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PubMed1989

Sleep-related laryngeal obstruction presenting as snoring or sleep apnea.

The difference between snoring (with or without sleep apnea) and laryngeal stridor resulting from laryngeal dysfunction may not be readily apparent. Two cases of Shy-Drager syndrome and one undiagnosed case in which laryngeal dysfunction was exacerbated by sleep are reported. Such dysfunction might create life-threatening situations for which emergency tracheostomy should be considered. The importance of differentiating stridor from snoring is discussed.

Aged↗
PubMed1992

Continuous positive airway pressure. Use in bilateral vocal cord paralysis.

Continuous positive airway pressure has been used in the management of a number of upper airway problems, and has become well established as a treatment option for obstructive sleep apnea. The therapeutic value is achieved by an internal splinting effect on the compromised airway. Airway compromise from bilateral recurrent laryngeal nerve trauma can occur with surgical procedures associated with extensive dissection of these nerves. The use of continuous positive airway pressure for the management of bilateral vocal cord paralysis, although not previously described, to my knowledge, is outlined in this article.

Carcinoma, Squamous Cell↗
PubMed2005

[Sleep apnea syndrome].

Obstructive sleep apnea syndrome (OSAS) is strongly associated with cardiovascular disease which means these patients could suffer sudden death from these cardiovascular diseases, but it is a rare case that common OSAS itself causes sudden death directly. On the other hand, we never wrongly diagnose serious sleep-related breathing disorders (SBDs) such as sleep hypoventilation syndrome, OSAS patients with cardiovascular disease (i.e. ischemic heart disease, cardiac arrhythmia and cardiac failure) and bilateral vocal cord paralysis caused by multiple system atrophy as common OSAS. This section describes how to distinguish these SBDs from common OSAS.

Death, Sudden↗
PubMed2000

An outbreak of enterovirus 71 infection in Taiwan, 1998: epidemiologic and clinical manifestations.

BACKGROUND: An outbreak of enterovirus infections occurred throughout Taiwan in 1998. The diseases were manifectated with hand, foot, and mouth disease (HFMD), some associated with meningitis, encephalitis, or acute flaccid paralysis (AFP). OBJECTIVES: This study is aimed to characterize and analyze the epidermologic and clinical features during the outbreak. STUDY DESIGN: The epidemiologic information was collected from the Ministry of Health on passive surveillance; clinical and virological investigations were carried out at National Cheng Kung University Medical Center. RESULTS: Between April and December 1998, 405 children were hospitalized, and 78 patients died during this outbreak in Taiwan. There were 119 cases identified to be EV71 infection in Tainan and Chiayi areas; 105 cases by virus isolation and 14 by serological assay. The outbreak had a biphasic curve with peak in June and October, especially in the southern Taiwan. Seventy-two percent of patients were below 3 years of age. The spectrum of disease included HFMD in 54, HFMD with central nerve system (CNS) involvement in 37, herpangina in 12, aseptic meningitis in three, encephalitis/ meningoencephalitis in ten, acute flaccid paralysis in three. There was nine fatal cases complicated with neurogenic pulmonary edema. Myoclonus with sleep disturbance was the most important early sign of EV71 infection with CNS involvement. CONCLUSION: Our experience demonstrated that the EV71 isolated in Taiwan had strong dermatotropic as well as neurotropic tendencies. Early detecting CNS involvement and commencing aggressive therapy may reduce the mortality.

Adolescent↗
PubMed1977

Total intravenous anesthesia with etomidate. II. Evaluation of a practical technique for children.

A practical technique for the administration of anesthesia to children is described, using only intravenous agents. Anesthesia was induced using etomidate 0.3 mg/kg, analgesia being provided by fentanyl or pentazocine, and muscle relaxation by suxamethonium or pancuronium. Unconsciousness was maintained by infusion of a 1% solution of etomidate given at a pre-determined rate of 30 microgram/kg/min. Paralysis was maintained throughout the period of surgical stimulation, in the majority of patients by continuous infusion of suxamethonium 0.1 mg/kg/min. The chosen rate of infusion of etomidate appears to be adequate to reliably maintain sleep in children, yet allow rapid recovery of consciousness when the infusion is stopped, thereby relieving the anesthetist of concern about these points. The maintenance of complete paralysis throughout operation removes the possibility of movement, the major cause of unsatisfactory anesthesia using only intravenous agents.

Adolescent↗
PubMed2002

Palatal adhesion: the treatment of unilateral palatal paralysis after high vagus nerve injury.

