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1.
Sci Rep ; 14(1): 9297, 2024 04 23.
Artigo em Inglês | MEDLINE | ID: mdl-38654036

RESUMO

Voice change is often the first sign of laryngeal cancer, leading to diagnosis through hospital laryngoscopy. Screening for laryngeal cancer solely based on voice could enhance early detection. However, identifying voice indicators specific to laryngeal cancer is challenging, especially when differentiating it from other laryngeal ailments. This study presents an artificial intelligence model designed to distinguish between healthy voices, laryngeal cancer voices, and those of the other laryngeal conditions. We gathered voice samples of individuals with laryngeal cancer, vocal cord paralysis, benign mucosal diseases, and healthy participants. Comprehensive testing was conducted to determine the best mel-frequency cepstral coefficient conversion and machine learning techniques, with results analyzed in-depth. In our tests, laryngeal diseases distinguishing from healthy voices achieved an accuracy of 0.85-0.97. However, when multiclass classification, accuracy ranged from 0.75 to 0.83. These findings highlight the challenges of artificial intelligence-driven voice-based diagnosis due to overlaps with benign conditions but also underscore its potential.


Assuntos
Inteligência Artificial , Doenças da Laringe , Estroboscopia , Prega Vocal , Qualidade da Voz , Adulto , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Estudos de Casos e Controles , Saúde , Doenças da Laringe/classificação , Doenças da Laringe/diagnóstico , Doenças da Laringe/fisiopatologia , Neoplasias Laríngeas/diagnóstico , Redes Neurais de Computação , Carcinoma de Células Escamosas de Cabeça e Pescoço , Máquina de Vetores de Suporte , Paralisia das Pregas Vocais/diagnóstico , Prega Vocal/patologia , Prega Vocal/fisiopatologia , Distúrbios da Voz/classificação , Distúrbios da Voz/diagnóstico , Distúrbios da Voz/fisiopatologia
2.
J Clin Monit Comput ; 37(2): 517-524, 2023 04.
Artigo em Inglês | MEDLINE | ID: mdl-36063277

RESUMO

To address the problem of lack of clinical evidence for airway devices introduced to the market, the Difficult Airway Society (UK) developed an approach (termed ADEPT; Airway Device Evaluation Project Team) to standardise the model for device evaluation. Under this framework we assessed the LMA Protector, a second generation laryngeal mask airway. A total of 111 sequential adult patients were recruited and the LMA Protector inserted after induction of general anaesthesia. Effective insertion was confirmed by resistance to further distal movement, manual ventilation, and listening for gas leakage at the mouth. The breathing circuit was connected to the airway channel and airway patency confirmed with manual test ventilation at 20 cm H20 (water) pressure for 3 s. Data was collected in relation to the time for placement, intraoperative performance and postoperative performance of the airway device. Additionally, investigators rated the ease of insertion and adequacy of lung ventilation on a 5-point scale. The median (interquartile range [range]) time taken to insertion of the device was 31 (26-40[14-780]) s with the ability to ventilate after device insertion 100 (95% CI 96.7- 100)%. Secondary endpoints included one or more manoeuvres 60.3 (95% CI 50.6-69.5)% cases requiring to assist insertion; a median ease of insertion score of 4 (2-5[3-5]), and a median adequacy of ventilation score of 5 (5-5[4-5]). However, the first time insertion rate failure was 9.9% (95% CI 5.1-17.0%). There were no episodes of patient harm recorded, particularly desaturation. The LMA Protector appears suitable for clinical use, but an accompanying article discusses our reflections on the ADEPT approach to studying airway devices from a strategic perspective.


Assuntos
Máscaras Laríngeas , Adulto , Humanos , Intubação Intratraqueal , Respiração Artificial , Movimento , Boca
3.
Auris Nasus Larynx ; 49(5): 868-874, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-35354545

RESUMO

OBJECTIVE: To evaluate the ultrasonography (US) characteristics of pharyngeal/laryngeal masses and the role of US in the assessment of laryngeal squamous cell carcinoma (LSCC). METHODS: This study enrolled patients who underwent US for evaluation of pharyngeal/laryngeal masses between 2018 and 2021. Characteristics of pharyngeal/laryngeal masses and subsite invasion in cases of LSCC were evaluated using US. RESULTS: Forty-six patients with pharyngeal (n = 22) /laryngeal (n = 24) masses were enrolled. The pathological results were benign and malignant in 7 (15.2%) and 39 (84.8%) patients, respectively. Malignant masses were significantly associated with US characteristics of heterogeneity (P = 0.002), irregular/speculated margin (P < 0.001), and increased internal vascularity (P = 0.014) compared with benign masses. In patients with LSCC, the detection rate of US for subsites invasion, including that of the anterior commissure, paraglottic space, outer cortex of the thyroid cartilage, cricoid cartilage, and extralaryngeal soft tissue, was similar to that of computed tomography (CT). Although the difference was not statistically significant, US more frequently demonstrated invasion of the inner cortex of the thyroid cartilage than CT (40.9% vs. 22.7%; P = 0.195). US and CT had a concordance rate of 81% (18 of 22 patients) in determining the tumour stage of the lesions. CONCLUSION: US could facilitate differentiation between benign and malignant masses of the pharynx and larynx in selective patients and has a possible role in the assessment of LSCC.


