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1.
Dysphagia ; 35(4): 545-548, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32533346

RESUMEN

Cranial nerve involvement is a finding often observed in patients infected with severe acute respiratory syndrome coronavirus 2 during the pandemic outbreak of coronavirus disease 2019 (COVID-19). To our knowledge, this is the first report of oropharyngeal dysphagia associated with COVID-19. A 70-year-old male developed dysphagia and consequent aspiration pneumonia during recovery from severe COVID-19. He had altered sense of taste and absent gag reflex. Videoendoscopy, videofluorography, and high-resolution manometry revealed impaired pharyngolaryngeal sensation, silent aspiration, and mesopharyngeal contractile dysfunction. These findings suggested that glossopharyngeal and vagal neuropathy might have elicited dysphagia following COVID-19. The current case emphasizes the importance of presuming neurologic involvement and concurrent dysphagia, and that subsequent aspiration pneumonia might be overlooked in severe respiratory infection during COVID-19.


Asunto(s)
Infecciones por Coronavirus/complicaciones , Trastornos de Deglución/etiología , Neumonía por Aspiración/etiología , Neumonía Viral/complicaciones , Anciano , Infecciones por Coronavirus/diagnóstico por imagen , Infecciones por Coronavirus/patología , Trastornos de Deglución/virología , Humanos , Pulmón/diagnóstico por imagen , Pulmón/patología , Pulmón/virología , Masculino , Orofaringe/patología , Orofaringe/virología , Pandemias , Neumonía por Aspiración/virología , Neumonía Viral/diagnóstico por imagen , Neumonía Viral/patología , Tomografía Computarizada por Rayos X
2.
Anticancer Res ; 40(3): 1631-1636, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32132067

RESUMEN

Lymphangioma insults in adults are uncommon and the occurrence in the oropharynx is extremely rare. Although disease history and clinical symptoms may help in distinguishing it from malignant tumors, the pathophysiology of lymphangioma via histological examinations should be established for convenient and precise diagnosis. We present a 20-year-old male with lymphangioma in the right oropharynx, and the multiple-angle examination and treatment plan used. The case further emphasizes the need to consider lymphangioma in the differential diagnosis of an oropharyngeal mass. Awareness that lymphangioma can occur in adults is important for its proper management, which includes complete surgical removal to prevent recurrence.


Asunto(s)
Linfangioma/diagnóstico , Orofaringe/patología , Adulto , Humanos , Linfangioma/patología , Masculino , Adulto Joven
3.
Spine (Phila Pa 1976) ; 45(2): 103-108, 2020 Jan 15.
Artículo en Inglés | MEDLINE | ID: mdl-31415467

RESUMEN

STUDY DESIGN: Videoflurographic swallowing study in asymptomatic volunteers. OBJECTIVE: The purpose of this study was to investigate the relationship between the severity of dysphagia and various parameters of the subjects. SUMMARY OF BACKGROUND DATA: Occipitocervical fixation is associated with several potential complications. Malalignment of craniovertebral junction and associated dysphagia have been well described in the literature. However, there has been little attention given to investigate the association between the degree of swallowing dysfunction and various patient's parameters. METHODS: Thirty-nine healthy asymptomatic volunteers, 18 males and 21 females, were enrolled in this study. Based on videofluorographic swallowing study (VFSS), two scoring systems of swallowing dysfunction (dysphagia rating scale [DRS], dysphagia outcome and severity scale [DOSS]) were measured in neutral and retraction position. Multiple linear regression analysis was performed to evaluate the relationship between the degree of swallowing dysfunction and various factors of the subjects such as radiological and clinical parameters. RESULTS: There was statistically significant correlation between DRS and DOSS (r = -0.354, P < 0.05). Multiple regression analysis showed that there was a significant association of the dysphagia severity (DRS and DOSS) with the percentile change of the narrowest oropharyngeal diameter (OD) (%dn OD) (r = 0.121, P < 0.01 and r = 0.020, P < 0.01, respectively). Percentile change of OD (neutral and retraction position) was positively associated with the difference of C0-2 angle (r = 1.676, P < 0.01). None of the other variables such as age, sex, C0-1 angle, C1-2 angle, and C2-7 angle were significantly associated with the degree of dysphagia or %dn OD. CONCLUSION: This study demonstrated that the severity of dysphagia is significantly associated with the percentile change of OD and the C0-2 angle has considerable effect on the OD after O-C fusion. Therefore, C0-2 angle could be the most critical radiological parameter not only for predicting the stricture of oropharyngeal space but also for preventing postoperative dysphagia. LEVEL OF EVIDENCE: 4.


