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1.
BMJ Case Rep ; 14(2)2021 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-33526525

RESUMO

We present a case of multifocal laryngotracheal amyloidosis (LTA) in a 43-year-old man with persistent and progressive dysphonia and dyspnoea, and a first inconclusive histology. Although laryngeal amyloidosis accounts for fewer than 1% of all benign laryngeal tumours, it is in fact the most common site of amyloid deposition in the head, neck and respiratory tract. The clinical scenario is non-specific and diagnosis depends on a high degree of suspicion and on histology. Imaging is useful in mapping lesions, which are often more extensive than they appear during laryngoscopy. Despite being a benign entity, the prognosis is variable with a high-rate and long-latency recurrences, requiring long-term follow-up.


Assuntos
Amiloidose de Cadeia Leve de Imunoglobulina/diagnóstico , Doenças da Laringe/diagnóstico por imagem , Doenças da Traqueia/diagnóstico por imagem , Adulto , Broncoscopia , Disfonia/fisiopatologia , Dispneia/fisiopatologia , Humanos , Amiloidose de Cadeia Leve de Imunoglobulina/patologia , Amiloidose de Cadeia Leve de Imunoglobulina/fisiopatologia , Doenças da Laringe/patologia , Doenças da Laringe/fisiopatologia , Laringoscopia , Masculino , Tomografia Computadorizada por Raios X , Doenças da Traqueia/patologia , Doenças da Traqueia/fisiopatologia
3.
Artigo em Chinês | MEDLINE | ID: mdl-32791777

RESUMO

Objective: To investigate whether laryngopharyngeal reflux(LPR) is an independent risk factor for vocal fold polyps and to analyze the potential mechanism. Methods: Case control survey was designed. Subjects who came to the Department of Otorhinolaryngology Head and Neck Surgery of the First Affiliated Hospital of Chongqing Medical University from September 2018 to December 2019, including 152 cases with vocal fold polyps and 176 cases with normal vocal folds, were selected. All the subjects filled in a questionnaire and were assessed by the reflux symptom index (RSI) and the reflux finding score (RFS) scale. RSI>13 and(or) RFS>7 were classified as LPR. Chi-square test, univariate and multivariate unconditional logistic regression models were used for statistical analysis. Results: The incidence of LPR and throat clearing in vocal fold polyps group (47.37%, 73.68%) was significantly higher than that in control group (27.27%, 59.09%), with statistically significant difference (P<0.001, P=0.005, respectively). The incidence of troublesome cough, indigestion or stomach acid coming up was no difference between the two groups(P=0.672, P=0.099). Multivariate unconditional logistic regression analysis showed that LPR (OR=1.815, 95%CI:1.061-3.103), occupational exposure(OR=2.655, 95%CI:1.397-5.042), spicy food(OR=1.958, 95%CI:1.142-3.355) were risk factors for vocal fold polyps. Conclusion: LPR, occupational exposure, spicy food are independent risk factors for vocal fold polyps. Frequent throat clearing caused by LPR may be the main cause of vocal ford polyps. In order to prevent vocal fold polyps, we need to take action to treat laryngopharyngeal reflux disease actively.


Assuntos
Doenças da Laringe , Refluxo Laringofaríngeo , Pólipos , Prega Vocal/patologia , Estudos de Casos e Controles , Humanos , Doenças da Laringe/etiologia , Doenças da Laringe/patologia , Refluxo Laringofaríngeo/complicações , Pólipos/patologia , Fatores de Risco , Inquéritos e Questionários
4.
Medicine (Baltimore) ; 99(27): e21014, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629721

RESUMO

INTRODUCTION: Multiple symmetric lipomatosis (MSL) is an uncommon medical condition characterized by symmetric fat accumulation mainly in the neck and other upper body regions. The involvement of the larynx is rare according to the literature, and we present a case of MSL with larynx involvement treated with a surgical approach. PATIENT CONCERNS: A 55-year-old male was admitted to our hospital due to progressively aggravated breathing difficulty, and tracheotomy was performed before transfer. When he tried to block the cannula, the breathing difficulty returned. The patient's neck had been thickening for the past 2 years. DIAGNOSIS: Pathological examination confirmed the diagnosis of MSL. INTERVENTIONS: The patient underwent lumpectomy and neck exploration. OUTCOMES: The lipoma was removed, the patient was free of any dyspnea symptoms and recovered well, and the tracheal cannula was removed at a local hospital. CONCLUSION: MSL can infiltrate the larynx and grow into the preepiglottic space and paraglottic spaces, resulting in breathing difficulties. Lipomas present in the spaces described above must be removed at the same time; otherwise, symptoms of dyspnea cannot be alleviated.


