Office-Based Treatment of Laryngeal Papillomatosis with Percutaneous Injection of Cidofovir

2002 ◽  
Vol 126 (6) ◽  
pp. 642-648 ◽  
Author(s):  
Dinesh K. Chhetri ◽  
Joel H. Blumin ◽  
Nina L. Shapiro ◽  
Gerald S. Berke
Keyword(s):  
Laser Ablation ◽  
Direct Laryngoscopy ◽  
Retrospective Review ◽  
Anterior Commissure ◽  
Case Series ◽  
Adult Patients ◽  
Injection Technique ◽  
Laryngeal Papillomatosis ◽  
Vocal Cords ◽  
Percutaneous Injection

OBJECTIVE: Our aim was to report our experience with office-based treatment of severe laryngeal papillomatosis with percutaneous injection of cidofovir in a case series of 5 patients. STUDY DESIGN AND SETTING: We conducted a retrospective review of a case series in a tertiary academic care voice disorders clinic. Adult patients with papillomas of the vocal cords and anterior commissure received percutaneous injection using a point-touch technique. Clinical improvement or remission of the papillomatosis was noted. RESULTS: Before initiation of office treatments, patients required direct laryngoscopy and CO2 laser ablation of papillomas on average every 2.8 months. There were no complications related to the injection technique. During a treatment period of 7 to 16 months (mean 12 months), a significant reduction in the volume of papillomatosis was achieved in all patients. One patient received 2 treatments and another received 1 treatment in the operating room for final clearance of papillomas. CONCLUSION: Office-based treatment of adult patients with anterior laryngeal papillomatosis using percutaneous injection of cidofovir reduces the need for repeated direct laryngoscopy and laser ablation under general anesthesia. SIGNIFICANCE: Percutaneous injection treatment with cidofovir is a useful adjunct to direct laryngoscopy and laser ablation in the treatment of laryngeal papillomatosis.

scholarly journals White papilloma involving both vocal cords: A Case Report

2020 ◽  
Vol 26 (1) ◽  
pp. 73-76
Author(s):  
Abirvab Naha ◽  
Utpal Dutta ◽  
Pran Gopal Datta ◽  
Ashim Kumar Biswas ◽  
MA Chowdhury
Keyword(s):  
Case Report ◽  
Respiratory Tract ◽  
Human Papilloma Virus ◽  
Male Patient ◽  
Direct Laryngoscopy ◽  
Histopathological Examination ◽  
Anterior Commissure ◽  
Indirect Laryngoscopy ◽  
Vocal Cords ◽  
Papilloma Virus

White papilloma are rare lesions that may occur at any site of mucosa- lined respiratory tract especially in vocal cords. Morphologically it appears villas looking, clinically & microscopically benign in most cases. We report a 70 years old male patient with white papilloma near anterior commissure involving both vocal cords found during indirect laryngoscopy. The lesion was completely resected with a unipolar coagulation device under direct laryngoscopy. Histopathological examination showed papilloma of vocal cords associated with Human papilloma virus(HPV) wart. To our knowledge this is the second reported case concomitant white papilloma with concomitant HPV in the vocal cords. Bangladesh J Otorhinolaryngol; April 2020; 26(1): 73-76

Surgeon-performed intubation in awake patients utilising an anterior commissure laryngoscope with bougie: a retrospective case series

2019 ◽  
Vol 133 (11) ◽  
pp. 986-991
Author(s):  
N R Vasan ◽  
E Kosik ◽  
B Collins ◽  
M Clampitt
Keyword(s):  
Difficult Airway ◽  
Direct Laryngoscopy ◽  
Anterior Commissure ◽  
Case Series ◽  
Operating Theatre ◽  
Current Procedural Terminology ◽  
Failed Intubation ◽  
Retrospective Case ◽  
Retrospective Case Series ◽  
Reliable Procedure

AbstractObjectiveThis retrospective case series examined the outcomes of surgeon-performed intubation using the anterior commissure rigid laryngoscope and bougie in adults with a difficult airway, including awake patients.MethodsThis study comprised a series of adult patients who underwent surgeon-performed intubation over a 10-year period. They were identified by a records search for the Current Procedural Terminology (‘CPT’) code 31500 – ‘intubation by surgeon’.ResultsForty-nine intubations performed in the operating theatre were reviewed. Intubation performed by the surgeon using the rigid anterior commissure laryngoscope was successful in 47 of the cases (96 per cent). Over half of the patients had experienced failed intubation attempts with other methods by other providers prior to the surgeon performing direct laryngoscopy. Twenty intubations were performed without paralytics and with the patient awake.ConclusionIn properly selected adults who need an urgent, secure airway in the operating theatre, surgeon-performed anterior commissure laryngoscopic intubation using a bougie should be considered a safe, reliable procedure. In most cases, this procedure can be performed in selected patients whilst awake, with sedation.

scholarly journals Providing safe care for patients in the coronavirus disease 2019 (COVID-19) era: A case series evaluating risk for hospital-associated COVID-19