Asunto(s)
Trastornos de Deglución/diagnóstico por imagen , Deglución , Orofaringe/diagnóstico por imagen , Orofaringe/patología , Índice de Severidad de la Enfermedad , Adulto , Anciano , Vértebras Cervicales/diagnóstico por imagen , Femenino , Fluoroscopía , Voluntarios Sanos , Humanos , Masculino , Persona de Mediana Edad , Tamaño de los Órganos , Postura , Adulto Joven
4.
Acta Oncol ; 58(10): 1489-1494, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31510843

RESUMEN

Background: Oropharyngeal squamous cell carcinomas (OPSCC) are rising rapidly in incidence due to Human Papillomavirus (HPV) and/or tobacco smoking. Prognosis is better for patients with HPV-positive disease, but may also be influenced by tobacco smoking and other factors. There is a need to individualize treatment to minimize morbidity and improve prognosis. Patient-derived xenografts (PDX) is an emerging pre-clinical research model that may more accurately reflect the human disease, and is an attractive platform to study disease biology and develop treatments and biomarkers. In this study we describe the establishment of PDX models, compare PDX tumors to the human original, and assess the suitability of this model for radiotherapy research and biomarker development. Material and methods: Tumor biopsies from 34 patients with previously untreated OPSCC were implanted in immunodeficient mice, giving rise to 12 squamous cell carcinoma PDX models (7 HPV+, 5 HPV-). Primary and PDX tumors were characterized extensively, examining histology, immunohistochemistry, cancer gene sequencing and gene expression analysis. Radiosensitivity was assessed in vivo in a growth delay assay. Results: Established PDX models maintained histological and immunohistochemical characteristics as well as HPV-status of the primary tumor. Important cancer driver gene mutations, e.g., in TP53, PIK3CA and others, were preserved. Gene expression related to cancer stem cell markers and gene expression subtype were preserved, while gene expression related to hypoxia and immune response differed. Radiosensitivity studies showed high concordance with clinical observations. Conclusion: PDX from OPSCC preserves important molecular characteristics of the human primary tumor. Radiosensitivity were in accordance with clinically observed treatment response. The PDX model is a clinically relevant surrogate model of head and neck cancer. Perspectives include increased understanding of disease biology, which could lead to development of novel treatments and biomarkers.


Asunto(s)
Biomarcadores de Tumor/análisis , Neoplasias Orofaríngeas/radioterapia , Infecciones por Papillomavirus/radioterapia , Tolerancia a Radiación , Carcinoma de Células Escamosas de Cabeza y Cuello/radioterapia , Anciano , Animales , Femenino , Humanos , Masculino , Ratones , Persona de Mediana Edad , Neoplasias Orofaríngeas/patología , Neoplasias Orofaríngeas/virología , Orofaringe/patología , Orofaringe/efectos de la radiación , Papillomaviridae/aislamiento & purificación , Papillomaviridae/patogenicidad , Infecciones por Papillomavirus/patología , Infecciones por Papillomavirus/virología , Carcinoma de Células Escamosas de Cabeza y Cuello/patología , Carcinoma de Células Escamosas de Cabeza y Cuello/virología , Ensayos Antitumor por Modelo de Xenoinjerto
5.
Artículo en Chino | MEDLINE | ID: mdl-31327203

RESUMEN

Objective:TThe aim of this study is to investigate the effect of in vitro cultured Calculus Bovis on the inflammation of oropharynx and body in patients with OSA during the perioperative period of H-UPPP.Method:Eighty patients with OSA and H-UPPP indications were enrolled. The patients were divided into experimental group and control group by random number table, 40 cases in each group. The experimental group was given in vitro cultured Calculus Bovis, while the control group was not given bovine bezoar in vitro. The postoperative oropharyngeal pain, time to resume normal diet, local edema, concentration of IL-1ß, IL-8 and TNF-α in saliva, and concentration of IL-1ß, IL-8 and TNF-α in blood were compared between the two groups. Result:The pain of oropharynx in the experimental group was lighter than that in the control group on the 3rd, 5th and 7th day after operation (P<0.05), but there was no significant difference in the pain of oropharynx between the two groups on the 1st day after operation(P>0.05); the time of restoring normal diet in the experimental group was shorter than that in the control group (P<0.05); the edema of oropharynx in the experimental group was lighter than that in the control group on the 5th and 7th day after operation (P<0.05).The levels of IL-1ß, IL-8 and TNF-α in saliva were lower than those in control group on the 3rd, 5th and 7th day after operation (P<0.05), and the levels of IL-1ß, IL-8 and TNF-α in blood on the 5th and 7th day after operation were lower than those in control group (P<0.05).Conclusion:In vitro perioperative period of H-UPPP can improve the postoperative sore throat and local edema of oropharynx, shorten the time of normal diet and reduce the expression of related inflammatory factors in oropharynx and blood.


