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2.
N Z Med J ; 133(1520): 120-124, 2020 08 21.
Artigo em Inglês | MEDLINE | ID: mdl-32994602

RESUMO

Spontaneous bleeding in the head and neck region is exceedingly rare, particularly in the absence of trauma or an underlying disorder. We describe a case of an atraumatic lingual haematoma in an 88-year-old male presenting with threatened airway obstruction. The only risk factor our patient had was Aspirin use. Our patient was able to be managed conservatively with observation in the hospital's high dependency unit (HDU) and intravenous steroid (Dexamethasone) and antibiotic (Amoxicillin + Clavulanic acid) therapy. We discuss this case to highlight the importance of recognising an impending airway emergency in the setting of deep space bleeding or swelling.


Assuntos
Obstrução das Vias Respiratórias/etiologia , Hematoma/complicações , Língua/patologia , Administração Intravenosa , Idoso de 80 Anos ou mais , Combinação Amoxicilina e Clavulanato de Potássio/uso terapêutico , Antibacterianos/uso terapêutico , Anti-Inflamatórios/administração & dosagem , Anti-Inflamatórios/uso terapêutico , Dexametasona/administração & dosagem , Dexametasona/uso terapêutico , Quimioterapia Combinada/métodos , Hematoma/tratamento farmacológico , Humanos , Masculino , Língua/irrigação sanguínea , Resultado do Tratamento
5.
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
6.
Zhonghua Jie He He Hu Xi Za Zhi ; 43(7): 571-576, 2020 Jul 12.
Artigo em Chinês | MEDLINE | ID: mdl-32629556

RESUMO

Objective: To explore the efficacy and safety of the covered airway stent loaded with (125)I seeds for the treatment of tracheal adenoid cystic carcinoma (TACC). Methods: We retrospectively reviewed the clinical data from 8 patients with TACC who had received placement of the covered stent loaded with (125)I seeds between December 2014 and July 2017 in the endoscopic center of the Second Affiliated Hospital of Xiamen Medical College. We compared the difference in the dyspnea index, the diameter of the airway lumen, and the lesion surrounding the airway wall before and after treatment. The complications were also recorded during follow-up. Results: Eight patients underwent successful placement of a total of 11 radioactive stents (2 straight-type stents, 2 L-shape stents, and 7 Y-shape stents, all loaded a total of 243 radioactive particles). Displacement of stents took place within 2 weeks in 2 patients, who were managed with re-stenting and fixation. No further displacement occurred during follow-up. The median time to stent removal was 2.9(interquartile range: 2.3,3.0) months. After stent placement, the dyspnea index was significantly decreased compared with pre-treatment level (mean: 0.1 vs. 3.4, t=8.881, P<0.001). Bronchoscopic re-assessment showed that the residual tumor within the airway was detected in only one patient and that the tumor completely disappeared in the remaining 7 patients. Treatment with stents loaded with radioactive particles yielded smooth and pale airway mucosa with formation of partial scar formation. Chest computed tomography re-assessment demonstrated significantly larger luminal diameter than that before treatment (mean: 13.1 mm vs. 3.3 mm, t=-7.839, P<0.001). The airway wall thickness was notably reduced after treatment (mean: 4.3 mm vs. 14.4 mm, t=7.620, P<0.001). The lesions surrounding the airway wall completely disappeared in 7 patients and decreased for more than 50% in a single patient. The median duration of follow-up was 28.0(interquartile range: 24.8,31.5) months. Recurrence of tumor was documented in a single case within 2 years. Six patients did not experience recurrence within the 2-year follow-up period. No death or severe complications were recorded during follow-up. Conclusion: The (125)I radioactive stent is effective for dilating the stenotic airway and ameliorating the symptoms, and thus might be an effective and safe method for the treatment of TACC. Further studies that explore the efficacy of stents loaded with (125)I particles are needed.


