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Humanos , Femenino , Adulto , Epiglotis , Intubación Intratraqueal/clasificación , LaringoscopíaRESUMEN
BACKGROUND: Neurogenic tumors of the larynx are rare, with few cases having been reported in the literature. Schwannomas are responsible for 0.1% of all benign tumors of the larynx. They arise in the sheaths of the peripheral, autonomic, and cranial nerves. The objective of this report is to describe a case of a bulky laryngeal schwannoma, the surgical procedure for its removal, and the long-term patient follow-up. CASE PRESENTATION: A 19-year-old Brazilian woman presented to our institution with a complaint of progressive dyspnea over the preceding year, as well as dysphonia, dysphagia for solids, and globus pharyngeus. Direct rigid laryngoscopy showed a supraglottic tumor obstructing approximately 90% of the larynx. With the symptoms progressing to severe dyspnea, an emergency tracheostomy was performed. After infusion of intravenous contrast, magnetic resonance imaging revealed a mass lesion with intense, heterogeneous contrast enhancement along the posterior wall of the hypopharynx, blocking all of the lumen and measuring 2.8 cm and 2.2 cm at its largest diameters. The image suggested a neoplastic lesion. The patient underwent open surgery for tumor resection. Her postsurgical recovery was uncomplicated. Histopathology and immunohistochemistry revealed the tumor to be a laryngeal schwannoma. CONCLUSION: The definitive diagnosis of laryngeal lesions can be difficult, and histopathology plays a pivotal role. Laryngeal schwannomas are rare; however, tumors can become large and may ultimately lead to airway obstruction.
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Neoplasias Laríngeas , Laringe , Neurilemoma , Adulto , Brasil , Epiglotis/diagnóstico por imagen , Epiglotis/cirugía , Femenino , Humanos , Neoplasias Laríngeas/diagnóstico por imagen , Neoplasias Laríngeas/cirugía , Laringectomía , Laringoscopía , Neurilemoma/diagnóstico por imagen , Neurilemoma/cirugía , Rotación , Adulto JovenRESUMEN
Dorsal displacement of the soft palate (DDSP) usually occurs in athletic adult horses. Congenital DDSP in foals secondary to the persistent frenulum of the epiglottis is rarely observed. The aim of this report was to describe a case of a seven-day-old female neonate Quarter Horse presenting dysphagia, milk reflux through the nostrils and mouth, and expiratory dyspnea since 4 days. Thoracic auscultation was indicative of aspiration pneumonia. Diagnosis of DDSP associated with local inflammation was made after endoscopic examination of upper respiratory tract. Radiographic examination was performed to rule out hypoplasia of the epiglottis. No clinical improvement was observed after anti-inflammatory treatment with flunixin meglumine. Oral endoscopy under general anesthesia revealed that the displacement of the soft palate was caused by a persistent frenulum of the epiglottis. Using a 30° rigid endoscope and a curved laparoscopic scissors, the frenulum was transected. After surgery, no dysphagia or dyspnea at rest was observed. However, discreet respiratory noise persisted during exercise for 5 days postoperatively. After discharge, the owner reported that the animal was completely normal during exercise. The animal is currently 3 years old and is developing a normal athletic performance. Persistent frenulum of the epiglottis should be considered while examining neonates with nasal milk reflux associated with expiratory dyspnea. This case report emphasizes the importance of the differential diagnosis for DDSP and for DDSP secondary to the persistent frenulum of the epiglottis in neonatal foals. It also underlines the importance of oral endoscopic examination for diagnosis.
