods85 infants with suspected middle ear pathology were retrospectively reviewed after referral for failed NBHS. All subjects underwent a diagnostic microscopic exam with myringotomy with or without placement of a ventilation tube in the presence of a middle ear effusion and had intra-operative auditory brainstem response (ABR) testing or testing at a later date.ResultsAt the initial office visit, a normal middle ear space bilaterally was documented in 5 babies (6%), 29/85 (34%) had an equivocal exam while 51/85 (60%) had at least a unilateral OME. Myringotomy with or without tube placement due to presence of an effusion was performed on 65/85 (76%) neonates. Normal hearing was established in 17/85 (20%) after intervention, avoiding the need for any further audiologic workup. Bilateral or unilateral sensorineural hearing loss (SNHL) or mixed hearing loss was noted in 54/85 (64%) and these children were referred for amplification. Initially observation with follow up outpatient visits was initiated in 27/85 (32%) however, only 3/27 (11%) resolved with watchful waiting and 24/27 (89%) ultimately required at least unilateral tube placement due to OME and 14/24 (59%) were found to have at least a unilateral mixed or SNHL.ConclusionsAn effective initial management plan for children with suspected middle ear pathology and failed NBHS is diagnostic operative microscopy with placement of a ventilation tube in the presence of a MEE along with either intra-operative ABR or close follow-up ABR. This allows for the identification and treatment of babies with a conductive component due to OME, accurate diagnosing of an underlying SNHL component and for prompt aural rehabilitation.



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The Allergic Rhinitis Clinical Investigator Collaborative (AR-CIC): verification of nasal allergen challenge procedures in a study utilizing an investigational immunotherapy for cat allergy

The Allergic Rhinitis Clinical Investigator Collaborative (AR-CIC) is a network of experienced Allergic Rhinitis (AR) researchers developing better research tools based on the nasal allergen challenge (NAC). A...

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SQ house dust mite sublingual immunotherapy tablet subgroup efficacy and local application site reaction duration

Publication date: Available online 12 April 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): David I. Bernstein, Joerg Kleine-Tebbe, Harold S. Nelson, Jose A. Bardelas, Gordon L. Sussman, Susan Lu, Dorte Rehm, Bodil Svanholm Fogh, Hendrik Nolte
BackgroundAllergic rhinitis with or without conjunctivitis (AR/C) is common, necessitating evaluation of SQ house dust mite (HDM) sublingual immunotherapy (SLIT)-tablet efficacy in various subgroups.ObjectiveTo evaluate 12 SQ-HDM efficacy and safety across subgroups, and the onset, duration, and recurrence of local application site reactions.MethodsSubgroup (age, gender, race, asthma status, and allergen sensitization) efficacy was assessed using pooled data from two previously described trials of daily 12 SQ-HDM vs placebo for AR/C (N=2138). Efficacy was measured by average total combined rhinitis score (TCRS; rhinitis daily symptom plus medication score) during the last 8 weeks of treatment. Safety in subgroups and local application site reaction onset, duration, and recurrence were evaluated using pooled data from five previously described trials of SQ HDM SLIT-tablet (N=2923).ResultsThere was significant (based on 95% CIs) reduction in TCRS with 12 SQ-HDM relative to placebo across all subgroups, with TCRS improvements ranging from 15%-25%. The AE profile was generally similar within subgroups. Approximately 95% of local application site reactions were mild-to-moderate in severity. Median duration on day 1 of treatment for the most common local application site reactions (throat irritation, oral pruritus, ear pruritus, and lip swelling) ranged from 30-60 minutes; median first day of onset ranged from days 1-4 of treatment; median days that reactions recurred ranged from 3-12 days.ConclusionTreatment with 12 SQ-HDM consistently improved symptoms and was well tolerated in relevant subgroups of subjects with HDM AR/C. Local application site reactions to 12 SQ-HDM were typically mild-to-moderate and transient.



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Short and long-term management of cases of venom induced anaphylaxis (via) is suboptimal

Publication date: Available online 12 April 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): Ashley Tritt, Sofianne Gabrielli, Sarah Zahabi, Ann Clarke, Jocelyn Moisan, Harley Eisman, Judy Morris, Lea Restivo, Greg Shand, Moshe Ben-Shoshan
BACKGROUNDVenom induced anaphylaxis (VIA) accounts for severe reactions. However, little is known about the short and long-term management of VIA cases.OBJECTIVETo assess the short and long-term management of VIA.METHODSUsing a national anaphylaxis registry (C-CARE), we identified VIA cases presenting to EDs in Montreal and to emergency medical services(EMS) in Western Quebec over a four-year period. Data were collected on clinical characteristics, triggers, and management. Consenting patients were contacted annually regarding long-term management. Univariate and multivariate logistic regression were used to identify factors associated with epinephrine use, allergist assessment, and administration of immunotherapy.RESULTSBetween June 2013 and May 2017, 115 VIA cases were identified. Epinephrine was administered to 63.5% (95%CI 53.9, 72.1%) of all VIA cases by a healthcare professional. Treatment of reactions without epinephrine was more likely in reactions occurring at home and in non-severe cases (no hypotension, hypoxia or loss of consciousness). Among 48 patients who responded to a follow-up questionnaire, 95.8% (95%CI, 84.6%, 99.3%) were prescribed epinephrine auto-injector, 68.8% (95%CI, 53.6%, 80.9%) saw an allergist who confirmed the allergy in 63.6% of cases, and 81.0% of those with positive testing were administered immunotherapy. Among cases with follow-up, seeing an allergist was less likely in patients with known ischemic heart disease.CONCLUSIONAlmost 30% of patients with suspected VIA did not see an allergist, only two thirds of those seeing an allergist had allergy confirmation, and almost one fifth of those with confirmed allergy did not receive immunotherapy. Educational programs are required to bridge this knowledge-to-action gap.