Assuntos
Carcinoma Adenoide Cístico/patologia , Carcinoma Adenoide Cístico/cirurgia , Radioisótopos do Iodo , Stents , Neoplasias da Traqueia/patologia , Neoplasias da Traqueia/cirurgia , Estenose Traqueal/terapia , Obstrução das Vias Respiratórias/etiologia , Carcinoma Adenoide Cístico/complicações , Humanos , Recidiva Local de Neoplasia , Estudos Retrospectivos , Neoplasias da Traqueia/complicações , Resultado do Tratamento
7.
J Laryngol Otol ; 134(7): 650-653, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32605677

RESUMO

BACKGROUND: Ex utero intrapartum treatment ('EXIT' procedure) is a well described method for maintaining maternal-fetal circulation in the setting of airway obstruction from compressive neck masses. When ex utero intrapartum treatment to airway is not feasible, ex utero intrapartum treatment to extracorporeal membrane oxygenation ('ECMO') has been described in fetal cardiopulmonary abnormalities. OBJECTIVE: This paper presents the case of a massively compressive midline neck teratoma managed with ex utero intrapartum treatment to extracorporeal membrane oxygenation, allowing for neonatal survival, with controlled airway management and subsequent resection. CASE REPORT: A 34-year-old-female presented with a fetal magnetic resonance imaging scan demonstrating a 15 cm compressive midline neck teratoma. Concern for failure of ex utero intrapartum treatment to airway was high. The addition of the ex utero intrapartum treatment to extracorporeal membrane oxygenation procedure provided time for the planned subsequent resection of the mass and tracheostomy. CONCLUSION: Ex utero intrapartum treatment procedures allow for securement of the difficult neonatal airway, while maintaining a supply of oxygenated blood to the newborn. Ex utero intrapartum treatment circulation lasts on average less than 30 minutes. The arrival of extracorporeal membrane oxygenation has enabled the survival of neonates with disease processes previously incompatible with life.


Assuntos
Cesárea/métodos , Oxigenação por Membrana Extracorpórea/métodos , Neoplasias de Cabeça e Pescoço/embriologia , Troca Materno-Fetal , Teratoma/embriologia , Adulto , Obstrução das Vias Respiratórias/embriologia , Obstrução das Vias Respiratórias/etiologia , Feminino , Neoplasias de Cabeça e Pescoço/cirurgia , Neoplasias de Cabeça e Pescoço/terapia , Humanos , Masculino , Gravidez , Teratoma/cirurgia , Teratoma/terapia
10.
J Craniofac Surg ; 31(5): e495-e497, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32541267

RESUMO

BACKGROUND: Respiratory distress is a frequent occurrence in neonates, typically caused by a variety of pulmonary conditions. Accurate diagnosis of the cause is vital to appropriately treat neonates and prevent long-term complications. Neck masses rarely cause respiratory distress in this setting but should be considered when clinical signs indicate. METHODS: The authors present the patient with a neonate born at term who developed stertor, respiratory distress requiring intubation, and repeated failure to extubate. RESULTS: Physical examination showed right-sided lower and midface enlargement with a firm mass mostly over the parotid and right neck. Both computerized and magnetic resonance tomography demonstrated a right-sided neck mass. Surgical exploration revealed extensive tumor burden emanating from the great auricular, hypoglossal, and other nerves of the neck, including invasion of the carotid sheath encasing the artery. Excisional biopsy showed plexiform neurofibroma, and pathognomonic for neurofibromatosis type 1. The decision was made to pursue medical management, as complete excision would have resulted in increased morbidity due to the involvement of multiple cranial nerves. The patient underwent microlaryngoscopy, bronchoscopy, and tracheostomy and was started on Trametinib chemotherapy. CONCLUSION: Neonatal airway obstruction can rarely be caused by unanticipated mass lesion, such as plexiform neurofibroma. A high index of suspicion must be maintained for early onset mass lesions causing respiratory obstruction to inhibit early disease progression and avoid potentially fatal sequelae.


