RESUMO
OBJECTIVE: We report the case of an osteoblastoma of the larynx arising from the vocal fold, which presented with acute airway obstruction and cardiopulmonary arrest. METHOD: The histopathological findings, differential diagnoses and a novel method of treating laryngeal osteoblastoma, using transoral laser therapy, are discussed. RESULTS: Benign osteoblastoma is a rare primary bone tumour usually presenting in young patients in the spine and sacrum. Its occurrence in the larynx is very rare, with only three similar case reports in the literature, none involving tumour arising from the vocal fold. Differential diagnoses must be considered and excluded using both histopathological and clinical features. Once the diagnosis is confirmed, successful treatment is achieved with surgical excision. CONCLUSION: Osteoblastoma of the larynx is rare, and the clinical features can vary with the anatomical site of the lesion. The recommended treatment is surgical excision which, if available, may be achieved by transoral laser microsurgery. Due to its potential rapid growth, careful follow up is essential in order to detect recurrence.
Assuntos
Obstrução das Vias Respiratórias/etiologia , Neoplasias Laríngeas/complicações , Osteoblastoma/complicações , Idoso , Obstrução das Vias Respiratórias/cirurgia , Diagnóstico Diferencial , Humanos , Neoplasias Laríngeas/patologia , Neoplasias Laríngeas/cirurgia , Terapia a Laser/métodos , Masculino , Osteoblastoma/patologia , Osteoblastoma/cirurgia , Resultado do TratamentoRESUMO
Intracellular trafficking of the DeltaF508 cystic fibrosis transmembrane conductance regulator (CFTR) is repaired by sodium 4-phenylbutyrate (4PBA) by an undetermined mechanism. 4PBA downregulates protein and mRNA expression of the heat shock cognate protein HSC70 (the constitutively expressed member of the 70-kDa heat shock protein family) by approximately 40-50% and decreases formation of a HSC70-DeltaF508 CFTR complex that may be important in the intracellular degradation of DeltaF508 CFTR. We examined the potential mechanisms by which 4PBA decreases HSC70 mRNA and protein expression. In IB3-1 cells, 1 mM 4PBA did not alter the activity of the Chinese hamster ovary HSC70 promoter or of a human HSC70 promoter fragment in luciferase reporter assays nor did it alter HSC70 mRNA synthesis in nuclear runoff assays. In contrast, preincubation with 4PBA increased the rate of HSC70 mRNA degradation by approximately 40%. The initial rate of 35S-HSC70 protein synthesis in 4PBA-treated IB3-1 cells was reduced by approximately 40%, consistent with the steady-state mRNA level, whereas its rate of degradation was unaltered by 4PBA. 4PBA also reduced the steady-state accumulation of (35)S-HSC70 by approximately 40%. These data suggest that 4PBA decreases the expression of HSC70 mRNA and protein by inducing cellular adaptations that result in the decreased stability of HSC70 mRNA.
Assuntos
Proteínas de Choque Térmico HSP70/genética , Proteínas de Choque Térmico HSP70/metabolismo , Fenilbutiratos/farmacologia , RNA Mensageiro/metabolismo , Animais , Linhagem Celular , Cricetinae , Cricetulus , Regulação para Baixo , Proteínas de Choque Térmico HSC70 , Proteínas de Choque Térmico HSP70/biossíntese , Homeostase , Humanos , CinéticaRESUMO
Oncocytomas are rare tumours that occur predominantly in the major salivary glands, particularly the parotid of older individuals. We present the exceptionally rare occurrence of an oncocytoma in the post-nasal space and its treatment for the first time via a Le Fort I osteotomy. The potential for local spread to the surrounding skull base makes it vital to achieve good oncological clearance. We found that this was possible using the Le Fort I technique and would recommend that this approach should be considered in future, when approaching such lesions.