BACKGROUND: Resection of skull base tumors commonly necessitates intraoperative sacrifice of lower cranial nerves at the level of the jugular foramen. Sequelae of unilateral vagus nerve loss include ipsilateral laryngeal paralysis, ipsilateral palatal and pharyngeal paralysis, and velopharyngeal incompetence (VPI) marked by hypernasal speech and nasopharyngeal reflux of liquids during swallowing. METHODS: Palatal adhesion (PA), a procedure whereby the unilaterally paralyzed palate is attached to the posterior pharyngeal wall, decreases the size of the velopharyngeal port and minimizes the symptoms. This study assessed the outcome of PA in 31 patients with VPI secondary to proximal vagus nerve injury. RESULTS: PA decreased postoperative nasality in 96% of patients. Nasopharyngeal reflux was significantly improved in 83%. Three patients (11%) had minor wound breakdown postoperatively, all of which healed completely with conservative management. CONCLUSION: PA offers a favorable result with minimal concomitant morbidity and is recommended for patients with VPI secondary to unilateral proximal vagus nerve paralysis.

Adult↗
PubMed2000

[Fiberoptic endoscopy confirms the cause of upper respiratory obstruction in small children. The most common causes to referrals are sleep apnea syndrome and inspiratory stridor].

Guidelines for the clinical investigation of young children with stridor and sleep apnea are presented. Clinical examination and flexible videolaryngoscopy performed in local anaesthesia are the most important diagnostic tools for this group of children. If the impairment is severe or an objective evaluation is needed the child should also undergo nocturnal polygraphic recording and lung function tests. Out of 43 children examined with flexible videolaryngoscopy 21 had positive findings, laryngomalacia being the most common diagnosis. Flexible videolaryngoscopy is a good complement to laryngoscopy under general anaesthesia. It can be performed as early as in the neonatal period.

Child, Preschool↗
PubMed1997

Otolaryngologic manifestations of neurofibromatosis in children.

OBJECTIVE: Neurofibromatosis (NF) is a genetic disease with a wide variety of clinical manifestations. Eight patients with otolaryngologic manifestations of NF are presented. This represents 4.9% of all NF patients currently registered at the NF clinic at the Montreal Children's Hospital. METHODS: Clinical manifestations are divided into cosmetic and functional categorizations. RESULTS: Five patients presented with cosmetic deformities, the most common being an enlarging facial mass. Three patients presented with functional impairments, the most common being hearing loss and airway obstruction. Radiologic findings include the presence of plexiform neurofibromas and airway obstruction. Management was individualized to improve cosmesis and/or function. In the literature, the incidence of head and neck manifestations in patients with NF varies between 14% and 37%. Cosmetic lesions include pigmentary changes (café-au-lait spots), prominent neurofibromas, and osseous lesions. Functional deficits include hearing loss, speech and voice abnormalities, airway obstruction, dysphagia, facial paresis, lip incompetence, and impaired mastication. Diagnosis of NF-1 (classic von Recklinghausen's disease) and NF-2 (bilateral acoustic schwannomas) can be made using specific criteria. Management of patients with NF is individualized depending on the cosmetic deformity, functional impairment, and/or malignant potential of tumours. NF is progressive and has no cure. Prognosis depends on individual clinical manifestations, surgical resectability, and the potential for sarcomatous degeneration. CONCLUSION: This study provides a unique classification of the otolaryngologic findings in NF, giving the otolaryngologist an operable framework for diagnosis, treatment and prognosis.

Airway Obstruction↗
PubMed1977

Studies on drug metabolism and liver ultrastructure after conjoint treatment with pregnenolone-16alpha-carbonitrile and dl-ethionine.

Zoxazolamine paralysis, hexobarbital anesthesia and digitoxin convulsions were diminished in rats by 3 days of pretreatment with pregnenolone-16alpha-carbonitrile (PCN). Simultaneous injection of dl-ethionine did not block this effect of PCN. Dl-Ethionine decreased, while PCN or PCN + ethionene increased, zoxazolamine metabolism by the 9,000g supernatant fraction of the liver. Dl-ethionine neutralized the influence of PCN and phenobarbital on zoxazolamine metabolism in rats that were pretreated with PCN or phenobarbital for 1 day, and it inhibited the action of phenobarbital on hexobarbital anesthesia. PCN augmented the liver weight of animals given dl-ehtionine whereas dl-ethionine in itself did not. PCN produced SER proliferation in hepatocytes and dl-ethionine caused lipid accumulation, SER proliferation and myelin-figure formation. When administered conjointly, these compounds had an additive effect on the liver cell ultrastructure.

