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PubMed1987

Surgical correction of laryngotracheal stenoses in children.

A modified surgical technique according to Rhéti is described: the cricoid and the uppermost tracheal rings are longitudinally dissected ventrally and dorsally. The enlargement of the lumen is stabilized by interposition of a notched piece of costal cartilage into the dissected posterior wall of the cricoid. A total of 63 children with laryngotracheal stenosis have been operated on by this method in Zurich since 1973 and in Munich since 1982. Laryngotracheal plasty is successful in over 80% of small children in whom the procedure is necessary. The voice becomes a little hoarse, but respiration is adequate, as demonstrated by our juvenile patients, some of whom have been decannulated for over 10 years. The earlier opinion that laryngoplasty performed in small children might impair laryngeal growth and result in severe stenoses has been disproved by the results presented. Our experience shows that prognosis is worse in children with tracheal stenosis and associated anomalies, such as paralysis of the vocal cord.

Child↗
PubMed1996

Herpes simplex virus type I reactivation as a cause of a unilateral temporary paralysis of the vagus nerve.

Infection by neurotropic viruses, as exemplified by the herpes family, is universally accepted as a cause of palsies of the cochleo-vestibular and facial nerve. Palsies of the vagus nerve with a possible viral etiology have been described, although viruses have been identified in only a few selected cases. We report a 52-year-old man with unilateral otalgia, hoarseness and dysphagia. Examination revealed unilateral (left-sided) pharyngeal dysfunction, and paralysis of the left vocal cord fixed in the paramedian position. A barium swallow documented dysfunction of the left pharyngeal constrictor muscles. These findings suggested the lesion to be located either at the inferior ganglion of the vagus nerve or cranially. At direct laryngoscopy a smear was obtained from a 4-mm mucosal ulcer at the region of the left arytenoid cartilage. This smear demonstrated antibodies to herpes simplex virus (HSV) type I by immunofluorescence. On follow-up 19 months after the initial infection there was complete remission of the paralysis of the left vocal cord and normal pharyngeal function. The demonstration of HSV type 1 antibodies from a mucosal lesion in the distribution of the superior laryngeal nerve suggests that reactivation of HSV type I was the most likely explanation for the temporary nerve palsy seen.

Antibodies, Viral↗
PubMed1993

Chondrosarcoma of the larynx.

Chondrosarcoma of the larynx is a rare, slow-growing malignant tumor. One hundred and fifty cases of this entity have been reported in the literature. In 75% of cases the site of involvement was the cricoid cartilage, while 20% have involved the thyroid cartilage. The tumor presents as a space-occupying lesion in the subglottic region, or as a neck mass. An insidious, slowly progressing disease course associated with hoarseness and dyspnea accounts for usual delays in arriving at a diagnosis. We report our experiences with six cases of this entity and discuss a diagnostic and therapeutic approach. Whenever possible a conservative surgical management should be attempted.

Adult↗
PubMed1996

Imaging features in 35 cases of submucosal laryngeal mass lesions.

We evaluated the clinical and radiological findings in 35 patients with submucosal laryngeal masses. The presenting symptoms were hoarseness, stridor, dysphagia and external neck mass. In 20 cases an important delay between the onset of symptoms and direct laryngoscopy was found. There was a considerable delay between laryngoscopy and definitive diagnosis in 13 cases due to repeated negative biopsies. Computed tomography pointed out the location and extension of the masses in all cases. In 27 mass lesions CT allowed correct prediction of the malignant or benign character of the lesion. In 6 cases no reliable differentiation could be made. The lesion was mischaracterised in 2 cases. Magnetic resonance imaging was also performed in 4 patients, and showed the extent of the lesion better; in 1 case MRI narrowed the differential diagnosis. In the case of a negative biopsy result, radiological findings should incite further investigation, reducing the possible delay between the onset of symptoms and definitive diagnosis.

Adult↗
PubMed1986

Acute epiglottitis: management by short duration of intubation and hospitalisation.

One hundred and thirty-seven patients with acute epiglottitis were studied retrospectively with regard to the efficacy and safety of short duration of intubation and hospitalisation. All patients were treated by nasotracheal intubation and antibiotic therapy. Inhalation anesthesia with halothane/oxygen was the preferred method for intubation (80.3%). Extubation was based on clinical improvement in 88.1% and on laryngoscopy in 11.9% of cases. Fifty-four percent of the patients were extubated successfully within 24 h and 94.8% within 48 h. Three patients (2.2%) had to be reintubated once. The mean duration of intubation was 27.6 h (range 8-86) and of hospitalisation 4.0 days (range 2-9). Two children (1.5%) died because of severe hypoxic brain damage due to cardiorespiratory arrest prior to hospital admission. A follow-up study conducted via the family physician revealed only two major complications (granulation polyp of the vocal cords, 1; long-lasting hoarseness, 1). It is concluded that short duration of intubation and hospitalisation are effective and safe in the management of acute epiglottitis.

