A Rare Recurrence of Guillain-Barré Syndrome.

Guillain-Barré syndrome (GBS) is an autoimmune polyneuroradiculopathy that is often characterized by progressive motor and sensory deficits. GBS often follows a particular trigger and is more common in males. Recurrent GBS is uncommon, but it can occur in 2-3% of patients with a prior GBS episode. Although recurrent GBS is generally milder than the initial episode, exceptions are possible, as illustrated in the case presented here. For both monophasic or recurrent GBS, treatment usually centers on supportive care, intravenous immunoglobulin administration, and plasmapheresis, with steroids having no impact on the prognosis. We present a case in which an 80-year-old woman with severe recurrent GBS experienced rapid deterioration within hours.

Management of postintubation tracheal stenosis: appropriate indications make outcome differences.

BACKGROUND: Laryngotracheal stenosis is difficult to treat and its etiologies are multiple; nowadays, the most common ones are postintubation or posttracheostomy stenoses. OBJECTIVE: To provide an algorithm for the management of postintubation laryngotracheal stenoses (PILTS) based on the experience of a tertiary care referral center. METHODS: A retrospective study was conducted on all patients treated for PILTS over a 10-year period. Patients were divided into a surgically and an endoscopically treated group according to predefined criteria. The characteristics of the two groups were analyzed and the outcomes compared. RESULTS: Thirty-three consecutive patients were included in the study: 14 in the surgically treated group and 19 in the endoscopically treated group. Our candidates for airway surgery were healthy patients presenting with complex tracheal stenoses, subglottic involvement or associated tracheomalacia. The endoscopic candidates were chronically ill patients presenting with simple, strictly tracheal stenoses not exceeding 4 cm in length. Stents were placed if the stenosis was associated with tracheomalacia or exceeded 2 cm in total length. In the surgically treated group, 2/14 patients needed more than one procedure versus 8/19 patients in the endoscopically treated group. At the end of the intervention, 50% of the patients were decannulated in the surgically treated group versus 84.2% in the endoscopically treated group (p = 0.03). However, the decannulation rates at 6 months and the symptomatology at rest and on exertion on the last follow-up visit were comparable in the two groups. CONCLUSION: Our experience in the management of PILTS demonstrates that both surgery and endoscopy yield excellent functional outcomes if the treatment strategy is based on clear, predefined objective criteria.