Assuntos
Carcinoma de Células Escamosas , Neoplasias de Cabeça e Pescoço , Neoplasias Laríngeas , Laringe , Carcinoma de Células Escamosas/diagnóstico por imagem , Carcinoma de Células Escamosas/patologia , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Neoplasias Laríngeas/diagnóstico por imagem , Neoplasias Laríngeas/patologia , Laringe/diagnóstico por imagem , Invasividade Neoplásica/patologia , Estadiamento de Neoplasias , Faringe/diagnóstico por imagem , Faringe/patologia , Carcinoma de Células Escamosas de Cabeça e Pescoço/diagnóstico por imagem , Carcinoma de Células Escamosas de Cabeça e Pescoço/patologia , Cartilagem Tireóidea/diagnóstico por imagem , Ultrassonografia
4.
Cancer Rep (Hoboken) ; 5(7): e1530, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-34396712

RESUMO

BACKGROUND: We report the case of a patient with smoking-induced radiation laryngeal necrosis (RLN) after undergoing definitive radiotherapy (RT) alone for T1a glottic squamous cell carcinoma. CASE: The patient was a 63-year-old man who had a history of heavy smoking. He quit smoking when he was diagnosed with glottic squamous cell carcinoma. The RT dose was 63 Gy, delivered in 28 fractions with the three-dimensional conventional RT technique for the larynx. After RT completion, the initial treatment response was complete response. He then underwent follow-up examinations. At 13 months after RT, the patient resumed smoking. At 2 months after resuming smoking, he had severe sore throat and hoarseness. Laryngoscopy revealed a large tumor in the glottis. Surgical excision was performed, and the patient was histologically diagnosed with RLN, as late toxicity without cancer recurrence. At 3 weeks postoperatively, the patient had dyspnea, and laryngoscopy revealed total laryngeal paralysis. Thus, he underwent an emergent tracheostomy. The administration of steroids affected RLN, and laryngeal paralysis gradually improved. CONCLUSIONS: This case suggests that smoking may have the potential to induce RLN after RT. Moreover, continuing smoking cessation is significantly important for patients with glottic cancer who receive RT. Rather than leaving smoking cessation up to the patient, it would be necessary for clinicians to actively intervene to help patients continue their effort to quit smoking.


Assuntos
Neoplasias de Cabeça e Pescoço , Neoplasias Laríngeas , Laringe , Lesões por Radiação , Paralisia das Pregas Vocais , Glote/patologia , Glote/cirurgia , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Neoplasias Laríngeas/etiologia , Neoplasias Laríngeas/radioterapia , Neoplasias Laríngeas/cirurgia , Laringe/patologia , Masculino , Pessoa de Meia-Idade , Necrose/patologia , Recidiva Local de Neoplasia/patologia , Fumar/efeitos adversos , Carcinoma de Células Escamosas de Cabeça e Pescoço/patologia , Carcinoma de Células Escamosas de Cabeça e Pescoço/radioterapia , Paralisia das Pregas Vocais/patologia
5.
Eur Ann Otorhinolaryngol Head Neck Dis ; 139(2): 73-76, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34140266

RESUMO

OBJECTIVES: To study voice prosthesis survival, complications, efficacy and impact on quality of life. METHODS: A single-center observational study was performed in patients treated for squamous cell carcinoma of the larynx or hypopharynx by total (pharyngo)-laryngectomy between 2010 and 2015. Study data comprised: maximum phonation time (sec), number of and reasons for prosthesis exchanges (leakage through or around the prosthesis, expulsion or inclusion of the prosthesis), plus 2 quality of life questionnaires (QLQ-C30, QLQ-H&N35) and the Voice Handicap Inventory (VHI 30). RESULTS: Forty-nine patients were included. The most common causes of prosthesis exchange were leakage through (73.2%) or around the prosthesis (18.5%). The median time between exchanges was 4 months. Global quality of life status on the QLQ-C30 was 63.5. Mean maximum phonation time was 7.4sec. Mean VHI was 46/120; 10 patients had a mild voice handicap, 12 moderate and 10 severe. No relation emerged between the number of prosthesis exchanges per year and quality of life. Voice handicap significantly decreased quality of life, with QLQ-C30 72.3 for the 22 patients with mild to moderate voice handicap and 44.2 for the 10 patients with severe voice handicap (P=0.001). CONCLUSION: Voice restoration by tracheoesophageal prosthesis after total (pharyngo)-laryngectomy is a reliable technique that decreases voice handicap and, despite potentially serious complications, has little negative impact on quality of life.


