RESUMO
Vocal polyps are benign vocal cord lesions, which mainly manifest as a hoarse voice. Laryngeal microsurgery is the most common treatment. However, because of anxiety regarding invasive treatment, it is necessary to have a non-invasive treatment option. A 43 year old female patient who is a teacher visited a Korean medical hospital for persistent hoarseness with a vocal polyp. After taking herbal medicine for hoarseness (Kyung-Hee-cheong-um-whan) and pharyngitis (cheong-in-li-gyok-tang and cheong-in-ryu-que-whan) for almost 10 weeks, the vocal polyp was reduced and symptoms improved. Herbal prescription for pharyngitis and hoarseness can be applied to vocal polyps as non-invasive treatment.
Assuntos
Doenças da Laringe , Pólipos , Adulto , Feminino , Medicina Herbária , Rouquidão/tratamento farmacológico , Rouquidão/etiologia , Rouquidão/patologia , Humanos , Doenças da Laringe/tratamento farmacológico , Doenças da Laringe/patologia , Pólipos/tratamento farmacológico , Pólipos/patologia , Pólipos/cirurgia , Prega Vocal/patologiaRESUMO
BACKGROUND: It was hitherto common practice to analyse each removed gallbladder for the presence of gall bladder cancer (GBC) although this approach may be questioned. The aim of this study was to determine whether a policy of selective histopathological analysis (Sel-HPA) is oncologically safe and cost effective. METHODS: This retrospective study was conducted in a single Dutch teaching hospital. Immediately following cholecystectomy, the surgeon decided on the basis of inspection and palpation whether histological examination was indicated. The Dutch Comprehensive Cancer Organisation (IKNL) registry was used to identify the number of GBC during this time period. RESULTS: Of 2271 patients who underwent a cholecystectomy in our institution between January 2012 and December 2017, 1083 (47.7%) were deemed indicated for histopathological analysis. Sixteen pathological gallbladders (1.5%) were identified in that period (intestinal metaplasia, nâ¯=â¯3; low grade dysplasia nâ¯=â¯7; carcinoma nâ¯=â¯6). During follow-up, no patient was found to have GBC recurrence in the population whose gallbladder was not sent for pathology (52.3%, nâ¯=â¯1188, median 49 months of follow up). The percentage of gallbladders that were analysed decreased over the six years of observation from 83% to 38%. Our policy of Sel-HP saved over 65 000. CONCLUSIONS: A policy of selective histopathology after cholecystectomy is oncologically safe and reduces costs.
Assuntos
Carcinoma/diagnóstico , Colecistectomia , Doenças da Vesícula Biliar/cirurgia , Neoplasias da Vesícula Biliar/diagnóstico , Vesícula Biliar/patologia , Pólipos/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma/diagnóstico por imagem , Carcinoma/patologia , Colecistectomia Laparoscópica , Colecistite Aguda/cirurgia , Colecistolitíase/cirurgia , Análise Custo-Benefício , Feminino , Vesícula Biliar/diagnóstico por imagem , Neoplasias da Vesícula Biliar/diagnóstico por imagem , Neoplasias da Vesícula Biliar/patologia , Humanos , Masculino , Metaplasia , Pessoa de Meia-Idade , Países Baixos , Seleção de Pacientes , Pólipos/diagnóstico por imagem , Pólipos/patologia , Estudos Retrospectivos , Adulto JovemRESUMO
OBJECTIVE: Despite the fact that vocal nodules are the most common cause of chronic dysphonia in children, uncertainty and lack of consensus complicates practically every diagnostic and management decision. Selecting an optimal staging system is fundamental to understanding a disease process, mandatory for uniform reporting, and crucial to predicting natural history and treatment outcomes. The ideal prognostic model for vocal nodules is under intense debate. The purpose of this study was to analyze the predictive power of vocal nodule grade to severity of voice metrics in children. METHODS: Seventy-nine patients diagnosed with vocal cord nodules between 2006 and 2012 were drawn from UPMC Children's Hospital of Pittsburgh Voice, Resonance and Swallowing Center Research Registry. Subject age at time of diagnosis, nodule grade, relevant co-morbidities, scores on The Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V), parent-reported Pediatric Voice Handicap Index (pVHI), the phonotraumatic behaviors profile, habitual speaking pitch fundamental frequencies, pitch range, volume intensity, and s/z ratio were recorded and compiled into a de-identified database for analysis. RESULTS: Based on the Kruskal-Wallis H Test, there was no statistically significant correlation between nodule grade and total pitch range (pâ¯=â¯.21), s/z ratio (pâ¯=â¯.50), volume intensity (pâ¯=â¯.33), overall CAPE-V Scores (pâ¯=â¯.15), or pVHI Scores (pâ¯=â¯.29). Chi-squared tests also revealed no significant associations between nodule grade and abnormality in habitual speaking pitch (pâ¯=â¯.14 for fundamental frequency while sustaining a vowel sound, pâ¯=â¯.37 for fundamental frequency while speaking structured tasks i.e. counting, or pâ¯=â¯.76 while speaking in conversation). CONCLUSION: The current "gold-standard" for grading vocal nodule size suggests that the nodules themselves are not driving the standard dysphonic metrics that are most commonly collected and monitored in such children. This outcome is consistent with other studies reporting similar findings and was expected based on the inconsistencies in the reported literature to date. By extension, the conventional wisdom of avoiding surgical treatment of vocal nodules in children seems prudent as there is little evidence to suggest that the nodules themselves are "driving" the severity of the dysphonia. Ultimately identifying the true "drivers" of dysphonia in children will suggest alternative therapies that are more specific and directed to the pathophysiology. Most pediatric voice care professionals will welcome such discoveries as those in the front line of patient care are often rendered helpless and frustrated.
