RESUMEN
Palatal tremor (PT) is a rare cause of objective tinnitus. Symptomatic PT is caused by injuries of the Guillain-Mollaret triangle with contraction of levator veli palatini. Essential PT causes are unknown and is produced by contraction of tensor veli palatini, with pathognomonic audible ear click. This is a case report of a 36-year-old female, who developed bilateral objective tinnitus, as well as vertigo, blepharospasm, and neck tension after a free fall trauma 30 metres in the net. She was diagnosed with essential PT and treated with botulinum neurotoxin injections in the soft palate.
Asunto(s)
Mioclonía , Acúfeno , Femenino , Humanos , Adulto , Acúfeno/etiología , Temblor/complicaciones , Temblor/diagnóstico , Músculos Palatinos , Paladar Blando , Mioclonía/complicacionesRESUMEN
Laryngeal dystonia (LD) is a rare neurological disorder emerging in middle-aged persons as a chronic and disabling voice disorder. It is a focal dystonia affecting intrinsic laryngeal muscle control only during speech, resulting in voice breaks, effortful phonation, and strangled voice. Due to lack of awareness and lack of well-defined diagnostic criteria, it can be difficult for patients to be diagnosed and treated. This review, the first Danish publication on the subject of LD, presents the latest terminology, a brief history, treatment options and the psychosocial consequences of LD.
Asunto(s)
Disfonía , Distonía , Persona de Mediana Edad , Humanos , Distonía/diagnóstico , Distonía/etiología , Distonía/terapia , Disfonía/diagnóstico , Disfonía/etiología , Disfonía/terapia , Músculos Laríngeos , ElectromiografíaRESUMEN
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.
Asunto(s)
Glotis/patología , Glotis/cirugía , Neoplasias Laríngeas/diagnóstico , Laringoscopía/métodos , Lesiones Precancerosas/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Área Bajo la Curva , Femenino , Glotis/irrigación sanguínea , Humanos , Cuidados Intraoperatorios , Enfermedades de la Laringe/diagnóstico , Enfermedades de la Laringe/patología , Enfermedades de la Laringe/cirugía , Neoplasias Laríngeas/irrigación sanguínea , Neoplasias Laríngeas/patología , Neoplasias Laríngeas/cirugía , Modelos Logísticos , Masculino , Persona de Mediana Edad , Lesiones Precancerosas/patología , Lesiones Precancerosas/cirugía , Cuidados Preoperatorios , Estudios Prospectivos , Sistema de Registros , Mucosa Respiratoria/irrigación sanguínea , Mucosa Respiratoria/patología , Mucosa Respiratoria/cirugía , Sensibilidad y Especificidad , Pliegues Vocales/irrigación sanguínea , Pliegues Vocales/patología , Pliegues Vocales/cirugíaRESUMEN
OBJECTIVES: "Cold-steel" phonosurgery (PS) of Reinke edema is challenging, as the delicate structures of the vocal folds are difficult to preserve. This study aimed to evaluate the results of PS using the Multidimensional Voice Program (MDVP) . MATERIALS AND METHODS: From 2003 to 2007, 76 consecutive patients with Reinke edema were treated with PS for the first time. Reliable MDVP data were available in 37 female patients with both pre- and postoperative values in 14 patients. Voice quality and outcome after PS were evaluated by jitter, shimmer, soft phonation index, and fundamental frequency (f0) using MDVP, videostroboscopy, and a five-step voice outcome score. RESULTS: In the 14 patients, the mean f0 increased from 172 to 222 (P = 0.01), and jitter decreased from 2.03 to 1.17 (P = 0.04) 3 months postoperatively. Vocal fold grading based on videostroboscopy correlated significantly with jitter (P = 0.01). Patients with high preoperative values of jitter, shimmer, or soft phonation index had larger reductions than those with normal values. All had a postoperative reduction of the edemas. The mean voice outcome score increased postoperatively. None of the 37 patients reported complications, but seven patients were reoperated. Preoperatively, 95% of the 37 patients were smokers and only 9 (24%) changed smoking habits. Pre- or postoperative voice therapy was used in 23 (62%) patients. CONCLUSIONS: f0 and jitter by MDVP adequately reflected the postoperative voice improvement and reduction of the edema. Removal of large amounts of edematous tissue, many years of vocal abuse, and unchanged smoking habits may prevent optimal results.
