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1.
No Shinkei Geka ; 48(8): 707-710, 2020 Aug.
Artigo em Japonês | MEDLINE | ID: mdl-32830135

RESUMO

Retropharyngeal hematomas are uncommon, but they may rarely cause occlusion of the upper airway and threaten life. Retropharyngeal hematomas often occur due to head or neck injury;they rarely occur due to iatrogenic causes such as insertion of a gastric tube or anticoagulant therapy. It has been found that patients receiving anticoagulant therapy are more likely to experience potentially severe retropharyngeal hematomas. We report the case of a patient with retropharyngeal hematoma with cervical cord damage. A 75-year-old man was transferred to our hospital after he sustained a fall and damaged his face. CT showed a massive retropharyngeal hematoma, but he did not complain of any breathing issues. Therefore, we selected conservative therapy. However, after approximately 4 hours, he suddenly complained of breathing problems and suffered from loss of consciousness. We performed intubation and provided sedation. After one week, his condition clearly improved and he was extubated.


Assuntos
Medula Cervical , Lesões do Pescoço , Doenças Faríngeas , Idoso , Anticoagulantes , Hematoma , Humanos , Masculino
2.
Artigo em Chinês | MEDLINE | ID: mdl-32791620

RESUMO

Objective:To discuss the clinical efficacy of low-temperature radiofrequency ablaion assisted by endoscopy for the treatment of congenital pyriform sinus fistula in infants. Method:Clinical data of 15 patients with CPSF received the low-temperature radiofrequency ablaion assisted by endoscopy under laryngoscope were reviewed. After the operation, patients were followed up closely at different stages. All patients underwent neck color doppler ultrasound and electronic laryngoscopy, and the results were analyzed. Result:The operation of 15 children was successfully completed without pharyngeal fistula, dysphagia, perifistula and distal fistula infection. Followup survey ranged from 3 months to 3 years and no one recurred. Conclusion:Low-temperature radiofrequency ablaion assisted by endoscopy is a promising method for the CPSF with less trauma, less haemorrhage and good vision. It is safe and effective for the treatment of CPSF in infants and children, and is worthy of clinical promotion.


Assuntos
Fístula , Doenças Faríngeas , Seio Piriforme , Criança , Endoscopia , Humanos , Lactente , Temperatura , Resultado do Tratamento
3.
Mycopathologia ; 185(4): 607-611, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32737746

RESUMO

The coronavirus disease 2019 (COVID-19) pandemic emerged in Wuhan, China, in late 2109, and has rapidly spread around the world. Until May 25, 2020, there were 133,521 confirmed COVID-19 cases and 7359 deaths in Iran. The role of opportunistic fungal infections in the morbidity and mortality of COVID-19 patients remains less defined. Based on our multicenter experiences, we categorized the risks of opportunistic fungal infections in COVID-19 patients in Iran. The COVID-19 patients at high risk included those with acute respiratory distress syndrome, in intensive care units, receiving broad-spectrum antibiotics, immunosuppressants or corticosteroid, and supported by invasive or noninvasive ventilation. The patients were most likely to develop pulmonary aspergillosis, oral candidiasis, or pneumocystis pneumonia. Most diagnoses were probable as the accurate diagnosis of opportunistic fungal infections remains challenging in resource-poor settings. We summarize the clinical signs and laboratory tests needed to confirm candidiasis, aspergillosis, or pneumocystosis in our COVID-19 patients.


Assuntos
Infecções por Coronavirus/complicações , Micoses/complicações , Infecções Oportunistas/complicações , Pneumonia Viral/complicações , Candidíase Bucal/complicações , Candidíase Bucal/diagnóstico , Candidíase Bucal/epidemiologia , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Humanos , Irã (Geográfico)/epidemiologia , Micoses/diagnóstico , Micoses/epidemiologia , Infecções Oportunistas/diagnóstico , Infecções Oportunistas/epidemiologia , Pandemias , Doenças Faríngeas/complicações , Doenças Faríngeas/diagnóstico , Doenças Faríngeas/epidemiologia , Doenças Faríngeas/microbiologia , Pneumocystis carinii , Pneumonia por Pneumocystis/complicações , Pneumonia por Pneumocystis/diagnóstico , Pneumonia por Pneumocystis/epidemiologia , Pneumonia por Pneumocystis/microbiologia , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Aspergilose Pulmonar/complicações , Aspergilose Pulmonar/diagnóstico , Aspergilose Pulmonar/epidemiologia
4.
J Laryngol Otol ; 134(7): 623-625, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32741379

