Lipoma of the pre-epiglottic space: A common pathology in an uncommon place / Lipoma del espacio pre-epiglótico: una patología común en un lugar poco común

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Laryngeal Fracture after Blunt Cervical Trauma in Motorcycle Accident and Its Management.

Laryngeal fracture is a rare traumatic injury, potentially fatal, with an estimated incidence of 1 in 30,000 patients admitted to severe trauma centers. Because of the rarity of this injury, physician may be not aware of its existence, leading to a late diagnosis of this entity. We report a case of a 59-year-old woman admitted to the emergency room after a motorcycle accident with cervical trauma. The patient presented with dysphonia, hemoptysis, cervical subcutaneous emphysema, and increasing respiratory distress that led to the intubation of the patient. CT-scan demonstrated displaced fracture of the cricoid and thyroid cartilage. The patient was submitted to tracheostomy and the fracture was surgically repaired. Tracheostomy was removed in third postoperative month. The patient presented a good recovery, reporting only hoarseness but without swallowing or breathing problems at 6-month follow-up.

Asymmetric c-fos expression in the ventral orbital cortex is associated with impaired reversal learning in a right-sided neuropathy.

BACKGROUND: Recently we showed that unilateral peripheral neuropathic lesions impacted differentially on rat's emotional/cognitive behavior depending on its left/right location; importantly, this observation recapitulates clinical reports. The prefrontal cortex (PFC), a brain region morphofunctionally affected in chronic pain conditions, is involved in the modulation of both emotion and executive function and displays functional lateralization. To test whether the PFC is involved in the lateralization bias associated with left/right pain, c-fos expression in medial and orbital areas was analyzed in rats with an unilateral spared nerve injury neuropathy installed in the left or in the right side after performing an attentional set-shifting, a strongly PFC-dependent task. RESULTS: SNI-R animals required more trials to successfully terminate the reversal steps of the attentional set-shifting task. A generalized increase of c-fos density in medial and orbital PFC (mPFC/OFC), irrespectively of the hemisphere, was observed in both SNI-L and SNI-R. However, individual laterality indexes revealed that contrary to controls and SNI-L, SNI-R animals presented a leftward shift in c-fos density in the ventral OFC (VO). None of these effects were observed in the neighboring primary motor area. CONCLUSIONS: Our results demonstrate that chronic neuropathic pain is associated with a bilateral mPFC and OFC hyperactivation. We hypothesize that the impaired performance of SNI-R animals is associated with a left/right activity inversion in the VO, whose functional integrity is critical for reversal learning.

Differential effects of left/right neuropathy on rats' anxiety and cognitive behavior.

Chronic pain is frequently accompanied by a deterioration of emotional behavior and cognitive function. A small number of studies in humans concluded that pain-associated negative affect is more pronounced when pain is localized in the left side of the body. It has been suggested that such side bias results from cortical function lateralization. It is not known, however, if other pain-associated behavioral changes are differentially affected by left- and right-sided pain. To test this hypothesis, the performance of rats with a unilateral spared nerve injury neuropathy installed in the left (SNI-L) or in the right (SNI-R) side was compared in anxiety (elevated-plus maze) and cognitive (spatial working and reference memory, attentional set-shifting task, and delay-to-signal impulsivity task) behavioral paradigms. Results show that SNI-L animals presented an increased anxiety-like profile while maintaining preserved cognitive function. On the contrary, SNI-R animals presented cognitive deficits in all tasks except in the reference memory, but displayed a normal anxiety-like profile. Our results show that left- and right-sided neuropathic pain differentially affects emotional behavior, which is in accordance with previous observations in human subjects, both in experimentally induced pain and in chronic pain conditions. Additionally, our results demonstrate that the cognitive function deterioration associated with unilateral neuropathic chronic pain conditions is also differentially affected.