Asunto(s)
Edema Laríngeo/cirugía , Laringoscopía/métodos , Microcirugia/métodos , Fonación , Colgajos Quirúrgicos , Pliegues Vocales/cirugía , Calidad de la Voz , Acústica , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Edema Laríngeo/diagnóstico , Edema Laríngeo/fisiopatología , Laringoscopía/efectos adversos , Microcirugia/efectos adversos , Persona de Mediana Edad , Recuperación de la Función , Estudios Retrospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Fumar/efectos adversos , Estroboscopía , Factores de Tiempo , Resultado del Tratamiento , Grabación en Video , Pliegues Vocales/patología , Pliegues Vocales/fisiopatologíaRESUMEN
This article presents recommendations regarding early management of patients after intake of corrosive chemicals, based on best evidence and clinical experience. Risk assessment built on clinical history, presentation and endoscopy is discussed as well as initial treatment, surgical appraisal and observation. Controversy still surrounds the need for endoscopy in asymptomatic patients, the use of computed tomography in assessing the severity of lesions as well as pharmacological treatment for preventing strictures.
Asunto(s)
Quemaduras Químicas , Cáusticos/efectos adversos , Quemaduras Químicas/clasificación , Quemaduras Químicas/diagnóstico , Quemaduras Químicas/terapia , Deglución , Tracto Gastrointestinal/lesiones , Humanos , Medición de RiesgoRESUMEN
OBJECTIVES: Therapy with mesenchymal stem cells exhibits potential for the development of novel interventions for many diseases and injuries. The use of mesenchymal stem cells in regenerative therapy for vocal fold scarring exhibited promising results to reduce stiffness and enhance the biomechanical properties of injured vocal folds. This study evaluated the biomechanical effects of mesenchymal stem cell therapy for the treatment of vocal fold scarring. DATA SOURCES: PubMed, Embase, the Cochrane Library and Google Scholar were searched. METHODS: Controlled studies that assessed the biomechanical effects of mesenchymal stem cell therapy for the treatment of vocal fold scarring were included. Primary outcomes were viscoelastic properties and mucosal wave amplitude. RESULTS: Seven preclinical animal studies (n = 152 single vocal folds) were eligible for inclusion. Evaluation of viscoelastic parameters revealed a decreased dynamic viscosity (η') and elastic modulus (G'), i.e., decreased resistance and stiffness, in scarred vocal folds treated with mesenchymal stem cells compared to non-treated scarred vocal folds. Mucosal wave amplitude was increased in scarred vocal folds treated with mesenchymal stem cells vs. non-treated scarred vocal folds. CONCLUSION: The results from these studies suggest an increased regenerative effect of therapy with mesenchymal stem cells for scarred vocal folds and are encouraging for further clinical studies.
Asunto(s)
Cicatriz/terapia , Células Madre Mesenquimatosas/citología , Trasplante de Células Madre , Pliegues Vocales/patología , Animales , HumanosRESUMEN
PURPOSE: The Multi-Dimensional Voice Program (MDVP) is used for assessment of voice quality. A simple procedure for MDVP recordings was used in a randomized clinical trial (RCT) on induced vocal fold trauma due to intubation. This secondary study compares the common MDVP parameters with other normative values for adults and investigates the correlation between these MDVP parameters in relation to the "standardized" trauma of endotracheal intubation. METHODS: Preoperative and postoperative assessments of vocal fold pathology with flexible videolaryngoscopy and voice analysis with MDVP using the best-of-three standardized recording were performed in 121 patients with normal voices included consecutively in the RCT. The procedures of anesthesia were standardized. RESULTS: The normative MDVP values of this study are consistently lower compared with most normative values presented in other studies. The preoperative to postoperative differences in jitter values (jitter and relative average perturbation) were closely correlated to the shimmer values for patients with postoperative vocal fold edemas. In the patients with edema, the preoperative to postoperative differences in jitter had a correlation coefficient of 0.95 (P < 0.0001) to the difference in shimmer, compared with a correlation coefficient of 0.39 (P < 0.0001) in the patients without edema. CONCLUSIONS: This study supports the use of the "Best-of-Three" procedures for precise and relevant MDVP parameter calculations. The MDVP parameters, with closely correlated changes in jitter and shimmer values, accurately reflect the induced vocal fold edema when using the preoperative to postoperative changes.
