Accidental aspiration of a solid tablet of sodium hydroxide.

Sodium hydroxide is a corrosive, highly alkaline (PKa=14.8) household product. Ingestion of sodium hydroxide liquid is common, showing toxicity on the oesophagus and stomach. Nevertheless, cases of sodium hydroxide ingestions in pellet are rare and the management of them is unknown. We report the case of a 65-year-old man who accidentally swallowed a bleach tablet of 3.5 g. Six hours later, the patient developed an aphonia associated with dysponea stage IV, motivating a nasofibroscopy showing glottis and supraglottic necrosis and oedema for which the patient received intravenous steroids, was intubated and then underwent a tracheotomy. After 2 weeks under tracheotomy, local evolution was favourable allowing a removal of the cannula and a return back home.

Association of alirocumab therapy with inflammatory lesions of the vocal folds: A case report.

Therapeutic monocolonal antibodies (MAbs) are a new, rapidly growing class of medications that frequently have poorly characterized side-effect profiles. We present a patient who developed inflammatory lesions of the vocal folds in temporal relation to the initiation of alirocumab. Lesions of the vocal folds represent a previously unreported adverse effect of alirocumab therapy, making it the second MAb documented with such a side effect. The potential laryngeal effects of alirocumab specifically, and of MAbs more broadly, warrant investigation. Laryngoscope, 127:1652-1654, 2017.

Aphonia and quadriplegia---a rare complication following epidural labor analgesia.

We report an obstetric patient who developed unusual neurological complications after an epidural injection of a local anesthetic and a narcotic in a seemingly faultless manner. Ten minutes after receiving a loading dose, the patient developed aphonia, quadriplegia, and facial palsy while retaining normal consciousness and stable hemodynamics. The episode spontaneously resolved 40 minutes later. We wish to draw attention to anesthesiologists of the possibility that even in the presence of a negative aspiration test or without noticeable dural puncture, the injected drugs may enter the intrathecal or subdural space instead of pooling entirely in the epidural compartment. Once an unexpected high block and unusual symptoms or signs are noted, a prompt differential diagnosis must be made and treatment initiated as soon as possible.

How safe is percutaneous ethanol injection for treatment of thyroid nodule? Report of a case of severe toxic necrosis of the larynx and adjacent skin.

OBJECTIVE: Since 1990, percutaneous ethanol injection therapy (PEIT) has been clinically applied as a treatment for autonomous functioning nodules of the thyroid as well as for cystic lesions. Some additional indications are currently under consideration, e.g. inoperable advanced cancer of the thyroid. Since its inception, PEIT has generally been regarded as an effective, low-risk, inexpensive procedure which can be performed on an ambulatory basis. MATERIAL AND METHODS: We report the first case of severe ethyl toxic necrosis of the larynx combined with necrotic dermatitis in a patient treated with PEIT by a radiologist. RESULTS: The patient was admitted to hospital, where the necrosis and dermatitis were treated conservatively. A cyst which developed in the right false vocal fold was removed by microsurgery 10 months later. Voice was restored almost to normal but a significant reduction in nodular volume was not seen, probably due to the inexperience of the operator. CONCLUSION: PEIT for functional thyroid gland autonomy is an inexpensive method of treating hyperthyroidism with focal autonomy on an ambulatory basis if surgical intervention and radioiodine therapy are not feasible either for medical reasons or because of refusal by the patient. Severe complications must be taken into consideration and discussed with the patient. To avoid complications, substantial experience and a precise ultrasound-guided injection are required. In the case of complications the opinion of a specialist should be sought at anearly stage.

[Atypical acute dystonia]. / Atypisk akut dystoni.

Acute dystonia is a common adverse effect following anti-psychotic medication, which mainly appears shortly after beginning treatment or increasing the dosage. Laryngeal dysfunction may carely occur as part of the picture of acute dystonia and, if so, usually with dyspnoea. We describe a case of acute dystonia with atypical onset without relation to changes in dosage and with laryngeal involvement with aphonia, but without dyspnoea.

Accidental total spinal block: a complication of an epidural test dose.

A case is presented of a 36-yr-old parturient who developed a total spinal block after an epidural test dose. After placement of an epidural catheter and confirming negative aspiration for blood or CSF, 3 ml lidocaine 1.5% (45 mg), with 1:200,000 epinephrine (15 micrograms) was injected via the catheter over 30 sec. Within two minutes the patient developed hypotension and extensive sensory and motor block including respiratory paralysis and aphonia. She remained fully conscious and alert and spontaneous respiration recommenced in five minutes. A live healthy infant was delivered by emergency Caesarean section shortly afterwards under general anaesthesia and the mother recovered completely without any untoward sequelae.