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[PMID]:29443747
[Au] Autor:Pu S; Xu H; Li X
[Ad] Endereço:Department of Otolaryngology-Head and Neck Surgery, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China.
[Ti] Título:Supraglottoplasty in neonates and infants: A radiofrequency ablation approach.
[So] Source:Medicine (Baltimore);97(7):e9850, 2018 Feb.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Supraglottoplasty is the mainstay of surgical treatment for laryngomalacia. A novel supraglottoplasty surgical technique is needed to achieve better efficacy. The purpose of this study was to introduce modified microscopic radiofrequency ablation supraglottoplasty (MMRAS) for the treatment of congenital laryngomalacia and to evaluate the outcome and effectiveness of this novel approach. METHODS: Seventeen children with severe laryngomalacia who underwent MMRAS were studied retrospectively. Supraglottoplasty of type III laryngomalacia was different from classical method. All the patients were kept intubated for 5 days after surgery to achieve a better epiglottal position and to avoid reconglutination of aryepiglottic folds. The patients' demographic information, symptoms, comorbidities, type of laryngomalacia, synchronous airway lesions and final outcomes were examined. RESULTS: The median age at the time of surgery was 3.36 months (3 months 10 days). Operative indications included feeding difficulties, noisy breathing or respiratory distress (or both), and sleep-related symptoms. The MMRAS success rate was 82.4%. Most patients were extubated successfully on postoperative day 5. The major postoperative complication was pulmonary infection which occurred in 3 cases (17.6%) and required anti-infective therapy. No perioperative deaths and no long-term complications occurred. Failures were observed in 3 (17.6%) of 17 cases, 2 patients presented with a neurological disease and required tracheostomy, 1 patient relapsed because of postoperative adhesions and later underwent revision supraglottoplasty. CONCLUSIONS: From these results, we conclude that MMRAS is an effective and safe treatment for symptomatic laryngomalacia and has the potential to provide better breathing, feeding, and sleeping outcomes in children with severe laryngomalacia. Postoperative intubation for 5 days may result in better therapeutic outcomes. Multicenter cooperative studies of comparison between MMRAS and conventional approaches would lend further evidence-based support for this surgical method.
[Mh] Termos MeSH primário: Ablação por Cateter/métodos
Epiglote/cirurgia
Laringomalácia/cirurgia
Microcirurgia/métodos
Procedimentos Cirúrgicos Reconstrutivos/métodos
[Mh] Termos MeSH secundário: Feminino
Seres Humanos
Lactente
Recém-Nascido
Masculino
Estudos Retrospectivos
Resultado do Tratamento
[Pt] Tipo de publicação:EVALUATION STUDIES; JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180222
[Lr] Data última revisão:
180222
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180215
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009850


  2 / 2157 MEDLINE  
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[PMID]:29365380
[Au] Autor:Li LJ; Du C; Wang L; Yan Y; Zeng J; Xu CY; Sun SL
[Ad] Endereço:Department of Otorhinolaryngology Head and Neck Surgery, Peking University Third Hospital, Beijing 100191, China.
[Ti] Título:[Application of endoscope assisted curved laryngoscopy technique in transoral laryngopharyngeal minimally invasive surgery].
[So] Source:Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi;53(1):45-48, 2018 Jan 07.
[Is] ISSN:1673-0860
[Cp] País de publicação:China
[La] Idioma:chi
[Ab] Resumo:To explore the possibility of endoscope assisted curved laryngoscopy technique applied in transoral laryngopharyngeal minimally invasive surgery and evaluate the advantages of this technique. Eight patients with huge benign lesions in larynx and pharynx undergoing transoral microsurgery at Peking University Third Hospital between February 2016 and February 2017 were enrolled in this study.The diagnosis included cyst at the base of tongue in two patients, cysts in the epiglottis in two patients, hemangioma in two patients, multiple masses of the hypopharynx and amyloidosis in supraglottic area in one patient each.The time and exposure during surgery, occurrence rate of complication and conditions of following-up were recorded. The mean time of surgery was 20 min, the exposure was satisfying.There was no obvious complication after surgery.No residual or recurrent lesion was observed after 1 to 12 months follow-up(mean time 4.5 months). The endoscope assisted curved laryngoscopy technique has advantages in shortening the time of surgery, improving exposure and reducing the rate of complication and recurrence.