Asunto(s)
Ácidos Cólicos/uso terapéutico , Inflamación/prevención & control , Materia Medica/uso terapéutico , Orofaringe/patología , Procedimientos Quirúrgicos Otorrinolaringológicos , Apnea Obstructiva del Sueño/cirugía , Animales , Bovinos , Humanos , Interleucina-1beta/análisis , Interleucina-8/análisis , Periodo Posoperatorio , Factor de Necrosis Tumoral alfa/análisis
6.
PLoS One ; 14(7): e0218989, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31310629

RESUMEN

Head and neck squamous cell carcinomas (HNSCC) includes multiple subsites that exhibit differential treatment outcome, which is in turn reflective of tumor stage/histopathology and molecular profile. This study hypothesized that the molecular profile is an accurate prognostic adjunct in patients triaged based on clinico-pathological characteristics. Towards this effect, publically available micro-array datasets (n = 8), were downloaded, classified based on HPV association (n = 83) and site (tongue n = 88; laryngopharynx n = 53; oropharynx n = 51) and re-analyzed (Genespring; v13.1). The significant genes were validated in respective cohorts in The Cancer Genome Atlas (TCGA) for correlation with clinico-pathological parameters/survival. The gene entities (n = 3258) identified from HPV based analysis, when validated in TCGA identified the subset specifically altered in HPV+ HNSCC (n = 63), with three genes showing survival impact (RPP25, NUDCD2, NOVA1). Site-specific meta-analysis identified respective differentials (tongue: 3508, laryngopharynx: 4893, oropharynx: 2386); validation in TCGA revealed markers with high incidence (altered in >10% of patients) in tongue (n = 331), laryngopharynx (n = 701) and oropharynx (n = 404). Assessment of these genes in clinical sub-cohorts of TCGA indicated that early stage tongue (MTFR1, C8ORF33, OTUD6B) and laryngeal cancers (TWISTNB, KLHL13 and UBE2Q1) were defined by distinct prognosticators. Similarly, correlation with perineural/angiolymophatic invasion, identified discrete marker panels with survival impact (tongue: NUDCD1, PRKC1; laryngopharynx: SLC4A1AP, PIK3CA, AP2M1). Alterations in ANO1, NUDCD1, PIK3CA defined survival in tongue cancer patients with nodal metastasis (node+ECS-), while EPS8 is a significant differential in node+ECS- laryngopharyngeal cancers. In oropharynx, wherein HPV is a major etiological factor, distinct prognosticators were identified in HPV+ (ECHDC2, HERC5, GGT6) and HPV- (GRB10, EMILIN1, FNDC1). Meta-analysis in combination with TCGA validation carried out in this study emphasized on the molecular heterogeneity inherent within HNSCC; the feasibility of leveraging this information for improving prognostic efficacy is also established. Subject to large scale clinical validation, the marker panel identified in this study can prove to be valuable prognostic adjuncts.


Asunto(s)
Proteínas de Neoplasias/genética , Infecciones por Papillomavirus/genética , Pronóstico , Carcinoma de Células Escamosas de Cabeza y Cuello/genética , Femenino , Regulación Neoplásica de la Expresión Génica/genética , Ontología de Genes , Humanos , Masculino , Análisis por Micromatrices , Persona de Mediana Edad , Orofaringe/metabolismo , Orofaringe/patología , Infecciones por Papillomavirus/clasificación , Infecciones por Papillomavirus/tratamiento farmacológico , Infecciones por Papillomavirus/patología , Carcinoma de Células Escamosas de Cabeza y Cuello/clasificación , Carcinoma de Células Escamosas de Cabeza y Cuello/tratamiento farmacológico , Carcinoma de Células Escamosas de Cabeza y Cuello/patología , Lengua/metabolismo , Lengua/patología , Resultado del Tratamiento , Enzimas Ubiquitina-Conjugadoras/genética
7.
BMJ Case Rep ; 12(7)2019 Jul 08.
Artículo en Inglés | MEDLINE | ID: mdl-31289156