2021 ◽  
pp. 1-7
Author(s):  
Elizabeth B. Habermann ◽  
Aaron J. Tande ◽  
Benjamin D. Pollock ◽  
Matthew R. Neville ◽  
Henry H. Ting ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Tertiary Care ◽  
Case Series ◽  
Adult Patients ◽  
Care Hospital ◽  
Strict Adherence ◽  
Large Tertiary Care ◽  
Healthcare Associated ◽  
Serology Testing ◽  
Pcr Test

Abstract Objective: We evaluated the risk of patients contracting coronavirus disease 2019 (COVID-19) during their hospital stay to inform the safety of hospitalization for a non–COVID-19 indication during this pandemic. Methods: A case series of adult patients hospitalized for 2 or more nights from May 15 to June 15, 2020 at large tertiary-care hospital in the midwestern United States was reviewed. All patients were screened at admission with the severe acute respiratory coronavirus virus 2 (SARS-CoV-2) polymerase chain reaction (PCR) test. Selected adult patients were also tested by IgG serology. After dismissal, patients with negative serology and PCR at admission were asked to undergo repeat serologic testing at 14–21 days after discharge. The primary outcome was healthcare-associated COVID-19 defined as a new positive SARS-CoV-2 PCR test on or after day 4 of hospital stay or within 7 days of hospital dismissal, or seroconversion in patients previously established as seronegative. Results: Of the 2,068 eligible adult patients, 1,778 (86.0%) completed admission PCR testing, while 1,339 (64.7%) also completed admission serology testing. Of the 1,310 (97.8%) who were both PCR and seronegative, 445 (34.0%) repeated postdischarge serology testing. No healthcare-associated COVID-19 cases were detected during the study period. Of 1,310 eligible PCR and seronegative adults, no patients tested PCR positive during hospital admission (95% confidence interval [CI], 0.0%–0.3%). Of the 445 (34.0%) who completed postdischarge serology testing, no patients seroconverted (0.0%; 95% CI, 0.0%–0.9%). Conclusion: We found low likelihood of hospital-associated COVID-19 with strict adherence to universal masking, physical distancing, and hand hygiene along with limited visitors and screening of admissions with PCR.

scholarly journals Macrophage Activation Syndrome in Adults: A Retrospective Case Series

2021 ◽  
Vol 9 ◽  
pp. 232470962110264
Author(s):  
Taylor Warmoth ◽  
Malvika Ramesh ◽  
Kenneth Iwuji ◽  
John S. Pixley
Keyword(s):  
Macrophage Activation Syndrome ◽  
Macrophage Activation ◽  
Pediatric Patients ◽  
Inflammatory Diseases ◽  
Systemic Juvenile Idiopathic Arthritis ◽  
Case Series ◽  
Adult Patients ◽  
Retrospective Case ◽  
Life Threatening ◽  
Activation Syndrome

Macrophage activation syndrome (MAS) is a form of hemophagocytic lymphohistocytosis that occurs in patients with a variety of inflammatory rheumatologic conditions. Traditionally, it is noted in pediatric patients with systemic juvenile idiopathic arthritis and systemic lupus erythematous. It is a rapidly progressive and life-threatening syndrome of excess immune activation with an estimated mortality rate of 40% in children. It has become clear recently that MAS occurs in adult patients with underlying rheumatic inflammatory diseases. In this article, we describe 6 adult patients with likely underlying MAS. This case series will outline factors related to diagnosis, pathophysiology, and review present therapeutic strategies.

Difficult Laryngoscopy/Intubation: The Child with Mandibular Hypoplasia

1983 ◽  
Vol 92 (4) ◽  
pp. 401-404 ◽  
Author(s):  
Steven D. Handler ◽  
Thomas P. Keon
Keyword(s):  
Temporomandibular Joint ◽  
Direct Laryngoscopy ◽  
Anterior Commissure ◽  
Difficult Laryngoscopy ◽  
Treacher Collins Syndrome ◽  
Pierre Robin Sequence ◽  
Hemifacial Microsomia ◽  
Mandibular Hypoplasia ◽  
Pierre Robin ◽  
Infants And Young Children

The child with mandibular hypoplasia (Treacher Collins syndrome, Pierre Robin sequence, hemifacial microsomia, etc) presents the otolaryngologist and anesthesiologist with considerable problems when direct laryngoscopy and/or endotracheal intubation is attempted. In addition to the small mandible, several other features of these patients contribute to the difficult laryngoscopy: macroglossia, glossoptosis, trismus related to temporomandibular joint abnormalities, and prominent maxilla or maxillary incisors. Most of the techniques that have been described for laryngoscopy/intubation in problem cases are difficult or impossible to use in infants and young children with mandibular hypoplasia. We present a modification of the standard direct laryngoscopic procedure, utilizing the 9-cm anterior commissure laryngoscope and an optical stylet in the task of exposing and intubating the larynx of a child with mandibular hypoplasia.