Anti-Bacterial Agents↗
PubMed1993

Transhiatal esophagectomy for esophageal carcinoma in Turkey: with special reference to respiratory function.

Esophagectomy without opening the thoracic cavity--transhiatal esophagectomy--(THE) were performed in 47 patients with malignant tumors localized at various levels of the esophagus. Pulmonary function studies were performed in all patients and they are categorized as low, moderate, or high risk for probable postoperative pulmonary complications according to the risk category system. Nine of these patients were classified as high risk, seven as moderate risk, and the rest as low risk. In all patients but four, reconstruction was accomplished by using their stomachs as a substitute. In the remaining patient, intestinal continuity was established by a left and right colonic interposition. Three patients were lost in the early postoperative period. Two patients categorized as low risk died from pulmonary thromboembolism and cardiac failure, respectively. One patient categorized in the high risk group died of coronary thrombosis. Postoperative complications included transient hoarseness due to recurrent laryngeal nerve paresis in one patient, right pleural effusion in one patient, pneumothorax in two patients, and thrombophlebitis in one patient. In the high risk patient group, there were no pulmonary complications. This clinical study demonstrated the protective effect of THE in patients with serious pulmonary problems.

Aged↗
PubMed1989

A case of combined Farber and Sandhoff disease.

We describe a patient with the biochemically established combination of Farber and Sandhoff disease. A 6-month-old girl of consanguineous Turkish parents presented with hoarseness, stridor, scattered skin nodules, painful swelling of hand joints and ankles, and cherry-red macular spots. Until the age of 2 years her motor and physical condition deteriorated distinctly, however her mental state remained unchanged. A biopsied skin nodule disclosed lysosomal inclusions within storage cells that were typical of Farber disease (curved tubular structures). However, other inclusions (e.g. zebra bodies) were also found. Biochemical findings included ceramide accumulation in skin nodules and cultured fibroblasts, impaired ceramide degradation on loading of cultured fibroblasts with radioactive sphingomyelin, profoundly decreased ceramidase activity in fibroblasts as well as total beta-hexosaminidase activity in fibroblasts and serum, absent hexosaminidase A and B bands on cellogel zymograms, increased urinary oligosaccharide excretion of the Sandhoff disease type, and a partial reduction of ceramidase and total beta-hexosaminidase activities in fibroblasts from her father. A diagnosis of combined Farber and Sandhoff disease was made. The effect of both enzyme deficiencies on the clinical manifestations in this patient and the genetic basis of this combination require further studies.

Biopsy↗
PubMed1981

The Weaver syndrome: a rare type of primordial overgrowth.

A boy with primordial overgrowth, macrocephaly, and anomalies of the face, nails, feet and skeleton is reported. Two cases in the literature- referred to as Weaver syndrome- exhibited nearly identical anomalies. All three cases were sporadic. Main symptoms of the Weaver syndrome are increased birth weight, early overgrowth, macrocephaly, accelerated osseous maturation, typical facies, hoarse, low pitched voice, hypertonia of muscles and mild developmental delay. Further symptoms are thin, deep-set nails, talipes equinovarus, widened distal femora, and some minor abnormalities. A second boy with primordial overgrowth and macrocephaly demonstrated some, but not all, the symptoms of this syndrome. Whether this boy showed a milder expression of the Weaver syndrome or benign familial macrocephaly is discussed.

Abnormalities, Multiple↗
PubMed1985

A comment on laryngeal cytology.

Cytology of the laryngeal mucosa proved to be a suitable method for diagnosing low-grade and intermediate dysplasia, but it did not allow any distinction between high-grade dysplasia and invasive cancer. In our experience, the use of this method should be restricted to a few conditions, such as the persistance of recurrent dysplasias and certain extended lesions from which biopsies give a high risk for scarring and permanent hoarseness.

Biopsy↗
PubMed1976

[Chronic laryngitis and carcinoma (author's transl)].

35 cases of continuous series of 841 laryngeal cancers were studied separately. Those patients had already been suffering from hoarseness for more than 2 years, in the average for 9 years. Many of these patients had been examined and treated by inhalations, and biopsies were taken because of a chronic laryngitis. Clinically in half of the cases a big carcinoma could be found. In 10 cases a chronic laryngitis had been diagnosed; in spite of the preceeding examination by microlaryngoscopy in 4 cases, however, the carcinoma could only be proved by histologic examination. The histologic examinations of the specimens regularly displayed an extended field of epidermisation of the laryngeal mucosa following chronic laryngitis, In these fields of epidermisation the carcinoma developed multicentrically and--in the early stages--mostly showed a covering-like, minutely infiltrating growth. Disseminated dot-like cancer-focuses in the epidermisation field and cancer buds arising from the basal layers of an intact covering of the hypertrophic epithelium could be observed several times. Chronic-hypertrophic laryngitis seems to favour the development of cancer within some patients (promoting factor), it even might accelerate it. As in about 6% of all the vocal cord cancers a preexistent chronic laryngitis is proved by history and clinical findings each patient with a chronic hypertrophic laryngitis must be examined by microlaryngoscopy as well as histological examinations and must be constantly observed.