RESUMO

BACKGROUND: Pharyngocutaneous fistula is a troublesome complication. Recently, synthetic materials such as fibrin sealant have been used as a secondary measure to treat fistula. This work assessed whether the primary use of fibrin sealant can reduce the rate of fistula. METHOD: A retrospective review of 50 cases from 2 centres was completed. Tisseel was an adjunct to primary closure in all cases. RESULTS: In the first centre, 3 out of 34 cases developed pharyngocutaneous fistula (fistula rate of 9 per cent). All three were salvage cases. In the second centre, 0 out of 16 cases developed a fistula. CONCLUSION: The incidence of pharyngocutaneous fistula post-radiation and post-chemoradiotherapy in laryngectomy cases has been quoted as 23 per cent and 34 per cent respectively. This study represents the first patient series on the use of fibrin sealant as an adjunct in primary closure following laryngectomy. The results are promising, encouraging the use of Tisseel as an adjunct to meticulous closure.


Assuntos
Fístula Cutânea/cirurgia , Adesivo Tecidual de Fibrina/uso terapêutico , Doenças Faríngeas/cirurgia , Fístula Cutânea/etiologia , Humanos , Laringectomia/efeitos adversos , Laringectomia/métodos , Doenças Faríngeas/etiologia , Estudos Retrospectivos , Terapia de Salvação/métodos , Resultado do Tratamento
5.
Artigo em Chinês | MEDLINE | ID: mdl-32842226

RESUMO

Objective:To compare the effect of closure of pharyngeal cavity with linear stapler and manual suture in total laryngectomy. Method:A retrospective study was conducted on 32 patients who underwent total laryngectomy with linear stapler to close the pharyngeal from December 2014 to March 2019. Among them, 25 patients used closed technique and 7 patients used open technique. At the same time, 23 patients who underwent total laryngectomy with manual suture the pharyngeal by the same operator from January 2010 to December 2014 were collected. The clinical parameters of the two groups were compared and analyzed. Result:Compared with the control group, the closed technical group had no significant difference in terms of gender, diabetes mellitus, second surgery, T stage, and surgical method(P> 0.05). While the age (63.60 ± 9.46) years and (54.35 ± 11.13) years , operation time (239.67 ± 88.43) min and (474.35 ± 140.16) min , oral feeding time (12.84 ± 3.65) min and (17.3 ± 9.71)min , hospitalization days after operation ( 15.48 ± 3.78) d and (20.22 ± 10.14) d, incidence of Pharygocutaneous fistula 4.0% (1/25) and 26.1% (6/23), had significant statistical differences (P <0.05) Between two groups; Compared with the control group, the opener group had no statistically significant difference in gender, T stage, oral feeding time, hospitalization days after operation,surgical method and incidence of Pharygocutaneous fistula (P> 0.05),while there was a statistically significant difference in diabetes mellitus, second surgery, and operation time (P<0.05). Conclusion:The linear stapler closed closure technique can reduce the incidence of Pharygocutaneous fistula, shorten the operation time and oral feeding time, and reduce the length of hospital stay.


Assuntos
Fístula Cutânea , Neoplasias Laríngeas/cirurgia , Doenças Faríngeas , Humanos , Laringectomia , Complicações Pós-Operatórias , Estudos Retrospectivos
6.
Medicine (Baltimore) ; 99(31): e21528, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756199

RESUMO

RATIONALE: Massive retropharyngeal hematoma secondary to a minor blunt trauma is rare and easy to be missed in emergency settings due to the absence of visible tissue injury, especially in young patients. However, missing this pathology is dangerous and can result in airway obstruction and even death. Therefore, an effective diagnostic strategy must be developed and thoroughly performed to minimize missed retropharyngeal hematoma. PATIENT CONCERNS: A 49-year-old man with a brief cervical hyperextension secondary to a minor collision presented with mild respiratory discomfort. No externally visible injuries were found; however, dyspnea was persistent and aggravating. DIAGNOSIS: Lateral neck X-ray, neck computed tomography, and spine magnetic resonance imaging revealed a huge retropharyngeal hematoma obstructing the upper airway, without any severe fracture or ligament injury. INTERVENTIONS: An emergent orotracheal intubation followed by imaging studies was performed to resolve the aggravating dyspnea. Neck exploration surgery was immediately performed for rapid absorption of the hematoma, bleeding control, and identification of the reason of the pathology. OUTCOMES: The surgery was successful, and the patient was discharged without any postoperative sequelae on the 30 postoperative day. CONCLUSION: Retropharyngeal hematoma that develops in young patients without visible injuries or severe symptoms after a minor trauma can easily go undetected. Although most hematomas under observation resolve spontaneously, the retropharyngeal hematomas missed at initial assessment may result in critical complications. High level of suspicion, repeated neck CT, and thorough tertiary survey in emergency rooms are helpful in avoiding missed life-threatening retropharyngeal hematoma.