[Mh] Termos MeSH primário: Doenças da Laringe/cirurgia
Laringoscópios
Laringoscopia/instrumentação
Laringoscopia/métodos
[Mh] Termos MeSH secundário: Amiloidose/cirurgia
Cistos/cirurgia
Epiglote/cirurgia
Desenho de Equipamento
Hemangioma/cirurgia
Seres Humanos
Hipofaringe/cirurgia
Microcirurgia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180215
[Lr] Data última revisão:
180215
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180125
[St] Status:MEDLINE
[do] DOI:10.3760/cma.j.issn.1673-0860.2018.01.010


  3 / 2157 MEDLINE  
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[PMID]:28766977
[Au] Autor:Tam K; Jeffery C; Sung CK
[Ad] Endereço:1 Stanford University School of Medicine, Stanford, California, USA.
[Ti] Título:Surgical Management of Supraglottic Stenosis Using Intubationless Optiflow.
[So] Source:Ann Otol Rhinol Laryngol;126(9):669-672, 2017 Sep.
[Is] ISSN:1943-572X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: Airway management during endoscopic surgical treatment of supraglottic and pharyngeal stenosis is often challenging and can be accomplished by various means, including tracheostomy, jet ventilation, or direct laryngoscopy. We describe CO laser excision of supraglottic-pharyngeal stenosis using intubationless Optiflow high-flow nasal cannula (HFNC). METHODS: A 55-year-old male presented with dyspnea and dysphagia secondary to severe supraglottic-pharyngeal stenosis in the setting of previous chemoradiation for a T0N2aM0 squamous cell carcinoma. Laryngoscopy revealed severe supraglottic-pharyngeal stenosis with tethering of the epiglottis to the lateral pharyngeal walls. Optiflow HFNC was used to deliver 70 L/min of oxygen. After anesthetic induction, CO laser microlaryngoscopy was utilized to release scar tissue along the lateral epiglottic border, opening up the supraglottic airway sufficiently for endotracheal intubation and further laser resection. RESULTS: Airway management with Optiflow HFNC allowed initial endoscopic surgical access, partial stenotic release, and intubation. From anesthetic induction to intubation, the patient remained apneic for 26 minutes. The patient's stenosis was successfully addressed, and 10-month follow-up demonstrated stable patency of the airway. CONCLUSION: Optiflow is an important new tool in the management of severe supraglottic stenosis. It provides sufficient oxygenation to perform extended apneic surgery and improves endoscopic surgical access in a limited airway.
[Mh] Termos MeSH primário: Obstrução das Vias Respiratórias/cirurgia
Cânula
Transtornos de Deglutição/cirurgia
Epiglote/cirurgia
Laringoscopia/métodos
Terapia a Laser/métodos
Oxigenoterapia/instrumentação
Doenças Faríngeas/cirurgia
[Mh] Termos MeSH secundário: Obstrução das Vias Respiratórias/etiologia
Carcinoma de Células Escamosas/terapia
Quimiorradioterapia/efeitos adversos
Constrição Patológica/etiologia
Constrição Patológica/cirurgia
Transtornos de Deglutição/etiologia
Neoplasias de Cabeça e Pescoço/terapia
Seres Humanos
Intubação Intratraqueal
Lasers de Gás/uso terapêutico
Masculino
Meia-Idade
Oxigenoterapia/métodos
Doenças Faríngeas/etiologia
Neoplasias Faríngeas/terapia
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170821
[Lr] Data última revisão:
170821
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170803
[St] Status:MEDLINE
[do] DOI:10.1177/0003489417720220


  4 / 2157 MEDLINE  
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[PMID]:28651794
[Au] Autor:Genta PR; Sands SA; Butler JP; Loring SH; Katz ES; Demko BG; Kezirian EJ; White DP; Wellman A
[Ad] Endereço:Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil. Electronic address: p
[Ti] Título:Airflow Shape Is Associated With the Pharyngeal Structure Causing OSA.
[So] Source:Chest;152(3):537-546, 2017 Sep.
