RESUMEN
OBJECTIVE: Unilateral vocal fold immobility (UVFI) results in deficits in phonatory, respiratory, and swallow function of the pediatric patient. Little is known about long-term functional swallow outcomes. METHODS: Medical records of children diagnosed with UVFI between 2005 and 2014 at a tertiary children's hospital were retrospectively reviewed. Etiology, laryngoscopy findings, and swallow status at diagnosis and follow-up were recorded. Swallow outcomes were compared by etiology using Fisher's exact test. McNemar's test was used to identify correlations between return of mobility and swallow recovery. Rates of pneumonia were compared with initial swallow evaluation results using a two-tailed t-test. RESULTS: Eighty-eight patients with UVFI were identified and 73 patients (47% female, mean age 14.4 months, standard deviation (SD) 26.7 months) had complete medical records. Mean follow up time was 52.7 months (SD 36.8 months). Etiologies included cardiothoracic surgery (68.5%), idiopathic (12.3%), prolonged intubation (11.0%), central nervous system (CNS) abnormality (5.5%), and non-cardiac iatrogenic injury to the recurrent laryngeal nerve (2.7%). Forty-seven patients underwent a follow up laryngoscopy, and recovery of vocal fold (VF) mobility was documented in 42.6% (20/47). At diagnosis, 31.5% fed orally, compared with 79.5% at follow-up. Direct correlation between recovery of VF mobility and swallow recovery was not demonstrated. Cardiac etiologies demonstrated higher rates of swallow recovery than CNS abnormalities (p = 0.0393). Twenty-five children aspirated on initial modified barium swallow (MBS) and 10 children developed pneumonias at some point during the follow up period. There was no significant difference in rates of pneumonia in patients with and without aspiration on MBS. CONCLUSION: Recovery of swallow in children with UVFI does not directly parallel return of VF mobility. Long-term swallow outcome is favorable in this population. Initial MBS does not indicate ultimate swallow outcome.
Asunto(s)
Trastornos de Deglución/etiología , Parálisis de los Pliegues Vocales/complicaciones , Adolescente , Niño , Preescolar , Trastornos de Deglución/diagnóstico , Trastornos de Deglución/fisiopatología , Femenino , Humanos , Lactante , Laringoscopía , Masculino , Recuperación de la Función , Estudios Retrospectivos , Parálisis de los Pliegues Vocales/fisiopatología , Pliegues Vocales/fisiopatologíaRESUMEN
OBJECTIVE: There is a growing trend for the routine use of the facial nerve monitor (FNM) in chronic ear surgery. We aimed to examine current patterns in the use of FNMs in chronic ear surgery. STUDY DESIGN: Descriptive design (survey). SETTING: Academic health center. METHODS: A 10-question survey was designed to identify level of training, scope of practice, specific otologic surgeries where monitoring was most used, and the opinion of respondents regarding the use of FNMs as standard of care for chronic and/or middle ear surgery. A randomized list of 2000 board-certified members of the American Academy of Otolaryngology-Head and Neck Surgery was generated. One thousand subjects received a mailed survey with a self-addressed return envelope and 1000 subjects received an emailed survey through Surveymonkey.com. RESULTS: There were 359 (36%) surveys returned by mail and 258 (26%) surveys returned electronically. Forty-three percent of respondents were in private practice, and 31% were fellowship trained in otology/neurotology. Sixty-five percent used a FNM in their training and 95% had regular access to a FNM. Revision mastoid surgery, cholesteatoma, canal wall down mastoidectomy, and facial recess approach were the settings where a FNM was most used. Forty-nine percent of respondents felt that a FNM should be used as the standard of care in chronic ear surgery; this represents an increase from 32% in a similar study done approximately 10 years ago. CONCLUSION: There is a growing trend for routine facial nerve monitoring in the setting of chronic ear surgery.
Asunto(s)
Traumatismos del Nervio Facial/prevención & control , Monitoreo Intraoperatorio/métodos , Procedimientos Quirúrgicos Otológicos/métodos , Encuestas y Cuestionarios , Centros Médicos Académicos , Enfermedad Crónica , Enfermedades del Oído/diagnóstico , Enfermedades del Oído/cirugía , Femenino , Predicción , Encuestas de Atención de la Salud , Humanos , Masculino , Monitoreo Intraoperatorio/tendencias , Procedimientos Quirúrgicos Otológicos/efectos adversos , Pautas de la Práctica en Medicina/normas , Pautas de la Práctica en Medicina/tendencias , Estados UnidosRESUMEN
Ischemic pre-condition of an extremity (IPC) induces effects on local and remote tissues that are protective against ischemic injury. To test the effects of IPC on the normal hypoxic increase in pulmonary pressures and exercise performance, 8 amateur cyclists were evaluated under normoxia and hypoxia (13% F(I)O(2)) in a randomized cross-over trial. IPC was induced using an arterial occlusive cuff to one thigh for 5 min followed by deflation for 5 min for 4 cycles. In the control condition, the resting pulmonary artery systolic pressure (PASP) increased from a normoxic value of 25.6±2.3 mmHg to 41.8±7.2 mmHg following 90 min of hypoxia. In the IPC condition, the PASP increased to only 32.4±3.1 mmHg following hypoxia, representing a 72.8% attenuation (p=0.003). No significant difference was detected in cycle ergometer time trial duration between control and IPC conditions with either normoxia or hypoxia. IPC administered prior to hypoxic exposure was associated with profound attenuation of the normal hypoxic increase of pulmonary artery systolic pressure.
Asunto(s)
Presión Sanguínea/fisiología , Ejercicio Físico/fisiología , Hipoxia/fisiopatología , Precondicionamiento Isquémico , Adulto , Estudios Cruzados , Ecocardiografía Doppler en Color , Femenino , Humanos , Pierna/irrigación sanguínea , Masculino , Persona de Mediana Edad , Arteria Pulmonar/fisiologíaRESUMEN
The systemic administration of an agonist antibody against glucocorticoid-induced tumor necrosis factor receptor related (GITR) protein has been shown to be effective in overcoming immune tolerance and promoting tumor rejection in a variety of murine tumor models. However, little is known regarding the functional consequence of ligation of GITR with its natural ligand (GITR-L) in the context of regulatory T cell (Treg) suppression in vivo. To determine the mechanism of GITR-L action in vivo, we generated a panel of tumor cell clones that express varying levels of GITR-L. The ectopic expression of GITR-L on the tumor cell surface was sufficient to enhance anti-tumor immunity and delay tumor growth in syngeneic BALB/c mice. Within the range examined, the extent of anti-tumor activity in vivo did not correlate with the level of GITR-L expression, as all clones tested exhibited a similar delay in tumor growth. The localized expression of GITR-L on tumor cells led to a significant increase in CD8+ T cell infiltration compared to the levels seen in control tumors. The increased proportion of CD8+ T cells was only observed locally at the tumor site and was not seen in the tumor draining lymph node. Depletion studies showed that CD8+ T cells, but not CD4+ T cells, were required for GITR-L mediated protection against tumor growth. These studies demonstrate that signaling between GITR-L and GITR in the tumor microenvironment promotes the infiltration of CD8+ T cells, which are essential for controlling tumor growth.