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Current trends in practices in the treatment of pediatric unilateral vocal fold immobility: A survey on injections, thyroplasty and nerve reinnervation

Publication date: June 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 109
Author(s): Sarah Bouhabel, Christopher J. Hartnick
IntroductionThe objective of this study was to poll pediatric otolaryngologists with a special interest in pediatric laryngology on their experience with injection medialization laryngoplasty (IML), thyroplasty, and reinnervation procedures in order to reflect on changing clinical practices.MethodA 10-items questionnaire was designed to inquire about current management practices in the treatment of symptomatic UVFI. The 59 members of an ASPO pediatric laryngology working group received the anonymous online survey. A 47% (28/59) response rate was obtained over a 2 weeks period.ResultsCarboxymethylcellulose gel (Prolaryn) is the most popular injectable material used in the setting of IMLs (preferred by 46%; 13 respondents). Most clinicians perform IMLs in the operating room. However, 14% (4/28) of respondents currently perform office-based injections on older patients. When faced with the case of a young child with longstanding iatrogenic VFP, most respondents (41%; 11/27) would perform an IML alone as a first step for management. 37% (10/27) of respondents would inject and perform a laryngeal EMG while 22% (6/27) would offer reinnervation and concomitant IML. When faced with the case of a teenager with long-standing VFP, the polled physicians' opinions were divided: 37% (10/27) favored reinnervation and concomitant IML, while 26% (7/27) would proceed to an IML only. The remaining 37% (10/27) would first assess for vocal atrophy through LEMG or visual inspection.ConclusionsTwo significant shifts in practice seem to have occurred. First, ansa-RLN reinnervation procedures are now being considered as a first line treatment for a subset of patients in whom only IML was considered in the past. In fact, more than 20% of respondents did consider this route of management. Second, there is an increased use of in-office augmentations for older pediatric patients.



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Impact of adenotonsillectomy on urinary storage symptoms in children with sleep-disordered breathing

Publication date: June 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 109
Author(s): Jong Cheol Lee, Kyung Hyun Moon, Taekmin Kwon, Seong Kyeong Yang, Sungchan Park
ObjectiveTo prospectively evaluate the effectiveness of adenotonsillectomy on resolving urinary storage symptoms such as frequency, urgency, and urgency urinary incontinence (UUI) in indicated sleep disordered breathing (SDB) patients.MethodsWe prospectively analyzed changes in storage symptoms and SDB score before and after surgery in 102 children (74 males, 28 females, mean age 8.4 ± 2.8 years) who underwent adenotonsillectomy between July 2011 and Feb 2012. Before and 3 months after surgery, all children and their parents were requested to answer a self-reported SDB scale-questionnaire (22 questions, 0–22 points) and a urinary storage symptoms questionnaire.ResultsThe prevalence of urgency in the overall patients was 31.2%. After adenotonsillectomy, prevalence of frequency and, urgency in addition to SDB score were significantly decreased (p ≦ 0.001). The prevalence of UUI was also significantly lower (11.6%–7.4%, p < 0.001). Patients with urgency had a significantly higher SDB score than those without (11.4 ± 4.3 vs. 7.8 ± 4.0, p < 0.001). After treatment, there was no difference between these two groups.ConclusionAdenotonsillectomy markedly improved both SDB score and decreased the prevalence of voiding symptoms (frequency, urgency, and UUI). There was a strong correlation between preoperative SDB score and severity of urgency in children with SDB.



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Genetic Background of a Recurrent Unusual Combined Form of Retinal Vein Occlusion: A Case Report

The authors report a rare case of nonischemic branch retinal vein occlusion and nonischemic hemiretinal vein occlusion in a patient with impaired fibrinolysis. A 61-year-old woman presented to the Department of Ophthalmology, Clinical Hospital Center Split, Croatia, with acute blurring of vision in the right eye (RE) due to branch retinal vein occlusion. Ophthalmologic evaluation revealed a best corrected visual acuity (BCVA) of 0.02 in the RE and of 1.0 in the left eye. Ophthalmoscopy and fluorescein angiography of the RE demonstrated signs of nonischemic branch retinal vein occlusion. She was otherwise healthy and had no other ocular and systemic diseases. She was treated with 3 consecutive intravitreal applications of anti-vascular endothelial growth factor (anti-VEGF; bevacizumab) due to cystoid macular edema with full resolution of the intraretinal fluid and improvement of the BCVA to 0.9. After 8 months, she presented again with acute blurring of vision in the same (right) eye with a BCVA of 0.5. Ophthalmoscopy and fluorescein angiography of the RE indicated nonischemic hemiretinal vein occlusion. She was treated with a single intravitreal application of anti-VEGF (ranibizumab) due to macular edema. Full resolution of the intraretinal fluid and improvement of the BCVA to 0.9 were achieved. A laboratory workup was performed to rule out all known causes of retinal venous occlusive disease, which showed negative results. A molecular analysis showed the gen of thrombophilia – plasminogen activator inhibitor (PAI)-1 4G/5G polymorphism genotype – as the only risk factor for retinal venous occlusive disease in our patient.
Case Rep Ophthalmol 2018;9:248–253