Assuntos
Doenças da Laringe/diagnóstico , Lipomatose Simétrica Múltipla/diagnóstico , Obstrução das Vias Respiratórias/etiologia , Progressão da Doença , Humanos , Doenças da Laringe/etiologia , Doenças da Laringe/patologia , Doenças da Laringe/cirurgia , Lipomatose Simétrica Múltipla/complicações , Lipomatose Simétrica Múltipla/patologia , Lipomatose Simétrica Múltipla/cirurgia , Masculino , Pessoa de Meia-Idade
5.
Cell Mol Life Sci ; 77(19): 3781-3795, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32253462

RESUMO

The larynx and vocal folds sit at the crossroad between digestive and respiratory tracts and fulfill multiple functions related to breathing, protection and phonation. They develop at the head and trunk interface through a sequence of morphogenetic events that require precise temporo-spatial coordination. We are beginning to understand some of the molecular and cellular mechanisms that underlie critical processes such as specification of the laryngeal field, epithelial lamina formation and recanalization as well as the development and differentiation of mesenchymal cell populations. Nevertheless, many gaps remain in our knowledge, the filling of which is essential for understanding congenital laryngeal disorders and the evaluation and treatment approaches in human patients. This review highlights recent advances in our understanding of the laryngeal embryogenesis. Proposed genes and signaling pathways that are critical for the laryngeal development have a potential to be harnessed in the field of regenerative medicine.


Assuntos
Doenças da Laringe/patologia , Laringe/metabolismo , Prega Vocal/metabolismo , Animais , Diferenciação Celular , Humanos , Doenças da Laringe/metabolismo , Laringe/crescimento & desenvolvimento , Células-Tronco Mesenquimais/citologia , Células-Tronco Mesenquimais/metabolismo , Fatores de Transcrição SOXB1/metabolismo , Transdução de Sinais , Fator Nuclear 1 de Tireoide/metabolismo , Prega Vocal/crescimento & desenvolvimento
6.
Acta Vet Scand ; 62(1): 12, 2020 Mar 04.
Artigo em Inglês | MEDLINE | ID: mdl-32131871

RESUMO

BACKGROUND: Ovine laryngeal chondritis is a rare entity of sheep in the USA, Great Britain, New Zealand and Iceland, but has not been reported in Germany so far. Here, two German cases are reported. CASE PRESENTATION: Two rams showed severe and progressive signs of dyspnea. Endoscopically, a severe bilateral swelling of the larynx was identified in both rams. Due to poor prognosis and progression of clinical signs one ram was euthanized, while the other ram died overnight. In both cases, a necrosuppurative laryngitis and chondritis of arytenoid cartilages was found at necropsy. Fusobacterium necrophorum and Streptococcus ovis were isolated from the laryngeal lesion in one animal. CONCLUSIONS: This is the first report of ovine laryngeal chondritis in continental Europe. This entity should be considered a differential diagnosis for upper airway disease in sheep.


Assuntos
Doenças das Cartilagens/veterinária , Infecções por Fusobacterium/veterinária , Doenças da Laringe/veterinária , Doenças dos Ovinos/diagnóstico , Doenças dos Ovinos/patologia , Infecções Estreptocócicas/veterinária , Animais , Autopsia , Doenças das Cartilagens/diagnóstico , Doenças das Cartilagens/microbiologia , Doenças das Cartilagens/patologia , Eutanásia Animal , Evolução Fatal , Infecções por Fusobacterium/diagnóstico , Infecções por Fusobacterium/patologia , Fusobacterium necrophorum/isolamento & purificação , Alemanha , Doenças da Laringe/diagnóstico , Doenças da Laringe/microbiologia , Doenças da Laringe/patologia , Laringe/microbiologia , Laringe/patologia , Masculino , Ovinos , Doenças dos Ovinos/microbiologia , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/patologia , Streptococcus/isolamento & purificação
7.
Ann Thorac Surg ; 110(1): 251-257, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32199826