RESUMEN

A 69-year-old Caucasian woman presented with chronic lymphocytic leukaemia (CLL; stage 1-Rai System), significant oropharyngeal lymphoid enlargement, snoring and fatigue. Overnight polysomnography revealed moderately severe obstructive sleep apnoea (OSA), which was managed successfully with oral appliance therapy with resolution of snoring and daytime fatigue. Structural abnormalities of the upper airways are known to cause OSA. Airway narrowing can result from bony structural abnormalities, nasopharyngeal growth, soft tissue redundancy, macroglossia, malignant and benign growth of the upper aero-digestive tract, and adenotonsilar enlargement. Clinicians should be encouraged to consider a diagnosis of OSA in patients with CLL when they present with symptoms of worsening fatigue.


Asunto(s)
Tratamiento Conservador/métodos , Leucemia Linfocítica Crónica de Células B/complicaciones , Diseño de Aparato Ortodóncico/instrumentación , Apnea Obstructiva del Sueño/etiología , Anciano , Femenino , Humanos , Orofaringe/patología , Polisomnografía , Apnea Obstructiva del Sueño/fisiopatología , Ronquido/etiología , Resultado del Tratamiento
8.
Sex Transm Infect ; 95(7): 516-521, 2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31073095

RESUMEN

OBJECTIVES: A mathematical model suggested that a significant proportion of oropharyngeal gonorrhoea cases are acquired via oropharynx-to-oropharynx transmission (ie, tongue-kissing), but to date, no empirical study has investigated this. This study aimed to examine the association between kissing and oropharyngeal gonorrhoea among gay and bisexual men who have sex with men (MSM). METHODS: MSM attending a public sexual health centre in Melbourne, Australia, between March 2016 and February 2017 were invited to participate in a brief survey that collected data on their number of male partners in the last 3 months, in three distinct categories: kissing-only (ie, no sex including no oral and/or anal sex), sex-only (ie, any sex without kissing), and kissing-with-sex (ie, kissing with any sex). Univariable and multivariable logistic regression analyses were performed to examine associations between oropharyngeal gonorrhoea positivity by nucleic acid amplification tests and the three distinct partner categories. RESULTS: A total of 3677 men completed the survey and were tested for oropharyngeal gonorrhoea. Their median age was 30 (IQR 25-37) and 6.2% (n=229) had oropharyngeal gonorrhoea. Men had a mean number of 4.3 kissing-only, 1.4 sex-only, and 5.0 kissing-with-sex partners in the last 3 months. Kissing-only and kissing-with-sex were associated with oropharyngeal gonorrhoea, but sex-only was not. The adjusted odds for having oropharyngeal gonorrhoea were 1.46-fold (95% CI 1.04 to 2.06) for men with ≥4 kissing-only partners and 1.81-fold (95% CI 1.17 to 2.79) for men with ≥4 kissing-with-sex partners. CONCLUSIONS: These data suggest that kissing may be associated with transmission of oropharyngeal gonorrhoea in MSM, irrespective of whether sex also occurs.


Asunto(s)
Transmisión de Enfermedad Infecciosa , Gonorrea/transmisión , Orofaringe/patología , Conducta Sexual , Adolescente , Adulto , Australia , Estudios Transversales , Homosexualidad Masculina , Humanos , Masculino , Medición de Riesgo , Adulto Joven
9.
Clin Exp Dermatol ; 44(5): e181-e188, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-30706506

RESUMEN

A wide differential diagnosis must be entertained in patients with unusual oral and pharyngeal ulcerations. A mucosal biopsy is essential. We retrospectively reviewed 10 cases from the Infectious Diseases Division at Mayo Clinic Rochester (MN, USA), in which the diagnosis proved to be Histoplasma capsulatum infection. Between 1995 and 2016, 10 patients were diagnosed with oropharyngeal histoplasmosis. Common presenting symptoms included weight loss, weakness and oropharyngeal pain with ulcerations. Despite specialty evaluation at other facilities, diagnostic delay occurred in six patients due to lack of biopsy or fungal staining. Yeast forms consistent with H. capsulatum were identified in the biopsy specimens of all our patients. Treatment included intravenous amphotericin B and prolonged courses of azoles. Oral histoplasmosis occurred in both immunocompetent and immunosuppressed patients, and was a manifestation of disseminated infection. Severe pain involving all areas of the mouth was typical. Diagnostic delay may be avoided by early biopsy using fungal stains.


