RESUMO
OBJECTIVES: To establish the prevalence of hypocalcaemia following laryngectomy and demonstrate that total thyroidectomy is a risk factor. METHODS: A retrospective cohort study was conducted that included all patients who underwent total laryngectomy from 1st January 2006 to 1st August 2017. Exclusion criteria were: pre-operative calcium derangement, previous thyroid or parathyroid surgery, concurrent glossectomy, pharyngectomy, or oesophagectomy. RESULTS: Ninety patients were included. Sixteen patients had early hypocalcaemia (18 per cent), seven had protracted hypocalcaemia (8 per cent) and six had permanent hypocalcaemia (10 per cent). Exact logistic regression values for hypocalcaemia following total thyroidectomy compared to other patients were: early hypocalcaemia, odds ratio = 15.5 (95 per cent confidence interval = 2.2-181.9; model p = 0.002); protracted hypocalcaemia, odds ratio = 13.3 (95 per cent confidence interval = 1.5-117.1; model p = 0.01); and permanent hypocalcaemia, odds ratio = 22.7 (95 per cent confidence interval = 1.9-376.5; model p = 0.005). CONCLUSION: This is the largest study to investigate the prevalence of hypocalcaemia following laryngectomy and the first to include follow up of longer than three months. Total thyroidectomy significantly increased the risk of hypocalcaemia at all time frames and independent of other variables.
Assuntos
Hipocalcemia/epidemiologia , Hipocalcemia/etiologia , Laringectomia/efeitos adversos , Tireoidectomia/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Prevalência , Estudos Retrospectivos , Fatores de RiscoRESUMO
Introduction Transnasal oesophagoscopy is a relatively new method of examining the upper aerodigestive tract via the nasal passage as an outpatient procedure without the need for sedation. It has been shown to be a well tolerated, safe and accurate technique, that can therefore be used in the investigation of patients thought to have globus pharyngeus and other non sinister causes of dysphagia. Methods A total of 150 consecutive patients undergoing transnasal oesophagoscopy were analysed retrospectively. Results The main indications for this procedure were non-progressive dysphagia (n=68, 45%) and globus pharyngeus (n=60, 40%). Transnasal oesophagoscopy was normal in 65% of patients and 42% of patients were discharged from clinic at the same appointment with no further investigation. The most common positive findings were laryngeal erythema (13%) and oesophagitis (10%). Conclusions Transnasal oesophagoscopy is a useful adjunct to the management of patients with the symptoms of globus pharyngeus and non-progressive dysphagia.
Assuntos
Transtornos de Deglutição/diagnóstico , Gerenciamento Clínico , Esofagoscopia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Transtornos de Deglutição/fisiopatologia , Progressão da Doença , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Nariz , Reprodutibilidade dos Testes , Estudos RetrospectivosRESUMO
Alkaptonuria (AKU) is a rare autosomal recessive condition caused by deficiency of the enzyme homogentisate 1,2 dioxygenase, resulting in widespread deposition of oxidised homogentisic acid (HGA) polymer, primarily in joint tissues but also in other connective tissues. Macroscopic pigmentation of connective tissues in AKU is well documented and is the end point of a process that is not understood. Deposition in less common regions may provide clues to the pigment formation process. This is the first report of detection of ochronotic pigment in acinar cells and lumina in the submandibular gland of a patient with AKU. Deposition was noted in the apical region of the cells. A lobar duct presented a large calculus with unusual deposits possibly associated with calcium salts. This report highlights the effect that local and intracellular factors may have on converting HGA into polymeric derivatives in the absence of an extracellular matrix.
Assuntos
Alcaptonúria/complicações , Ocronose/etiologia , Cálculos das Glândulas Salivares/etiologia , Doenças da Glândula Submandibular/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Ocronose/patologia , Cálculos das Glândulas Salivares/patologia , Doenças da Glândula Submandibular/patologiaRESUMO
Laryngopharyngeal reflux (LPR) is a common condition encountered in otolaryngological practice in the United Kingdom. It is one of the most important aetiological factors for many inflammatory disorders of the upper aerodigestive tract. The presentations are diverse and include chronic hoarseness, sensation of a foreign body in the throat, sore throat, dysphagia, postnasal drip, excessive throat mucous, chronic cough and throat clearing. LPR patients may not complain of heartburn. Although LPR is common, its diagnosis may not be easy, as its symptoms are non specific and the laryngeal findings are not always associated with symptom severity. This article discusses an overall view of LPR in terms of pathophysiology, clinical presentation, diagnosis and treatment
Assuntos
Refluxo Gastroesofágico/diagnóstico , Doenças da Laringe/diagnóstico , Doenças Faríngeas/diagnóstico , Diagnóstico Diferencial , Refluxo Gastroesofágico/etiologia , Refluxo Gastroesofágico/terapia , Humanos , Doenças da Laringe/etiologia , Doenças da Laringe/terapia , Doenças Faríngeas/etiologia , Doenças Faríngeas/terapiaRESUMO
AIM: To evaluate the reliability of infrared tympanic thermometry in children who have undergone myringotomy with grommet insertion. METHOD: Forty children who had undergone myringotomy with at least one grommet insertion had the tympanic temperature of each ear and the axillary temperature measured on admission and 30 minutes post-operatively. RESULT: No difference was found between the pre- and post-operative temperatures measured by either method (p > 0.05, paired t-test, hypothesized difference of 0). CONCLUSION: Infrared tympanic thermometry is reliable in monitoring body temperature in children who have had minor ear surgery.