RESUMO

BACKGROUND: Airway management during repair of laryngotracheal stenosis is demanding, and there is currently no accepted standard of care. Recently an increasing number of airway centers have started to use a laryngeal mask until the airway is surgically exposed and cross-table ventilation can be initiated. However detailed data on this approach are missing in the literature. METHODS: Patients receiving laryngotracheal surgery from November 2011 until October 2018 were retrospectively included in this single-center study, except for patients who presented with a preexisting tracheostomy at time of surgery. Airway management uniformly consisted of laryngeal mask ventilation until cross-table ventilation was established. Clinical variables, perioperative complications, and airway complications were analyzed. RESULTS: One hundred eight patients (65 women, 43 men) receiving tracheal resection (n = 50), cricotracheal resection (n = 49), or single-stage laryngotracheal reconstruction (n = 9) were included in the analysis. Of the included patients 23 (21.3%) had malignant disease and 85 (78.7%) a benign pathology. In the subgroup of patients with subglottic disease 85.1% had high-grade stenosis (Myer-Cotton III°). Airway management with a laryngeal mask was successful in all except 1 patient (99.1%). Mean pulse oximetry and mean end-tidal CO2 during laryngeal mask ventilation was 98.7% ± 2.4% and 34.8 ± 7.6 mm Hg, respectively. At the end of surgery 95 patients (88%) were successfully weaned from the respirator using the laryngeal mask. CONCLUSIONS: The laryngeal mask as the primary airway device is feasible and safe in patients undergoing laryngotracheal surgery even in cases with high-grade stenosis.


Assuntos
Doenças da Laringe/cirurgia , Máscaras Laríngeas , Doenças da Traqueia/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Viabilidade , Feminino , Humanos , Doenças da Laringe/complicações , Doenças da Laringe/patologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Doenças da Traqueia/complicações , Doenças da Traqueia/patologia , Resultado do Tratamento , Adulto Jovem
8.
J Vet Med Sci ; 82(1): 64-67, 2020 Jan 17.
Artigo em Inglês | MEDLINE | ID: mdl-31839650

RESUMO

Brachycephalic airway syndrome (BAS) is a common disease in certain "flat-faced" dog breeds. This syndrome includes stenotic nares, elongated and thickened soft palate, laryngeal collapse, and tracheal hypoplasia. Pharyngeal collapse is also commonly observed, but it is unclear if laryngopharynx motions are merely sequelae or actually contribute to BAS respiratory symptoms. Laryngopharynx motion was imaged using dynamic four-dimensional computed tomography (4D-CT) during spontaneous respiration in four dogs with different BAS types. Dynamic 4D-CT showed laryngopharynx motion in the following order during inspiration: pharyngeal collapse, contraction, and laryngospasm. We concluded that dynamic 4D-CT is a highly-detailed diagnostic approach for detecting laryngopharynx motion. Pharyngeal contraction during inspiration appears to contribute toward the worsening of clinical respiratory signs of BAS.


Assuntos
Doenças do Cão/diagnóstico por imagem , Doenças da Laringe/veterinária , Doenças Faríngeas/veterinária , Obstrução das Vias Respiratórias/veterinária , Animais , Doenças do Cão/patologia , Cães , Feminino , Tomografia Computadorizada Quadridimensional/veterinária , Doenças da Laringe/diagnóstico por imagem , Doenças da Laringe/patologia , Laringismo/veterinária , Masculino , Doenças Faríngeas/diagnóstico por imagem , Doenças Faríngeas/patologia
9.
Eur Arch Otorhinolaryngol ; 277(1): 207-215, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31654182

RESUMO

PURPOSE: To evaluate the individual and combined ability of videostroboscopy (VS), high-speed digital imaging (HSDI), enhanced endoscopy (EE) and saline infusion (SI) to predict neoplasia, defined as glottic precursor lesion (GPL) or T1a glottic cancer, in patients suspected for glottic neoplasia. METHODS: A nationwide prospective cohort study of patients treated by cordectomy for suspected GPL or T1a glottic cancer from August 1st 2016 to October 31st 2018 was conducted in the five Danish University Departments of Head and Neck surgery. Sensitivity, specificity, negative and positive predictive values, and area under Receiver Operating Curves (AUC-ROC) were calculated with 95% confidence intervals with respect to the histological diagnosis. Logistic regression with an imputation model for missing data was applied. RESULTS: 261 patients aged 34-91 years participated; 79 (30.3%) with non-neoplasia (i.e., inflammation, papilloma, hyperkeratosis) and 182 (69.7%) neoplasia, hereof 95 (36.4%) with GPL and 87 (33.3%) with T1a glottic cancer. Data from 188 VS, 60 HSDI, 100 preoperative EE, 209 intraoperative EE, and 234 SI were analyzed. In the complete case analysis the AUC-ROC of each diagnostic test was low, but increased when the tests were combined and especially if the combination included EE. However, multinomial logistic regression with imputation showed significant association (p < 0.05) only between age, male gender, and perpendicular vasculature in intraoperative EE, and the endpoint neoplasia. CONCLUSIONS: Intraoperative EE was the most accurate diagnostic method in detecting neoplasia. The prediction ability of methods applied preoperatively was more limited, but improved when test modalities were combined.