Assuntos
Disfonia/diagnóstico , Disfonia/etiologia , Doenças da Laringe/complicações , Doenças da Laringe/diagnóstico , Pólipos/complicações , Pólipos/diagnóstico , Adolescente , Criança , Pré-Escolar , Estudos de Coortes , Disfonia/terapia , Feminino , Humanos , Doenças da Laringe/cirurgia , Masculino , Pólipos/cirurgia , Valor Preditivo dos Testes , Índice de Gravidade de Doença , Qualidade da VozAssuntos
Anestesia Local/métodos , Doenças da Laringe/cirurgia , Terapia a Laser/métodos , Lasers de Estado Sólido/uso terapêutico , Cirurgia Endoscópica por Orifício Natural/métodos , Pólipos/cirurgia , Prega Vocal/cirurgia , Feminino , Tecnologia de Fibra Óptica/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Nariz , Estudos Prospectivos , Resultado do TratamentoRESUMO
OBJECTIVE: Phonomicrosurgery is generally considered to be the treatment of choice for removing vocal fold polyps. However, specific techniques of voice therapy may represent, in selected cases and under certain conditions, a noninvasive therapeutic option for the treatment of such laryngeal lesions. The aim of the present study is to longitudinally assess, in terms of clinical outcomes and quality of life, two groups of patients with cordal polyps, treated either with standard surgery plus standard voice therapy or with a specific training of voice therapy alone, which we have called "Voice Therapy Expulsion." STUDY DESIGN: This study is a randomized controlled trial. METHODS: A total of 150 patients with vocal fold polyps were randomly assigned to either standard surgery or "voice therapy expulsion" protocol. The trial was carried out at the Division of Phoniatrics and Audiology of the Second University of Naples and at the Division of Communication Disorders of Local Health Unit (3 Naples South) from January 2010 to December 2013. A thorough phoniatric evaluation, including laryngostroboscopy, acoustic voice analysis, global grade of dysphonia, instability, roughness, breathiness, asthenia, and strain scale, Voice Handicap Index, and Voice-Related Quality of Life, was performed by using standardized tools, at baseline, at the end of the treatment, and up to 1 year after treatment. RESULTS: We found no significant differences between the two experimental groups in terms of clinical outcomes and personal satisfaction. However, "Voice Therapy Expulsion" was associated with higher scores for quality of life at endpoint evaluation. CONCLUSIONS: Besides phonosurgery, this specific "Voice Therapy Expulsion" technique should be considered as a valid, noninvasive, and well-tolerated therapeutic option for the treatment of selected patients with vocal fold polyps.