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Textbook of Rapid Response Systems: Concept and Implementation, 2nd ed

No abstract available

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Pain and Its Long-term Interference of Daily Life After Critical Illness

BACKGROUND: Persistent pain likely interferes with quality of life in survivors of critical illness, but data are limited on its prevalence and risk factors. We sought to determine the prevalence of persistent pain after critical illness and its interference with daily life. Additionally, we sought to determine if intensive care unit (ICU) opioid exposure is a risk factor for its development. METHODS: In a cohort of adult medical and surgical ICU survivors, we used the brief pain inventory (BPI) to assess pain intensity and pain interference of daily life at 3 and 12 months after hospital discharge. We used proportional odds logistic regression with Bonferroni correction to evaluate the independent association of ICU opioid exposure with BPI scores, adjusting for potential confounders including age, preadmission opioid use, frailty, surgery, severity of illness, and durations of delirium and sepsis while in the ICU. RESULTS: We obtained BPI outcomes in 295 patients overall. At 3 and 12 months, 77% and 74% of patients reported persistent pain symptoms, respectively. The median (interquartile range) pain intensity score was 3 (1, 5) at both 3 and 12 months. Pain interference with daily life was reported in 59% and 62% of patients at 3 and 12 months, respectively. The median overall pain interference score was 2 (0, 5) at both 3 and 12 months. ICU opioid exposure was not associated with increased pain intensity at 3 months (odds ratio [OR; 95% confidence interval], 2.12 [0.92–4.93]; P = .18) or 12 months (OR, 2.58 [1.26–5.29]; P = .04). ICU opioid exposure was not associated with increased pain interference of daily life at 3 months (OR, 1.48 [0.65–3.38]; P = .64) or 12 months (OR, 1.46 [0.72–2.96]; P = .58). CONCLUSIONS: Persistent pain is prevalent after critical illness and frequently interferes with daily life. Increased ICU opioid exposure was not associated with worse pain symptoms. Further studies are needed to identify modifiable risk factors for persistent pain in the critically ill and the effects of ICU opioids on patients with and without chronic pain. Accepted for publication February 16, 2018. Funding: C.G.H. is supported by American Geriatrics Society Jahnigen Career Development Award and National Institutes of Health R01HL111111, R03AG045085 (Bethesda, MD). This project was supported by the National Institutes on Aging AG027472 (Bethesda, MD). The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (https://ift.tt/KegmMq). Trial Registry Number: NCT00392795. Reprints will not be available from the authors. Address correspondence to Christina J. Hayhurst, MD, Division of Anesthesiology Critical Care Medicine, Vanderbilt University School of Medicine, 1211 21st Ave S, Medical Arts Bldg 526, Nashville, TN 37212. Address e-mail to christina.j.hayhurst@vanderbilt.edu. © 2018 International Anesthesia Research Society

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Does the Incidence of Postoperative Complications After Inguinal Hernia Repair Justify Hospital Admission in Prematurely and Term Born Infants?

BACKGROUND: Postoperatively, young infants are admitted overnight in view of the risk for respiratory complications such as desaturation and apnea. This risk seems much lower than previously reported. Until what age this risk persists, and which infants might actually qualify for day-care treatment, is unknown. METHODS: We retrospectively reviewed medical charts from preterm infants 1 month of age are uncommon, which justifies day-care admission for this type of surgical procedure. Accepted for publication March 9, 2018. Funding: None. The authors declare no conflicts of interest. M. Massoud and A. Y. R. Kühlmann contributed equally and share first authorship. Reprints will not be available from the authors. Address correspondence to A. Y. Rosalie Kühlmann, MD, Department of Pediatric Surgery, Erasmus University Medical Center-Sophia Children's Hospital, Postbus 2060, Room SK 1268, 3000CB Rotterdam, the Netherlands. Address e-mail to a.kuhlmann@erasmusmc.nl. © 2018 International Anesthesia Research Society

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Dexmedetomidine Sedation for Paroxysmal Supraventricular Tachycardia Ablation Is Not Associated With Alteration of Arrhythmia Inducibility