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Enfermedades de los Caballos , Condicionamiento Físico Animal , Animales , Endoscopía/veterinaria , Epiglotis/cirugía , Femenino , Enfermedades de los Caballos/diagnóstico , Caballos , Recién Nacido , Paladar Blando/cirugíaRESUMEN
Se realizó un estudio prospectivo y descriptivo, incluyendo 103 pacientes que fueron tratados por cáncer de laringe en etapa inicial (T1-T2) con cirugía transoral. De ellos, 55 se diagnosticaron en estadio T1, 16 en estadio T1-b y 32 en estadio T2. El control local inicial (CLI) en pacientes con tumores malignos de laringe estadificados T1 fue 91%, el control local con rescate (CLR) 96%, la preservación de la función de la laringe (PFL) 93% y la sobrevida específica 96%. En T1-b, el CLI fue 81%, el CLR 94%, la PFL 94% y la sobrevida específica 94%. En T2, el CLI fue 63%, el CLR 94%, la PFL 72% y la sobrevida específica 78%. La cirugía transoral en cáncer de laringe con T inicial tiene resultados oncológicos similares a otros tratamientos (cirugía externa o radioterapia), pero consideramos que es la mejor opción por su baja morbilidad, menor duración del tratamiento, y porque deja abiertas todas las posibilidades para tratar posibles recurrencias. (AU)
A prospective and descriptive study was conducted, including 103 patients who were treated for early stage laryngeal cancer (T1-T2) with transoral surgery. Of these, 55 were diagnosed in stage T1, 16 in stage T1-b and 32 in stage T2. The initial local control (CLI) in patients with malignant T1 laryngeal tumors was: 91%, local control with rescue (CLR) 96%, preservation of larynx function (PFL) 93% and specific survival 96%. In T1-b the CLI was 81%, the CLR 94%, the PFL 94% and the specific survival 94%. In T2 the CLI was 63%, the CLR 94%, the PFL 72% and the specific survival 78%. Transoral surgery in laryngeal cancer with initial T has oncological results similar to other treatments (external surgery or radiotherapy), but we consider that it is the best option because of its low morbidity, shorter duration of treatment, and because it leaves open all the possibilities to treat possible recurrences. (AU)
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Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Neoplasias Laríngeas/cirugía , Recurrencia Local de Neoplasia/prevención & control , Complicaciones Posoperatorias/prevención & control , Procedimientos Quirúrgicos Operativos/métodos , Pliegues Vocales/patología , Calidad de la Voz , Traqueostomía/estadística & datos numéricos , Neoplasias Laríngeas/clasificación , Neoplasias Laríngeas/diagnóstico , Neoplasias Laríngeas/fisiopatología , Neoplasias Laríngeas/mortalidad , Neoplasias Laríngeas/radioterapia , Estudios Prospectivos , Epiglotis/patología , Duración de la Terapia , Intubación Gastrointestinal/estadística & datos numéricosRESUMEN
RESUMO Objetivo investigar o possível impacto da angulação do osso hioide na segurança da deglutição de pacientes submetidos à laringectomia supracricóidea. Métodos série de casos de 13 adultos, entre 48 e 79 anos, majoritariamente homens (n=11), submetidos à laringectomia supracricóidea em pós-operatório inferior ou igual a dez meses. Realizaram videofluoroscopia da deglutição de 5 ml de líquido fino, 5 ml de alimento pastoso e sólido, em livre oferta. A medida do ângulo do osso hioide foi definida por duas linhas: uma tangente à margem superior do corpo do osso hioide e uma tangente ao ponto mais inferior de sua margem inferior, paralela ao plano horizontal da imagem. O desfecho de aspiração durante o exame seguiu a escala desenvolvida por Rosenbek et al. (1996). Resultados Dos 13 pacientes, 5 apresentaram aspiração silente e 8 não apresentaram aspiração. Dos 5 indivíduos com aspiração, apenas 1 manteve preservadas ambas as cartilagens aritenoides em sua reconstrução e a angulação do osso hioide foi abaixo de 60º, em todos os casos. Dos 8 indivíduos sem aspiração laringotraqueal, a maioria (n=5) apresentava as duas cartilagens aritenoides em sua reconstrução e a angulação do osso hioide foi acima de 60º, em todos os casos. Conclusão uma angulação maior que 60º do osso hioide parece favorecer a proteção das vias aéreas inferiores e promover maior segurança do mecanismo de deglutição.
ABSTRACT Purpose to investigate the possible impact of hyoid bone angulation on swallowing safety in patients undergoing supracricoid laryngectomy. Methods the case series comprised 13 adults, between 48 and 79 years-old, male in its majority (n=11), within ten months or less post-supracricoid laryngectomy and cricohyoidoepiglottopexy. All volunteers were submitted to videofluroscopy at rest and during swallowing of 5 ml of thin fluid, 5 ml of pureed consistency and dry solid food. Images were captured in lateral view. The hyoid angle was taken at rest and defined by two lines: a tangent to the upper margin of the body of the hyoid bone and a horizontal line, tangent to the lowest point of its lower margin. The aspiration was assessed using the scale developed by Rosenbek et al. (1996). Results five cases had silent aspiration and eight had no aspiration. In the group with silent aspiration, only one individual had both arytenoid cartilages preserved, while all individuals had the hyoid bone angle below 60º. In the group without aspiration, five individuals had both cricoarytenoids preserved, while all cases had the average hyoid bone angle above 60º. Conclusion the hyoid bone being at an angle greater than 60º seemed to increase the protection of the lower airways, promoting a safer swallowing mechanism.