Assuntos
Glote/patologia , Glote/cirurgia , Neoplasias Laríngeas/diagnóstico , Laringoscopia/métodos , Lesões Pré-Cancerosas/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Feminino , Glote/irrigação sanguínea , Humanos , Cuidados Intraoperatórios , Doenças da Laringe/diagnóstico , Doenças da Laringe/patologia , Doenças da Laringe/cirurgia , Neoplasias Laríngeas/irrigação sanguínea , Neoplasias Laríngeas/patologia , Neoplasias Laríngeas/cirurgia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Lesões Pré-Cancerosas/patologia , Lesões Pré-Cancerosas/cirurgia , Cuidados Pré-Operatórios , Estudos Prospectivos , Sistema de Registros , Mucosa Respiratória/irrigação sanguínea , Mucosa Respiratória/patologia , Mucosa Respiratória/cirurgia , Sensibilidade e Especificidade , Prega Vocal/irrigação sanguínea , Prega Vocal/patologia , Prega Vocal/cirurgia
10.
BMJ Case Rep ; 12(10)2019 Oct 25.
Artigo em Inglês | MEDLINE | ID: mdl-31653628

RESUMO

A 42-year-old man with multiple comorbidities, including gout, presented to the emergency department with severe odynophagia for 4 days with intermittent dysphagia for 1-2 months. A CT scan of the neck showed right longus colli tendinitis and partially calcified excrescences from the right thyroid cartilage which raised suspicion of a cartilaginous tumour. He underwent an MRI scan of the neck to better evaluate the thyroid cartilage findings, which showed a heterogeneous mass suspicious for a chondroid tumour. He then underwent a positron-emission tomography-CT scan which showed a fluorodeoxyglucose-avid mass containing foci of calcification involving the right thyroid cartilage and adjacent strap muscle, with high standardised uptake value of 7.7. He subsequently underwent a CT-guided biopsy and an open biopsy of the right thyroid cartilage, and the results revealed gouty tophi. To our knowledge, this is the first reported case of laryngeal gout with longus coli tendinitis, both of which are rare conditions.


Assuntos
Gota/patologia , Doenças da Laringe/patologia , Músculos do Pescoço/patologia , Tendinopatia/patologia , Cartilagem Tireóidea/patologia , Adulto , Condrossarcoma , Diagnóstico Diferencial , Gota/tratamento farmacológico , Gota/cirurgia , Humanos , Doenças da Laringe/tratamento farmacológico , Doenças da Laringe/cirurgia , Masculino , Esteroides/uso terapêutico , Cartilagem Tireóidea/cirurgia , Tomografia Computadorizada por Raios X
11.
Braz. j. otorhinolaryngol. (Impr.) ; 85(5): 588-596, Sept.-Oct. 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1039291

RESUMO

Abstract Introduction: There is still no general method for discriminating between benign and malignant leukoplakia and identifying vocal fold leukoplakia. Objective: To evaluate the reliability of a morphological classification and the correlation between morphological types and pathological grades of vocal fold leukoplakia. Methods: A total of 375 patients with vocal fold leukoplakia between 2009 and 2015 were retrospectively reviewed. Two observers divided the vocal fold leukoplakia into flat and smooth, elevated and smooth, and rough type on the basis of morphological appearance. The inter-observer reliability was evaluated and the results of classification from both observers were compared with final pathological grades. Clinical characteristics between low risk and high risk group were also analyzed. Results: The percentage inter-observer agreement of the morphological classification was 78.7% (κ = 0.615, p < 0.001). In the results from both observers, the morphological types were significantly correlated with the pathological grades (p1 < 0.001, p2 < 0.001, Kruskal-Wallis test; r1 = 0.646, p1 < 0.001, r2 = 0.539, p2 < 0.001, Spearman Correlation Analysis). Multivariate analysis showed patient's age (p = 0.018), the size of lesion (p < 0.001), and morphological type (p < 0.001) were significantly different between low risk group and high risk group. Combined receiver operating characteristic curve analysis of significant parameters revealed an area under the receiver operating characteristic curve of 0.863 (95% CI 0.823-0.903, p < 0.001). Conclusions: The proposed morphological classification of vocal fold leukoplakia was consistent between observers and morphological types correlated with pathological grades. Patient's age, the size of lesion, and morphological type might enable risk stratification and provide treatment guidelines for vocal fold leukoplakia.