Asunto(s)
Diagnóstico Tardío , Histoplasmosis/diagnóstico , Enfermedades Faríngeas/diagnóstico , Anciano , Anciano de 80 o más Años , Anfotericina B/uso terapéutico , Antifúngicos/uso terapéutico , Biopsia , Pruebas de Fijación del Complemento , Femenino , Histoplasmosis/tratamiento farmacológico , Histoplasmosis/inmunología , Histoplasmosis/patología , Humanos , Huésped Inmunocomprometido , Masculino , Persona de Mediana Edad , Orofaringe/patología , Enfermedades Faríngeas/tratamiento farmacológico , Enfermedades Faríngeas/inmunología , Enfermedades Faríngeas/patología , Estudios Retrospectivos , Fumar , Lengua/patología , Pérdida de Peso
10.
Bol Med Hosp Infant Mex ; 76(1): 35-43, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30657465

RESUMEN

Background: Oropharyngeal mucositis (OM) is one of the primary complications arising during oncological treatment, which significantly reduces the patient's quality of life (QoL). The aim of this study was to translate, culturally adapt, and validate the use of a new Spanish version of the Oropharyngeal Mucositis-Specific Quality-of-Life instrument (OMQoL) for pediatric patients. Methods: A multicentric, cross-sectional validation study was conducted to translate and adapt OMQoL from English to Spanish for its use by children with OM aged 8-16 years. Reliability was measured using Cronbach's alpha; content and construct validity, in conjunction with exploratory factor analysis. The convergent validity, with the correlations of the scales for OM defined by the WHO, OMAS (Oropharingeal Mucositis Assessment Scale) and the PedsQL-3 cancer module in Spanish. Results: One hundred and ninety-three children with mean age of 10.91 ± 2.38 years participated in the study, out of which 101 (52.3%) were females. In this sample, 80 children (41.5%) suffered from acute lymphoblastic leukemia and 111 (57.5%) had grade 2 and 3 OM. The factorial analysis resulted in four dimensions with loads >0.40. Among the 31 items of the OMQoL, six were eliminated. Cronbach alpha of OMQoL-Spanish was 0.954. Spearman´s correlations (r) with the OMS and OMAS scales were significant (with r = -0.720 and r = -0.689; p < 0.01, respectively). Moderate correlation was observed with the PedsQL-3 cancer module (r = 0.426; p < 0.01). Conclusions: OMQoL-Spanish demonstrated adequate psychometric properties, resulting in a reliable and valid instrument for measuring QoL in children with MO.


Asunto(s)
Mucositis/patología , Neoplasias/terapia , Enfermedades Faríngeas/patología , Calidad de Vida , Adolescente , Niño , Estudios Transversales , Humanos , Masculino , Mucositis/etiología , Orofaringe/patología , Enfermedades Faríngeas/etiología , Psicometría , Reproducibilidad de los Resultados
11.
Forensic Sci Med Pathol ; 15(3): 494-497, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-30390279

RESUMEN

An 86-year-old woman with a history of angioedema was found dead at her home address. She had recently complained of a swollen tongue. At autopsy the tongue was grossly edematous, protruding from the mouth. There was also marked edema of the tonsillar fossae, epiglottis and glottic inlet, causing critical obstruction. Histology of the tongue and upper airway demonstrated marked submucosal edema. Death was attributed to upper airway obstruction due to angioedema of the tongue, oropharynx and glottic inlet. Angioedema is characterized by localized non-pitting edema of the deep dermis and subcutaneous/submucosal tissues. It may be acute or chronic, acquired or inherited. Sudden death may result from critical airway occlusion, although both stroke and ischemic heart disease are known to occur. Post mortem genetic testing for hereditary variants can be conducted for SERPING1 gene and F12 gene/THR328 mutations.