Asunto(s)
Acústica , Intubación Intratraqueal/efectos adversos , Edema Laríngeo/diagnóstico , Fonación , Acústica del Lenguaje , Medición de la Producción del Habla/métodos , Pliegues Vocales/fisiopatología , Calidad de la Voz , Adulto , Anciano , Extubación Traqueal , Humanos , Edema Laríngeo/etiología , Edema Laríngeo/patología , Edema Laríngeo/fisiopatología , Laringoscopía , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Reproducibilidad de los Resultados , Encuestas y Cuestionarios , Resultado del Tratamiento , Grabación en Video , Pliegues Vocales/patologíaAsunto(s)
Neoplasias Óseas/patología , Hueso Hioides/patología , Anciano de 80 o más Años , Neoplasias Óseas/diagnóstico por imagen , Neoplasias Óseas/cirugía , Quiste Coloide/diagnóstico por imagen , Quiste Coloide/patología , Quiste Coloide/cirugía , Humanos , Hueso Hioides/diagnóstico por imagen , Hueso Hioides/cirugía , Masculino , Tomografía Computarizada por Rayos XRESUMEN
This article investigates the extent to which biosecurity measures are recognized and have been implemented in the Nordic countries, in the absence of formalized security standards and legislation. Two trials were undertaken: first, a broad combined biosafety and biosecurity questionnaire survey of the Nordic countries, and, second, a focused on-site audit of 22 facilities, with 94 laboratories, in Denmark. Both trials indicated that external security had been partially implemented but that little attention had been paid to internal security and the establishment of biosecurity. It was demonstrated that the backgrounds and identities of insiders were rarely checked and that they could have gained access to both pathogen inventory lists and freezers in many facilities. In 81% of pathogen-containing facilities, pathogens were not routinely and centrally accounted for. The authors recommend the establishment of a legal framework congruent with international standards and obligations; novel governmental national biosecurity authorities, requiring a fusion of both microbiological and technical expertise and legislative powers; and the formulation of a new code of conduct termed "Good Biosecurity Practice."
Asunto(s)
Bioterrorismo/prevención & control , Medidas de Seguridad/organización & administración , Auditoría Administrativa , Países Escandinavos y Nórdicos , Encuestas y CuestionariosRESUMEN
The aim of this short review is to present the Danish experience with the U.K. anthrax vaccine as compared with international reviews regarding the immunological response, efficiency, safety and adverse reactions of the U.K. and U.S. anthrax vaccines.
Asunto(s)
Vacunas contra el Carbunco/normas , Carbunco/prevención & control , Bioterrorismo/prevención & control , Vacunas contra el Carbunco/administración & dosificación , Vacunas contra el Carbunco/efectos adversos , Antibacterianos/administración & dosificación , Ciprofloxacina/administración & dosificación , Dinamarca , Humanos , SeguridadRESUMEN
INTRODUCTION: Disease outbreak monitoring is relevant not only for naturally occurring diseases but also for detecting a biological terror event. Surveillance systems are already operational in Denmark, but none of these has the high update frequencies necessary for early warning, and the majority monitor specific infectious diseases. MATERIALS AND METHODS: An early-warning system for detection of disease outbreaks in Denmark based on ambulance transport frequency was developed and tested employing a biological outbreak scenario. RESULTS: The system, termed "Bioalarm", demonstrated an ability to adapt to minor statistical variations due to, e.g., mild influenza epidemics and at the same time to elicit an early warning in the event of a outbreak consistent with a bioterrorist attack. CONCLUSION: Bioalarm not only is relevant for early warning of a disease outbreak as a result of a biological attack but also facilitates early detection of naturally occurring outbreaks.