Assuntos
Neoplasias Laríngeas , Laringe Artificial , Carcinoma de Células Escamosas de Cabeça e Pescoço , Voz , Humanos , Neoplasias Laríngeas/cirurgia , Laringectomia/efeitos adversos , Laringectomia/métodos , Qualidade de Vida , Fala , Carcinoma de Células Escamosas de Cabeça e Pescoço/cirurgia
6.
J Laryngol Otol ; 136(4): 368-372, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-34819184

RESUMO

BACKGROUND: Post-laryngectomy tracheostomal stenosis is common and often results in an inadequate airway. Several techniques have been described to minimise tracheostomal stenosis. The star technique involves an 'X' incision with four flaps sutured into the trachea. The petal technique involves two inferior flaps on either side being sutured into the trachea. The authors combined the star and petal techniques, resulting in an innovative fish mouth technique. METHODS AND RESULTS: This innovation involves two lateral skin flaps being sutured into an incision on either side of the lateral wall of the trachea. This results in an elongated, broadened and elliptical tracheostoma, mimicking that of a fish mouth. CONCLUSION: Benefits of the fish mouth technique include adequate stoma size for respiration, easier clearing of secretions, self-sufficiency without a stent, easier cleaning of a tracheoesophageal voice prosthesis, and stoma occlusion for voice production. The fish mouth technique is easily reproducible and suitable for those with a voice prosthesis.


Assuntos
Laringe Artificial , Animais , Constrição Patológica/etiologia , Constrição Patológica/cirurgia , Humanos , Laringectomia/efeitos adversos , Boca , Traqueia/cirurgia
7.
Can J Anaesth ; 69(4): 504-508, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-34907504

RESUMO

PURPOSE: Awake flexible bronchoscope-guided intubation is challenging in patients with extremely limited mouth opening (when there is inadequate space for an oropharyngeal airway), especially when nasal access is unavailable. Alternatives include awake front of neck access, which is an invasive procedure and not suitable for elective surgery. We present a novel technique to facilitate flexible bronchoscope-guided oral intubation in these patients. CLINICAL FEATURES: Tube tip in pharynx (TTIP) is a technique for establishing a patent airway if ventilation is difficult or has failed using a face mask, supraglottic airway, or endotracheal tube. The technique involves placing the tip of the endotracheal tube in the pharynx, 10-14 cm past the teeth, filling the cuff with air, closing the mouth and nose of the patient, and then initiating ventilation. The TTIP method thus combines the function of an oropharyngeal airway and a face mask akin to a supraglottic airway device, but is more flexible with regard to insertion depth and cuff inflation and demands only minimal mouth opening. We have adapted the TTIP technique for awake flexible bronchoscope-guided oral intubation and report the technique illustrated with three cases where mouth opening was so restricted that it precluded insertion of an oropharyngeal airway. CONCLUSION: By placing an endotracheal tube with the tip in the pharynx, TTIP can establish a conduit for awake oral flexible bronchoscope-guided intubation in patients with extremely limited mouth opening and unavailable nasal access. This technique requires equipment that is readily available and may help avoid unnecessary awake tracheostomy.