BACKGROUND: Dexmedetomidine (Dex) is an attractive agent for procedural sedation due to its unique pharmacodynamic profile, specifically affording predictable sedation without concurrent respiratory depression. However, Dex has previously been reported to prevent or terminate arrhythmias. The purpose of this study was to investigate paroxysmal supraventricular tachycardia (PSVT) inducibility and homeostatic stability during electrophysiology studies (EPSs) and ablation when a standardized Dex protocol was used as the primary sedation agent. METHODS: We performed a retrospective review of 163 consecutive procedures for PSVT ablation that received Dex as the primary sedative with adjunct fentanyl and midazolam boluses (DEX-FENT-MIDAZ). This cohort was compared to 163 consecutive control procedures wherein strictly fentanyl and midazolam were used for sedation. The primary outcome reviewed was PSVT inducibility assessed before ablation. Reviewed secondary outcomes included level of sedation and intraprocedure hemodynamics and oxygenation. RESULTS: The arrhythmia profiles of the DEX-FENT-MIDAZ and control cohorts were very similar. The overall incidence of a "negative" EPSs in which arrhythmia was not induced was 24% in the DEX-FENT-MIDAZ group and 26% in the control group (P = .7). Unintended deep sedation was significantly less with DEX-FENT-MIDAZ (4.3% vs 27%; P ≤ .0001). However, DEX-FENT-MIDAZ use was associated with a higher incidence of intraprocedure hypotension. CONCLUSIONS: Dex sedation during EPSs is not associated with a reduction in PSVT inducibility. The therapeutic utility of Dex during EPS arises from the predictable sedation Dex affords but is associated with an increased incidence of intraprocedure hypotension. Accepted for publication February 5, 2018. Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (https://ift.tt/KegmMq). This material is the result of the work supported with resources and the use of facilities at the Veterans Affairs Portland Health Care System. The contents do not represent the views of the US Department of Veterans Affairs or the US Government. The STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) guidelines for reporting observational studies were followed while conducting this study and for preparation of this manuscript. Reprints will not be available from the authors. Address correspondence to Peter M. Jessel, MD, Division of Cardiology, Veterans Affairs Portland Health Care System, 3710 SW US Veterans Hospital Rd, Portland, OR 97239. Address e-mail to JesselP@ohsu.edu. © 2018 International Anesthesia Research Society

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Resistin Is a Novel Marker for Postoperative Pain Intensity

BACKGROUND: Pro- and anti-inflammatory cytokines (adipokines) associated with adipose tissue can modulate inflammatory processes and lead to systemic inflammatory conditions such as metabolic syndrome. In the present pilot study, we investigated 3 major adipokines (leptin, adiponectin, and resistin) and 2 nonspecific proinflammatory cytokines (tumor necrosis factor α and interleukin-6) with regard to their association with postoperative pain intensity. METHODS: We analyzed a total of 45 single-nucleotide polymorphisms of the adipokines in 57 patients with postlaparotomy pain. We adjusted for multiple testing to reduce the chance of false-positive results by controlling the false discovery rate. Serum levels of the adipokines and proinflammatory cytokines were measured in another 36 patients undergoing laparotomy. A stepwise multiple linear regression analysis using these measurements and opioid dosages as independent variables was performed to explore the factors associated with postoperative pain. RESULTS: Only 1 variant of the resistin gene (rs3745367) demonstrated a significant association with postoperative pain (P

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Low Level of Vegetative State After Traumatic Brain Injury in a Swiss Academic Hospital

BACKGROUND: No standards exist regarding decision making for comatose patients, especially concerning life-saving treatments. The aim of this retrospective, single-center study was to analyze outcomes and the decision-making process at the end of life (EOL) in patients with traumatic brain injury (TBI) in a Swiss academic tertiary care hospital. METHODS: Consecutive admissions to the surgical intensive care unit (ICU) with stays of at least 48 hours between January 1, 2012 and June 30, 2015 in patients with moderate to severe TBI and with fatality within 6 months after trauma were included. Descriptive statistics were used. RESULTS: Of 994 ICU admissions with TBI in the study period, 182 had an initial Glasgow Coma Scale 48 hours. For 174 of them, a 6-month outcome assessment based on the Glasgow Outcome Scale (GOS) was available: 43.1% (36.0%–50.5%) had favorable outcomes (GOS 4 or 5), 28.7% (22.5%–35.9%) a severe disability (GOS 3), 0.6% (0%–3.2%) a vegetative state (GOS 2), and 27.6% (21.5%–34.7%) died (GOS 1). Among the GOS 1 individuals, 45 patients had a complete dataset (73% men; median age, 67 years; interquartile range, 43–79 years). Life-prolonging therapies were limited in 95.6% (85.2%–99.2%) of the cases after interdisciplinary prognostication and involvement of the surrogate decision maker (SDM) to respect the patient's documented or presumed will. In 97.7% (87.9%–99.9%) of the cases, a next of kin was the SDM and was involved in the EOL decision and process in 100% (96.3%–100.0%) of the cases. Written advance directives (ADs) were available for 14.0% (6.6%–27.3%) of the patients, and 34.9% (22.4%–49.8%) of the patients had shared their EOL will with relatives before trauma. In the other cases, each patient's presumed will was acknowledged after a meeting with the SDM and was binding for the EOL decision. CONCLUSIONS: At our institution, the majority of deaths after TBI follow a decision to limit life-prolonging therapies. The frequency of patients in vegetative state 6 months after TBI is lower than expected; this could be due to the high prevalence of limitation of life-prolonging therapies. EOL decision making follows a standardized process, based on patients' will documented in the ADs or on preferences assumed by the SDM. The prevalence of ADs was low and should be encouraged. Accepted for publication March 5, 2018. Funding: None. The authors declare no conflicts of interest. Reprints will not be available from the authors. Address correspondence to Giovanna Brandi, MD, Surgical Intensive Care Unit, University Hospital of Zurich, Rämistrasse 100, CH-8091 Zurich, Switzerland. Address e-mail to giovanna.brandi@usz.ch. © 2018 International Anesthesia Research Society