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Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Trastornos de Deglución/diagnóstico por imagen , Hueso Hioides/fisiopatología , Laringectomía/efectos adversos , Laringectomía/rehabilitación , Carcinoma de Células Escamosas , Neoplasias Laríngeas/cirugía , Estudios Transversales , Cartílago Cricoides/cirugía , Epiglotis/cirugíaRESUMEN
Introducción: la tuberculosis epiglótica constituye una entidad rara, cuya frecuencia ha experimentado un aumento en los últimos años, secundaria al desarrollo de nuevos métodos diagnósticos y el incremento en la esperanza de vida. Típicamente se presenta en personas inmunocomprometidas, siendo más frecuentes los casos secundarios a una infección primaria pulmonar. Presentación de caso: paciente adulto mayor que consulta por odinofagia y pérdida de peso de varios meses de evolución, se diagnosticó el cuadro inicialmente como una infección respiratoria alta. Al no presentar mejoría es referido al servicio de gastroenterología donde se realizó endoscopia digestiva alta, en la que se evidenció una lesión granulomatosa a nivel de epiglotis. Por histopatología se confirma diagnóstico de tuberculosis. Conclusiones: la tuberculosis epiglótica es una entidad rara, representando menos del 1% de las causas de tuberculosis extra pulmonar.
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Humanos , Masculino , Femenino , Tuberculosis , Deglución , Endoscopía , Epiglotis , Huésped Inmunocomprometido , Ecuador , Absceso PulmonarRESUMEN
OBJECTIVE: Drug-induced sleep endoscopy (DISE) has gained interest for upper airway evaluation in patients with snoring and obstructive sleep apnea (OSA), and different drugs have been used to induce sedation. Nevertheless, all drugs have presented specific advantages and disadvantages with differential effects on respiratory physiology. This study evaluated and compared the effects of midazolam, propofol and dexmedetomidine on DISE findings, O2 nadir, and bispectral index (BIS) in the same sample of patients. STUDY DESIGN: Case series prospective study. METHODS: Consecutive patients who elected to undergo surgery for OSA treatment and were intolerant to conservative therapies underwent DISE with propofol, dexmedetomidine, and midazolam between July 2015 and July 2016. RESULTS: Fifty-two patients were analyzed, and 43 (82.7%) were men. Agreement among drugs for both degree and patterns of obstruction was excellent at all sites (velum, oropharynx, and epiglottis) except for the tongue base. Dexmedetomidine had the least complete collapse sites and highest O2 nadir and was the only drug for which apnea severity and obstruction levels (upper, lower, or combined) were correlated. The variability among drug treatments for the BIS index was considerable, and propofol had the lowest variability and average value. CONCLUSION: Drug selection had a relevant influence in DISE findings. Compared with dexmedetomidine, midazolam and propofol presented higher incidence of tongue base collapse, lower O2 levels, and lower BIS index values. Propofol resulted in an O2 nadir that most resembled that observed during polysomnography. The BIS index variability differed among drugs, and its use was considered relevant for sedation orientation. LEVEL OF EVIDENCE: 4 Laryngoscope, 129:506-513, 2019.