Animals↗
PubMed2006

Hypocretin (orexin) deficiency predicts severe objective excessive daytime sleepiness in narcolepsy with cataplexy.

Cerebrospinal fluid (CSF) hypocretin-1 deficiency is associated with definite ("clear cut") cataplexy in patients with narcolepsy. The relationship between CSF hypocretin-1 levels and other narcoleptic symptoms (including excessive daytime sleepiness, EDS) is not properly understood. In a consecutive series of 18 subjects with narcolepsy and definite cataplexy, patients with undetectable CSF hypocretin-1 (n = 12) were found to have significantly lower mean sleep latencies (p = 0.045) and a higher frequency of sleep onset REM periods (SOREMPs, p = 0.025) on multiple sleep latency test than patients (n = 6) with detectable levels. Conversely, Epworth sleepiness scale scores, the frequency of hallucinations/sleep paralysis, and the frequency and severity of cataplexy were similar in both groups. These results suggest that hypocretin deficiency identifies a homogenous group of patients with narcolepsy characterised by the presence of definite cataplexy, severe EDS, and frequent SOREMPs.

Adolescent↗
PubMed1998

[Effective nasal CPAP therapy for heavy snoring and paradoxical respiration during sleep in a case of multiple system atrophy].

A 64-year-old man with multiple system atrophy complained of daytime sleepiness, fatigue, and snoring. Neurological examination revealed severe autonomic failure, mild cerebellar ataxia and akinesia. Daytime blood gas analysis showed respiratory acidosis with hypoxia and hypercapnia. MR imaging of the brain showed atrophy of the pons, cerebellum and bilateral frontal lobes. Although paralysis of the vocal cord abduction was not found by laryngoscopy during daytime examination, polysomnography (PSG) showed heavy snoring with paradoxical respiration associated with severe desaturation during sleep as well as reduced slow wave sleep and REM sleep. He was diagnosed as having sleep-related upper airway obstructive breathing disorder probably due to Gerhardt syndrome. Tracheostomy was considered, but we performed nasal CPAP therapy during sleep because this therapy is non-invasive and would not impair his daily life. After nasal CPAP therapy, daytime sleepiness, fatigue, and snoring with desaturation improved, and PSG showed increased slow wave sleep. These results demonstrate that nasal CPAP therapy improves the quality of sleep and should be considered in patients with early stages of multiple system atrophy who exhibit sleep-related breathing disorders.

Humans↗
PubMed2000

Reanimation of the paralyzed eyelid with the enhanced palpebral spring or the gold weight: modern replacements for tarsorrhaphy.

The enhanced palpebral spring and the gold weight are the modern devices that should nearly completely replace tarsorrhaphy in the management of ocular problems secondary to facial paralysis. They actually reanimate the lid, rather than merely hold the lids closed in a disfigured position, as does tarsorrhaphy. The surgical techniques of each procedure, results, and pros and cons of each are compared. Personal experience with over 1400 spring implantations is discussed, as is experience with the use of bandage contact lenses in lieu of lid surgery. The gold weight implantation is simpler to learn and perform than the enhanced spring procedure, in which the levator is tightened in addition to implanting the spring. However, when it is really important to close the eye well, the spring is the superior procedure. Unlike the weight, the spring closes the eye well in the supine position, such as when the patient sleeps.

Contact Lenses↗
PubMed1993

Altered foci of hepatocytes in rats initiated with diethylnitrosamine after prolonged fasting.

The influence of fasting on the potential of diethylnitrosamine (DEN) to initiate liver carcinogenesis was tested in a medium-term assay using the development of putative preneoplastic altered foci of hepatocytes (AFH) as the endpoint. Male Wistar rats fasted for 48 hr were given a single ip injection of DEN (200 mg/kg body weight). Partial hepatectomies were carried out at wk 3 and the rats were killed at wk 8. Fasted rats exhibited a small increase in the numbers of AFH with glutathione S-transferase in the placental form and eosinophilic AFH when compared with non-fasted animals. However, after a 6-wk exposure to 0.05% sodium phenobarbital in the diet, there were no differences in the numbers of AFH between fasted and non-fasted animals. Fasting also increased DEN-dependent centrilobular cell necrosis and specifically drug metabolism as indicated in vivo by a decreased time of paralysis of the lower limbs induced by zoxazolamine (40 mg/kg body weight, ip) and by an unaltered sleeping time induced by sodium pentobarbital (40 mg/kg body weight, ip). The results indicate that although fasting during the initiation stage of carcinogenesis increases DEN hepatoxicity, it does not interfere quantitatively with the development of liver preneoplastic lesions.

Animals↗