Resumo Introdução: Ainda não há um método universal estabelecido para diferenciar entre a leucoplasia benigna e maligna ou identificar as leucoplasias das pregas vocais. Objetivo: Avaliar a confiabilidade de uma classificação morfológica e a correlação entre os tipos morfológicos e os graus histopatológicos das leucoplasias de pregas vocais. Método: Os registros de 375 pacientes com leucoplasia da prega vocal assistidos entre 2009 e 2015 foram revisados retrospectivamente. Dois observadores dividiram a leucoplasia da prega vocal entre tipo plano e liso, elevado e liso, e rugoso, com base na aparência morfológica. A confiabilidade interobservador foi avaliada e os resultados de classificação de ambos os observadores foram comparados com os graus histopatológicos finais. As características clínicas entre os grupos de baixo risco e alto risco também foram analisadas. Resultados: A porcentagem da concordância interobservador da classificação morfológica foi de 78,7% (κ = 0,615, p < 0,001). Nos resultados de ambos os observadores, os tipos morfológicos correlacionaram-se significativamente com os graus histopatológicos (p1 < 0,001, p2 < 0,001, teste de Kruskal-Wallis; r1 = 0,646, p1 < 0,001, r2 = 0,539, p2 < 0,001, análise de correlação de Spearman). A análise multivariada mostrou que a idade do paciente (p = 0,018), o tamanho da lesão (p < 0,001) e o tipo morfológico (p < 0,001) foram significativamente diferentes entre o grupo de baixo risco e o de alto risco. A análise da curva ROC (Receiver Operating Characteristic) combinada de parâmetros significativos revelou uma área sob a curva de 0,863 (IC 95%: 0,823 ± 0,903, p < 0,001). Conclusões: A classificação morfológica proposta para leucoplasia de prega vocal foi consistente entre observadores e os tipos morfológicos correlacionaram-se com os graus histopatológicos. A idade do paciente, o tamanho da lesão e o tipo morfológico podem permitir a estratificação de risco e fornecem diretrizes de tratamento para a leucoplasia da prega vocal.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Prega Vocal/patologia , Doenças da Laringe/patologia , Leucoplasia/patologia , Prega Vocal/anatomia & histologia , Prega Vocal/cirurgia , Variações Dependentes do Observador , Doenças da Laringe/cirurgia , Doenças da Laringe/diagnóstico por imagem , Reprodutibilidade dos Testes , Estudos Retrospectivos , Medição de Risco , Laringoscopia , Leucoplasia/cirurgia , Leucoplasia/diagnóstico por imagem
12.
Eur Arch Otorhinolaryngol ; 276(11): 3165-3171, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31473780

RESUMO

OBJECTIVE: To investigate the presence of sulcus vocalis in patients who underwent phonomicrosurgery due to benign vocal cord lesions. METHODS: Between January 2013 and June 2018, the records of 133 patients who underwent operations for benign vocal fold pathology were retrospectively reviewed. Intraoperative findings of the patients were noted. Patients were divided into two groups: patients with only benign vocal fold lesions (BVFL) and patients with benign vocal fold lesions and accompanying sulcus vocalis (SV + BVFL). RESULTS: In total, 67 patients (50.4%; 38 females, 29 males) had BVFL and 66 (49.6%; 37 females, 29 males) had SV + BVFL. The patients in the SV + BVFL group were significantly younger than those in the BVFL group (p = 0.039). The sulcus was unilateral in 60.6% of the patients. The presence of sulcus vocalis was 49% and 47.6% in patients with a diagnosis of polyps (n = 51) and cysts (n = 42), respectively. A total of 12 of 13 patients with multiple benign vocal fold lesions had accompanying sulcus vocalis. CONCLUSION: Approximately half of the patients who underwent operations for benign vocal fold lesions had accompanying sulcus vocalis. More than half of the sulcus associated with benign lesions was unilateral.