[Is] ISSN:1931-3543
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: OSA results from the collapse of different pharyngeal structures (soft palate, tongue, lateral walls, and epiglottis). The structure involved in collapse has been shown to impact non-CPAP OSA treatment. Different inspiratory airflow shapes are also observed among patients with OSA. We hypothesized that inspiratory flow shape reflects the underlying pharyngeal structure involved in airway collapse. METHODS: Subjects with OSA were studied with a pediatric endoscope and simultaneous nasal flow and pharyngeal pressure recordings during natural sleep. The mechanism causing collapse was classified as tongue-related, isolated palatal, lateral walls, or epiglottis. Flow shape was classified according to the degree of negative effort dependence (NED), defined as the percent reduction in inspiratory flow from peak to plateau. RESULTS: Thirty-one subjects with OSA (mean apnea-hypopnea index score ± SD, 54 ± 27 events/h) who were 50 ± 9 years of age were studied. NED was associated with the structure causing collapse (P < .001). Tongue-related obstruction (n = 13) was associated with a small amount of NED (median, 19; interquartile range [IQR], 14%-25%). Moderate NED was found among subjects with isolated palatal collapse (median, 45; IQR, 39%-52%; n = 8) and lateral wall collapse (median, 50; IQR, 44%-64%; n = 8). The epiglottis was associated with severe NED (median, 89; IQR, 78%-91%) and abrupt discontinuities in inspiratory flow (n = 9). CONCLUSIONS: Inspiratory flow shape is influenced by the pharyngeal structure causing collapse. Flow shape analysis may be used as a noninvasive tool to help determine the pharyngeal structure causing collapse.
[Mh] Termos MeSH primário: Inalação/fisiologia
Faringe/patologia
Apneia Obstrutiva do Sono/etiologia
Apneia Obstrutiva do Sono/patologia
[Mh] Termos MeSH secundário: Adulto
Resistência das Vias Respiratórias/fisiologia
Broncoscopia
Epiglote/patologia
Epiglote/fisiopatologia
Feminino
Seres Humanos
Capacidade Inspiratória
Masculino
Pressões Respiratórias Máximas
Meia-Idade
Palato/patologia
Palato/fisiopatologia
Faringe/fisiopatologia
Apneia Obstrutiva do Sono/fisiopatologia
Língua/patologia
Língua/fisiopatologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170922
[Lr] Data última revisão:
170922
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170628
[St] Status:MEDLINE


  5 / 2157 MEDLINE  
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[PMID]:28497615
[Au] Autor:Gale DC; Bhatt NK; Paniello RC
[Ad] Endereço:Department of Otolaryngology, Washington University School of Medicine, St. Louis, Missouri, U.S.A.
[Ti] Título:Quantification of rat supraglottic laryngeal sensation threshold.
[So] Source:Laryngoscope;127(8):E265-E269, 2017 Aug.
[Is] ISSN:1531-4995
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: Laryngeal adductor response (LAR) to air puff is used as a reliable method in evaluating sensation thresholds (ST) in human laryngeal sensory disorders. This method has been difficult to perform in small subjects such as rodents. The aims of this study were to 1) evaluate ST to air puff under binocular microlaryngoscopy in rats to evaluate laryngeal sensory disorders, 2) determine sensory thresholds at varying target locations, and 3) determine the ideal depth of anesthesia. STUDY DESIGN: Animal study. METHODS: Rats were induced with ketamine/xylazine. The level of anesthesia was monitored by spontaneous glottic closure and corneal reflex testing. Air puffs were delivered to the epiglottis, arytenoid, and piriform sinus at varied pressures with pulse time kept constant. Sensation thresholds were determined by direct visualization of the larynx using a binocular microscope. Topical lidocaine was then applied to the larynx and ST was determined. Trials were repeated in a small subset of animals. RESULTS: Twenty-six trials were performed in 14 rats. Mean STs were 39 ± 9.7 mm Hg at the epiglottis, 48.8 ± 10.5 at the arytenoid, and not detectable at the pyriform sinus. Repeated trials demonstrated consistent results. Lidocaine effectively ablated the LAR in each trial. The LAR was difficult to induce while corneal reflex was absent and was difficult to distinguish from spontaneous glottic closures while under lighter sedation. CONCLUSION: Air pulse stimulation in rats is a simple, reliable, and effective way to determine laryngopharyngeal STs in rats and can be used as an efficient and affordable method for experimentation involving laryngeal sensory disorders. LEVEL OF EVIDENCE: NA. Laryngoscope, 127:E265-E269, 2017.