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Endoscopía/métodos , Hipnóticos y Sedantes/farmacología , Polisomnografía/métodos , Apnea Obstructiva del Sueño/diagnóstico , Sueño/efectos de los fármacos , Adulto , Dexmedetomidina/farmacología , Epiglotis/efectos de los fármacos , Femenino , Humanos , Masculino , Midazolam/farmacología , Persona de Mediana Edad , Nariz/efectos de los fármacos , Orofaringe/efectos de los fármacos , Propofol/farmacología , Estudios Prospectivos , Lengua/efectos de los fármacos , Adulto JovenRESUMEN
INTRODUCTION: Laryngomalacia (LM) is the first cause of stridor in infants. 10 to 20% of patients with LM may require surgery due to the development of severe symptoms. Supraglottoplasty is the most commonly performed surgery for severe LM. However, it is insufficient for the rostrocaudal displacement of the epiglottis against the posterior pharyngeal wall. CASE SUMMARY: We report a case of a 2-month-old infant with severe laryngomalacia with a remarkable collapse of the epiglottis towards the glottis with secondary obstruction of the airway, alteration in swallowing and failure to thrive. The patient was treated satisfactorily through epiglottopexy by an external puncture. During a follow-up of 2 years, the patient has been asymptomatic, without any adverse event. DISCUSSION: Glottic obstruction from posterior epiglottic collapse is the most severe type of laryngomalacia, generating severe respiratory symptoms and failure to thrive. Epiglottopexy by external puncture is a new technique, certainly affordable since it does not require special instruments and it can be performed in medical centers through suspension laryngoscopy. It can be achieved alone or in combination with traditional supraglottoplasty.
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Obstrucción de las Vías Aéreas/cirugía , Epiglotis/cirugía , Enfermedades de la Laringe/cirugía , Laringomalacia/complicaciones , Punciones/métodos , Obstrucción de las Vías Aéreas/etiología , Humanos , Lactante , Enfermedades de la Laringe/complicaciones , Laringoscopía , Masculino , Prolapso , Ruidos Respiratorios/etiologíaRESUMEN
INTRODUCTION: Cardiovascular disease is the main cause of mortality worldwide. In women, its incidence increases at the sixth decade of life, coinciding with postmenopause. Whether this effect is due to menopause-related hormonal changes is not known. OBJECTIVE: To evaluate the differences in cardiovascular risk in pre- and postmenopausal women by means of the Globorisk risk scale, the triglyceride/high-density lipoproteinsHDL cholesterol (Tg/HDL-C) ratio and metabolic syndrome (MS) criteria. METHOD: Cross-sectional study that included 408 women from 40 to 60 years of age; anthropometric measurements and biochemical determinations were performed. The participants were classified as premenopausal and postmenopausal. Cardiovascular risk was assessed using the MS criteria, the Globorisk risk calculator and the Tg/HDL-C ratio. RESULTS: Postmenopausal women showed a significant increase in waist circumference, total cholesterol and triglycerides Tg in comparison with premenopausal women. Significant associations were found between hormonal state and Globorisk-measured cardiovascular risk (OR = 2.50; 95 % CI = 1.67-3.74) and the Tgtriglyceride/HDL-C ratio (OR = 1.66; 95 % CI = 1.09-2.52). CONCLUSION: Cardiovascular risk factors have a higher prevalence in postmenopause. The Globorisk scale and Tg/HDL-C ratio identify cardiovascular risk in postmenopausal women.
INTRODUCCIÓN: La laringectomía subtotal supracricoidea asociada con cricohioidoepiglotopexia es la técnica quirúrgica conservadora más eficiente para preservar las funciones laríngeas de los pacientes con carcinoma localmente avanzado de la laringe. La complicación más temida de esta intervención es la aspiración en el momento de la deglución y la neumonía secundaria; existen diversas formas de evaluar la aspiración y el grado de esta. Presentamos una novedosa forma de identificar incluso pequeñas cantidades de aspiración traqueobronquial. MÉTODO: Se incluyeron pacientes sometidos a laringectomía subtotal y cricohioidoepiglotopexia por cáncer laríngeo; todos evaluados con trago radiactivo posoperatorio. Con base en la sintomatología y resultado del gammagramma se decidió prolongar el tiempo de alimentación por sonda. RESULTADOS: Se incluyeron 37 pacientes, cuatro habían recibido radioterapia; la tasa de aspiración fue de 29.7 %; 50 % de los pacientes que habían recibido radioterapia presentó aspiración y 18 % de los pacientes con aspiración requirió prolongación del tiempo de alimentación por sonda nasogástrica; ninguno necesitó laringectomía total por aspiración que no permitiera la deglución. CONCLUSIONES: La evaluación posoperatoria de pacientes sometidos a laringectomía subtotal con trago radiactivo permite identificar líquido aspirado al árbol bronquial, incluso en cantidades mínimas, y planear el momento para iniciar la deglución.