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Airway Management Practice in Adults With an Unstable Cervical Spine: The Harborview Medical Center Experience

BACKGROUND: Airway management in the presence of acute cervical spine injury (CSI) is challenging. Because it limits cervical spine motion during tracheal intubation and allows for neurological examination after the procedure, awake fiberoptic bronchoscopy (FOB) has traditionally been recommended. However, with the widespread availability of video laryngoscopy (VL), its use has declined dramatically. Our aim was to describe the frequency of airway management techniques used in patients with CSI at our level I trauma center and report the incidence of neurological injury attributable to airway management. METHODS: Adults presenting to the operating room with CSI without a tracheal tube in situ between September 2010 and June 2017 were included. All patients were intubated in the presence of manual-in-line stabilization, a hard cervical collar, or surgical traction. Worsening neurological status was defined as new motor or sensory deficits on postoperative examination. RESULTS: Two hundred fifty-two patients were included, of which 76 (30.2%) had preexisting neurological deficits. VL was the most frequent initial airway management technique used (49.6%). Asleep FOB was commonly performed alone (30.6%) or in conjunction with VL (13.5%). Awake FOB was rarely performed (2.3%), as was direct laryngoscopy (2.8%). All techniques were associated with high first-attempt success rates, and no cases of neurological injury attributable to airway management technique were identified. CONCLUSIONS: Among patients with acute CSI at a high-volume academic trauma center, VL was the most commonly used initial intubation technique. Awake FOB and direct laryngoscopy were performed infrequently. No cases of neurological deterioration secondary to airway management occurred with any method. Assuming care is taken to limit neck movement, providers should use the intubation technique with which they have the most comfort and skill. Accepted for publication February 26, 2018. Funding: None. The authors declare no conflicts of interest. Reprints will not be available from the authors. Address correspondence to Michael G. Holmes, MD, Department of Anesthesiology and Pain Medicine, University of Washington, 1959 NE Pacific St, BB-1469, Seattle, WA 98195. Address e-mail to mgholmes@uw.edu. © 2018 International Anesthesia Research Society

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Predictors of Admission After the Implementation of an Enhanced Recovery After Surgery Pathway for Minimally Invasive Gynecologic Surgery

BACKGROUND: Enhanced recovery after surgery (ERAS) pathways in gynecologic surgery have been shown to decrease length of stay with no impact on readmission, but no study has assessed predictors of admission in this population. The purpose of this study was to identify predictors of admission after laparoscopic hysterectomy (LH) and robotic-assisted hysterectomy (RAH) performed under an ERAS pathway. METHODS: This is a prospective observational study of women undergoing LH/RAH for benign indications within an ERAS pathway. Data collected included same-day discharge, reason for admission, incidences of urgent clinic and emergency room (ER) visits, readmissions, reoperations, and 9 postulated predictors of admission listed below. Patient demographics, markers of baseline health, and clinical outcomes were compared between groups (ERAS patients discharged on the day of surgery versus admitted) using Fisher exact and Student t tests. Multivariable logistic regression was used to assess the potential risk factors for being admitted, adjusting for age, race, body mass index, American Society of Anesthesiologists (ASA) physical status score, preoperative diagnosis indicative of hysterectomy, preoperative chronic pain, completion of a preprocedure pain-coping skills counseling session, procedure time, and compliance to the ERAS pathway. RESULTS: There were 165 patients undergoing LH/RAH within an ERAS pathway; 93 (56%) were discharged on the day of surgery and 72 were admitted. There were no significant differences in ER visits, readmissions, and reoperations between groups (ER visits: discharged 13% versus admitted 13%, P = .99; 90-day readmission: discharged 4% versus admitted 7%, P = .51; and 90-day reoperation: discharged 4% versus admitted 3%, P = .70). The most common reasons for admission were postoperative urinary retention (n = 21, 30%), inadequate pain control (n = 21, 30%), postoperative nausea and vomiting (n = 7, 10%), and planned admissions (n = 7, 10%). Increased ASA physical status, being African American, and increased length of procedure were significantly associated with an increased risk of admission (ASA physical status III versus ASA physical status I or II: odds ratio [OR], 3.12; 95% confidence interval [CI], 1.36–7.16; P = .007; African American: OR, 2.47; 95% CI, 1.02–5.96; P = .04; and length of procedure, assessed in 30-minute increments: OR, 1.23; 95% CI, 1.02–1.50; P = .04). CONCLUSIONS: We were able to define predictors of admission for patients having LH/RAH managed with an ERAS pathway. Increased ASA physical status, being African American, and increased length of procedure were significantly associated with admission after LH/RAH performed under an ERAS pathway. In addition, the incidences of urgent clinic and ER visits, readmissions, and reoperations within 90 days of surgery were similar for patients who were discharged on the day of surgery compared to those admitted. Accepted for publication February 16, 2018. Funding: None. The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (https://ift.tt/KegmMq). Reprints will not be available from the authors. Address correspondence to Jay W. Schoenherr, MD, Department of Anesthesiology, University of North Carolina at Chapel Hill School of Medicine, N2198 UNC Hospitals, CB 7010, Chapel Hill, NC 27599. Address e-mail to jschoenherr@aims.unc.edu. © 2018 International Anesthesia Research Society