Assuntos
Febre/diagnóstico , Ventilação da Orelha Média , Complicações Pós-Operatórias/diagnóstico , Termômetros , Membrana Timpânica/fisiopatologia , Axila/fisiopatologia , Temperatura Corporal , Criança , Feminino , Humanos , Masculino , Otite Média com Derrame/fisiopatologia , Otite Média com Derrame/cirurgia , Estudos Prospectivos , Sensibilidade e Especificidade , TermografiaRESUMO
Wegener's granulomatosis (WG) is an autoimmune disease which has a clinical predilection for the upper airways, lungs and kidneys. It is a necrotising granulomatous vasculitis which is associated with a distinct autoantibody--the antineutrophil cytoplasmic antibody (ANCA). A heightened index of suspicion by clinicians is needed in the diagnosis of this complex and rare condition. A multidisciplinary approach should then be used to treat this chronic multisystem disease. Treatment involves the use of various regimens of corticosteroids and immunosuppressive medication. Mortality due to WG has been significantly decreased by this therapy. In this article, we focus on clinical manifestations and review the salient histologic, laboratory and serologic features and treatment.
Assuntos
Anticorpos Anticitoplasma de Neutrófilos/imunologia , Granulomatose com Poliangiite/imunologia , Granulomatose com Poliangiite/patologia , Biópsia por Agulha , Doença Crônica , Progressão da Doença , Feminino , Granulomatose com Poliangiite/epidemiologia , Humanos , Imuno-Histoquímica , Masculino , Prognóstico , Medição de Risco , Análise de SobrevidaRESUMO
A previous pilot study suggested that a sustained-release conjugate that provided a slow release of 5-fluorouracil and triamcinolone acetonide injected into the tracheal and paratracheal tissues of rabbits at the time of subglottic surgery reduced the formation of subglottic stenosis. Our study was undertaken to confirm the effect. Ten milligrams of the compound suspended in hyaluronic acid was injected at the time of injury via a laryngofissure approach. The results showed that the control group had a mean stenosis of 52%, whereas the treated group had a mean stenosis of 32%. There was a significant difference between the treated and untreated groups (p = .003). It is hoped that this co-drug ultimately can be used in humans to reduce stenosis formation after laryngotracheal surgery and in other forms of otorhinolaryngological surgery.
Assuntos
Fluoruracila/administração & dosagem , Laringoestenose/tratamento farmacológico , Triancinolona/administração & dosagem , Animais , Preparações de Ação Retardada , Combinação de Medicamentos , Glote , Injeções , Projetos Piloto , CoelhosRESUMO
Endoscopic sinus surgery (ESS) is a technique which carries great potential benefits for the treatment of many nasal conditions. However, it also carries substantial risks. The key to safe surgery lies with adequate training. A survey carried out as part of a North (East) Thames Region audit of higher surgical trainees revealed large discrepancies in their training and in their subsequent clinical practice. Almost half the trainees had started ESS without having been on a training course or performed any cadaver dissections. Despite the potential hazards of ESS, audit of complications and outcome received a low priority. The trainees made several suggestions for improving training, including better provision of courses, regional training programmes and improved access to cadavers for dissection. Other surgical specialties are being forced to examine the prospect of specific accreditation for minimally invasive techniques and otorhinolaryngology may have to follow suit.