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Carcinoma de Células Escamosas/cirugía , Deglución/fisiología , Neoplasias Laríngeas/cirugía , Laringectomía/métodos , Aspiración Respiratoria/etiología , Carcinoma de Células Escamosas/patología , Cartílago Cricoides/cirugía , Trastornos de Deglución/epidemiología , Trastornos de Deglución/etiología , Epiglotis/cirugía , Humanos , Hueso Hioides/cirugía , Neoplasias Laríngeas/patología , Aspiración Respiratoria/epidemiologíaRESUMEN
Vallecular cyst is more frequent in neonatal life, but could be present in adults. Frequently it is asymptomatic although some people has foreign body sensation upon swallowing and obstructive problems to sleep. The best treatment for these cases is complete resection, as recurrence is usual with any cyst remnant wall causing re-accumulation. We present the case of a patient with symptomatic vallecular cyst treated with transoral robotic surgery. The technique confirmed the advantages related with tridimensional vision close to the cyst, associated with multi-articulated 5 mm EndoWrist® instruments that made real safe and efficient surgery.
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Quistes/cirugía , Endoscopía , Epiglotis/cirugía , Enfermedades de la Laringe/cirugía , Procedimientos Quirúrgicos Robotizados , Quistes/diagnóstico por imagen , Epiglotis/diagnóstico por imagen , Humanos , Enfermedades de la Laringe/diagnóstico por imagen , Masculino , Persona de Mediana EdadRESUMEN
El quiste de vallécula congénito es una malformación de vía aérea poco frecuente que se manifiesta principalmente con estridor laríngeo y que puede plantear problemas diagnósticos y terapéuticos complejos, a menudo en situaciones de riesgo vital. Se presenta el caso de un recién nacido de pretérmino (RNPT) de 36 semanas pequeño edad gesta-cional (PEG), portador de un estridor laríngeo congénito y mal incremento pondoestatural que en relación a una infección respiratoria baja, presentó empeoramiento del estridor laríngeo a los 48 días de edad cronológica. Por insuficiencia respiratoria aguda requirió de intubación orotraqueal que no resultó dificultosa. La extubación fue fallida por presentar estridor inspiratorio franco. La nasofibroscopía demostró una lesión de aspecto quístico en base de lengua que desplazaba la epiglotis hacia posterior obstruyendo parcialmente el lumen de la vía aérea. Por laringoscopía directa se realizó marsupialización. Se realiza la revisión bibliográfica y se analiza el caso y su tratamiento.
Congenital vallecular cyst is a rare airway malformation mainly manifested by laryngeal stridor and could generate complex diagnostic and therapeutic problems, often in life-threatening situations. We present the case of a pre-term newborn of 36 weeks small for gestational age, who at 48 days of chronological age showed worsening of a congenital laryngeal stridor in the context of a lower respiratory tract infection associated to low weight gain from birth. For reasons of acute respiratory failure, orotracheal intubation was executed which was not difficult. Extubation was failed because the child presents significant inspiratory stridor. Nasofibroscopy showed a cystic lesion of the tongue base that pushed backward the epiglottis obstructing partially the airway lumen. Marsupialization was performed by direct laryngoscopy. A Bibliographic review was done and the case and its treatment are discuss.
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Humanos , Masculino , Lactante , Ruidos Respiratorios/etiología , Enfermedades de la Laringe/cirugía , Enfermedades de la Laringe/etiología , Quistes/complicaciones , Obstrucción de las Vías Aéreas/etiología , EpiglotisRESUMEN
Abstract Introduction The diode laser has been frequently used in the management of laryngeal disorders. The portability and functional diversity of this tool make it a reasonable alternative to conventional lasers. However, whether diode laser has been applied in transoral laser microsurgery, the ideal parameters, outcomes, and adverse effects remain unclear. Objective The main objective of this systematic review is to provide a reliable evaluation of the use of diode laser in laryngeal diseases, trying to clarify its ideal parameters in the larynx, as well as its outcomes and complications. Data Synthesis We included eleven studies in the final analysis. From the included articles, we collected data on patient and lesion characteristics, treatment (diode laser's parameters used in surgery), and outcomes related to the laser surgery performed. Only two studies were prospective and there were no randomized controlled trials. Most of the evidence suggests that the diode laser can be a useful tool for treatment of different pathologies in the larynx. In this sense, the parameters must be set depending on the goal (vaporization, section, or coagulation) and the clinical problem. Conclusion: The literature lacks studies on the ideal parameters of the diode laser in laryngeal surgery. The available data indicate that diode laser is a useful tool that should be considered in laryngeal surgeries. Thus, large, well-designed studies correlated with diode compared with other lasers are needed to better estimate its effects.