Management of Refractory Intracranial Hypotension Using Percutaneous Fibrin Sealant Patch – A Case Series and Review of the Literature

2019 ◽  
pp. 13-31
Author(s):  
Kevin Wong
Keyword(s):  
Literature Review ◽  
Fibrin Sealant ◽  
Intracranial Hypotension ◽  
Case Reports ◽  
Case Series ◽  
Retrospective Case ◽  
Percutaneous Injection ◽  
Retrospective Case Series ◽  
Blood Patch

Background: Intracranial hypotension (IH) among patients with persistent cerebrospinal fluid (CSF) leakage remains a challenging problem. The majority of these cases resolve spontaneously with conservative measures. The customary treatment for IH is epidural blood patch (EBP). In some cases, CSF leaks can persist for months or even years despite multiple trials of EBP. To date, there are only a limited number of published studies documenting the percutaneous injection of fibrin sealant for treatment of IH refractory to conservative measures and EBP. Objective: Our objective was to perform a literature review and retrospective case series regarding patients who underwent percutaneous injection of fibrin sealant for treatment of refractory IH at our institution. Study Design: This case series used a singlecentered retrospective observational study design and literature review. Setting: Patients in this case series were treated at a community-based tertiary care medical center. Methods: Five consecutive patients with the diagnosis of IH refractory to conservative measures and EBP who underwent percutaneous patching with fibrin sealant were identified at our institution between January 1, 2000 and January 1, 2016. A retrospective chart review was performed and data including demographics, characteristics, interventions, clinical outcomes, and complications were collected. A critical review of the current literature regarding the percutaneous use of fibrin sealant for treatment of IH was conducted. Results: Four of the 5 patients (80%) experienced no further symptoms of IH and no adverse events were noted. One patient (20%) ultimately required surgical duroplasty. Review of the current literature showed a total of 2 prospective case series, 4 retrospective case series, and 11 case reports. Our present case series and literature review demonstrated that fibrin sealants were well-tolerated by most patients and associated with low incidences of complications and recurrence. Limitations: This study is limited by the small retrospective case series of 5 patients. Conclusions: Percutaneous injection of fibrin sealant may be considered in refractory cases of IH when repeated trials of EBP have persistently failed. It appears to be a highly effective, safe, and easy-touse alternative therapy for patients with refractory IH in an ambulatory setting. Our review of the literature revealed only studies with low quality of evidence, including case series and case reports. There is a substantial need for high-quality studies and clinical evidence to corroborate the efficacy and safety of this percutaneous technique. However, this ideal is very challenging because of the relative rarity and heterogeneous etiologies of cases. Keywords: Fibrin sealant, intracranial hypotension, CSF leak, epidural blood patch, orthostatic headache, refractory, quality of life, percutaneous

Do femoral fractures in adult patients with osteogenesis imperfecta imitate atypical femoral fractures? A case series

2018 ◽  
Vol 30 (2) ◽  
pp. 513-517 ◽  
Author(s):  
J. D. Andersen ◽  
M. H. Bünger ◽  
O. Rahbek ◽  
J. D. Hald ◽  
T. Harsløf ◽  
...  
Keyword(s):  
Osteogenesis Imperfecta ◽  
Case Series ◽  
Femoral Fractures ◽  
Adult Patients ◽  
Atypical Femoral Fractures

Effects of nasal positive-pressure hyperventilation on the glottis in normal awake subjects

1995 ◽  
Vol 79 (1) ◽  
pp. 176-185 ◽  
Author(s):  
V. Jounieaux ◽  
G. Aubert ◽  
M. Dury ◽  
P. Delguste ◽  
D. O. Rodenstein
Keyword(s):  
Tidal Volume ◽  
Positive Pressure Ventilation ◽  
Anterior Commissure ◽  
Minute Ventilation ◽  
Intermittent Positive Pressure Ventilation ◽  
Positive Pressure ◽  
Vocal Cords ◽  
Diaphragmatic Muscle ◽  
Inspiratory Resistance ◽  
Cyclic Changes

We have recently observed obstructive apneas during nasal intermittent positive-pressure ventilation (nIPPV) and suggested that they were due to hypocapnia-induced glottic closure. To confirm this hypothesis, we studied seven healthy subjects and submitted them to nIPPV while their glottis was continuously monitored through a fiber-optic bronchoscope. During wakefulness, we measured breath by breath the widest inspiratory angle formed by the vocal cords at the anterior commissure along with several other indexes. Mechanical ventilation was progressively increased up to 30 l/min. In the absence of diaphragmatic activity, increases in delivered minute ventilation resulted in progressive narrowing of the vocal cords, with an increase in inspiratory resistance and a progressive reduction in the percentage of the delivered tidal volume effectively reaching the lungs. Adding CO2 to the inspired gas led to partial widening of the glottis in two of three subjects. Moreover, activation of the diaphragmatic muscle was always associated with a significant inspiratory abduction of the vocal cords. Sporadically, complete adduction of the vocal cords was directly responsible for obstructive laryngeal apneas and cyclic changes in the glottic aperture resulted in waxing and waning of tidal volume. We conclude that in awake humans passive ventilation with nIPPV results in vocal cord adduction that depends partly on hypocapnia, but our results suggest that other factors may also influence glottic width.

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