RéSUMé: OBJECTIF: L'intubation éveillée guidée par bronchoscope flexible est un défi chez les patients présentant une ouverture buccale extrêmement restreinte (lorsqu'il n'y a pas suffisamment d'espace pour une canule oropharyngée), et tout particulièrement lorsqu'un accès nasal est non disponible. Les alternatives incluent l'accès antérieur du cou chez patient éveillé, une procédure invasive qui ne convient pas pour la chirurgie élective. Nous présentons une technique innovante pour faciliter l'intubation orale guidée par bronchoscope flexible chez ces patients. CARACTéRISTIQUES CLINIQUES: La technique TTIP (de l'anglais Tube Tip In Pharynx) permet d'établir un accès aux voies aériennes si la ventilation est difficile ou a échoué à l'aide d'un masque, d'un dispositif supraglottique ou d'un tube endotrachéal. La technique consiste à placer l'extrémité du tube endotrachéal dans le pharynx, à 10-14 cm au-delà des dents, à remplir le ballonnet d'air, à fermer la bouche et le nez du patient, puis à amorcer la ventilation. La méthode TTIP combine ainsi la fonction d'une canule oropharyngée et d'un masque facial, de façon similaire à un dispositif supraglottique, mais est plus flexible en ce qui concerne la profondeur d'insertion et le gonflage du ballonnet et ne nécessite qu'une ouverture minimale de la bouche. Nous avons adapté la technique TTIP pour l'intubation orale éveillée guidée par bronchoscope flexible et rapportons la technique en l'illustrant par trois cas où l'ouverture de la bouche était si restreinte qu'elle empêchait l'insertion d'une canule oropharyngée. CONCLUSION: En plaçant l'extrémité d'un tube endotrachéal dans le pharynx, la technique TTIP peut établir un passage pour l'intubation orale éveillée guidée par bronchoscope flexible chez les patients ayant une ouverture de la bouche extrêmement limitée et un accès nasal indisponible. Cette technique nécessite du matériel facilement disponible et peut contribuer à éviter une trachéotomie non nécessaire chez patient éveillé.


Assuntos
Máscaras Laríngeas , Faringe , Tecnologia de Fibra Óptica , Humanos , Intubação Intratraqueal , Boca , Vigília
8.
Acta Otolaryngol ; 141(12): 1070-1074, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34823427

RESUMO

BACKGROUND: Malnutrition and systemic inflammatory response have been confirmed to be important risk factors for various cancers. OBJECTIVE: To compare pretreatment prognostic nutrition index (PNI) among patients with laryngeal squamous cell carcinoma (LSCC), laryngeal precancerous lesion (LPL) and laryngeal benign lesion (LBL). METHODS: A total of 253 male patients with laryngeal lesions were divided into LBL, LPL with low risk (LPL (l)), LPL with high risk (LPL(h)), LSCC (i), LSCC (ii) and LSCC (iii) groups according to their histopathological findings and the TNM staging system. PNI and other clinical parameters were calculated. Kruskal-Wallis, Mann-Whitney U or Chi-square or Fisher's exact test were used for comparison of different parameters among groups. Logistic regression was performed to estimate the odds ratios (OR) and the corresponding 95% confidence intervals (CI). RESULTS: The PNI in the LSCC group was significantly lower than those of the LBL and LPL groups (p = .013 and p = .004, respectively), and decreased from LPL(l) to LSCC (iii) (from 53.97 ± 3.69 to 50.02 ± 4.75). LPL patients with lower PNI values had a higher risk of LSCC, the OR was 0.91 (95% CI: 0.84, 0.97) for a one-unit decrease. CONCLUSIONS: PNI could be a simple and reproducible marker for predicting the severity of laryngeal diseases.


Assuntos
Carcinoma de Células Escamosas/patologia , Doenças da Laringe/patologia , Neoplasias Laríngeas/patologia , Avaliação Nutricional , Lesões Pré-Cancerosas/patologia , Distribuição de Qui-Quadrado , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Gravidade do Paciente , Prognóstico , Estudos Retrospectivos , Carcinoma de Células Escamosas de Cabeça e Pescoço/patologia , Estatísticas não Paramétricas
9.
Laryngoscope ; 131(3): 587-591, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-32542687

RESUMO

OBJECTIVE: Microlaryngeal surgery typically requires oxygenation and ventilation via either an endotracheal tube (ETT), jet ventilation (JV), or intermittent apnea with an ETT. Transnasal Humidified Rapid Insufflation Ventilatory Exchange (THRIVE) delivered by high flow nasal cannula has been reported as an alternative technique. This method of apneic oxygenation and ventilation allows for stable, unobstructed visualization of immobile laryngeal structures. We aim to describe the technique and characterize intraoperative parameters related to its safety. STUDY DESIGN: Case Series. METHODS: The electronic medical record was reviewed for patients who underwent microlaryngoscopy using THRIVE technique. Patient demographics, procedural details, operative parameters, and anesthesia records were reviewed. Descriptive statistics were reported. RESULTS: A total of 53 patients underwent microlaryngoscopy using THRIVE as the sole method of ventilation, with 62% female. Median age was 51 years, and median BMI was 25 kg/m2 . Most patients were ASA class 2, and most had a Mallampati score of 2. The most common surgical indications were subglottic stenosis, vocal fold lesions, and vocal fold paralysis. Median apnea time was 16 minutes. At the end of case, median end tidal CO2 was 50 mmHg, and median minimum SpO2 was 95. Six cases required supplementation of THRIVE with JV or tracheal intubation for sustained oxygen desaturation. There was an increase in end tidal CO2 of 0.844 mmHg/min of apneic time. CONCLUSIONS: THRIVE is a safe and effective technique for oxygenation and ventilation in microlaryngeal, non-laser surgery in appropriately selected patients. To ensure safety, back-up plans such as jet ventilation and microlaryngeal ETT should be available. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:587-591, 2021.