Assuntos
Obstrução das Vias Respiratórias/cirurgia , Neurofibroma Plexiforme/cirurgia , Neurofibromatose 1/cirurgia , Obstrução das Vias Respiratórias/diagnóstico por imagem , Obstrução das Vias Respiratórias/etiologia , Biópsia , Diagnóstico Precoce , Intervenção Médica Precoce , Feminino , Humanos , Recém-Nascido , Neurofibroma Plexiforme/complicações , Neurofibroma Plexiforme/diagnóstico por imagem , Neurofibromatose 1/complicações , Neurofibromatose 1/diagnóstico por imagem , Tomografia Computadorizada por Raios X
11.
Medicine (Baltimore) ; 99(21): e20363, 2020 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-32481331

RESUMO

RATIONALE: Parkinson disease (PD) is a chronic neurodegenerative condition often suffered by the elderly. Upper airway obstruction, though rare in patients with PD, can be life threatening and is associated with vocal cord paralysis, laryngeal spasm, and dystonia of jaw and neck muscles. PATIENT CONCERNS: We describe a life-threatening upper airway obstruction caused by bilateral vocal cord paralysis, in an elderly man with PD, during extubation after general anesthesia. DIAGNOSES: Based on clinical presentation and visual laryngoscopy, the patient was diagnosed with laryngeal spasm and bilateral vocal cord paralysis after extubation. INTERVENTIONS: Re-intubation was carried out and dopamine hydrazine tablets were administered via a nasal feeding tube. OUTCOMES: After re-intubation and further treatment, the endotracheal tube was successfully removed and no symptoms of respiratory distress were observed. LESSONS: Patients with PD may be at a risk of life-threatening upper airway obstruction after extubation, which should be prevented systematically.


Assuntos
Extubação/efeitos adversos , Obstrução das Vias Respiratórias/etiologia , Doença de Parkinson/complicações , Idoso , Extubação/métodos , Obstrução das Vias Respiratórias/complicações , Anestesia Geral/efeitos adversos , Anestesia Geral/métodos , Humanos , Masculino , Paralisia das Pregas Vocais/complicações , Paralisia das Pregas Vocais/etiologia
12.
Pneumologie ; 74(8): 509-514, 2020 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-32492719

RESUMO

INTRODUCTION: Snoring was monitored in patients with obstructive sleep apnea (OSA) using the LEOSound-Monitor and simultaneously polysomnographic (PSG) recording. In obstructive apneas snoring is normally apparent after apnea termination and the beginning of ventilation. We wanted to know how often obstructive apneas are terminated by ventilation in combination with snoring. METHODS AND INTENTION: In 40 patients with OSA (AHI > 15/h) simultaneous polysomnographic recordings were performed amongst long-term respiratory sound monitoring using the LEOSound monitor. Patients' average age was 57 ±â€Š11 years. Average weight was 100 ±â€Š19 kg by a mean body  mass  index (BMI) of 33 ±â€Š7 kg/m2. 12 out of 40 recordings had to be rejected for further analysis because of artifacts. Snoring recorded by polysomnography was compared with snoring monitored by LEOSound. RESULTS: 3778 obstructive apnea episodes were monitored. LEOSound identified snoring in 1921 (51,0 %), polysomnography in 2229 (58,8 %) obstructive apneas. Only in one patient there was a higher difference in snoring episodes between PSG and LEOSound. DISCUSSION: In nearly 60 % of obstructive apnea events we found snoring during apnea-terminating hyperpnoea. LEOSound is a good diagnostic tool to monitor snoring. It is necessary to clarify why only 60 % of all obstructive events/hyperpnoea develop snoring. From a pathophysiological point of view opening of collapsed upper airway should lead in a very high percentage to turbulences in airstream and committed snoring.


Assuntos
Obstrução das Vias Respiratórias/etiologia , Polissonografia/métodos , Apneia Obstrutiva do Sono/fisiopatologia , Ronco/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Humanos , Pessoa de Meia-Idade , Respiração , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/epidemiologia , Ronco/etiologia
13.
Rev Mal Respir ; 37(6): 492-496, 2020 Jun.
Artigo em Francês | MEDLINE | ID: mdl-32430157

RESUMO

Endobronchial hamartochondroma is a rare benign tumor which differs from the parenchymal form in its symptomatology and also by its treatment which should be as conservative as possible. The endobronchial location is exceptional. Here we present the cases of two patients with endobronchial hamartochondroma associated with clinical manifestation, chest pain and repeated pulmonary infections, respectively. The diagnosis was made after performing a CT-scan, a PET-SCAN and histological analysis. After discussion in a multidisciplinary staff meeting, conservative treatment was chosen in both cases.