Assuntos
Doenças da Laringe/cirurgia , Microcirurgia/métodos , Pólipos/cirurgia , Prega Vocal/cirurgia , Distúrbios da Voz/cirurgia , Qualidade da Voz , Treinamento da Voz , Humanos , Itália , Doenças da Laringe/diagnóstico , Doenças da Laringe/fisiopatologia , Microcirurgia/efeitos adversos , Pólipos/diagnóstico , Pólipos/fisiopatologia , Qualidade de Vida , Recuperação de Função Fisiológica , Inquéritos e Questionários , Fatores de Tempo , Resultado do Tratamento , Prega Vocal/fisiopatologia , Distúrbios da Voz/diagnóstico , Distúrbios da Voz/fisiopatologiaRESUMO
STUDY OBJECTIVE: To assess procedural success, patient acceptability, and cost-saving potential of operative hysteroscopy using conventional equipment and local anesthetic in an outpatient clinic. DESIGN: Feasibility study/service evaluation (Canadian Task Force classification II-3). SETTING: Outpatient (office) clinic in a large UK teaching hospital. PATIENTS: One hundred eighteen women with diagnosed or suspected intrauterine myomas or polyps. INTERVENTIONS: Operative hysteroscopy (122 monopolar resection procedures using 8- or 10-mm diameter rigid resectoscopes with glycine solution for uterine irrigation) with the patient under local anesthesia in an outpatient (office) clinic. MEASUREMENTS AND MAIN RESULTS: Procedural success, duration of procedure, pathologic measurements, glycine irrigant deficit, patient pain scores and satisfaction, and comparative costs were recorded. Success of outpatient procedures was 90% (110 of 122 attempted), with a significantly reduced median procedure duration compared with a surgical setting using local (-7 minutes; p = .009) or general (-12.5 minutes; p < .001) anesthetic. Glycine irrigant absorption was low (median deficit, 0 mL), and no deficit was observed in 81% of patients. Mean (SD) estimated disease volume was comparable to that of hysteroscopic resection procedures in a surgical setting (3.38 [5.09] cm(3)), and weight was 1.8 (1.84) g. Patients tolerated the procedure well and reported low pain scores (highest median periprocedure pain measurement was 1.25 of 10), and 7-day follow-up satisfaction responses were positive. Retrospective cost analysis demonstrated that operative resection in an outpatient clinic was less expensive than in a surgical setting using general anesthetic (-$1003) or local anaesthetic (-$234). Reduced staff costs were the primary reason for this saving. CONCLUSIONS: Operative hysteroscopic resection of myomas and polyps is feasible and well tolerated by patients in an outpatient/office setting using local anaesthetic and conventional equipment. The outpatient procedure is less expensive and its duration is shorter than in a surgical setting.
Assuntos
Procedimentos Cirúrgicos Ambulatórios , Anestésicos Locais , Histeroscopia , Leiomioma/cirurgia , Dor Pós-Operatória/prevenção & controle , Pólipos/cirurgia , Adulto , Idoso , Instituições de Assistência Ambulatorial , Anestesia Local , Análise Custo-Benefício , Estudos de Viabilidade , Feminino , Humanos , Histeroscopia/instrumentação , Histeroscopia/métodos , Leiomioma/epidemiologia , Medição da Dor , Dor Pós-Operatória/epidemiologia , Satisfação do Paciente , Pólipos/epidemiologia , Gravidez , Estudos Retrospectivos , Reino Unido/epidemiologiaRESUMO
UNLABELLED: The vocal cord polyp is an inflammatory false tumour of the larynx. It is characterized mainly by the specific existence of fibrinous exsudats organized in loose network or mounds, surrounded by newly formed vascular slits. The epithelium covering the polyp is usually more or less impaired. CLINICAL CASES: The authors report two adult patients among whom the initial presentation in video-stroboscopy was that of an intracordal lesion of a cystic type, however; with unusual characteristics (purplish color, angiomatous aspect). The surgery consisted of a cordotomy, the surface epithelium appearing normal. After dissection, the two lesions seemed to be presenting the typical aspect of fibrinoïd mound of a polyp, observation confirmed by the anatomo-pathological study. In these cases, the resection was finally carried out with no mucous loss. CONCLUSION: The particular etiopathogeny of these lesions is been discussed. The treatment, medical and of rehabilitation could achieve a partial recovery. In the event of surgery, an access to the lesion through a cordotomy and not directly by removal with microcissors is advised.
Assuntos
Doenças da Laringe , Pólipos , Prega Vocal , Adulto , Feminino , Seguimentos , Homeopatia , Humanos , Doenças da Laringe/diagnóstico , Doenças da Laringe/patologia , Doenças da Laringe/reabilitação , Doenças da Laringe/cirurgia , Laringoscopia , Masculino , Microcirurgia , Pessoa de Meia-Idade , Pólipos/diagnóstico , Pólipos/patologia , Pólipos/reabilitação , Pólipos/cirurgia , Cuidados Pré-Operatórios , Estroboscopia , Fatores de Tempo , Resultado do Tratamento , Gravação em Vídeo , Prega Vocal/patologia , Prega Vocal/cirurgia , Distúrbios da Voz/etiologiaRESUMO
OBJECTIVES: Lesions in the anterior segment of the vocal fold are sometimes difficult to access by means of conventional suspension microlaryngoscopy under general anaesthesia because of anatomical factors such as short, stout and inflexible necks, reduced jaw protrusion, and long incisors. Various techniques have recently been proposed for the management of inaccessible glottic lesions, most of which are performed under general anaesthesia. The use of flexible videoendoscopic surgery under topical anaesthesia in two cases of anterior glottic lesions that could not be treated by means of conventional suspension laryngoscopy is described. STUDY DESIGN: Case report. METHODS: A flexible videobronchoscope with an instrument channel was inserted transnasally on an out-patient basis. While the examiner carried out the endoscopy, an assistant maneuvered the biopsy forceps through the instrument channel, and removed the lesion. RESULTS: Both patients underwent successful removal of an anterior glottic polyp, and the one-year follow-up evaluation revealed normal anatomy of the vocal folds and normal vocal function. CONCLUSIONS: Flexible videoendoscopic surgery under topical anaesthesia is a safe, simple and minimally invasive procedure that can be considered as an alternative to traditional endoscopic surgery for inaccessible anterior glottic lesions.