Assuntos
Insuflação/métodos , Laringoscopia/métodos , Microcirurgia/métodos , Oxigenoterapia/métodos , Respiração Artificial/métodos , Adulto , Idoso , Cânula , Feminino , Humanos , Insuflação/instrumentação , Doenças da Laringe/cirurgia , Masculino , Pessoa de Meia-Idade , Cavidade Nasal/cirurgia , Oxigenoterapia/instrumentação , Respiração Artificial/instrumentação , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
10.
Ear Nose Throat J ; 100(1_suppl): 100S-104S, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32804574

RESUMO

INTRODUCTION: Despite good results of transoral laser CO2 microsurgery (CO2TOLMS) of the larynx, a lack of data related to the safety of this technique as a day-case procedure across the literature is evident. MATERIALS AND METHODS: An observational, retrospective, non-randomized study. RESULTS: One hundred four (62.6%) patients met the inclusion criteria, 96 (92.3%) patients were male, and 8 (7.7%) patients were female. The mean age of the study group was 66 ± 11 years (min: 34/max: 90). All the patients underwent CO2TOLMS were treated as an outpatient procedure. The glottis was the most common location affecting 97 (93.3%) patients, regarding the need of readmission, just 4 (3.8%) patients needed to be readmitted after surgery due to dyspnea secondary to laryngeal edema in 2 cases by laryngeal bleeding, and cervical emphysema in one case, respectively. Being just necessary to reintubate 1 patient (<1%) to control the bleeding. We didn't find any statistical correlation between variables and the need for readmission of reintubation. CONCLUSION: According to our results, CO2TOLMS of the larynx can be safely performed as an outpatient procedure. To establish a proper protocol and to perform a careful preoperative assessment are essential to increase our success rate and to prevent any potential complication.


Assuntos
Procedimentos Cirúrgicos Ambulatórios/métodos , Doenças da Laringe/cirurgia , Laringoscopia/métodos , Lasers de Gás/uso terapêutico , Microcirurgia/métodos , Cirurgia Endoscópica por Orifício Natural/métodos , Idoso , Dióxido de Carbono , Feminino , Glote/cirurgia , Humanos , Laringe/cirurgia , Masculino , Pessoa de Meia-Idade , Boca/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
11.
Rev. chil. anest ; 50(5): 716-719, 2021. ilus
Artigo em Espanhol | LILACS | ID: biblio-1532907

RESUMO

INTRODUCTION: Ichthyosis are hereditary disorders of keratinization which are characterized for the presence of hyperkeratosis and/or peeling. This disorder group can put in danger the life of the patient because of the severe alteration of the skin barrier, associated with a severe transdermic loss of water, different grades of hypothermia and a hypernatremic dehydration. OBJECTIVE: Introducing the clinic case of an infant patient with the diagnosis of ichthyosis plus severe dehydration who is scheduled for placement of CVC. CLINICAL CASE: Male infant, 3 months old, with the diagnosis of ichthyosis and severe dehydration, scheduled for placement of CVC. CONCLUSIONS: Due to the urgency of our patient, who presented severe dehydration, an inhaled general anesthesia with sevoflurane and oxygen was decided, without instrumenting the airway which in these patients has the risk of being potentially difficult, from the placement of the face mask itself, until finding lesions within the oral cavity, ventilatory assis- tance should be maintained by the pediatric anesthesiologist, once venous access is achieved, the fluids restitution is performed with loads of 10 to 20 ml/kg of the patient's weight, hyperthermia was controlled with physical means.


INTRODUCCIÓN: Las ictiosis son trastornos hereditarios de la queratinización caracterizadas por la presencia de hiperqueratosis y/o descamación. Este grupo de patologías pueden poner en peligro la vida del paciente debido a la severa alteración de la barrera cutánea, asociada a intensa pérdida transepidérmica de agua, diferentes grados de hipotermia y la deshidratación hipernatrémica. OBJETIVO: Presentar un caso clínico de paciente lactante menor con diagnóstico de ictiosis, cursando un cuadro grave por deshidratación, al que se le instala un CVC. CASO CLÍNICO: Lactante masculino, 3 meses de edad, con diagnóstico de ictiosis y deshidratación grave programado para colocación de CVC. CONCLUSIONES: Debido a la urgencia del paciente quien presentaba un caso de deshidratación severa se decide anestesia general inhalada con sevoflurano y oxígeno, sin instrumentación de la vía área, la cual en estos pacientes tiene el riesgo de ser potencialmente difícil, desde la propia colocación de la mascarilla facial hasta encontrar lesiones dentro de la cavidad oral; se debe mantener la asistencia ventilatoria por el anestesiólogo pediatra, una vez logrado el acceso venoso se procede a la restitución hídrica con cargas de 10 a 20 ml/kg de peso del paciente, el control de la hipertermia fue con medios físicos.