Assuntos
Adenoma Oxífilo/cirurgia , Neoplasias Nasais/cirurgia , Adenoma Oxífilo/complicações , Adenoma Oxífilo/patologia , Idoso , Perda Auditiva Condutiva/etiologia , Perda Auditiva Condutiva/cirurgia , Humanos , Imageamento por Ressonância Magnética , Masculino , Microscopia Eletrônica , Neoplasias Nasais/complicações , Neoplasias Nasais/patologia , OsteotomiaAssuntos
Seio Etmoidal/patologia , Seio Frontal/patologia , Mucocele/complicações , Transtornos da Motilidade Ocular/etiologia , Endoscopia , Seio Etmoidal/cirurgia , Feminino , Seguimentos , Seio Frontal/cirurgia , Humanos , Pessoa de Meia-Idade , Mucocele/diagnóstico , Mucocele/cirurgia , Transtornos da Motilidade Ocular/diagnóstico , Músculos Oculomotores/fisiopatologia , Síndrome , Tomografia Computadorizada por Raios XRESUMO
Disorders of voice are a common problem in general practice. An understanding of the complex mechanism of voice production enables us to appreciate how many systemic disorders can affect voice. This article details the pathophysiology of voice production and how to assess the patient with hoarseness. Contemporary management of vocal disorders is described with reference to some newer surgical and investigative techniques.
Assuntos
Rouquidão/etiologia , Doenças da Laringe , Rouquidão/fisiopatologia , Humanos , Doenças da Laringe/complicações , Doenças da Laringe/fisiopatologia , Doenças da Laringe/terapiaRESUMO
Juvenile angiofibroma is a benign tumor, well known for aggressive extracranial growth, that frequently spreads to involve the skull base and intracranial compartment as well. The meninges, however, provide a strong barrier against intracerebral spread. This article reports an unusual case of angiofibroma with dural penetration, cavernous sinus involvement, and adherence to the temporal lobe of the brain. Controversy exists as to how the intracranial extensions are best managed. Our experience with this case, combined with review of the literature, suggests that these lesions can be removed surgically, eliminating in most cases the need for radiation therapy.
RESUMO
Inverting papilloma is a locally aggressive neoplasm; however, intracranial extension is very rare. The authors herein report a case of massive inverting papilloma with intracranial extension and an associated frontal sinus mucocele, causing marked frontal lobe compression. Treatment consisted of combined anterior craniofacial resection. Magnetic resonance imaging provided accurate preoperative differentiation between neoplasm and inflammation. Skull base reconstruction may prove more difficult when there is significant frontal dead space resulting from chronic brain displacement by an associated mucocele. The management of this unusual neoplasm and a review of the literature is presented.
RESUMO
Radical surgery for sinonasal neoplasms in combination with radiation therapy has vastly improved the outlook for these tumors. Magnetic resonance imaging (MRI) combined with high resolution computerized tomography (CT) scanning and recognition of symptoms suggestive of extensive disease has allowed more accurate determination of surgical margins. Long-term follow-up is still needed to define the limits of radical surgery necessary to treat very extensive tumors.
Assuntos
Neoplasias Nasais/cirurgia , Neoplasias dos Seios Paranasais/cirurgia , Humanos , Métodos , Cavidade Nasal , Neoplasias Nasais/diagnóstico , Neoplasias dos Seios Paranasais/diagnósticoRESUMO
We have reviewed 21 cases with the clinical diagnosis of Post Traumatic Syringomyelia (P.T.S.). Fifteen of these cases had proven syrinx formation on Contrast Computed Tomography (C.C.T.) and the other 6 had obviously abnormal cords. A much earlier onset of P.T.C.M. was found in complete spinal injuries than in incomplete ones. We have discussed the technique of contrast computed tomography used at this hospital, its value in the diagnosis of this condition and its ability to define actual spinal cord structure. Most cases (91%) benefitted from surgery and several had marked sensory improvement, which previously has been described as unusual. Syringo-cisternal shunting, a new technique for the drainage of cervical and upper thoracic syrinxes is described. A theory is proposed to explain why, in some patients with classical presentations of P.T.S., no syrinx was found on C.C.T., although abnormal cords were found in all cases. It is felt that these abnormal areas of spinal cord are responsible for the presenting symptomatology and may be precursors of syrinxes.