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Epiglotis/fisiopatología , Neoplasias Laríngeas , Terapia por Láser , Dióxido de Carbono , Pliegues Vocales/fisiopatologíaRESUMEN
Amiloidose é o depósito anormal extracelular de substância proteica fibrilar, insolúvel, mais comum em idosos, que pode ser resultado de um grande e heterogêneo grupo de transtornos e pode gerar danos e disfunção de variados órgãos potencialmente envolvidos. O envolvimento esofágico da amiloidose é incomum, assim como a epiglote, não é habitualmente foco primário de um linfoma não-Hodgkin (LNH). O presente relato apresenta um caso incomum de amiloidose esofágica relacionada à tuberculose pulmonar e ao linfoma não-Hodgkin de epiglote. Paciente de 79 anos, com queixa de disfagia progressiva e disfonia, há 2 anos. Radiografia contrastada de esôfago revelou estenose com irregularidade da mucosa no 1/3 superior de esôfago e a endoscopia digestiva alta evidenciou lesão infiltrativa e estenosante de esôfago torácico superior e médio, com aspecto neoplásico; porém, anatomopatológico das biópsias evidenciou mucosa escamosa própria do esôfago com acantose, papilomatose, apresentando, abaixo da mucosa, material amorfo eosinofílico e fragmentado que, após aplicação de corantes especiais (Vermelho Congo e Cristal Violeta), revelou tratar-se de depósito amiloide, confirmado por análise imuno-histoquímica. Durante investigação de outros órgãos acometidos, diagnosticado envolvimento linfonodal e pulmonar. Tentado tratamento sintomático do quadro de disfagia com dilatação com vela de Savary, além de uso de colchicina como tentativa de reduzir deposição de amiloide. Mais tarde, em investigação da etiologia da doença, descoberto Linfoma Não-Hodgkin de epiglote e tuberculose pulmonar como possíveis causas da mesma, sendo então encaminhada para tratamento quimioterápico e antituberculínico.
The lack of therapeutic options for celiac disease (CD) has become a relevant issue in the pharmaceutical sector, as a result of the improvement on technical diagnostic serological and the following increase in the number of individuals with confirmed diagnosis for this disease. To date, the only effective therapy to CD is the gluten-free diet, a seemingly simple treatment, but that has enormous repercussions in the social and nutritional habits of the patient. New findings on the complex pathogenic mechanism of CD allowed gradually the development of researches to look for new therapeutic options, among which we can highlight the oral intake of enzymes capable to hydrolyze the gluten, inhibitors of tissue transglutaminase enzyme, inhibitors of intestinal permeability, and tolerance induction of gluten. This study, besides to describing some features of celiac disease and its relationship with the structure of gluten, compiles information from several authors regarding the development of new treatment of this disease, with the goal of identifying therapeutic options that present the biggest advances and, therefore, has the potential to be at the disposal of celiac patients in a near future.
Asunto(s)
Humanos , Femenino , Anciano , Tuberculosis Pulmonar , Linfoma no Hodgkin , Epiglotis , Estenosis Esofágica , Esófago , AmiloidosisRESUMEN
Purpose When swallowing efficiency is impaired, residue accumulates in the pharynx. Cued or spontaneous swallows in the head neutral position do not always successfully clear residue. We investigated the impact of a novel maneuver on residue clearance by combining a head turn with the chin down posture. Methods Data were collected from 26 participants who demonstrated persistent vallecular residue after an initial head neutral clearance swallow in videofluoroscopy. Participants were cued to perform a head-turn-plus-chin-down swallow, with the direction of head turn randomized. Pixel-based measures of residue in the vallecular space before and after the maneuver were made on still frame lateral images using ImageJ software. Measures of % full and the Normalized Residue Ratio Scale (NRRS) were extracted. Univariate analyses of variance were used to detect significant reductions in residue. Results On average, pre-maneuver measures showed residue filling 56-73% of the valleculae, depending on stimulus consistency (NRRS scores: 0.2-0.4). More than 80% of pre-swallow measures displayed NRRS ratios > 0.06, a threshold previously linked to increased risk of post-swallow aspiration. Conclusion The head-turn-plus-chin-down maneuver achieved significant reductions in residue for thin and nectar-thick fluids, suggesting that this maneuver can be effective in reducing persistent vallecular residue with these consistencies.