Assuntos
Humanos , Masculino , Lactente , Cateterismo Venoso Central/métodos , Ictiose/complicações , Anestesia/métodos , Máscaras Laríngeas , Desidratação , Hipertermia
12.
Dermatol Surg ; 46(12): 1676-1682, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33165083

RESUMO

BACKGROUND: Laser procedures are becoming more prevalent across multiple medical specialties for a variety of indications. The plumes created by these lasers have raised concern for the dissemination of an infectious material. OBJECTIVE: To review and summarize the information on viral dissemination in laser plumes available in the literature. MATERIALS AND METHODS: Data Sources A systematic review was performed on English and non-English articles using the PubMed and the Cochrane databases. A manual search of bibliographies from relevant articles was also performed to collect additional studies. STUDY SELECTION: Only articles in the English language with full texts available that pertained to viral particles in laser plumes were included. Data Extraction Two authors performed independent article selections using predefined inclusion and exclusion criteria. RESULTS: There have been case reports of possible transmission of human papillomavirus (HPV) by inhalation of laser-produced aerosols. Multiple investigators have attempted to recreate this scenario in the laboratory to qualify this risk. Others have conducted clinical experiments to determine the presence of HPV in laser plumes. CONCLUSION: The current body of the literature suggests that laser surgeons are at a risk for HPV exposure by inhalation of laser-derived aerosols. We offer best practice recommendations for laser operators.


Assuntos
Aerossóis/efeitos adversos , Terapia a Laser/efeitos adversos , Doenças Profissionais/prevenção & controle , Exposição Ocupacional/efeitos adversos , Infecções por Papillomavirus/transmissão , Alphapapillomavirus/patogenicidade , Dermatologistas/normas , Dermatologistas/estatística & dados numéricos , Neoplasias de Cabeça e Pescoço/epidemiologia , Neoplasias de Cabeça e Pescoço/prevenção & controle , Neoplasias de Cabeça e Pescoço/virologia , Humanos , Incidência , Exposição por Inalação/efeitos adversos , Exposição por Inalação/normas , Exposição por Inalação/estatística & dados numéricos , Doenças da Laringe/epidemiologia , Doenças da Laringe/prevenção & controle , Doenças da Laringe/virologia , Terapia a Laser/normas , Terapia a Laser/estatística & dados numéricos , Máscaras/normas , Doenças Profissionais/epidemiologia , Doenças Profissionais/virologia , Exposição Ocupacional/estatística & dados numéricos , Infecções por Papillomavirus/epidemiologia , Infecções por Papillomavirus/cirurgia , Infecções por Papillomavirus/virologia , Guias de Prática Clínica como Assunto , Roupa de Proteção/normas , Pele/efeitos da radiação , Pele/virologia , Neoplasias Cutâneas/cirurgia , Neoplasias Cutâneas/virologia , Carcinoma de Células Escamosas de Cabeça e Pescoço/epidemiologia , Carcinoma de Células Escamosas de Cabeça e Pescoço/prevenção & controle , Carcinoma de Células Escamosas de Cabeça e Pescoço/virologia , Cirurgiões/normas , Cirurgiões/estatística & dados numéricos
13.
Rev. esp. anestesiol. reanim ; 67(4): 212-214, abr. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-198031

RESUMO

El uso de dispositivos supraglóticos para el manejo de la vía aérea ha aumentado en popularidad, principalmente debido a su alta tasa de éxito y bajas complicaciones. Sin embargo, hay muy poca información disponible sobre las potenciales complicaciones y específicas, con respecto a su uso en niños. Presentamos la primera descripción de un niño que desarrolló enfisema subcutáneo después del uso de una mascarilla laríngea. Creemos que se necesita una mayor conciencia del riesgo de eventos adversos perioperatorios con la inserción de mascarillas laríngeas en la población pediátrica


The use of supraglottic airway devices has been increasing in popularity, mostly due to their high success rate and low complications. However, there is very little information available about the potential and group specific concerns regarding their use in children. We present the first description of a child that developed subcutaneous emphysema after the use of a laryngeal mask. We believe that more awareness to the risk of perioperative adverse events with laryngeal mask insertion in the paediatric population is needed