Assuntos
Obstrução das Vias Respiratórias/etiologia , Neoplasias Brônquicas/complicações , Condroma/complicações , Hamartoma/complicações , Fumar Tabaco/efeitos adversos , Idoso , Obstrução das Vias Respiratórias/diagnóstico , Obstrução das Vias Respiratórias/patologia , Obstrução das Vias Respiratórias/cirurgia , Neoplasias Brônquicas/diagnóstico , Neoplasias Brônquicas/patologia , Neoplasias Brônquicas/cirurgia , Broncoscopia/métodos , Condroma/diagnóstico , Condroma/patologia , Condroma/cirurgia , Feminino , Hamartoma/diagnóstico , Hamartoma/patologia , Hamartoma/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons , Fumar Tabaco/patologia , Tomografia Computadorizada por Raios X
14.
Oral Oncol ; 107: 104784, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32414642

Assuntos
Obstrução das Vias Respiratórias/terapia , Infecções por Coronavirus/prevenção & controle , Tratamento de Emergência/métodos , Neoplasias de Cabeça e Pescoço/complicações , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Traqueostomia/normas , Obstrução das Vias Respiratórias/diagnóstico , Obstrução das Vias Respiratórias/etiologia , Betacoronavirus/isolamento & purificação , Betacoronavirus/patogenicidade , Técnicas de Laboratório Clínico/normas , Tratamento Conservador/normas , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Tratamento de Emergência/instrumentação , Tratamento de Emergência/normas , Glucocorticoides/administração & dosagem , Neoplasias de Cabeça e Pescoço/terapia , Humanos , Índia/epidemiologia , Controle de Infecções/instrumentação , Controle de Infecções/normas , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Transmissão de Doença Infecciosa do Profissional para o Paciente/prevenção & controle , Masculino , Salas Cirúrgicas/normas , Equipamento de Proteção Individual/normas , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Cuidados Pré-Operatórios/normas , Índice de Gravidade de Doença , Oncologia Cirúrgica/normas , Fatores de Tempo , Tempo para o Tratamento/normas , Traqueostomia/instrumentação
17.
J Laparoendosc Adv Surg Tech A ; 30(5): 477-480, 2020 May.
Artigo em Inglês | MEDLINE | ID: covidwho-88434

RESUMO

Background: The current global COVID-19 pandemic is caused by the novel coronavirus Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2). Given that SARS-CoV-2 is highly transmissible, surgical societies have recommended that procedures with a high risk of aerosolization be avoided or delayed. However, some high-risk procedures, such as those related to head and neck malignancies, cannot always be delayed. Care must be taken during aerosol-generating procedures to minimize viral transmission as much as possible. Preoperative testing for COVID-19, limited operating room personnel, adequate personal protective equipment, and surgical technique are factors to consider for high-risk procedures. Methods: This article presents the case of an awake tracheotomy performed for a transglottic mass causing airway obstruction. Results: With detailed planning and specific techniques, the amount of aerosolization was reduced, and the procedure was performed as safely as possible. Conclusion: This case provides a template for future aerosol-generating procedures during respiratory pandemics.