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Trastornos de Deglución/prevención & control , Trastornos de Deglución/fisiopatología , Epiglotis/fisiopatología , Postura , Adulto , Anciano , Anciano de 80 o más Años , Análisis de Varianza , Mentón/fisiología , Deglución/fisiología , Femenino , Fluoroscopía/métodos , Humanos , Masculino , Persona de Mediana Edad , Faringe/fisiopatología , Reproducibilidad de los Resultados , Aspiración Respiratoria/prevención & control , Factores de Riesgo , Resultado del Tratamiento , Adulto JovenRESUMEN
ABSTRACT Purpose When swallowing efficiency is impaired, residue accumulates in the pharynx. Cued or spontaneous swallows in the head neutral position do not always successfully clear residue. We investigated the impact of a novel maneuver on residue clearance by combining a head turn with the chin down posture. Methods Data were collected from 26 participants who demonstrated persistent vallecular residue after an initial head neutral clearance swallow in videofluoroscopy. Participants were cued to perform a head-turn-plus-chin-down swallow, with the direction of head turn randomized. Pixel-based measures of residue in the vallecular space before and after the maneuver were made on still frame lateral images using ImageJ software. Measures of % full and the Normalized Residue Ratio Scale (NRRS) were extracted. Univariate analyses of variance were used to detect significant reductions in residue. Results On average, pre-maneuver measures showed residue filling 56-73% of the valleculae, depending on stimulus consistency (NRRS scores: 0.2-0.4). More than 80% of pre-swallow measures displayed NRRS ratios > 0.06, a threshold previously linked to increased risk of post-swallow aspiration. Conclusion The head-turn-plus-chin-down maneuver achieved significant reductions in residue for thin and nectar-thick fluids, suggesting that this maneuver can be effective in reducing persistent vallecular residue with these consistencies.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Anciano , Anciano de 80 o más Años , Adulto Joven , Postura , Trastornos de Deglución/fisiopatología , Trastornos de Deglución/prevención & control , Epiglotis/fisiopatología , Faringe/fisiopatología , Fluoroscopía/métodos , Reproducibilidad de los Resultados , Factores de Riesgo , Análisis de Varianza , Mentón/fisiología , Resultado del Tratamiento , Deglución/fisiología , Aspiración Respiratoria/prevención & control , Persona de Mediana EdadRESUMEN
AIM: Finger-sucking in early childhood can induce morphologic changes in the oropharynx and upper airways, which could arise even in children without reported oral breathing. The aim of this study was to compare cephalometric findings in children with and without finger sucking habit with respect to oral breathing. MATERIALS AND METHODS: Fifty-six children aged 4 to 12 years (28 with diagnosis of finger sucking and 28 controls) treated at the Port Colombia Dental Clinic underwent cephalometric radiographs, from which morphologic (n=11, whole skull), upper airways (n=10), hyoid bone (n=3) and postural (n=5) measurements were performed. The unpaired t-test was used for comparison between groups. RESULTS: Both groups had similar age and gender distribution (7.9 yrs ± 2.9; M/F: 14/14). Patients with finger-sucking habit had a higher hard palate length from the anterior nasal spine to the posterior nasal spine (finger-sucking subjects: 50.18 mm; controls: 46.91 mm; p = 0.0001) and distance from the epiglottic vallecula to the posterior pharyngeal wall (finger-sucking subjects: 15.55 mm; controls: 13.36 mm; p = 0.0231) than control subjects. Patients with finger-sucking habits also had a shorter distance from the posterior nasal spine to the adenoids (14.91 mm vs. 17.82 mm; p = 0.0173), wider cranial-cervical angles (105.64 mm vs. 101.6 mm; p = 0.05) and lower hyoid bone positioning (14.55 mm vs. 11.82 mm; p = 0.0125) than controls. CONCLUSION: Finger-sucking habit is associated with characteristic cephalometric changes even in children without oral breathing, especially at the hyoid bone and postural measurements.