Assuntos
Cistos , Pólipos , Prega Vocal , Adulto , Correlação de Dados , Cistos/patologia , Cistos/cirurgia , Feminino , Humanos , Doenças da Laringe/patologia , Doenças da Laringe/cirurgia , Músculos Laríngeos/patologia , Masculino , Pessoa de Meia-Idade , Pólipos/patologia , Pólipos/cirurgia , Estudos Retrospectivos , Prega Vocal/patologia , Prega Vocal/cirurgia
13.
Ann Otol Rhinol Laryngol ; 128(10): 903-910, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31072118

RESUMO

OBJECTIVE: In laryngology practice, vocal fold leukoplakia is frequently evaluated by suspension laryngoscopy and biopsy examination upon the patient's complaints of hoarseness and dysphonia. The purpose of the present study is to investigate and analyze risk factors, diagnosis, treatment, and follow-up results of cases with Candida leukoplakia. STUDY DESIGN: Retrospective case control study. SETTING: Tertiary medical center. SUBJECTS AND METHODS: Patients with a diagnosis of vocal fold leukoplakia who underwent direct laryngoscopy and biopsy between 2007 and 2017 and diagnosed as candida or noncandida in their histopathology were assigned into 2 groups. Then they were compared in terms of their demographic characteristics, predisposing factors, diagnosis, treatment, and follow-up results. RESULTS: Of the 289 vocal fold leukoplakia cases, 36 were candida, and 253 were noncandida. The mean age of the patients with Candida leukoplakia was 60.86 years. As for the age groups, the largest group (26.1%) was in the seventh decade (P < .001). The use of inhaled corticosteroids was a significant risk factor (P < .001). For their medical therapy, the patients were administered fluconazole 200 mg per day for 3 weeks, and the treatment yielded successful results in 91.66% of them. In 5 of the patients, candida leukoplakia and superficial epithelial dysplasia were observed, and no malignant transformation was observed during a mean follow-up of 28 ± 13 months. CONCLUSION: Candidiasis causing vocal fold leukoplakia is rare, and we report the findings of the largest published case series to date. Eliminating predisposing factors and administrating oral fluconazole 200 mg for 3 weeks are sufficient for medical treatment.


Assuntos
Candidíase Bucal/diagnóstico , Candidíase Bucal/patologia , Doenças da Laringe/microbiologia , Doenças da Laringe/patologia , Leucoplasia/microbiologia , Prega Vocal/microbiologia , Prega Vocal/patologia , Administração por Inalação , Corticosteroides/efeitos adversos , Idoso , Antifúngicos/uso terapêutico , Biópsia , Candidíase Bucal/tratamento farmacológico , Estudos de Casos e Controles , Disfonia/etiologia , Feminino , Fluconazol/uso terapêutico , Seguimentos , Rouquidão/etiologia , Humanos , Doenças da Laringe/tratamento farmacológico , Laringoscopia , Leucoplasia/complicações , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco
14.
Clin Otolaryngol ; 44(4): 628-638, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31038820

RESUMO

OBJECTIVES: To study the inflammatory infiltrates associated with the different stages of laryngeal carcinogenesis. DESIGN: Observational, matched case-control study of histopathologic specimens. SETTING: An academic referral centre. PARTICIPANTS: A total of 45 patients who underwent removal of glottic lesions between 2008 and 2015. Patients were enrolled and categorised into three matched groups according to lesions' histopathologic diagnoses, 15 patients in each group: benign, pre-malignant and squamous cell carcinoma (SCC). Matching was based on age, gender and pack-years. MAIN OUTCOME MEASURES: Immunohistochemistry staining using monoclonal antibodies against CD4, CD8, CD68, CD20 and S100 representing T-helper cells, cytotoxic T cells, macrophages, B cells and dendritic cells, respectively. Cell counts and distributions were measured and compared between groups. Correlations between the different cells were examined. RESULTS: The predominant cell type was CD8+, followed by CD68+ and CD4+. All inflammatory cells increased significantly in number in SCC (P-value < 0.001), with no significant difference between benign and pre-malignant groups. Strong correlations between the different cells were demonstrated only in the malignant group. S100+ cells correlated with both T-cell subsets, CD4+ (rho = 0.769, P-value = 0.001) and CD8+ (rho = 0.697, P-value = 0.0004). Infiltrates exhibited more extensive distribution in SCC compared to pre-malignant and benign; CD8+ and CD68+ cells were demonstrated in both intraepithelial and stromal regions in 93% of SCC lesions (P-value = 0.0001). CONCLUSIONS: Laryngeal carcinoma demonstrates a unique pattern of inflammatory infiltrates, with significant changes in cell counts and distribution. Leucocyte infiltrates increased significantly in the transition from laryngeal pre-malignant lesion to malignancy while no significant differences were seen between benign and pre-malignant lesions.