Assuntos
Glote/cirurgia , Doenças da Laringe/cirurgia , Pólipos/cirurgia , Idoso , Anestesia Local , Feminino , Humanos , Laringoscopia/métodos , Masculino , Pessoa de Meia-Idade , Cirurgia Vídeoassistida/métodosRESUMO
OBJECTIVE: To evaluate the effect of microlaryngoscopic surgery in the treatment of vocal cord benign lesion. METHOD: The operation was performed using suspension laryngoscope and common operative microscope under surface anesthesia with 1% pontocaine. RESULT: In the 872 patients,438 cases had vocal nodules, 353 were vocal polyps and other vocal cord cysts. In 208 patients underwent successful operation, 171 cases were cured clinically and 36 cases improved after the first attempt with a general effective rate of 96.3%. CONCLUSION: The most patients who had vocal cord benign lesions without severe cardiovascular diseases could be operated under surface anesthesia which have the advantages of rare complications and rapid recovery.
Assuntos
Cistos/cirurgia , Doenças da Laringe/cirurgia , Pólipos/cirurgia , Prega Vocal/cirurgia , Adolescente , Adulto , Anestesia Local , Feminino , Humanos , Laringoscopia , Masculino , Microcirurgia , Pessoa de Meia-IdadeRESUMO
Se presenta grupo de 45 pacientes seropositivos al virus de la inmunodeficiencia humana, portadores anorrectal, que fueron separados en dos grupos: los HIV + (42,2 por ciento) y los con SIDA clínico (57,8 por ciento). Todos fueron de sexo masculino, jóvenes (edad promedio 32,2 años), siendo los factores de riesgo más frecuentes la homosexualidad (66,6 por ciento) y bisexualidad (22,2 por ciento). En los HIV+ la lesión más frecuente fue la considerada dentro de la de tipo común (47,3 por ciento), mientras que en los pacientes con SIDA clínico fue la ocasionada por inmunosupresión (50 por ciento). La patología común más frecuente en ambos grupos fue la enfermedad hemorroidaria. La enfermedad de transmisión sexual, también en ambos grupos, más frecuente fueron los condilomas. La respuesta al tratamiento en el grupo HIV+ fue óptima y/o buena en todos los casos. En los pacientes con SIDA clínico se observó evolución regular y mala, cuestión que resultó más frecuente en los sometidos a manejo quirúrgico (60 por ciento) que en los manejo médico (10 por ciento)
Assuntos
Humanos , Masculino , Adulto , Pessoa de Meia-Idade , Soropositividade para HIV/complicações , Doenças Retais/etiologia , Síndrome da Imunodeficiência Adquirida/complicações , Abscesso/etiologia , Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Evolução Clínica , Fissura Anal/etiologia , Fístula Retal/cirurgia , Fístula Retal/etiologia , Hemorroidas/etiologia , Terapia de Imunossupressão , Pólipos/cirurgia , Pólipos/etiologia , Sinais e SintomasRESUMO
41 cases still showing various symptoms and signs after having been operated on for intralaryngeal conditions were treated with Yiqi Kaiyin Tang [symbol: see text] the vital energy replenishing and voice restoring decoction). The chief clinical manifestations were hoarseness of voice, lack of strength for speech, feeling of dryness and pain in the throat with foreign body sensation or burning sensation, and aphonia. The treatment lasted 15-60 days, resulting in cure in 19 cases, improvement in 16 cases, and no response in 6 cases, making a total effectiveness rate of 85.4%.