Assuntos
Educação de Pós-Graduação em Medicina/normas , Endoscopia , Cirurgia Geral/educação , Seios Paranasais/cirurgia , Educação de Pós-Graduação em Medicina/organização & administração , Endoscopia/métodos , Inglaterra , Humanos , Auditoria Médica , Corpo Clínico Hospitalar/educação , Cuidados Pré-Operatórios/métodos , Inquéritos e Questionários , Ensino/métodosRESUMO
This experimental study investigates the effect of mitomycin C (MMC) on sinus mucosal healing. MMC has an antiproliferative action on fibroblasts. It is used in glaucoma surgery to prevent restenosis of fistulas. Antrostomies were drilled in rabbit maxillary sinuses. One side was used as a control and the other treated with MMC at a concentration of 0.04, 0.4, or 1 mg/mL. Two animals from each group were sacrificed at 1, 2, 4, and 12 weeks. The antrostomies in the control and 0.04-mg/mL groups had closed by 1 week; in the 0.4-mg/mL group by 4 weeks, and in the 1.0-mg/mL group by 12 weeks. Ciliary function was initially impaired but normalized within 1 week. Both light and scanning electron microscopy showed no permanent damage to the cilia. These results suggest that MMC can be used to delay closure of antrostomies in sinus surgery.
Assuntos
Antibióticos Antineoplásicos/farmacologia , Antibióticos Antineoplásicos/uso terapêutico , Seio Maxilar/efeitos dos fármacos , Seio Maxilar/cirurgia , Mitomicina/farmacologia , Mitomicina/uso terapêutico , Obstrução Nasal/tratamento farmacológico , Sinusite/cirurgia , Animais , Movimento Celular/efeitos dos fármacos , Endoscopia/métodos , Fibroblastos/efeitos dos fármacos , Masculino , Seio Maxilar/patologia , Mucosa/efeitos dos fármacos , Mucosa/patologia , Coelhos , Sinusite/patologiaRESUMO
The surgical management of subglottic stenosis may be complicated by reformation of strictures. A slow-release combination of 5-fluorouracil, which has an antiproliferative effect on fibroblasts, and the corticosteroid triamcinolone acetonide has been used experimentally to control scar production in ophthalmic operations. This study was performed to determine if this material also can be used to reduce formation of subglottic stenosis. Subglottic stenosis was induced in rabbits by means of injury to the subglottic mucosa and submucosa. A suspension of the compound at a concentration of 2.5 mg/ml or 12.5 mg/ml was injected into the adjacent soft tissues. A control group of rabbits received the same volume of the suspension fluid but no compound. Two rabbits from each group were killed 1, 2, and 12 weeks postoperatively. No stenosis was seen at 1 or 2 weeks, but at 12 weeks the rate of formation of subglottic stenosis was decreased to a mean of 15.20% in the experimental groups compared with 47.37% in the control group. There were no indications of local or systemic toxicity. The promising results from this preliminary study suggest that use of this compound may reduce restenosis among patients treated surgically for subglottic stenosis. Further studies are being conducted.
Assuntos
Anti-Inflamatórios/uso terapêutico , Antimetabólitos Antineoplásicos/uso terapêutico , Fluoruracila/uso terapêutico , Laringoestenose/tratamento farmacológico , Triancinolona/uso terapêutico , Animais , Anti-Inflamatórios/farmacologia , Antimetabólitos Antineoplásicos/farmacologia , Movimento Celular/efeitos dos fármacos , Preparações de Ação Retardada/farmacologia , Preparações de Ação Retardada/uso terapêutico , Fibroblastos/efeitos dos fármacos , Fluoruracila/farmacologia , Coelhos , Ratos , Triancinolona/farmacologia , Cicatrização/efeitos dos fármacosRESUMO
BACKGROUND: The fluorescence characteristics of tissues depend upon their biochemical composition and histomorphological architecture, both of which undergo a change during malignant transformation. These changes are detectable as an alteration in the fluorescence spectral profile of the tissues. METHODS: Biopsy specimens from clinically suspicious lesions and normal-appearing oral mucosa were obtained from patients. Fluorescence spectroscopic measurements were obtained to study the differences between normal and dysplastic tissues and to determine the most appropriate excitation wavelength(s) for exploiting these differences. RESULTS: Fluorescence spectra from a total of 12 histologically normal (healthy mucosa or benign lesions) and ten abnormal (dysplastic or malignant) tissue samples were compared. Significant spectral differences were seen between the two groups. These differences were most marked at the excitation wavelength of 410 nm. Using this wavelength, fluorescence correctly diagnosed 20 of 22 samples studied. CONCLUSIONS: This technique accurately differentiates normal from abnormal tissues in vitro and has the potential applications for in vivo use as a noninvasive diagnostic tool.
