Asunto(s)
Carcinoma de Células Escamosas/complicaciones , Seno Carotídeo , Neoplasias de Cabeza y Cuello/complicaciones , Síncope/etiología , Anciano , Biopsia con Aguja , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/secundario , Carcinoma de Células Escamosas/terapia , Endoscopía , Neoplasias de Cabeza y Cuello/diagnóstico , Neoplasias de Cabeza y Cuello/terapia , Humanos , Metástasis Linfática , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Síncope/diagnóstico , Tomografía Computarizada por Rayos XRESUMEN
Laryngeal electromyography is a valuable test to assess vocal cord paralysis in adults. This technique can be applied and adapted to the pediatric patient. In the operating room under general anesthesia and endoscopic guidance, bipolar hooked-wire electrodes are passed percutaneously through the anterior neck skin into both thyroarytenoid muscles. Electromyographic signals are evaluated during light anesthesia and on awakening. A critical appraisal of this technique is presented, including an analysis of sources of electrical interference in the operating room.
Asunto(s)
Electromiografía/métodos , Parálisis de los Pliegues Vocales/diagnóstico , Adolescente , Preescolar , Electrodos Implantados , Electromiografía/instrumentación , Femenino , Humanos , Lactante , Recién Nacido , Músculos Laríngeos/fisiopatología , Masculino , Parálisis de los Pliegues Vocales/fisiopatologíaRESUMEN
Major congenital synechiae of the oral cavity constitute a clinically confusing spectrum of abnormalities. On the basis of clinical data, we propose two categories: 1) abnormalities secondary to persistence of the buccopharyngeal membrane and 2) abnormalities secondary to formation of ectopic membranes. An ectopic membrane results from abnormal fusion and can be subclassified as a subglossopalatal membrane, glossopalatal ankylosis, or syngnathia. This classification is supported by embryologic studies and is used to reclassify all cases reported since 1900. Distinct differences, such as the presence of associated limb anomalies, emerge; these are reviewed and add support to the proposed classification.
Asunto(s)
Anomalías Maxilomandibulares/clasificación , Anomalías de la Boca/clasificación , Adherencias Tisulares/congénito , Anomalías Múltiples , Femenino , Humanos , Recién Nacido , Anomalías Maxilomandibulares/embriología , Masculino , Anomalías de la Boca/embriologíaRESUMEN
Laryngeal injection of botulinum toxin type A is currently the most effective method of treating spasmodic dysphonia. Botox, a crystalline preparation of botulinum toxin type A, is the only toxin approved for clinical use in the United States and is packaged in vials of 100 mouse units (MU). One MU corresponds to the calculated median lethal intraperitoneal dose (LD50) injected in mice. The logistic problems arising from the need for repeated injections of small amounts of Botox have been addressed by several investigators by refreezing unused Botox for use at a later time. Although FDA labeling recommends that Botox not used within 4 hours of reconstitution be discarded, data regarding degradation in potency after reconstitution and refreezing are not currently available. Using the LD50 Swiss-Webster mouse bioassay and statistical analysis by the Probit procedure, a 69.8% loss in potency was found when Botox was reconstituted, immediately frozen, and then assayed 2 weeks later (p < 0.0001). Statistically significant degradation in potency was seen after refrigerator storage for 12 hours (p = 0.007), but not for 6 hours (p = 0.16). Clinical implications regarding the dilution, use, and storage of Botox are discussed.