Assuntos
Obstrução das Vias Respiratórias/cirurgia , Infecções por Coronavirus/diagnóstico , Controle de Infecções/métodos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Pneumonia Viral/diagnóstico , Insuficiência Respiratória/cirurgia , Traqueotomia/métodos , Aerossóis/efeitos adversos , Obstrução das Vias Respiratórias/etiologia , Betacoronavirus/isolamento & purificação , Carcinoma de Células Escamosas/complicações , Infecções por Coronavirus/complicações , Infecções por Coronavirus/virologia , Glote , Humanos , Controle de Infecções/normas , Neoplasias Laríngeas/complicações , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/virologia , Insuficiência Respiratória/etiologia , Traqueotomia/efeitos adversos , Vigília
19.
J Laparoendosc Adv Surg Tech A ; 30(5): 477-480, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32311303

RESUMO

Background: The current global COVID-19 pandemic is caused by the novel coronavirus Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2). Given that SARS-CoV-2 is highly transmissible, surgical societies have recommended that procedures with a high risk of aerosolization be avoided or delayed. However, some high-risk procedures, such as those related to head and neck malignancies, cannot always be delayed. Care must be taken during aerosol-generating procedures to minimize viral transmission as much as possible. Preoperative testing for COVID-19, limited operating room personnel, adequate personal protective equipment, and surgical technique are factors to consider for high-risk procedures. Methods: This article presents the case of an awake tracheotomy performed for a transglottic mass causing airway obstruction. Results: With detailed planning and specific techniques, the amount of aerosolization was reduced, and the procedure was performed as safely as possible. Conclusion: This case provides a template for future aerosol-generating procedures during respiratory pandemics.


Assuntos
Obstrução das Vias Respiratórias/cirurgia , Infecções por Coronavirus/diagnóstico , Controle de Infecções/métodos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Pneumonia Viral/diagnóstico , Insuficiência Respiratória/cirurgia , Traqueotomia/métodos , Aerossóis/efeitos adversos , Obstrução das Vias Respiratórias/etiologia , Betacoronavirus/isolamento & purificação , Carcinoma de Células Escamosas/complicações , Infecções por Coronavirus/complicações , Infecções por Coronavirus/virologia , Glote , Humanos , Controle de Infecções/normas , Neoplasias Laríngeas/complicações , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/virologia , Insuficiência Respiratória/etiologia , Traqueotomia/efeitos adversos , Vigília
20.
Medicine (Baltimore) ; 99(16): e19736, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32311966

RESUMO

RATIONALE: Endotracheal intubation is an essential step for airway management during general anesthesia. When surgeons carry out thoracic surgery such as pneumonectomy, they usually request lung isolation to secure a clear surgical view. A double lumen endotracheal tube is used for lung isolation in routine thoracic surgeries. PATIENT CONCERNS: A 56-year-old man was previously diagnosed with left Aspergilloma, a tuberculosis destroyed lung, and diabetes mellitus. According to his chest x-ray and chest computed tomography, his left lung was nearly collapsed, and the result of a pulmonary function test was severely restricted. The patient's diffusing capacity for carbon monoxide was 63% and predicted postoperative forced expiratory volume in 1 second was 23.5% DIAGNOSES:: Due to his previous history, radiologic findings and laboratory test results, he was diagnosed with left Aspergilloma and tuberculosis destroyed lung. INTERVENTIONS: Due to recurrence of Aspergilloma in his left lung, the patient was scheduled for a left pneumonectomy. Since the patient's partial oxygen concentration was adequate despite his left lung being nearly totally collapsed, we thought that we would be capable of performing the pneumonectomy using a single lumen tube (SLT). For a better surgical view, we planned lung isolation via insertion of a SLT deep into the bronchus. OUTCOMES: During pneumonectomy, after tracheal suction was performed, we tried a lung recruitment maneuver. Suddenly end-tidal carbon dioxide did not show on the monitor. The patient's blood pressure dropped and heart rate was decreasing. We thought that cardiopulmonary resuscitation was needed and an approximately 2 cm sized hematoma was removed from the endotracheal tube after vigorous suctioning. After getting rid of the hematoma, we changed the single tube to a double lumen tube (DLT). LESSONS: This case led us to the conclusion that a DLT should be used for safety when carrying out thoracic surgery. We report a rare case of an airway obstruction using a SLT during pneumonectomy.


Assuntos
Obstrução das Vias Respiratórias/etiologia , Complicações Intraoperatórias/etiologia , Pneumonectomia , Trombose/complicações , Humanos , Masculino , Pessoa de Meia-Idade
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