Assuntos
Mucosa Bucal/patologia , Neoplasias Bucais/patologia , Espectrometria de Fluorescência , Biópsia , Diagnóstico Diferencial , Humanos , Neoplasias Bucais/diagnóstico , Valores de Referência , Sensibilidade e EspecificidadeRESUMO
This article outlines the historical development of the use of lasers in the tracheobronchial tree, the current indications for the use of carbon dioxide and neodymium:yttrium-aluminum-garnet lasers, and the management of complications. The merits of other laser wavelengths are mentioned, including use of the potassium titanyl phosphate laser in the pediatric airway. Photodynamic therapy is discussed, and some future developments are introduced.
Assuntos
Broncopatias/cirurgia , Terapia a Laser , Doenças da Traqueia/cirurgia , Silicatos de Alumínio , Broncopatias/tratamento farmacológico , Dióxido de Carbono , Criança , Endoscopia , História do Século XX , Humanos , Terapia a Laser/efeitos adversos , Terapia a Laser/história , Terapia a Laser/métodos , Neodímio , Fosfatos , Fotoquimioterapia , Titânio , Doenças da Traqueia/tratamento farmacológico , ÍtrioRESUMO
BACKGROUND: A laser technique has been developed in the laboratory using a noncontact 810-nm diode laser. RESULTS: Mucosal intact laser tonsillar ablation (MILTA) coagulates tonsillar lymphoid tissue while preserving the overlying mucosa. A canine model was used to evaluate this new method. The canine tonsils were exposed to laser energy for 5 to 6 minutes each at 8 to 10 W of power. This technique was compared with standard "cold" knife tonsillectomy. The dogs were observed carefully during the postoperative period. When comparing parameters such as onset of eating solid food, amount of food ingested per day, onset of normal activity, and degree of weight loss, MILTA showed significant benefit over the standard technique. The operative sites were evaluated and compared at 1.5 hours and at 7, 21, and 45 days after treatment. CONCLUSIONS: None of the tonsils treated by MILTA showed mucosal ulceration. At the end of 45 days, histopathological examination showed complete absence of tonsillar tissue with normal mucosa in both the MILTA and standard groups. Traditional tonsillectomy techniques are associated with moderate morbidity and the potential for serious hemorrhage. With the preservation of the overlying mucosa, the possible clinical advantages of this approach to tonsillectomy are the absence of bleeding, avoidance of general anesthesia in older patients, less operating time, and decreased postoperative morbidity. The potential for office treatment exists. Additional laboratory studies, as well as careful clinical trials, are indicated based on these encouraging results.
Assuntos
Fotocoagulação a Laser/métodos , Tonsilectomia/métodos , Animais , Cães , Mucosa/patologiaRESUMO
It is now widely accepted that snoring causes significant social dysfunction. In the absence of obstructive sleep apnoea syndrome, palatal surgery offers a very good chance of eliminating or reducing snoring. The traditional operation of uvulopalatopharyngoplasty remains the 'gold standard', but may be complicated by velopharyngeal incompetence, severe post-operative pain and even nasopharyngeal stenosis. A newer technique to reduce snoring caused by palatal flutter by using a neodymnium:yttrium aluminum garnet laser to stiffen the soft palate has been introduced recently by another unit. We show that this procedure can be carried out using a CO2 laser, and present the initial results of the first 29 patients operated on at The Royal National Throat, Nose and Ear Hospital.
Assuntos
Terapia a Laser , Palato/cirurgia , Síndromes da Apneia do Sono/cirurgia , Ronco/cirurgia , Dióxido de Carbono , Feminino , Humanos , Masculino , Projetos Piloto , Resultado do Tratamento , Úvula/cirurgiaRESUMO
Angiolymphoid hyperplasia with eosinophilia is a rare benign condition that causes swellings in the head and neck. It is difficult to diagnose prior to biopsy and is frequently mistaken for a malignant tumour. A case involving a 21-year-old man who presented with a 2 cm diameter fibrous lesion in the subcutaneous tissue of the cheek is reported. The clinical and histological features are reviewed and the differences between this condition and the similar condition of Kimura's disease are discussed. Initial treatment with intralesional or systemic steroids is suggested as this may avoid the need for excision.
Assuntos
Hiperplasia Angiolinfoide com Eosinofilia/diagnóstico , Adulto , Hiperplasia Angiolinfoide com Eosinofilia/patologia , Bochecha , Diagnóstico Diferencial , Humanos , MasculinoRESUMO
Polycystic disease of salivary glands is a rare condition which hitherto has been reported only in the parotid glands. We report a case in which an accessory salivary gland had evidence of polycystic disease.