Assuntos
Vértebras Cervicais/lesões , Dispneia/etiologia , Hematoma/etiologia , Doenças Faríngeas/etiologia , Ferimentos não Penetrantes/complicações , Acidentes de Trânsito , Humanos , Masculino , Pessoa de Meia-Idade
7.
J Clin Microbiol ; 58(9)2020 08 24.
Artigo em Inglês | MEDLINE | ID: mdl-32611792

RESUMO

The coronavirus disease 2019 (COVID-19) pandemic has led many clinics to move from clinician-collected to self-collected oropharyngeal swabs for the detection of sexually transmitted infections (STIs). Before this change, however, self-collection was used primarily for genital and anorectal infections, with only limited studies on the performance of self-collection of oropharyngeal swabs for oropharyngeal STI detection. The Melbourne Sexual Health Centre (MSHC) changed from clinician-collected to self-collected oropharyngeal swabs for oropharyngeal gonorrhea and chlamydia screening on 16 March 2020 in order to reduce health care worker risk during the COVID-19 pandemic. We compared the proportions of valid and positive samples for gonorrhea and chlamydia among men who have sex with men (MSM) in two time periods; the clinician collection period, between 20 January and 15 March 2020, and the self-collection period, between 16 March and 8 May 2020. A total of 4,097 oropharyngeal swabs were included. The proportion of oropharyngeal swabs with equivocal or invalid results for Neisseria gonorrhoeae was higher in the self-collection period (1.6% [24/1,497]) than in the clinician collection period (0.9% [23/2,600]) (P = 0.038), but the proportions did not differ for the detection of Chlamydia trachomatis The positivity rates of oropharyngeal N. gonorrhoeae (adjusted prevalence ratio [PR], 1.07 [95% confidence interval {CI}, 0.85 to 1.34]) (P = 0.583) and oropharyngeal C. trachomatis (adjusted PR, 0.84 [95% CI, 0.51 to 1.39]) (P = 0.504) specimens did not differ between the two periods. Self-collected oropharyngeal swabs for the detection of N. gonorrhoeae and C. trachomatis have acceptable performance characteristics and, importantly, reduce health care worker exposure to respiratory infections.


Assuntos
Infecções por Chlamydia/diagnóstico , Gonorreia/diagnóstico , Homossexualidade Masculina/estatística & dados numéricos , Doenças Faríngeas/diagnóstico , Manejo de Espécimes , Adulto , Betacoronavirus , Infecções por Coronavirus , Humanos , Masculino , Programas de Rastreamento/métodos , Programas de Rastreamento/estatística & dados numéricos , Orofaringe/microbiologia , Pandemias , Pneumonia Viral , Estudos Retrospectivos , Autocuidado , Manejo de Espécimes/métodos , Manejo de Espécimes/estatística & dados numéricos , Adulto Jovem
8.
Eur Arch Otorhinolaryngol ; 277(10): 2933-2935, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32621249

RESUMO

BACKGROUND: In the COVID-19 era physicians have to face with need to perform office procedures maintaining the maximum safety for both the patient and the Doctor himself. The purpose of this paper was to suggest some equipment useful to perform outpatient visits in an ENT setting. METHODS: A simple modification of the standard headlight used during an ENT visit provides the operator a better face protection without any impairment in vision and comfort. In addition, in order to perform a safer ENT examination, a droplet protective barrier has been adapted to the patient's chair. RESULTS: Both the devices have been texted with success during a period of 2 months in our ENT clinic. No cases of contamination have been registered among physicians. CONCLUSION: A simple modification to a device used in the routine ENT activity implemented its protective efficacy with low costs. On the other hand, a more structured tool permitted to obtain a more protected environment during patient examination.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Otopatias , Doenças Nasais , Pandemias/prevenção & controle , Equipamento de Proteção Individual , Doenças Faríngeas , Pneumonia Viral/prevenção & controle , Infecções por Coronavirus/transmissão , Humanos , Pneumonia Viral/transmissão
9.
Niger J Clin Pract ; 23(6): 759-763, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32525108

