What we have learned from a patient with partial tracheal rupture caused by penetrating neck injuries: a case report.

BACKGROUND: Airway management of patients with direct airway trauma caused by penetrating neck injuries is always challenging. When a failed airway occurs and surgery access is difficult, it is crucial to find the optimal approach to save the life. We propose the concept "Cannot intubate, Cannot oxygenate, Difficult surgery access" to describe this emergency scenario. CASE PRESENTATION: We report a case of a 24-year-old woman who presented with partial tracheal rupture and pneumothorax caused by a knife stab injury to the neck. A "double setup" strategy, simultaneous preparation for orotracheal intubation and tracheotomy, was carried out before rapid sequence induction. A tracheotomy under local anesthesia or an awake intubation was not preferred in consideration that the patient had a high risk of being uncooperative owing to existing mental disease and potential smothering sensation during operation. During rapid sequence intubation, distal part of the tube penetrates the tear and creates a false lumen outside the trachea then a failed airway subsequently occurred. Rescue tracheotomy was successfully performed by an otolaryngology surgeon, with the help of limited ventilation using sequential bag-mask and laryngeal mask airway ventilation provided by an anesthesiologist, without severe sequelae. CONCLUSIONS: The endotracheal tube have a risk of penetrating the tear outside the trachea in patient with partial tracheal rupture during orotracheal intubation, and once it occurs, proceeding directly to an emergency invasive airway access with optimizing oxygenation throughout procedure might increase the chance of success in rescuing the airway.

Identification of Viruses in Patients With Postviral Olfactory Dysfunction by Multiplex Reverse-Transcription Polymerase Chain Reaction.

OBJECTIVES/HYPOTHESIS: To investigate causative viruses in patients with postviral olfactory disorders (PVOD). STUDY DESIGN: Case-control study. METHODS: One hundred fifty-one consecutive patients diagnosed with PVOD were enrolled, and samples from 38 patients who visited the doctor within 3 months of symptom onset were collected and analyzed. Thirty-two individuals who underwent surgery for nasal septal deviation during the same time period were collected as the control group. The Sniffin' Sticks psychophysical olfactory test was used to evaluate olfactory function. Olfactory cleft specimens were collected using nasopharyngeal flocked swabs (COPAN FLOQSwabs). Eighteen viruses were tested for with the Luminex xTAG RVP FAST v2 Assay Kit. RESULTS: Out of the 38 patients with PVOD, rhinoviruses were detected in 13 patients, and coronavirus OC43 was detected in one patient. The frequency of positive virus detection in the patients with anosmia was higher than in those with hyposmia (58.8% vs. 19.0%, P = 0.018). In control group, rhinovirus was identified in one patient (3.1%). Nasal obstruction was the most common symptom and was experienced by 71.0% of patients. CONCLUSIONS: Rhinovirus and coronavirus are more commonly identified in PVOD. Our methods represent an approach to screen for viruses that may be involved in PVOD. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:158-164, 2021.

Three-dimensional reconstruction of laryngeal cancer with whole organ serial immunohistochemical sections.

Three-dimensional (3D) image reconstruction of tumors based on serial histological sectioning is one of the most powerful methods for accurate high-resolution visualization of tumor structures. However, 3D histological reconstruction of whole tumor has not yet been achieved. We established a high-resolution 3D model of molecular marked whole laryngeal cancer by optimizing the currently available techniques. A series of 5,388 HE stained or immunohistochemically stained whole light microscopic images (200 ×) were acquired (15.61 TB).The data set of block-face images (96.2 GB) was also captured. Direct volume rendering of serial 6.25 × light microscopy images did not demonstrate the major characteristics of the laryngeal cancer as expected. Based on fusion of two datasets, the accurate boundary of laryngeal tumor bulk was visualized in an anatomically realistic context. In the regions of interest, micro tumor structure, budding, cell proliferation and tumor lymph vessels were well represented in 3D after segmentation, which highlighted the advantages of 3D reconstruction of light microscopy images. In conclusion, generating 3D digital histopathological images of a whole solid tumor based on current technology is feasible. However, data mining strategy should be developed for complete utilization of the large amount of data generated.

A glimpse into the psychological status of E.N.T inpatients in China: A cross-sectional survey of three hospitals in different regions.

OBJECTIVE: To determine whether E.N.T inpatients have a higher prevalence of mental illness than the general population and whether certain diseases are more likely to be associated with mental illness than other diseases. METHODS: This cross-sectional survey was conducted in the E.N.T departments of three hospitals in different cities in China. The psychological status of all consecutive adult inpatients was assessed within 1-2 days following hospital admission using the Symptom Checklist-90 (SCL-90), Zung Self-Rating Depression Scale (SDS) and Zung Self-Rating Anxiety Scale (SAS). Inpatients from the general surgery and pneumology departments at the same hospital were enrolled and surveyed as control groups. RESULTS: The 439 patients enrolled in the final analysis accounted for 88.0% of all E.N.T inpatients during the study period. Of these patients, 16.4% were in an anxious state and 79.5% were in a depressive state. The overall anxiety (41.7 ± 9.7) and depression (55.9 ± 29.2) scores were much higher than Chinese norm (29.8 ± 10.0 and 33.5 ± 8.6, respectively), and significant differences were observed (t = 20.89, P < 0.01 and t = 13.12, P < 0.01, respectively). Although 18.7% of the E.N.T patients were psychiatric distress, these patients scored lower on the SCL-90 than the Chinese norm. Furthermore, the patients in the E.N.T department had a higher prevalence of anxiety and depression than those in the general surgery department but a similar prevalence to those in the respiratory department. CONCLUSION: Psychological distress, particularly anxiety and depression, are widespread in patients with otolaryngological diseases. Therefore, the identification and treatment of co-occurring psychiatric disorders in this high risk and clinically challenging group of patients are urgent in China.