Assuntos
Glote/patologia , Doenças da Laringe/patologia , Biomarcadores/análise , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/cirurgia , Estudos de Casos e Controles , Feminino , Glote/cirurgia , Humanos , Inflamação , Doenças da Laringe/cirurgia , Neoplasias Laríngeas/patologia , Neoplasias Laríngeas/cirurgia , Laringoscopia , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Lesões Pré-Cancerosas/patologia , Lesões Pré-Cancerosas/cirurgia , Estudos Retrospectivos
15.
Eur Arch Otorhinolaryngol ; 276(8): 2289-2292, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31144013

RESUMO

PURPOSE: Vocal fold scar is one the most challenging benign laryngeal pathologies. The purpose of this paper is to propose a classification that will allow for a common description of this entity between laryngologists, prevent discrepancies in interpretation, allow for comparison of related studies, and offer a training tool for young laryngologists. METHODS/RESULTS: Based on the depth and laterality of scarring, we propose 4 types: type I, characterized by atrophy of lamina propria with/without affected epithelium; type II, where the epithelium, lamina propria, and muscle are affected; type III, where the scar is located on the anterior commissure; type IV, which includes extended scar formation in both anteroposterior and rostro-caudal axis with significant loss of vocal fold mass. CONCLUSION: We believe that our proposal is comprehensive and encompasses all existing iatrogenic and non-iatrogenic etiologies in a simple and concise manner. It also serves its purpose as a descriptive, comparative, and training tool.


Assuntos
Cicatriz/classificação , Cicatriz/patologia , Doenças da Laringe/classificação , Prega Vocal/patologia , Epitélio/patologia , Humanos , Doenças da Laringe/etiologia , Doenças da Laringe/patologia , Membrana Mucosa/patologia , Prega Vocal/cirurgia
16.
Eur Arch Otorhinolaryngol ; 276(7): 2007-2013, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31134359

RESUMO

PURPOSE: To evaluate voice outcome after bilateral vocal fold injection with autologous fat in patients with non-paralytic glottic insufficiency due to vocal fold atrophy with or without sulcus. METHODS: This is a retrospective cohort study from September 2012 to December 2017 including 23 patients undergoing bilateral vocal fold injection with autologous fat (24 procedures) for vocal fold atrophy (15 procedures) or atrophy with sulcus (Ford type II or III) (9 procedures). Voice data were collected and analyzed for the preoperative and the 3- and 12-month postoperative time points according to a standardized protocol, including Voice Handicap Index (VHI)-30 and perceptive, acoustic and aerodynamic parameters. Failure rate was defined as non-relevant improvement (< 10 points) in VHI-30 at 12 months and number of revisions within 12 months. RESULTS: There was a clinically relevant (≥ 15 points) and statistically significant improvement in the VHI-30 (preoperative: 49.1 points; postoperative at 12 months: 29.7 points). Change in dynamic range was also statistically significant over time (p = 0.028). There were no differences in voice parameters between patients with atrophy only and atrophy with sulcus, although grade tended to be lower in patients with atrophy only over all time points. CONCLUSION: This study shows that bilateral vocal fold injection with autologous fat is a beneficial treatment not only for patients with atrophy but also for patients with sulcus. A comparison of the results with those reported from other forms of sulcus surgery confirmed this finding. However, there is a need for further prospective studies comparing the short- and long-term effects of different techniques.