[Mh] Termos MeSH primário: Epiglote/fisiopatologia
Laringoscopia
Transtornos das Sensações/fisiopatologia
[Mh] Termos MeSH secundário: Anestesia
Animais
Laringoscopia/métodos
Masculino
Ratos
Ratos Sprague-Dawley
Limiar Sensorial
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170828
[Lr] Data última revisão:
170828
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170513
[St] Status:MEDLINE
[do] DOI:10.1002/lary.26500


  6 / 2157 MEDLINE  
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[PMID]:28493349
[Au] Autor:Shapira Galitz Y; Shoffel-Havakuk H; Cohen O; Halperin D; Lahav Y
[Ad] Endereço:Department of Otolaryngology-Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel, affiliated with the Hebrew University of Jerusalem, Israel.
[Ti] Título:Adult acute supraglottitis: Analysis of 358 patients for predictors of airway intervention.
[So] Source:Laryngoscope;127(9):2106-2112, 2017 Sep.
[Is] ISSN:1531-4995
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES/HYPOTHESIS: Acute supraglottitis is a potentially life-threatening condition due to rapid onset upper airway obstruction. The study aimed to characterize adult acute supraglottitis patients and to recognize factors associated with an aggressive disease course. STUDY DESIGN: Retrospective chart review. METHODS: All adult acute supraglottitis patients admitted to a single academic medical center between 2000 and 2014 were included and their medical charts reviewed. The main outcome measures were airway intervention and mortality. RESULTS: Three hundred fifty-eight patients were enrolled. Mean age was 53 years (range, 16-92 years), with 62.8% males. Sore throat (79%) and dysphagia (70.9%) were the most common symptoms. Stridor (3.6%), tachypnea (5.7%), and dyspnea (6.4%) were uncommon but significantly associated with airway intervention. The epiglottis was most commonly involved (67%). Involvement of the epiglottis and aryepiglottic folds showed a trend of correlation to airway intervention. Blood glucose levels, C-reactive protein (CRP) levels, and relative neutrophilia were significantly higher in patients admitted to the intensive care unit or requiring airway intervention. Thirty-four patients (9.5%) required intensive care unit admission. Sixteen patients (4.4%) required airway intervention. Recurrent episodes of supraglottitis, seen in 19 patients, were more common in males (P = .048), and tended to have a more severe clinical course, requiring more airway interventions (P = .005) and intensive care unit admissions (P = .016). CONCLUSIONS: The typical high risk patient-a male, with dyspnea and stridor, presenting with edema of the epiglottis and aryepiglottic folds, elevated CRP, hyperglycemia, and a history of recurrent episodes-should warrant more aggressive treatment and closer observation. LEVEL OF EVIDENCE: 4 Laryngoscope, 127:2106-2112, 2017.
[Mh] Termos MeSH primário: Obstrução das Vias Respiratórias/etiologia
Progressão da Doença
Gravidade do Paciente
Supraglotite/patologia
[Mh] Termos MeSH secundário: Doença Aguda
Adolescente
Adulto
Idoso
Idoso de 80 Anos ou mais
Obstrução das Vias Respiratórias/terapia
Glicemia/análise
Proteína C-Reativa/análise
Transtornos de Deglutição/etiologia
Dispneia/etiologia
Epiglote/patologia
Feminino
Seres Humanos
Unidades de Terapia Intensiva/estatística & dados numéricos
Masculino
Meia-Idade
Neutrófilos
Admissão do Paciente/estatística & dados numéricos
Faringite/etiologia
Recidiva
Sons Respiratórios/etiologia
Estudos Retrospectivos
Medição de Risco/métodos
Fatores de Risco
Supraglotite/complicações
Supraglotite/mortalidade
Adulto Jovem
[Pt] Tipo de publicação:EVALUATION STUDIES; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Blood Glucose); 9007-41-4 (C-Reactive Protein)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170915
[Lr] Data última revisão:
170915
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170512
[St] Status:MEDLINE
[do] DOI:10.1002/lary.26609


  7 / 2157 MEDLINE  
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[PMID]:28329099
[Au] Autor:Marques M; Genta PR; Sands SA; Azarbazin A; de Melo C; Taranto-Montemurro L; White DP; Wellman A
[Ad] Endereço:Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
[Ti] Título:Effect of Sleeping Position on Upper Airway Patency in Obstructive Sleep Apnea Is Determined by the Pharyngeal Structure Causing Collapse.