RESUMO

Objective: The aim of this study was to detect the prevalence of soft tissue calcifications in the head and neck using cone beam computed tomography (CBCT) and to determine their clinical importance. Subjects and Methods: Soft tissue calcifications in the head and neck region were retrospectively evaluated in 1557 CBCT images obtained between 2013 and 2015. The findings were categorized as follows: tonsillolith (calcified tonsil), carotid artery calcification (CAC), sialolith (salivary stone), calcified triticeous cartilage (CTC), calcified lymph node (CLN), rhinolith, antrolith, calcification of the superior cornu of the thyroid cartilage (CSCTC), calcified stylohyoid ligaments (CSL), myositis ossifican, osteoma cutis, and intracranial calcification. A Chi-square test was performed for categorical variables. In the 1557 CBCT images, 520 (33.4%) contained had at least one soft tissue calcification in the head and neck region. Results: Tonsilloliths (18.8%) were the most prevalent soft tissue calcification, followed by CTC (5.8%), CAC (4.3%), intracranial calcifications (3.9%), CSL (3.7%), CSCTC (2.1%), osteoma cutis (1%), sialoliths (0.7%), antroliths (0.5%), myositis ossificans (0.4%), rhinoliths, and CLN (0.2%). Conclusion: There was a high prevalence of soft tissue calcifications in the head and neck region on CBCT images. Tonsilloliths were the most common type of calcification. CBCT imaging may aid the diagnosis and assessment of these calcifications.


Assuntos
Calcinose/diagnóstico por imagem , Calcinose/epidemiologia , Tomografia Computadorizada de Feixe Cônico/métodos , Cabeça/diagnóstico por imagem , Pescoço/diagnóstico por imagem , Tonsila Palatina/diagnóstico por imagem , Adulto , Doenças das Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/epidemiologia , Doenças das Cartilagens/diagnóstico por imagem , Doenças das Cartilagens/epidemiologia , Feminino , Humanos , Linfadenopatia/diagnóstico por imagem , Linfadenopatia/epidemiologia , Masculino , Pessoa de Meia-Idade , Doenças Faríngeas/diagnóstico por imagem , Doenças Faríngeas/epidemiologia , Prevalência , Estudos Retrospectivos
10.
PLoS One ; 15(5): e0232777, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32379802

RESUMO

BACKGROUND: The surveillance of emm types and macrolide susceptibility of group A streptococcus (GAS) in various areas and time periods enhances the understanding of the epidemiology of GAS infections and may guide treatment strategies and the formulation of type-specific vaccines. Greece has emerged as a country with high macrolide use. However, studies suggest a gradual reduction in macrolide consumption after 2007. METHODS: During a 7-year period (2011-2017), 604 GAS isolates were recovered from consecutive children presenting with pharyngeal or nonpharyngeal infections in Central Greece; 517 viable isolates underwent molecular analysis, including emm typing. RESULTS: Isolates belonged to 20 different emm types (in decreasing order of prevalence: 1, 89, 4, 12, 28, 3, 75 and 6, accounting for 88.2% of total isolates). The emm types comprised 10 emm clusters (five most common clusters: E4, A-C3, E1, A-C4 and A-C5). The emm89 isolates were acapsular ('new clade'). Overall macrolide resistance rate was 15.4%, and cMLSB emerged as the predominant resistance phenotype (56.4%). The lowest annual resistance rates occurred in 2014 (13.1%), 2016 (5.5%) and 2017(8.0%) (P for trend = 0.002). Consumption of macrolide/lincosamide/streptogramin B declined by 22.6% during 2011-2017. Macrolide resistance and emm28 and emm77 types were associated (both P<0.001). The most frequently identified genetic lineages of macrolide-resistant GAS included emm28/ST52, emm77/ST63, emm12/ST36, emm89/ST101 and emm4/ST39. We estimated that 98.8% of the isolates belonged to emm types incorporated into a novel 30-valent M protein vaccine. CONCLUSIONS: In Central Greece during 2011-2017, the acapsular emm89 isolates comprised the second most prevalent type. Susceptibility testing and molecular analyses revealed decreasing GAS macrolide resistance rates, which may be attributed to the reduction in the consumption of macrolides and/or the reduced circulation of macrolide-resistant clones in recent years. Such data may provide valuable baseline information in targeting therapeutic intervention and the formulation of type-specific GAS vaccines.