Asunto(s)
Obstrucción de las Vías Aéreas/etiología , Angioedema/patología , Edema/patología , Anciano de 80 o más Años , Edema/etiología , Epiglotis/patología , Resultado Fatal , Femenino , Humanos , Enfermedades de la Laringe/etiología , Enfermedades de la Laringe/patología , Orofaringe/patología , Tonsila Palatina/patología , Enfermedades Faríngeas/etiología , Enfermedades Faríngeas/patología , Enfermedades de la Lengua/etiología , Enfermedades de la Lengua/patología
13.
Arch Oral Biol ; 99: 1-8, 2019 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-30579132

RESUMEN

OBJECTIVES: To identify cytokeratins (CK) of significant correlations with clinical and histopathologic prognostic parameters in oral and oropharyngeal squamous cell carcinoma (SCC). DESIGN: The sample consisted of 100 cases retrieved from the archives of the Pathology Department/ King Hussein Cancer Center/Amman/ Jordan. Recorded data included: age, gender, location, grade, depth of invasion, the presence of epithelial dysplasia, tumor size, lymph node metastasis, number of positive lymph nodes, distant metastases, clinical stage, local recurrence, treatment modalities and 5-year survival rate. Immunohistochemical staining of 7 cytokeratins: 8, 10, 13, 14, 16, 18, and 19 was performed using standard protocols. Stained sections were digitized and analyzed using ImageJ-color deconvolution to identify the percentage of cytokeratin-positive area (score). Statistical tests used were: student t-test, analysis of variance, bivariate analysis and logistic regression. RESULTS: Lower CK8,18, 19 scores correlated with lower 5-year survival rate. Higher CK19 and lower CK 10, 14, 16 scores were associated with distant metastasis. Increased CK8, 18, 19 scores correlated with higher stage and with higher depth of invasion. Increased CK18 scores correlated with increased local recurrence. Higher CK10, 13, 16 scores correlated with well-differentiated grade. Higher CK19 and lower CK16 scores were associated with adjacent epithelial dysplasia. Regression analysis showed that better 5-year survival rate was significantly correlated with increased CK16, decreased CK18 and 19 scores. CONCLUSION: Expression scores of a panel of cytokeratin are potential prognostic indicators for 5-year survival and correlates with other prognostic parameters.


Asunto(s)
Carcinoma de Células Escamosas/metabolismo , Carcinoma de Células Escamosas/patología , Queratinas/metabolismo , Neoplasias de la Boca/metabolismo , Neoplasias de la Boca/patología , Adulto , Anciano , Anciano de 80 o más Años , Análisis de Varianza , Femenino , Encía/patología , Humanos , Inmunohistoquímica , Jordania , Queratina-10 , Queratina-13 , Queratina-14 , Queratina-16 , Queratina-18 , Queratina-19 , Queratina-8 , Metástasis Linfática , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Orofaringe/patología , Pronóstico , Análisis de Regresión , Tasa de Supervivencia , Adulto Joven
14.
Laryngoscope ; 129(6): 1360-1367, 2019 06.
Artículo en Inglés | MEDLINE | ID: mdl-30588625

RESUMEN

OBJECTIVE: The objective of our study was to assess the impact of a multidisciplinary difficult airway response team (DART), a quality improvement program, in the management of patients with difficult airway associated with oropharyngeal angioedema patients. METHODS: Individual retrospective cohort study. Retrospective review of patient charts from July 2003 to June 2008 (pre-DART) and retrospective review of prospectively collected data from July 2008 to June 2013 (post-DART). Patients with angioedema were identified using International Classification of Disease codes 995.1 and 277.6. Patients were included in the study if an otolaryngologist was consulted for airway management. Patients were excluded if they had a history of angioedema but no active issues. Patient characteristics, airway evaluation, and interventions (intubation/surgical airway) were compared between the pre-DART and post-DART cohort. RESULTS: The DART team attended to 27 patients with advanced oropharyngeal angioedema. Response time averaged 3.36 minutes. Preintubation fiberoptic airway evaluations were performed in 81% of the post-DART cohort and 56% of the pre-DART cohort. The incidence of patients requiring intubation was higher in the post-DART cohort (18 out of 27 [67%]) than the pre-DART (14 out of 36 [39%]) cohort. One emergency cricothyroidotomy was performed in each of the post-DART and pre-DART cohorts. CONCLUSION: Angioedema of the larynx is a predictor of intubation or cricothyroidotomy. Fiberoptic-guided intubation is primarily used for establishing airway in angioedema patients. A multidisciplinary standardized approach such as the DART program offers adequate time and resources for airway evaluation prior to intervention and allows fewer number of attempts to secure an airway. LEVEL OF EVIDENCE: 3 Laryngoscope, 129:1360-1367, 2019.