Assuntos
Gordura Abdominal/transplante , Doenças da Laringe , Prega Vocal , Qualidade da Voz , Adulto , Atrofia , Feminino , Humanos , Injeções/métodos , Doenças da Laringe/patologia , Doenças da Laringe/fisiopatologia , Doenças da Laringe/cirurgia , Masculino , Pessoa de Meia-Idade , Países Baixos , Assistência Perioperatória/métodos , Estudos Retrospectivos , Resultado do Tratamento , Prega Vocal/patologia , Prega Vocal/fisiopatologia , Prega Vocal/cirurgia
17.
J Pathol ; 249(2): 182-192, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31056746

RESUMO

Mutations in the Matrin 3 (MATR3) gene have been identified as a cause of amyotrophic lateral sclerosis (ALS) or vocal cord and pharyngeal weakness with distal myopathy (VCPDM). This study investigated the mechanism by which mutant MATR3 causes multisystem proteinopathy (MSP) including ALS and VCPDM. We first analyzed the muscle pathology of C57BL/6 mice injected with adeno-associated viruses expressing human WT or mutant (S85C) MATR3. We next generated transgenic mice that overexpress mutant (S85C) MATR3, driven by the CMV early enhancer/chicken ß-actin promoter, and evaluated their clinicopathological features. Intramuscular injection of viruses expressing WT and mutant MATR3 induced similar myogenic changes, including smaller myofibers with internal nuclei, and upregulated p62 and LC3-II. Mutant MATR3 transgenic mice showed decreased body weight and lower motor activity. Muscle histology demonstrated myopathic changes including fiber-size variation, internal nuclei and rimmed vacuoles. Spinal cord histology showed a reduced number of motor neurons, and activation of microglia and astrocytes. Comprehensive proteomic analyses of muscle demonstrated upregulation of proteins related to chaperones, stress response, protein degradation, and nuclear function. Overexpression of WT and mutant MATR3 similarly caused myotoxicity, recapitulating the clinicopathological features of MSP. These models will be helpful for analyzing MSP pathogenesis and for understanding the function of MATR3. © 2019 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.


Assuntos
Esclerose Amiotrófica Lateral/genética , Miopatias Distais/genética , Doenças da Laringe/genética , Músculo Esquelético/metabolismo , Mutação , Proteínas Associadas à Matriz Nuclear/genética , Doenças Faríngeas/genética , Proteínas de Ligação a RNA/genética , Medula Espinal/metabolismo , Esclerose Amiotrófica Lateral/metabolismo , Esclerose Amiotrófica Lateral/patologia , Esclerose Amiotrófica Lateral/fisiopatologia , Animais , Dependovirus/genética , Modelos Animais de Doenças , Miopatias Distais/metabolismo , Miopatias Distais/patologia , Miopatias Distais/fisiopatologia , Análise da Marcha , Técnicas de Transferência de Genes , Predisposição Genética para Doença , Humanos , Doenças da Laringe/metabolismo , Doenças da Laringe/patologia , Doenças da Laringe/fisiopatologia , Camundongos Endogâmicos C57BL , Camundongos Transgênicos , Proteínas Associadas aos Microtúbulos/metabolismo , Atividade Motora , Músculo Esquelético/patologia , Músculo Esquelético/fisiopatologia , Proteínas Associadas à Matriz Nuclear/metabolismo , Doenças Faríngeas/metabolismo , Doenças Faríngeas/patologia , Doenças Faríngeas/fisiopatologia , Proteínas de Ligação a RNA/metabolismo , Teste de Desempenho do Rota-Rod , Proteína Sequestossoma-1/metabolismo , Medula Espinal/patologia , Medula Espinal/fisiopatologia , Perda de Peso
18.
Int J Pediatr Otorhinolaryngol ; 122: 44-46, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30959336

RESUMO

Primary laryngeal amyloidosis is an uncommon condition, and cases in the pediatric population are even rarer. We present a case of a nine year old female patient who presented with sleep disordered breathing and dysphonia to our outpatient clinic. The patient underwent Microlaryngoscopy and Bronchoscopy for diagnosis which identified a large soft tissue mass in the supraglottis. After Histological diagnosis was made, she had subtotal debridement of the mass and has maintained a good exercise tolerance with no airway compromise.


Assuntos
Amiloidose/diagnóstico por imagem , Disfonia/etiologia , Doenças da Laringe/diagnóstico por imagem , Síndromes da Apneia do Sono/etiologia , Amiloidose/complicações , Amiloidose/patologia , Broncoscopia , Criança , Feminino , Humanos , Doenças da Laringe/complicações , Doenças da Laringe/patologia , Laringoscopia
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