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The Butchering Art: Joseph Lister’s Quest to Transform the Grisly World of Victorian Medicine

No abstract available

https://ift.tt/2qpTgyw

Obstructive Sleep Apnea in Pregnant Women: A Review of Pregnancy Outcomes and an Approach to Management

Among obese pregnant women, 15%–20% have obstructive sleep apnea (OSA) and this prevalence increases along with body mass index and in the presence of other comorbidities. Prepregnancy obesity and pregnancy-related weight gain are certainly risk factors for sleep-disordered breathing in pregnancy, but certain physiologic changes of pregnancy may also increase a woman's risk of developing or worsening OSA. While it has been shown that untreated OSA in postmenopausal women is associated with a range of cardiovascular, pulmonary, and metabolic comorbidities, a body of literature is emerging that suggests OSA may also have serious implications for the health of mothers and fetuses during and after pregnancy. In this review, we discuss the following: pregnancy as a vulnerable period for the development or worsening of OSA; the associations between OSA and maternal and fetal outcomes; the current screening modalities for OSA in pregnancy; and current recommendations regarding peripartum management of OSA. Accepted for publication February 14, 2018. Funding: This research was supported in part by NIH 5T32GM008600-20. Devices used in Dr Dominguez's and Dr Habib's research have been loaned by ResMed and Itamar Medical. Dr Habib is a Senior Editor for Anesthesia & Analgesia. The authors declare no conflicts of interest. Reprints will not be available from the authors. Address correspondence to Jennifer E. Dominguez, MD, MHS, Department of Anesthesiology, Duke University Medical Center, Box 3094, Mail Sort #9, Durham, NC 27710. Address e-mail to Jennifer.dominguez@dm.duke.edu. © 2018 International Anesthesia Research Society

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Pharmacological Characterization of Levorphanol, a G-Protein Biased Opioid Analgesic

BACKGROUND: Levorphanol is a potent analgesic that has been used for decades. Most commonly used for acute and cancer pain, it also is effective against neuropathic pain. The recent appreciation of the importance of functional bias and the uncovering of multiple µ opioid receptor splice variants may help explain the variability of patient responses to different opioid drugs. METHODS: Here, we evaluate levorphanol in a variety of traditional in vitro receptor binding and functional assays. In vivo analgesia studies using the radiant heat tail flick assay explored the receptor selectivity of the responses through the use of knockout (KO) mice, selective antagonists, and viral rescue approaches. RESULTS: Receptor binding studies revealed high levorphanol affinity for all the μ, δ, and κ opioid receptors. In 35S-GTPγS binding assays, it was a full agonist at most µ receptor subtypes, with the exception of MOR-1O, but displayed little activity in β-arrestin2 recruitment assays, indicating a preference for G-protein transduction mechanisms. A KO mouse and selective antagonists confirmed that levorphanol analgesia was mediated through classical µ receptors, but there was a contribution from 6 transmembrane targets, as illustrated by a lower response in an exon 11 KO mouse and its rescue with a virally transfected 6 transmembrane receptor splice variant. Compared to morphine, levorphanol had less respiratory depression at equianalgesic doses. CONCLUSIONS: While levorphanol shares many of the same properties as the classic opioid morphine, it displays subtle differences that may prove helpful in its clinical use. Its G-protein signaling bias is consistent with its diminished respiratory depression, while its incomplete cross tolerance with morphine suggests it may prove valuable clinically with opioid rotation. Accepted for publication February 9, 2018. Funding: This study was supported by grants from the National Institute on Drug Abuse (DA006241, DA007242), the Peter McManus Charitable Trust, Mayday Fund and Relmada Therapeutics, Inc (to G.W.P.), a core grant from the National Cancer Institute to MSKCC (CA008748), and the National Natural Science Foundation of China (81673412 to Z.L). The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (https://ift.tt/KegmMq). Reprints will not be available from the authors. Address correspondence to Gavril W. Pasternak, MD, PhD, Department of Neurology and Molecular Pharmacology Program, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065. Address e-mail to pasterng@mskcc.org. © 2018 International Anesthesia Research Society

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Blood Pressure Coefficient of Variation and Its Association With Cardiac Surgical Outcomes