Assuntos
Humanos , Feminino , Criança , Máscaras Laríngeas/efeitos adversos , Enfisema Subcutâneo/etiologia , Orelha Média/cirurgia , Anestesia Geral , Enfisema Subcutâneo/diagnóstico por imagem , Radiografia Torácica , Fentanila/uso terapêutico , Atropina/uso terapêutico , Adjuvantes Anestésicos/uso terapêutico , Propofol/uso terapêutico , Anestésicos Intravenosos/uso terapêutico
14.
Ann R Coll Surg Engl ; 102(2): e45-e47, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31538802

RESUMO

Parapharyngeal infections carry a significant risk of extensive suppuration and airway compromise. We report the case of a patient presenting with a right paranasopharyngeal abscess, featuring atypical symptoms that made diagnosis particularly challenging. Complications included evidence of right vocal cord paralysis, likely secondary to involvement of the vagus nerve. Notably, this paralysis occurred in isolation, without involvement of cranial nerves IX or XI, which would be expected from jugular foramen encroachment. Imaging demonstrated the presence of a collection extending towards the skull base, which was drained using a transnasal endoscopic approach, avoiding the use of external incisions. Tissue biopsies from the abscess wall suggest that the underlying aetiology was minor salivary gland sialadenitis, which has not been previously reported in the literature.


Assuntos
Abscesso/etiologia , Doenças Faríngeas/etiologia , Sialadenite/complicações , Paralisia das Pregas Vocais/etiologia , Abscesso/diagnóstico , Abscesso/cirurgia , Adolescente , Biópsia , Drenagem , Endoscopia , Feminino , Humanos , Imageamento por Ressonância Magnética , Cavidade Nasal/diagnóstico por imagem , Cavidade Nasal/patologia , Nasofaringe/diagnóstico por imagem , Nasofaringe/patologia , Doenças Faríngeas/diagnóstico , Doenças Faríngeas/cirurgia , Nervo Laríngeo Recorrente/diagnóstico por imagem , Glândulas Salivares Menores/patologia , Sialadenite/diagnóstico , Sialadenite/patologia , Base do Crânio/diagnóstico por imagem , Base do Crânio/patologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Paralisia das Pregas Vocais/diagnóstico
17.
Esophagus ; 17(1): 41-49, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31583502

RESUMO

BACKGROUND: In 2009, the Japan Esophageal Society (JES) established a system for certification of qualified surgeons as "Board Certified Esophageal Surgeons" (BCESs) or institutes as "Authorized Institutes for Board Certified Esophageal Surgeons" (AIBCESs). We examined the short-term outcomes after esophagectomy, taking into consideration the certifications statuses of the institutes and surgeons. METHODS: This study investigated patients who underwent esophagectomy for thoracic esophageal cancer and who were registered in the Japanese National Clinical Database (NCD) between 2015 and 2017. Using hierarchical multivariable logistic regression analysis adjusted for patient-level risk factors, we determined whether the institute's or surgeon's certification status had greater influence on surgery-related mortality or postoperative complications. RESULTS: Enrolled were 16,752 patients operated on at 854 institutes by 1879 surgeons. There were significant differences in the backgrounds and incidences of postoperative complications and surgery-related mortality rates between the 11,162 patients treated at AIBCESs and the 5590 treated at Non-AIBCESs (surgery-related mortality rates: 1.6% vs 2.8%). There were also differences between the 6854 patients operated on by a BCES and the 9898 treated by a Non-BCES (1.7% vs 2.2%). Hierarchical logistic regression analysis revealed that surgery-related mortality was significantly lower among patients treated at AIBCESs. The institute's certification had greater influence on short-term surgical outcomes than the operating surgeon's certification. CONCLUSIONS: The certification system for surgeons and institutes established by the JES appears to be appropriate, as indicated by the improved surgery-related mortality rate. It also appears that the JES certification system contributes to a more appropriate medical delivery system for thoracic esophageal cancer in Japan.


Assuntos
Certificação/estatística & dados numéricos , Neoplasias Esofágicas/cirurgia , Cirurgiões/estatística & dados numéricos , Cavidade Torácica/patologia , Neoplasias Torácicas/cirurgia , Academias e Institutos/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Competência Clínica/normas , Gerenciamento de Dados , Esofagectomia/efeitos adversos , Esofagectomia/mortalidade , Feminino , Humanos , Incidência , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Fatores de Risco , Sociedades Médicas/organização & administração , Cavidade Torácica/anatomia & histologia , Neoplasias Torácicas/patologia , Paralisia das Pregas Vocais/epidemiologia
18.
Head Neck Pathol ; 14(3): 771-777, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31873935