Asunto(s)
Manejo de la Vía Aérea/normas , Angioedema/terapia , Intubación Intratraqueal/estadística & datos numéricos , Grupo de Atención al Paciente/normas , Mejoramiento de la Calidad , Adulto , Anciano , Manejo de la Vía Aérea/métodos , Angioedema/patología , Femenino , Tecnología de Fibra Óptica , Humanos , Masculino , Persona de Mediana Edad , Orofaringe/patología , Estudios Prospectivos , Estudios Retrospectivos , Centros de Atención Terciaria
15.
Acta Med Okayama ; 72(6): 611-614, 2018 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-30573918

RESUMEN

The oropharynx is examined with a light source such as an electric light, a penlight, or a forehead mirror based on an acquired visual field using a tongue depressor. However, it is extremely difficult to obtain objective and reproducible images of tissue within the pharynx required in recent years with these methods, and insufficient progress in the examination tools has been made. There is an increasing need to develop a method for display during oropharyngeal examination. We conducted the present study to develop a novel oropharyngeal endoscope as an objective observation method.


Asunto(s)
Endoscopios , Diseño de Equipo , Orofaringe/diagnóstico por imagen , Orofaringe/patología , Otolaringología/instrumentación , Protocolos Clínicos , Humanos
17.
Biomed Res Int ; 2018: 9594568, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30310820

RESUMEN

Human papillomavirus (HPV) is an etiological risk factor for oropharyngeal squamous cell carcinomas (OPSCC). Our study investigates the prevalence, prognostic, and clinicopathologic features of HPV-related oropharyngeal cancer in Northeast China and elucidates the involvement of p16 in the tumorigenesis and progression of OPSCC. Specimens from 1470 OPSCC patients collected from 2000 to 2016 were analyzed using the status of HPV by polymerase chain reaction (PCR) and p16 immunohistochemistry. Overexpression of p16 was observed in 81 (5.51%) of the 1470 cases, and HPV positive was present in 78 cases (5.31%) of the 1470 cases. HPV positive and p16 overexpression have a good concordance. However, we found that the etiological fraction of HPV in cancers of the OPSCCs was obviously lower in Northeast China than other cohorts previously reported. Interestingly, nearly 89% of patients with p16 expression were smokers, and nearly 70% of patients with p16 expression had a history of alcohol. Our study also demonstrates that p16 expression is significantly associated with early stage primary OPSCCs and the patients with p16 expression tend to show better survival following surgery and radiotherapy.


Asunto(s)
Biomarcadores de Tumor/análisis , Inhibidor p16 de la Quinasa Dependiente de Ciclina/análisis , Neoplasias de la Boca/metabolismo , Neoplasias Orofaríngeas/epidemiología , Infecciones por Papillomavirus/epidemiología , Adulto , Anciano , Biomarcadores de Tumor/genética , China/epidemiología , Estudios de Cohortes , Inhibidor p16 de la Quinasa Dependiente de Ciclina/genética , Femenino , Histocitoquímica , Humanos , Masculino , Persona de Mediana Edad , Neoplasias de la Boca/epidemiología , Neoplasias de la Boca/genética , Neoplasias de la Boca/virología , Neoplasias Orofaríngeas/genética , Neoplasias Orofaríngeas/patología , Neoplasias Orofaríngeas/virología , Orofaringe/química , Orofaringe/patología , Papillomaviridae , Infecciones por Papillomavirus/genética , Infecciones por Papillomavirus/patología , Infecciones por Papillomavirus/virología , Factores de Riesgo
18.
Eur Arch Otorhinolaryngol ; 275(12): 2983-2990, 2018 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-30317385