Assuntos
Antibacterianos/uso terapêutico , Farmacorresistência Bacteriana , Macrolídeos/uso terapêutico , Infecções Estreptocócicas/diagnóstico , Streptococcus pyogenes/isolamento & purificação , Adolescente , Antígenos de Bactérias/genética , Proteínas da Membrana Bacteriana Externa/genética , Criança , Pré-Escolar , Feminino , Grécia/epidemiologia , Humanos , Lactente , Masculino , Tipagem de Sequências Multilocus , Doenças Faríngeas/microbiologia , Infecções Estreptocócicas/tratamento farmacológico , Infecções Estreptocócicas/epidemiologia , Streptococcus pyogenes/efeitos dos fármacos , Streptococcus pyogenes/genética
11.
Ann Otol Rhinol Laryngol ; 129(9): 849-855, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32312092

RESUMO

OBJECTIVE: Hemi-laryngopharyngeal spasm (HeLPS) has recently been described in the neurosurgical literature as a cause of intermittent laryngopharyngeal spasm and cough due to vascular compression of the vagus nerve at the cerebellopontine angle. We present the diagnostic criteria for this syndrome. METHODS: A retrospective chart review of six patients with HeLPS and three patients misdiagnosed with this condition are presented. All patients were diagnosed and treated at a tertiary care academic centre from July 2013 to July 2017. RESULTS: Patients with HeLPS had five defining characteristics: 1) All patients had symptoms of episodic laryngopharyngeal spasm and coughing. Patients were asymptomatic between episodes and were refractory to speech therapy and reflux management. 2) Laryngoscopy showed hyperactive twitching of the ipsilateral vocal fold in two of the six patients. No other inter-episodic abnormalities were seen. 3) Botulinum toxin A injections into the thyroarytenoid muscle on the affected ipsilateral side reduced laryngopharyngeal spasms. Botulinum toxin injection in the contralateral thyroarytenoid muscle did not improve laryngopharyngeal spasm. 4) Magnetic resonance imaging revealed ipsilateral neurovascular compression of the vagus nerve rootlets by the posterior inferior cerebellar artery. 5) Microvascular decompression (MVD) surgery of the ipsilateral vagus nerve resolved all symptoms (follow-up 2-4 years). CONCLUSION: The diagnostic criteria for hemi-laryngopharyngeal spasm (HeLPS) are proposed. Otolaryngology recognition of this new clinical entity may lead to a surgical cure and avoid the unnecessary therapies associated with misdiagnosis. LEVEL OF EVIDENCE: 4.


Assuntos
Laringismo/diagnóstico , Doenças Faríngeas/diagnóstico , Espasmo/diagnóstico , Adulto , Idoso , Feminino , Humanos , Laringoscopia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Síndrome
12.
J Laryngol Otol ; 134(4): 350-353, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32172698

RESUMO

OBJECTIVES: Pharyngocutaneous fistulae are dreaded complications following total laryngectomy. This paper presents our experience using 3-5 ml gastrografin to detect pharyngeal leaks following total laryngectomy, and compares post-operative videofluoroscopy with clinical follow-up findings in the detection of pharyngocutaneous fistulae. METHODS: A retrospective case-control study was conducted of total laryngectomy patients. The control group (n = 85) was assessed clinically for development of pharyngocutaneous fistulae, while the study group (n = 52) underwent small-volume (3-5 ml) post-operative gastrografin videofluoroscopy. RESULTS: In the control group, 24 of 85 patients (28 per cent) developed pharyngocutaneous fistulae, with 6 requiring surgical correction. In the study group, 24 of 52 patients (46 per cent) had videofluoroscopy-detected pharyngeal leaks; 4 patients (8 per cent) developed pharyngocutaneous fistulae, but all cases resolved following non-surgical management. Patients who underwent videofluoroscopy had a significantly lower risk of developing pharyngocutaneous fistulae; sensitivity and specificity in the detection of pharyngocutaneous fistulae were 58 per cent and 100 per cent respectively. CONCLUSION: Small-volume gastrografin videofluoroscopy reliably identified small pharyngeal leaks. Routine use in total laryngectomy combined with withholding feeds in cases of early leaks may prevent the development of pharyngocutaneous fistulae.