BACKGROUND: Multiple studies completed in the ambulatory nonsurgical setting show a significant association between short- and long-term blood pressure variability and poor outcomes. However, perioperative blood pressure variability outcomes have not been well studied, especially in the cardiac surgical setting. In this study, we sought to assess whether systolic and mean arterial blood pressure variability were associated with 30-day mortality and in-hospital renal failure in patients undergoing cardiac surgery requiring cardiopulmonary bypass. Furthermore, blood pressure variability has not been evaluated specifically during each phase of surgery, namely in the pre-, intra- and postbypass phases; thus, we aimed also to assess whether outcomes were associated with phase-specific systolic and mean arterial blood pressure variability. METHODS: All patients undergoing cardiac surgery from January 2008 to June 2014 were enrolled in this retrospective, single-center study. Demographic, intraoperative, and postoperative outcome data were obtained from the institution's Society of Thoracic Surgery database and Anesthesia Information Management System. Systolic and mean arterial blood pressure variability were assessed using the coefficient of variation (CV). The primary outcomes were 30-day mortality and in-hospital renal failure in relation to the entire duration of a case, while the secondary outcomes assessed phase-specific surgical periods. In an effort to control the family-wise error rate, P values <.0125 were considered significant for the primary outcomes. results: of patients analyzed died within days surgery and experienced in-hospital renal failure. after adjusting covariates we found a statistically association between increasing cv systolic blood pressure mortality every increase in cvsbp there was odds death ratio confidence interval p .0001 experiencing failure with driven primarily by prebypass period because during phase .01 not postbypass .08 no mean arterial either or any including bypass phase. conclusions: variability associated development phase-specific relationships observed. further research is required to determine how prospectively detect elucidate opportunities intervention. accepted publication february funding: v. prasad supported us department defense national science engineering graduate fellowship. b. subramaniam institutes health project grant gm statistical writing support provided center anesthesia excellence at beth israel deaconess medical center. authors declare conflicts interest. reprints will be available from authors. address correspondence balachundhar md mph harvard school one rd c-650 boston ma e-mail bsubrama international society>

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Tobacco Cessation Attempts Among Smokers With Head and Neck Cancer

This cross-sectional study of smokers with head and neck squamous cell carcinoma (HNSCC) examines tobacco cessation attempts and symptoms experienced prior to development of HNSCC, as well as the correlation of these symptoms with number of cessation attempts and maximum quit days.

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Survival in Surgically Treated Pediatric Head and Neck Sarcomas

This study investigates the role of facility and system factors associated with survival in pediatric patients with head and neck sarcomas.

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Formal Idiographic Inference in Medicine

This Viewpoint proposes an alternate framework for evaluating patients that begins with inference from previous patients and ends with an idiographic model formed with data acquired from the current patient.

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A Painful Infraorbital Mass

A man with recurrent sinus infections presented with progressive vertical diplopia, blurry vision, and medial right eye pain; test results revealed a soft-tissue mass expanding the bony margins of the infraorbital nerve canal. What is your diagnosis?

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Streptococcus bovis – unusual etiology of meningitis in a neonate with Down syndrome: a case report

Common etiological agents of neonatal meningitis include group B Streptococcus, Escherichia coli, and Staphylococcus aureus. Here we report a rare pathogen – Streptococcus bovis – causing meningitis in a prematur...

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Celiac axis stenosis due to median arcuate ligament compression in a patient who underwent pancreatoduodenectomy; intraoperative assessment of hepatic arterial flow using Doppler ultrasonography: a case report

Celiac axis stenosis due to compression by the median arcuate ligament has been reported in patients undergoing pancreaticoduodenectomy; it leads to the development of major collateral pathways that feed the h...

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Factors associated with increased risk of suicide among survivors of head and neck cancer: A population-based analysis

Publication date: June 2018
Source:Oral Oncology, Volume 81
Author(s): Nosayaba Osazuwa-Peters, Lauren D. Arnold, Travis M. Loux, Mark A. Varvares, Mario Schootman
ObjectivesCancer diagnosis is considered an independent predictor of suicide. We aimed to determine whether gender and human papillomavirus (HPV)-relatedness are associated with increased risks of suicide in the head and neck cancer (HNC) population.Materials and methodsAdult patients ≥18 years with HNC were selected using the Surveillance, Epidemiology, and End Results (SEER) data from 1973 to 2014. Using anatomic sites as proxy, patients were grouped as HPV-related or not HPV-related. Standardized Mortality Ratios (SMRs) were calculated, and association between suicide, gender, HPV-relatedness were estimated as adjusted rate ratios (aRR) using multivariable Poisson regression model.ResultsThere were 1036 suicides among 287,901 HNC patients in the study period (63 suicides per 100,000 person-years). Male patients were six times more likely to commit suicide compared to female patients (aRR = 5.74, 95% CI 3.88, 8.50); however, HPV-relatedness did not increase risk of suicide (aRR = 0.87, 95% CI 0.58, 1.29). Compared with white patients, blacks (aRR = 0.20, 95% CI 0.12, 0.33) and Hispanics (aRR = 0.25, 95% CI 0.14, 0.43) were less likely to commit suicide. Additionally, increased risks of suicide were found among the widowed (aRR = 1.48, 95% CI 1.10, 1.99) and divorced/separated (aRR = 1.30, 95% CI 1.00, 1.69), compared with married patients.ConclusionGender, not HPV-relatedness, was associated with risk of suicide in our study. We identified HNC patients more likely to commit suicide as: previously married, white, male, widowed, divorced or separated, ≥70 years. Our findings may be useful clinically in planning personalized cancer care and lifelong surveillance of HNC patients with higher risks of suicide.