Assuntos
Medicamentos de Ervas Chinesas/uso terapêutico , Rouquidão/tratamento farmacológico , Laringectomia , Complicações Pós-Operatórias/tratamento farmacológico , Adulto , Idoso , Diagnóstico Diferencial , Feminino , Rouquidão/diagnóstico , Humanos , Neoplasias Laríngeas/cirurgia , Laringectomia/reabilitação , Masculino , Medicina Tradicional Chinesa , Microcirurgia , Pessoa de Meia-Idade , Pólipos/cirurgia , Complicações Pós-Operatórias/diagnóstico , Prega Vocal/cirurgiaAssuntos
Pólipos do Colo/terapia , Terapia por Estimulação Elétrica/métodos , Endoscopia do Sistema Digestório/métodos , Cálculos Biliares/terapia , Marca-Passo Artificial , Idoso , Pólipos do Colo/complicações , Pólipos do Colo/cirurgia , Terapia Combinada , Terapia por Estimulação Elétrica/instrumentação , Eletrodos Implantados , Feminino , Cálculos Biliares/complicações , Cardiopatias/complicações , Cardiopatias/fisiopatologia , Humanos , Litotripsia , Masculino , Pessoa de Meia-Idade , Pólipos/complicações , Pólipos/cirurgia , Pólipos/terapia , Neoplasias Gástricas/complicações , Neoplasias Gástricas/cirurgia , Neoplasias Gástricas/terapiaAssuntos
Neoplasias do Ceco/diagnóstico , Neoplasias do Colo/diagnóstico , Pólipos/diagnóstico , Sulfato de Bário/administração & dosagem , Neoplasias do Ceco/cirurgia , Criança , Neoplasias do Colo/cirurgia , Colonoscopia , Enema , Humanos , Valva Ileocecal/diagnóstico por imagem , Valva Ileocecal/cirurgia , Masculino , Pólipos/cirurgia , RadiografiaRESUMO
Intranasal ethmoidectomy is a safe procedure that provides predictable, positive surgical results when accomplished by a knowledgeable rhinologic surgeon. Previously described as "the most dangerous operation in all of surgery," it should be mastered through detailed study of the pertinent surgical anatomy and meticulous attention to technique.
Assuntos
Seio Etmoidal/cirurgia , Anestesia Local/métodos , Cocaína , Seio Etmoidal/anatomia & histologia , Feminino , Humanos , Métodos , Pessoa de Meia-Idade , Neoplasias dos Seios Paranasais/cirurgia , Pólipos/cirurgia , Complicações Pós-Operatórias , Sinusite/cirurgia , Conchas Nasais/cirurgiaRESUMO
Fifty-five patients with colorectal sessile adenomas and adenomas with the severest dysplasia were followed up every 6 months with colonoscopy and/or double-contrast enema during 4 years, after a clean colon had been obtained, by repeated colonoscopy within 3 months after piecemeal polypectomy. The repetition at 3 months resulted in detection of two cancers. An overlooked cancer was detected at 1 year, and another cancer was diagnosed between examinations. Risk of new adenomas (19 patients) was related to original size, number, and glandular structure of the polyps. Twelve of the 19 patients had new polyps above the rectum. The 336 colonoscopies were complicated by 3 laparotomies, made necessary by perforation and bleeding. The results suggest that intervals between examinations of patients with the present type of adenomas may be prolonged, and patients are now allocated at random to colorectal follow-up examination every 6 and 12 months.
Assuntos
Adenoma/cirurgia , Pólipos do Colo/cirurgia , Recidiva Local de Neoplasia/diagnóstico , Pólipos/cirurgia , Neoplasias Retais/cirurgia , Adenoma/diagnóstico , Idoso , Pólipos do Colo/diagnóstico , Feminino , Seguimentos , Humanos , Masculino , Pólipos/diagnóstico , Estudos Prospectivos , Neoplasias Retais/diagnóstico , Fatores de TempoRESUMO
A review of 464 consecutive polypoid lesions of the colon reveals that virtually all pedunculated polyps and over 80% of 218 sessile polyps were removed colonoscopically. Although size or location of the lesions occasionally precludes colonoscopic excision, the endoscopic appearance of a sessile polyp is the most important factor in deciding upon the method of excision. In gneeral, smooth, soft, nonulcerated sessile lesions of all sizes were excised endoscopically, while approximately half of the larger (2-6 cm) firm, irregular-surfaced, benign sessile lesions, and all ulcerated or malignant sessile lesions required laparotomy for proper management. All polypoid lesions should be viewed endoscopically before deciding the method of excision, regardless of their size, location, or general appearnce by barium enema. Experience with endoscopic morphology and snare electrocautery technics was most important, since more than 85% of all polypoid lesions in this consecutive series were removed endoscopically.