Assuntos
Fístula Cutânea/diagnóstico por imagem , Diatrizoato de Meglumina/administração & dosagem , Fluoroscopia/métodos , Laringectomia/efeitos adversos , Doenças Faríngeas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Fístula Cutânea/prevenção & controle , Fístula Cutânea/terapia , Feminino , Fluoroscopia/tendências , Humanos , Masculino , Programas de Rastreamento/instrumentação , Pessoa de Meia-Idade , Faringe/diagnóstico por imagem , Faringe/patologia , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Sensibilidade e Especificidade
13.
Niger J Clin Pract ; 23(3): 329-336, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32134031

RESUMO

Objectives: The aim of this study is to determine the type, frequency, and location of incidental findings in the maxillofacial region in patients undergoing cone beam computed tomography (CBCT) scan for implant treatment.[5]. Methods: In this study, 300 patients who underwent CBCT imaging for implant treatment planning were evaluated retrospectively. Patients were evaluated in four different categories, namely, maxillary sinus pathologies, temporomandibular joint (TMJ) findings, dentoalveolar findings, and soft-tissue calcifications. In maxillary sinus pathologies, we categorized patients by mucosal thickening, polypoidal lesion, air-liquid level, total opacification, oroantral fistula, periapical lesion related with maxillary sinus, antrolith, hypoplasia, and foreign body presence. In the TMJ findings category, we evaluated patients for erosion, osteophyte, sclerosis, flattening, and bifid condyle. For dentoalveolar findings, we looked for the residual root and impacted tooth. In soft-tissue calcifications, we examined patients for tonsillolith, sialolith, lymph node calcification, styloid ligament calcification, carotid artery calcifications, and osteoma cutis. Results: Mucosal thickening was mostly seen in maxillary sinus pathology. One hundred and forty-eight (49.3%) of the patients had at least one TMJ incidental finding. We detected at least one impacted tooth in 17 (5.7%) patients' maxilla and 14 (4.7%) patients' mandibles. The most frequently seen calcification was styloid ligament calcification. There was no statistically significant relationship between the age groups and incidental findings (P > 0.05). Conclusions: Oral radiologists should be aware of incidental findings and evaluate the possibilities of underlying diseases in a comprehensive way, and if there is a concern about the finding, they should refer the patient to the relevant specialist.


Assuntos
Tomografia Computadorizada de Feixe Cônico/métodos , Seio Maxilar/diagnóstico por imagem , Articulação Temporomandibular/diagnóstico por imagem , Dente Impactado/diagnóstico por imagem , Adulto , Feminino , Humanos , Achados Incidentais , Masculino , Maxila , Seio Maxilar/patologia , Pessoa de Meia-Idade , Fístula Bucoantral/diagnóstico por imagem , Doenças Faríngeas , Estudos Retrospectivos , Dente Impactado/patologia
14.
J Oral Maxillofac Surg ; 78(5): 749-761, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32008991

RESUMO

PURPOSE: First branchial cleft fistula/sinus is a rare congenital developmental deformity that can sometimes be acquired from incision and drainage of a branchial cleft cyst. The aim of the present study was to explore the clinical manifestations, diagnosis, and surgical management of first branchial cleft fistula/sinus in both a large patient series and a review of the pertinent literature. MATERIALS AND METHODS: The data from 31 cases diagnosed from February 2004 to April 2019 as first branchial cleft fistula/sinus were retrospectively reviewed. The patient demographic data and outcomes were explored. In addition, we performed a literature review of studies reported from 1923 to 2018 for first branchial cleft fistula/sinus and summarized those results. RESULTS: The present study included 31 patients (15 males, 16 females) with a median age of 4 years. All the patients reviewed had presented with a unilateral first branchial cleft fistula/sinus. The parotid region was the most frequent site of presentation (41.9%) in these cases. The fistula/sinus had occurred on the left side in 13 patients (41.9%) and on the right side in 18 patients (58.1%). Of the 31 patients, 24 (77.4%) had acquired the disease from infection of an existing brachial cleft cyst or incomplete previous excision. Of the 31 cases, 28 (90%) had an intimate relationship between the tract and the facial nerve. Despite this close association, no patient developed postoperative facial nerve palsy. Of the 31 operations, 30 (97%) successfully accomplished complete resection with no recurrence postoperatively. Only 1 patient with a history of multiple recurrences experienced a subsequent recurrence, which was successfully treated with a second surgery. CONCLUSIONS: First branchial cleft fistula/sinus is a frequently misdiagnosed and, therefore, undertreated entity, which leads to recurrence. It is closely associated with the facial nerve and extra auditory canal. The correct diagnosis and meticulous removal can be effectively achieved with minimal risk to the facial nerve.