Asunto(s)
Cefalometría/métodos , Succión del Dedo , Faringe/diagnóstico por imagen , Tonsila Faríngea/diagnóstico por imagen , Estudios de Casos y Controles , Vértebras Cervicales/diagnóstico por imagen , Niño , Preescolar , Epiglotis/diagnóstico por imagen , Femenino , Humanos , Hueso Hioides/diagnóstico por imagen , Masculino , Mandíbula/diagnóstico por imagen , Hueso Nasal/diagnóstico por imagen , Paladar Duro/diagnóstico por imagen , Postura/fisiología , Radiografía , Base del Cráneo/diagnóstico por imagenRESUMEN
Congenital epiglottic cyst is a rare embryonic disease. As a congenital laryngeal mucocele, its clinical manifestations include repeated sudden dyspneic respiration and even suffocation accompanied by laryngeal stridor after birth. During food intake, bucking and vomiting is a key feature. Delay in diagnosis and treatment of the disease affects growth and the development of neonatorum leading to suffocation and death. This study was designed to investigate the safety of anesthesia in infants with congenital epiglottic cyst during operation to reduce the occurrence of its complications. The treatment of operations on 12 infants with congenital epiglottic cysts were retrospectively analyzed. Twelve cases of infants with epiglottic cysts received emergency enucleation. Owing to adequate preanesthetic preparation, cystectomies were successfully performed with microwave cauterization under suspension laryngoscopy. None of the 12 patients showed apparent suffocation during anesthesia, the surgical results were good, and after 6 months to 1 year of follow-up, the disease had not recurred. Because of the acute onset of the disease and its severe symptoms and complications, attention should be paid to improve preoperative preparation. Careful selection of proper anesthesia is the key to achieving a successful operation.
Asunto(s)
Anestesia/métodos , Atropina/efectos adversos , Quistes/cirugía , Epiglotis/patología , Enfermedades de la Laringe/congénito , Anestesia/efectos adversos , Atropina/administración & dosificación , Quistes/congénito , Femenino , Humanos , Lactante , Recién Nacido , Enfermedades de la Laringe/cirugía , Laringoscopía , Masculino , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
A cutia (Dasyprocta sp.) é um roedor silvestre com distribuição mundial. Atualmente, além de importante papel ecológico que exerce, está sendo utilizada como modelo em experimento animal. Estudos sobre a morfologia destes animais são importantes porque podem ser uma alternativa para o estudo de diversos processos patológicos, além de contribuirem para a preservação da espécie. A laringe é um órgão localizado entre a faringe e a traqueia, no qual está envolvido nas funções de respiração, deglutição e fonação. O presente estudo propôs realizar uma descrição morfológica macroscópica e microscópica da laringe da cutia. Para tanto, foram utilizadas quinze cutias pertencentes ao Centro de Ciências Agrárias da Universidade Federal do Piauí e provenientes do Núcleo de Estudos e Preservação de Animais Silvestres com licença do IBAMA (Nº 02/08-618, CTF Nº 474064). Todos os animais foram identificados, promovida a sexagem e, posteriormente, a laringe acessada e dissecada sendo os fragmentos cartilagíneos encaminhados para rotina histológica e corados pelo método de hematoxilina-eosina. As lâminas obtidas foram visualizadas em microscopia óptica de luz e foto documentadas. A laringe da cutia apresenta cinco cartilagens, com ausência da cartilagem cuneiforme e presença da incisura caudal na cartilagem tireoide. O tecido epitelial da laringe varia de epitélio estratificado pavimentoso queratinizado à não queratinizado e ciliado com células caliciformes.
The agouti (Dasyprocta sp.) is a wild rodent with worldwide distribution. Besides its ecological role, agouti is used as a model in animal experimentation. Studies on the morphology of agouti are important because they can be an alternative for the study of various pathological processes and contribute to the preservation of the species. The larynx, located between the pharynx and trachea, is involved in the functions of breathing, swallowing and speech. This study aimed to perform a macroscopic and microscopic morphology of the larynx of agouti. To this end, we used fifteen agoutis belonging to the Centre of Agricultural Sciences, Federal University of Piauí, and from the Center for Study and Preservation of Wild Animals with license of IBAMA (No. 02/08-618, CTF No. 474064). All animals were identified according to their gender, the larynx was dissected and cartilaginous fragments were sent for routine histology and stained with hematoxylin-eosin. The slides obtained were viewed in light microscopy and photo documented. The larynx of agouti has five cartilages, without the cuneiform cartilage but presence of the thyroid cartilage notch. The epithelial tissue of the larynx varies from stratified squamous epithelium to keratinized and non-keratinized ciliated caliciforme cells.