RESUMO
OBJECTIVES: In most cases, suspension laryngoscopy (SL) is efficient, bloodless and with minimal post-procedure discomfort. We aimed to identify predictive patient factors for acceptable surgical views at SL as well as quantify our tertiary airway unit's complication rates. DESIGN: Prospective cohort study of 150 consecutive microlaryngoscopy procedures involving SL over an 8-month period between November 2019 and July 2020. Patients were assessed preoperatively for pre-existing oral, temporomandibular, dental, pharyngeal or laryngeal pathology, interincisor distance and qualitative gross limitations to neck extension and forward head posture. Intraoperatively, the laryngoscopic view was graded by anaesthetic and surgical teams, and complications were recorded on patient interview in recovery. SETTING: Tertiary adult airway service for predominantly benign pathology. RESULTS: Adequate surgical views were obtained in 149/150 procedures. BMI had a weak positive correlation with a more difficult view (r = .22, p = .008) but did not correlate with a statistically significant increase in any complication. There was a weak negative correlation between age and interincisor gap (r = -.20, p = .014), and wider mouth opening correlated very weakly with a lower incidence of sore throat (r = -.19, p = .023). Gross macroglossia showed a significant moderate positive correlation with tongue symptoms (r = .45, p = 1.611 × 10-8 ). CONCLUSION: In the context of an experienced airway unit with a high caseload of predominantly benign pathology, SL is very effective and safe with low associated morbidity and no mortality. The most common complication of SL is temporary sore throat and there remain recognised risks of temporary tongue and dental symptoms.
Assuntos
Intubação Intratraqueal/métodos , Doenças da Laringe/cirurgia , Laringoscopia/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Prospectivos , Adulto JovemRESUMO
The preclinical efficacy and safety of GPi921, a glycogen phosphorylase inhibitor, was assessed following twenty-eight days of administration to Zucker Diabetic Fatty (ZDF) rats. The ZDF rat is an animal model of type 2 diabetes mellitus (TTDM) which develops severe hyperglycemia. Inhibition of glycogen phosphorylase throughout the duration of the study was demonstrated by reductions in twenty-four-hour glucose profiles and glycated hemoglobin levels. In addition, progression towards hyperglycemia was halted in treated but not control animals, which developed hyperglycemia over the twenty-eight days of the study. Biochemical and histopathological analysis revealed large increases in hepatic glycogen, which closely paralleled the development of hepatomegaly and ultimately resulted in increases in hepatic lipids. Furthermore, prolonged glycogen phosphorylase inhibition resulted in an increased incidence and severity of other adverse pathological findings in the liver, such as inflammation, fibrosis, hemorrhage, and necrosis. The observed biochemical and histopathological phenotype of the liver closely resembled that seen in severe cases of human glycogen storage diseases (GSD) and hepatic glycogenosis in poorly controlled diabetes mellitus. These findings revealed that although glycogen phosphorylase inhibitors are efficacious agents for the control of hyperglycemia, prolonged treatment might have the potential to cause significant clinical hepatic complications that resemble those seen in GSD and hepatic glycogenosis.
Assuntos
Glicogênio Fosforilase/antagonistas & inibidores , Doença de Depósito de Glicogênio/induzido quimicamente , Doença de Depósito de Glicogênio/patologia , Hipoglicemiantes/efeitos adversos , Fígado/efeitos dos fármacos , Animais , Área Sob a Curva , Glicemia/efeitos dos fármacos , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/tratamento farmacológico , Modelos Animais de Doenças , Inibidores Enzimáticos/efeitos adversos , Inibidores Enzimáticos/farmacocinética , Humanos , Hiperglicemia/tratamento farmacológico , Hiperglicemia/etiologia , Hipoglicemiantes/farmacocinética , Fígado/patologia , Masculino , Ratos , Ratos ZuckerAssuntos
Serviços de Saúde Comunitária/organização & administração , Serviços Contratados/organização & administração , Medicina Estatal/organização & administração , Serviços de Saúde Comunitária/economia , Serviços de Saúde Comunitária/normas , Serviços Contratados/economia , Serviços Contratados/normas , Controle de Custos/métodos , Eficiência Organizacional , Humanos , Medicina Estatal/economia , Medicina Estatal/normas , Reino UnidoAssuntos
Idoso Fragilizado , Serviços de Saúde para Idosos/normas , Serviços de Assistência Domiciliar/normas , Serviço Social/normas , Medicina Estatal/normas , Idoso , Serviços de Saúde para Idosos/economia , Serviços de Saúde para Idosos/tendências , Serviços de Assistência Domiciliar/economia , Serviços de Assistência Domiciliar/tendências , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Humanos , Tempo de Internação/economia , Tempo de Internação/estatística & dados numéricos , Serviço Social/economia , Serviço Social/tendências , Medicina Estatal/economia , Medicina Estatal/tendênciasAssuntos
Fechamento de Instituições de Saúde/economia , Planejamento Hospitalar/economia , Hospitais Gerais/economia , Hospitais Especializados/economia , Medicina Estatal/economia , Área Programática de Saúde/economia , Controle de Custos/métodos , Tamanho das Instituições de Saúde/economia , Tamanho das Instituições de Saúde/normas , Tamanho das Instituições de Saúde/tendências , Hospitais Gerais/organização & administração , Hospitais Gerais/tendências , Hospitais Especializados/organização & administração , Hospitais Especializados/normas , Humanos , Modelos Organizacionais , Avaliação de Programas e Projetos de Saúde/economia , Medicina Estatal/organização & administração , Medicina Estatal/tendências , Reino UnidoRESUMO
In patients with anorexia nervosa (AN) several factors combine to cause osteoporosis, and the risk of osteoporosis increases with chronicity of illness. The authors carried out a follow-up study in patients who attended the Eating Disorders department of the Hospital de Santa Maria. The average follow-up period was of 7.6 years. Fifteen patients were included. Patients answered clinical history questions and underwent neck of femur and spine densitometry. The most important variable with negative correlations to bone recovery was disease duration. A positive correlation between bone recovery and time since the first menstrual cycle post-amenorrhea was also found. However, AN is a condition in which once weight improves and menstrual cycles become regular, severe damage to bone structure is still likely to be maintained.