RESUMEN

PURPOSE: To evaluate, using drug-induced sleep endoscopy (DISE), sites of upper airway obstruction and pattern of collapse in patients over 65 years old affected by obstructive sleep apnea. To compare sites and pattern of collapse of elderly patients with a group of patients younger than 65 years. METHODS: A group of 55 patients aged over 65 years were enrolled in this prospective study. Fifty patients under 65 years old were collected in the control group. Polysomnographic data and clinical parameters such as the daytime sleepiness, and body mass index were evaluated for both groups of patients. All patients underwent DISE examination with VOTE classification. RESULTS: The AHI value increased with aging whereas elderly patients presented a reduction in daytime sleepiness. Elderly patients showed a higher incidence of total collapse in the velum region compared to younger patients (90.9% vs 70%;); the older patients showed a lower degree of total oropharyngeal lateral wall collapse with respect to younger patients, (20% vs 50%). No difference in tongue base collapse emerged between the two subgroups of patients. CONCLUSION: Elderly patients showed a higher incidence of total collapse in the velum and a lower incidence in the oropharyngeal lateral wall compared to younger patients.


Asunto(s)
Envejecimiento/fisiología , Apnea Obstructiva del Sueño/fisiopatología , Anciano , Envejecimiento/patología , Índice de Masa Corporal , Endoscopía/métodos , Femenino , Humanos , Laringe/patología , Laringe/fisiopatología , Masculino , Persona de Mediana Edad , Orofaringe/patología , Orofaringe/fisiopatología , Polisomnografía/métodos , Estudios Prospectivos , Apnea Obstructiva del Sueño/patología , Lengua/patología , Lengua/fisiopatología
19.
BMJ Case Rep ; 20182018 Aug 20.
Artículo en Inglés | MEDLINE | ID: mdl-30131403

RESUMEN

A 17-year-old man initially presented to his primary care physician with throat pain for 1 week and was started on amoxicillin. After four additional days of ongoing pain and difficulty swallowing with decreased oral intake, he presented to the emergency department. Exam showed fullness to the right posterior oropharynx and palpable mass in the right neck without stridor. Initial imaging was soft tissue neck CT with contrast, which showed cystic 8 cm mass in the parapharyngeal space. Patient additionally underwent MRI, which showed an 8.6 cm mass in the right posterior oropharynx with obliteration of the vallecula. Differential diagnosis included abscess; therefore, ear, nose, and throat (ENT) specialist was consulted for possible drainage. Intraoperatively, there was no abscess; alternatively a biopsy was obtained, which was identified by pathology as a ganglioneuroma. Patient was referred to paediatric ENT specialist, underwent extensive resection confirming diagnosis of ganglioneuroma and did well postoperatively.


Asunto(s)
Ganglioneuroma/patología , Neoplasias Faríngeas/patología , Adolescente , Trastornos de Deglución/diagnóstico , Trastornos de Deglución/etiología , Diagnóstico Diferencial , Ganglioneuroma/complicaciones , Ganglioneuroma/diagnóstico , Humanos , Masculino , Cuello/patología , Orofaringe/patología , Neoplasias Faríngeas/complicaciones , Neoplasias Faríngeas/diagnóstico , Faringitis/diagnóstico , Faringitis/etiología
20.
J Vis Exp ; (136)2018 06 28.
Artículo en Inglés | MEDLINE | ID: mdl-30010650

RESUMEN

Murine infection models are critical for understanding disease pathogenesis and testing the efficacy of novel therapeutics designed to combat causative pathogens. Infectious pneumonia is among the most common infections presented by patients in the clinic and thus warrants an appropriate in vivo model. Typical pneumonia models use intranasal inoculation, which deposits excessive organisms outside the lung, causing off-target complications and symptoms, such as sinusitis, gastritis, enteritis, physical trauma, or microparticle misting to mimic aerosol spread more typical of viral, tuberculous, or fungal pneumonia. These models do not accurately reflect the pathogenesis of typical community- or healthcare-acquired bacterial pneumonia. In contrast, this murine model of oropharyngeal aspiration pneumonia mimics the droplet route in healthcare-acquired pneumonia. Inoculating 50 µL of the bacteria suspension into the oropharynx of anesthetized mice causes reflexive aspiration, which results in pneumonia. With this model, one can examine the pathogenesis of pneumonia-causing pathogens and new treatments to combat these diseases.


Asunto(s)
Pulmón/patología , Orofaringe/patología , Neumonía por Aspiración/microbiología , Neumonía Bacteriana/microbiología , Neumonía Asociada al Ventilador/microbiología , Animales , Modelos Animales de Enfermedad , Humanos , Ratones , Neumonía por Aspiración/patología , Neumonía Bacteriana/patología , Neumonía Asociada al Ventilador/patología
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