Assuntos
Neoplasias de Cabeça e Pescoço , Doenças Faríngeas , Região Branquial , Pré-Escolar , Feminino , Humanos , Masculino , Recidiva Local de Neoplasia , Estudos Retrospectivos
15.
Ann Otol Rhinol Laryngol ; 129(7): 653-656, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32028786

RESUMO

OBJECTIVES: Congenital midline cervical cleft (CMCC) is a rare congenital anterior neck anatomical anomaly. We present the case of two related patients (grandchild and maternal grandmother) who were both born with a congenital midline cervical cleft along with genetic analysis. METHODS: Clinical examination of both patients and surgical excision of the grandchild was performed. Genetic analysis with exome sequencing (ES) was conducted for both patients. RESULTS: Genetic analysis with exome sequencing (ES) revealed apparently novel single nucleotide variants in 66 genes present in both proband and grandmother. Five of these variants are predicted to cause frameshifting in the coding region of the respective genes and truncated proteins (OVGP1, TYW1B, ZAN, SSPO, FOLR3). Two of these genes (TYW1B and SSPO) have homozygous indel mutations in both patients. CONCLUSIONS: To our knowledge, this is the first case of two related patients with a congenital midline cervical cleft. The results of our genetic analysis reveal potential relevance to CMCC development.


Assuntos
Região Branquial/anormalidades , Proteínas de Transporte/genética , Moléculas de Adesão Celular Neuronais/genética , Anormalidades Craniofaciais/genética , Glicoproteínas/genética , Pescoço/anormalidades , Doenças Faríngeas/genética , Região Branquial/cirurgia , Anormalidades Craniofaciais/cirurgia , Feminino , Mutação da Fase de Leitura , Avós , Humanos , Mutação INDEL , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Oxigenases de Função Mista/genética , Pescoço/cirurgia , Doenças Faríngeas/cirurgia , Polimorfismo de Nucleotídeo Único , Sequenciamento Completo do Exoma
16.
J Laryngol Otol ; 134(3): 256-262, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32079554

RESUMO

BACKGROUND: Total laryngectomy is often utilised to manage squamous cell carcinoma of the larynx or hypopharynx. This study reports on surgical trends and outcomes over a 10-year period. METHOD: A retrospective review of patients undergoing total laryngectomy for squamous cell carcinoma was performed (n = 173), dividing patients into primary and salvage total laryngectomy cohorts. RESULTS: A shift towards organ-sparing management was observed. Primary total laryngectomy was performed for locoregionally advanced disease and utilised reconstruction less than salvage total laryngectomy. Overall, 11 per cent of patients developed pharyngocutaneous fistulae (primary: 6 per cent; salvage: 20 per cent) and 11 per cent neopharyngeal stenosis (primary: 9 per cent; salvage: 15 per cent). Pharyngocutaneous fistulae rates were higher in the reconstructed primary total laryngectomy group (24 per cent; 4 of 17), compared with primary closure (3 per cent; 3 of 90) (p = 0.02). Patients were significantly more likely to develop neopharyngeal stenosis following pharyngocutaneous fistulae in salvage total laryngectomy (p = 0.01) and reconstruction in primary total laryngectomy (p = 0.02). Pre-operative haemoglobin level and adjuvant treatment failed to predict pharyngocutaneous fistulae development. CONCLUSION: Complications remain hard to predict and there are continuing causes of morbidity. Additionally, prior treatment continues to affect surgical outcomes.


Assuntos
Carcinoma de Células Escamosas/cirurgia , Neoplasias Hipofaríngeas/cirurgia , Neoplasias Laríngeas/cirurgia , Laringectomia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Adulto , Idoso , Causalidade , Fístula Cutânea/epidemiologia , Fístula Cutânea/etiologia , Feminino , Humanos , Laringoestenose/epidemiologia , Laringoestenose/etiologia , Masculino , Pessoa de Meia-Idade , Doenças Faríngeas/epidemiologia , Doenças Faríngeas/etiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Reino Unido/epidemiologia
17.
PLoS One ; 15(1): e0227985, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31945133