[So] Source:Sleep;40(3), 2017 Mar 01.
[Is] ISSN:1550-9109
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Objectives: In some patients, obstructive sleep apnea (OSA) can be resolved with improvement in pharyngeal patency by sleeping lateral rather than supine, possibly as gravitational effects on the tongue are relieved. Here we tested the hypothesis that the improvement in pharyngeal patency depends on the anatomical structure causing collapse, with patients with tongue-related obstruction and epiglottic collapse exhibiting preferential improvements. Methods: Twenty-four OSA patients underwent upper airway endoscopy during natural sleep to determine the pharyngeal structure associated with obstruction, with simultaneous recordings of airflow and pharyngeal pressure. Patients were grouped into three categories based on supine endoscopy: Tongue-related obstruction (posteriorly located tongue, N = 10), non-tongue related obstruction (collapse due to the palate or lateral walls, N = 8), and epiglottic collapse (N = 6). Improvement in pharyngeal obstruction was quantified using the change in peak inspiratory airflow and minute ventilation lateral versus supine. Results: Contrary to our hypothesis, patients with tongue-related obstruction showed no improvement in airflow, and the tongue remained posteriorly located while lateral. Patients without tongue involvement showed modest improvement in airflow (peak flow increased 0.07 L/s and ventilation increased 1.5 L/min). Epiglottic collapse was virtually abolished with lateral positioning and ventilation increased by 45% compared to supine position. Conclusions: Improvement in pharyngeal patency with sleeping position is structure specific, with profound improvements seen in patients with epiglottic collapse, modest effects in those without tongue involvement and-unexpectedly-no effect in those with tongue-related obstruction. Our data refute the notion that the tongue falls back into the airway during sleep via gravitational influences.
[Mh] Termos MeSH primário: Faringe/fisiopatologia
Postura/fisiologia
Apneia Obstrutiva do Sono/fisiopatologia
Sono/fisiologia
[Mh] Termos MeSH secundário: Adulto
Idoso
Endoscopia
Epiglote/fisiopatologia
Feminino
Seres Humanos
Masculino
Meia-Idade
Palato/fisiopatologia
Pressão
Respiração
Língua/fisiopatologia
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170627
[Lr] Data última revisão:
170627
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170323
[St] Status:MEDLINE
[do] DOI:10.1093/sleep/zsx005


  8 / 2157 MEDLINE  
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[PMID]:28291399
[Au] Autor:Schabbing KJ; Seaman JA
[Ad] Endereço:From the Atlantic Coast Veterinary Specialists, Bohemia, New York (K.J.S., J.A.S.); and Midwest Veterinary Referral Center, Chesterfield, Missouri (K.J.S.).
[Ti] Título:Resection and Primary Closure of Edematous Glossoepiglottic Mucosa in a Dog Causing Laryngeal Obstruction.
[So] Source:J Am Anim Hosp Assoc;53(3):180-184, 2017 May/Jun.
[Is] ISSN:0587-2871
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:An approximately 22 mo old male neutered English bulldog was evaluated for acute onset of dyspnea with suspected brachycephalic obstructive airway syndrome (BOAS). Laryngoscopic exam revealed diffuse, severe edema and static displacement of redundant glossoepiglottic (GE) mucosa causing complete obstruction of the larynx and epiglottic entrapment. Static displacement of the GE mucosa was observed and determined to be the overriding component of dyspnea in this patient with BOAS. Resection and primary closure with two separate, simple continuous sutures of the GE mucosa were performed. Resection and primary closure of the GE mucosa resolved the acute onset of dyspnea in this patient. Surgical correction of the stenotic nares, elongated soft palate, and everted laryngeal saccules were performed under the same anesthetic procedure. Static displacement of the GE mucosa may occur in patients with BOAS. Surgical resection and closure of the GE mucosa resolved this patient's dyspnea and is recommended in airway obstruction. It remains to be determined if primary closure and subsequent tensioning or scar tissue of the GE mucosa results in further complications related to restricted epiglottic movement.