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Report of a consensus meeting of a group of oral and general pathologists in India on grading of oral epithelial dysplasia

Publication date: Available online 11 April 2018
Source:Oral Oncology
Author(s): Saman Warnakulasuriya, W.M. Tilakaratne, K. Ranganathan, Moni A. Kuriakose




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Limitations of CT scanning in Bosniak staging of renal cystic carcinoma

Abstract

The Bosniak Classification is used to quantify the risk of malignancy and need for observation or radical treatment based on the findings of computed tomography (CT). The case described is that of a 65-year-old man with renal cystic disease who was initially given a Bosniak stage IIF classification and was subsequently managed with CT surveillance. CT surveillance showed increased cyst size in the left kidney with cystic changes, however, the Bosniak classification remained the same. It was not until the patient deteriorated further that an MRI was indicated. The MRI findings upgraded the lesion from Bosniak IIF to Bosniak III. As a result, the patient underwent a radical left nephrectomy and a biopsy, which revealed clear cell carcinoma. This case argues the limitations of the Bosniak classification and the value of using MRI at an earlier stage, especially with unusual circumstances such as a chronic history of enlarging cysts.

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Primary choriocarcinoma of the liver: a rare, but important differential diagnosis of liver lesions

Abstract

The case of a 64-year-old man with spontaneous acute abdominal bleeding is presented. Under suspicion of an atypical hepatocellular carcinoma an extended left hemihepatectomy was performed. Histological diagnosis after surgical therapy revealed a primary hepatic choriocarcinoma. During follow-up within 5 months several metastases were detected. Because of the number and localization of the metastases, there was no further curative surgical option and palliative systemic chemotherapy was initiated. Primary choriocarcinoma of the liver is an important differential-diagnosis in hypervascularized lesions of the liver. This tumor-entity is highly aggressive, with rapid tendency for metastatic spreading. This correlates with the poor prognosis of 12 months after tumor-detection.

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Effort thrombosis of the subclavian artery as a consequence of a unique anomaly

Abstract

Congenital anatomic anomalies and variations are frequent in the thoracic outlet and may be associated with clinical symptoms. Arterial thoracic outlet syndrome (TOS) is characterized by subclavian artery compression and vascular pathology, almost always in the presence of a bony abnormality. We describe here a patient with arterial thromboembolism following a fall on the outstretched arm, who was found to have subclavian artery stenosis and post-stenotic dilatation in the absence of a bony abnormality. Surgical exploration revealed a previously undescribed anomaly in which the subclavian artery passed through the costoclavicular space in front of the anterior scalene muscle, where it was subject to bony compression between the first rib and clavicle. Successful treatment was achieved by scalenectomy, first rib resection and interposition bypass graft reconstruction of the affected subclavian artery. This newly acknowledged anatomical variant adds to our understanding of the diverse factors that may contribute to development of TOS.

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Case 11-2018: A 48-Year-Old Woman with Recurrent Venous Thromboembolism and Pulmonary Artery Aneurysm

Presentation of Case. Dr. Samir Zaidi (Medicine): A 48-year-old woman with a history of venous thromboembolism was seen in the pulmonary clinic of this hospital because of cough and decreased exercise tolerance. Fifteen months before this presentation, at another hospital, the patient received a…

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Reply

Publication date: Available online 11 April 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Njira L. Lugogo, Cynthia Green, Monica Kraft




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Airway Management and Bronchoscopic Treatment of Subglottic and Tracheal Stenosis Using Holmium Laser with Balloon Dilatation

Abstract

Tracheal and subglottic stenosis are chronic inflammatory processes which can occur as a result of several possible aetiologies, most commonly as a result of prolonged intubation. All consecutive cases of subglottic and tracheal stenosis, secondary to prolonged intubation treated endoscopically over a period of 2 years were reviewed. The surgical approach consisted of radial incision and ablation using Holmium YAG laser, balloon dilatation and topical instillation of mitomycin C through flexible fiberoptic bronchoscope. Ventilation throughout was maintained through LMA. Laser fiber delivered through working channel of bronchoscope. CRA balloon passed through adopter of LMA. Every patient followed for 1 year with 1, 3, 6 months and 1 year interval. Serial balloon dilatation and mitomycin C instillation done in patients during follow up visit. Thirteen patients who underwent airway intervention during study period were studied for clinical outcome. Average follow up was 1 year. Etiology for airway stenosis in all patients of study group was intubation injury. Average frequency of balloon dilatation required was three. Average tracheal lumen achieved at the end of 1 year in our study group was 70%. Symptomatic improvement observed in all patients. Average PEFR achieved was up to 60% of predicted value. Benign subglottic and tracheal stenosis can be safely and effectively managed with flexible bronchoscopy, holmium YAG lasar ablation, balloon dilatation and Mitomycin-C after securing the airway with LMA for general anaesthesia and optimal ventilation.

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