RESUMO

Pharyngeal gonorrhoea is a common sexually transmitted infection among 'men having sex with other men' (MSM). Neisseria gonorrhoeae (NG) pharyngeal infections are usually characterized by the absence of symptoms, acting as an important reservoir for their further spread. To the best of our knowledge, no information about the composition of the pharyngeal microbiome during an ongoing NG infection is currently available. Therefore, in this study, we characterized the pharyngeal bacterial community profiles associated with NG infection in a well-selected cohort of HIV-negative MSM reporting unsafe oral intercourse. A total of 70 pharyngeal swabs were considered, comparing non-infected subjects (n = 45) versus patients with pharyngeal gonorrhoea (n = 25) whose microbiota composition was analyzed from pharyngeal swabs through sequencing of hypervariable V3-V4 regions of the 16S rRNA gene. The pharyngeal microbiome of all subjects was dominated by Prevotellaceae, Veillonellaceae and Streptococcaceae families. Patients with pharyngeal gonorrhoea harboured a pharyngeal microbiome quite similar to negative subjects. Nevertheless, when looking to less-represented bacterial species (relative abundance approximately 1% or less), an imbalance between aerobe and anaerobe microorganisms was observed in NG-infected patients. In particular, the pharyngeal microbiome of NG-positive individuals was richer in several anaerobes (e.g. Treponema, Parvimonas, Peptococcus, Catonella, Filifactor) and poorer in various aerobe genera (i.e. Pseudomonas, Escherichia), compared to non-infected controls. No significant differences were noticed in the distribution of commensal Neisseria species of the oropharynx between NG-positive and negative subjects. Metabolic variations induced by changes in the microbiome abundance were assessed by a functional prediction of the bacterial metabolic pathways: a more abundant involvement of D-glutamine and D-glutamate metabolism, carbohydrate metabolism, as well as a greater activation of the energy metabolism was observed in patients with pharyngeal gonorrhoea compared to non-infected individuals. Information about the bacterial composition of the pharyngeal microbiome in case of gonorrhoea could shed light on the pathogenesis of the infection and open new perspectives for the prevention and control of this condition.


Assuntos
Gonorreia/microbiologia , Microbiota/genética , Doenças Faríngeas/microbiologia , Faringe/microbiologia , RNA Ribossômico 16S , Estudos de Coortes , Humanos , Itália , Masculino , Minorias Sexuais e de Gênero , Sexo sem Proteção
18.
J Cardiothorac Surg ; 15(1): 12, 2020 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-31924238

RESUMO

BACKGROUND: Mediastinal hematoma rarely occurs after a minor traffic injury. CASE PRESENTATION: A woman in her forties was transferred to the emergency room by ambulance due to a traffic accident. Computed tomography (CT) revealed no abnormal findings, and she went home. Two days after the accident, the contrast-enhanced CT was repeated, which revealed cervical and mediastinal hematomas. Because it was possible that there was active bleeding from the right inferior thyroid artery, embolization of the right inferior thyroid artery was performed; however, her condition further deteriorated, so we performed emergency surgery to achieve hemostasis and remove the hematoma. Because of oozing from the right thyroid lobe, we performed right hemithyroidectomy and drainage of mediastinal space and right thoracic cavity. Since there was no bleeding site in the mediastinum, we thought that the mediastinal hematoma was due to bleeding from the thyroid gland. Her postoperative course was uneventful, and she is doing well at 9 months of follow-up after surgery. CONCLUSIONS: It is possible that mediastinal hematoma might be caused by a minor traffic injury.


Assuntos
Acidentes de Trânsito , Hematoma/etiologia , Hemorragia/etiologia , Doenças do Mediastino/etiologia , Lesões do Pescoço/complicações , Doenças Faríngeas/etiologia , Glândula Tireoide/lesões , Adulto , Drenagem , Embolização Terapêutica/efeitos adversos , Feminino , Hematoma/diagnóstico por imagem , Hematoma/cirurgia , Hemorragia/diagnóstico por imagem , Hemorragia/cirurgia , Humanos , Doenças do Mediastino/diagnóstico por imagem , Doenças do Mediastino/cirurgia , Doenças Faríngeas/diagnóstico por imagem , Doenças Faríngeas/cirurgia , Artéria Subclávia , Doenças da Glândula Tireoide/diagnóstico por imagem , Doenças da Glândula Tireoide/etiologia , Doenças da Glândula Tireoide/cirurgia , Glândula Tireoide/irrigação sanguínea , Glândula Tireoide/cirurgia , Tomografia Computadorizada por Raios X
19.
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 , Imagem 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
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