RESUMO

Basaloid squamous cell carcinoma (BSCC) with a spindle cell component of the head and neck is an uncommon entity. In this case, we present a radiology-pathology correlation of a rare laryngeal BSCC with sarcomatous transformation and osteosarcomatous differentiation involving the laryngeal cartilage, which thus mimicked clinically and radiographically osteosarcoma or chondrosarcoma with calcification. Microscopic examination revealed predominantly BSCC with extensive osseous metaplasia among sheets and nests of basaloid tumor cells. There were also small foci of osteosarcoma, undifferentiated pleomorphic sarcoma, and spindle cell carcinoma. The presence of squamous cell carcinoma (SCC) in-situ, small areas of conventional SCC and diffuse positivity of p40 in conventional and basaloid squamous components confirmed that this tumor was indeed derived from surface squamous epithelium. Awareness of the broad differentiation potentials of SCC can avoid misdiagnosis of SCCs as sarcoma. This case emphasizes the importance of radiologic-pathologic correlation in definitive diagnosis and clinical management of laryngeal malignancies.


Assuntos
Neoplasias Laríngeas/patologia , Sarcoma/patologia , Carcinoma de Células Escamosas de Cabeça e Pescoço/patologia , Cartilagem Tireóidea/patologia , Consumo de Bebidas Alcoólicas/efeitos adversos , Diferenciação Celular , Diagnóstico Diferencial , Humanos , Neoplasias Laríngeas/diagnóstico , Masculino , Pessoa de Meia-Idade , Sarcoma/diagnóstico , Fumar/efeitos adversos , Carcinoma de Células Escamosas de Cabeça e Pescoço/diagnóstico , Tabaco sem Fumaça/efeitos adversos
19.
Clin Perinatol ; 46(4): 745-763, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31653306

RESUMO

Safe and effective airway management of neonates requires unique knowledge and clinical skills. Practitioners should have an understanding of neonatal airway anatomy and respiratory physiology and their clinical implications related to airway management. It is vital to recognize the potential sequelae of prematurity. Clinicians should be familiar with the skills and techniques available for managing normal neonatal airways. This review provides stepwise considerations for managing the neonatal airway: specific considerations for neonatal airway management, assessment and preparation, induction and premedication, and techniques and strategies for airway management in patients with normal anatomy and in patients who are difficult to intubate.


Assuntos
Hipnóticos e Sedativos/uso terapêutico , Intubação Intratraqueal/métodos , Laringoscopia/métodos , Manuseio das Vias Aéreas/métodos , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Máscaras Laríngeas , Laringe/anatomia & histologia , Complacência Pulmonar/fisiologia , Máscaras , Boca/anatomia & histologia , Bloqueio Neuromuscular/métodos , Ventilação não Invasiva/métodos , Faringe/anatomia & histologia , Crânio/anatomia & histologia , Língua/anatomia & histologia
20.
Surg Endosc ; 33(9): 3034-3039, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31087173

RESUMO

BACKGROUND: The transoral endoscopic thyroidectomy vestibular approach (TOETVA) has been the subject of increasing interest from several institutions around the world over the last 2 years. Recently, we successfully performed TOETVA in live human patients without CO2 gas using our newly designed retractable blade. METHODS: We reviewed the medical records of 15 consecutive patients who underwent gasless TOETVA using a self-retaining retractor. RESULTS: We successfully performed 13 thyroid lobectomies and 2 total thyroidectomies in 15 patients. No patient exhibited serious postoperative complications such as recurrent laryngeal nerve palsy and permanent hypocalcemia. One patient developed transient hypocalcemia but recovered within 2 months. No patient developed a wound infection; furthermore, no visible scar or dimpling was evident on the neck of any patient. CONCLUSION: Gasless TOETVA provides enough working space and good visibility to perform thyroid surgery without any risk of CO2 gas-related complications.


Assuntos
Cicatriz , Hipocalcemia , Cirurgia Endoscópica por Orifício Natural , Complicações Pós-Operatórias/prevenção & controle , Doenças da Glândula Tireoide/cirurgia , Glândula Tireoide/cirurgia , Tireoidectomia , Paralisia das Pregas Vocais , Adulto , Cicatriz/etiologia , Cicatriz/prevenção & controle , Feminino , Humanos , Hipocalcemia/etiologia , Hipocalcemia/prevenção & controle , Masculino , Pessoa de Meia-Idade , Boca , Cirurgia Endoscópica por Orifício Natural/efeitos adversos , Cirurgia Endoscópica por Orifício Natural/métodos , Avaliação de Processos e Resultados em Cuidados de Saúde , República da Coreia , Tireoidectomia/efeitos adversos , Tireoidectomia/métodos , Paralisia das Pregas Vocais/etiologia , Paralisia das Pregas Vocais/prevenção & controle
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