[Mh] Termos MeSH primário: Doenças do Cão/cirurgia
Edema/veterinária
Epiglote/patologia
Doenças da Laringe/veterinária
Mucosa Respiratória/patologia
[Mh] Termos MeSH secundário: Animais
Cães
Doenças da Laringe/cirurgia
Masculino
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170629
[Lr] Data última revisão:
170629
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170315
[St] Status:MEDLINE
[do] DOI:10.5326/JAAHA-MS-6423


  9 / 2157 MEDLINE  
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[PMID]:28241903
[Au] Autor:Lindquist B; Zachariah S; Kulkarni A
[Ad] Endereço:Former Emergency Medicine Resident in the Stanford/Kaiser Emergency Medicine Residency Program in Stanford, CA. blindquist2@gmail.com.
[Ti] Título:Adult Epiglottitis: A Case Series.
[So] Source:Perm J;21, 2017.
[Is] ISSN:1552-5775
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Emergency Departments are inundated by patients with respiratory illness during the winter months. Emergency physicians are required to quickly identify critically ill patients among the large volume of patients with mild upper respiratory illness. Among these life-threatening conditions is acute epiglottitis. CASE PRESENTATION: We report a rare series of four adult patients who presented to our Emergency Department during a period of only one week in April 2015 and were ultimately diagnosed with acute epiglottitis. Three of the patients improved with conservative measures and were observed in the intensive care unit. One patient required an emergent tracheostomy. DISCUSSION: This series of patients is unique in that all four patients presented to a single Emergency Department within a few days of each other and, despite a myriad of presenting chief complaints, the patients were eventually found to have the same potentially life-threatening diagnosis.These cases reinforce the variability of presenting symptoms and physical examination findings that can occur in patients with epiglottitis. They also highlight clinical findings and adjunctive testing that can help identify patients who would most benefit from intervention.
[Mh] Termos MeSH primário: Epiglote/patologia
Epiglotite/diagnóstico
[Mh] Termos MeSH secundário: Doença Aguda
Idoso
Serviço Hospitalar de Emergência
Epiglotite/complicações
Epiglotite/terapia
Feminino
Seres Humanos
Masculino
Meia-Idade
Exame Físico
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170901
[Lr] Data última revisão:
170901
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170301
[St] Status:MEDLINE


  10 / 2157 MEDLINE  
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[PMID]:28012601
[Au] Autor:Rathi A; Rathi S
[Ad] Endereço:Department of Otolaryngology and Head & Neck Surgery, Christian Medical College, Vellore, India. Electronic address: alokrathi14@gmail.com.
[Ti] Título:Relative imbalance as etiology of laryngomalacia - A new theory.
[So] Source:Med Hypotheses;98:38-41, 2017 Jan.
[Is] ISSN:1532-2777
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Laryngomalacia literally means weak larynx. It is the most common cause of noisy breathing in infants and children constituting around 70% of cases. Its aetiology is not clear and various theories are proposed. Treatment remains following the child with regular weight monitoring in view of expected spontaneous resolution. However we cannot predict which child will resolve spontaneously and which child may need surgical intervention. We propose a new theory based on relative imbalance of demand supply of air, suggesting the increase in demand causing turbulent airflow, increasing suction pressure and causing collapse of laryngeal structures. This theory also helps us in predicting early, which child will resolve spontaneously and which child will need surgery. The methodology to evaluate hypothesis along with techniques and tools are also suggested.
[Mh] Termos MeSH primário: Laringomalácia/etiologia
Laringomalácia/cirurgia
Laringe/fisiopatologia
Respiração
[Mh] Termos MeSH secundário: Criança
Pré-Escolar
Endoscopia
Epiglote/fisiopatologia
Refluxo Gastroesofágico/patologia
Seres Humanos
Laringoscopia
Modelos Neurológicos
Modelos Teóricos
Volume de Ventilação Pulmonar
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170724
[Lr] Data última revisão:
170724
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161226
[St] Status:MEDLINE



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