Adult↗
PubMed1975

Subtotal pharyngolaryngectomy conservation surgery for carcinoma of sinus pyriformis extending toward the larynx.

In newly developed surgery for pyriform sinus tumor extending toward the larynx, the supraglottic portion of the larynx and the vertical half of the larynx on the tumor side are included in the area of resection. The arytenoid and cricoid cartilages on the tumor side and the vertical half of the hypopharyngeal wall are resected. Three out of seven patients remain cured at the end of 5 years and this ratio is the same as that for total pharyngolaryngectomy for pyriform sinus tumor. The resulting voice is somewhat hoarse, however, verbal communication is not remarkably affected. It is concluded that in surgical repair for pyriform sinus tumor extending toward the larynx, subtotal pharyngolaryngectomy is the procedure of choice to preserve the laryngeal function and anticipate reasonable prospects for a cure.

Follow-Up Studies↗
PubMed1996

Verrucous squamous cell carcinoma of the larynx: diagnostic and therapeutic considerations.

The clinical findings, histopathology, management and outcome of 31 patients with verrucous squamous cell carcinoma of the larynx (VSCC) are discussed. Laryngeal VSCC is a rare, highly differentiated variant of SCC and has specific morphological features and clinical behavior. A close liaison between the laryngologist and pathologist is needed to formulate a correct diagnosis, because this tumor appears to be malignant clinically and histologically benign. A low-power magnification of multiple large specimens, including the deep margins of the lesion, is required in order to differentiate VSCC from keratosis, verruca vulgaris or SCC with verrucous appearance, and to detect underlying microscopic foci of invasive SCC within or adjacent to a verrucous carcinoma. Long-lasting hoarseness was the most common symptom as the glottic region was the most common site of VSCC. Presumed clinically positive N1 lymph nodes were observed in the necks of 7 patients, but none had metastatic disease on histopathological study. Surgery alone was the most effective form of treatment, as it allowed a good outcome of all treated patients. Surgery plus radiotherapy was associated with an early recurrence and a poor outcome in 2 of 7 patients treated. The generally "benign" behavior of VSCC allows for conservative surgery, with complete endoscopic resection using the carbon dioxide laser representing a more conservative surgical approach. Neck dissection is not indicated due to the non-metastatic behavior of this tumor.

Adult↗
PubMed1995

The medullary vascular syndromes revisited.

There are two major vascular syndromes of the medulla oblongata: the medial and the lateral. The medial medullary syndrome is characterized by the triad of ipsilateral hypoglossal nerve palsy with contralateral hemiparesis and loss of deep sensation. Lateral medullary infarction commonly presents with Horner's syndrome, ataxia, alternating thermoanalgesia, nystagmus, vertigo and hoarseness. Combinations of the two major syndromes occur as bilateral medial medullary, hemimedullary and bilateral lateral medullary syndromes. Each of these syndromes frequently manifests with incomplete or atypical findings depending on the extent of the lesion. Magnetic resonance imaging has been useful in the clinical diagnosis of medullary infarctions. The site of the lesion may help predict the arteries involved.

Aged↗
PubMed1993

Acute pharyngoesophageal dysphagia secondary to spontaneous hemorrhage of a parathyroid adenoma.

Spontaneous hemorrhage of a parathyroid adenoma is a rare occurrence which may manifest with a variety of symptoms including cervical pain, hoarseness, respiratory distress, and dysphagia. We report a case of an elderly woman with a parathyroid adenoma diagnosed 10 years ago and for which she had refused surgery. Throughout this period her hypercalcemia was carefully monitored, and she experienced no symptoms or adverse sequelae from her disease. However, the patient subsequently presented with a 1 day history of a sore throat and a nonproductive cough followed by the acute onset of dysphagia. At this time she was found to have an anterior neck hematoma extending to the midthorax. Computerized tomography and direct laryngoscopy were suggestive of the diagnosis and neck exploration confirmed the presence of a large hematoma beginning at the site of the 3 x 4 cm parathyroid adenoma and extending into the left strap musculature. We report this case of spontaneous hemorrhage of a cervical parathyroid adenoma to bring to mind a rare etiology of acute pharyngoesophageal dysphagia.

Acute Disease↗
PubMedDate not supplied

Chronic traumatic aneurysms of the thoracic aorta.

During the last 10 years (1975-1985), a total of 18 cases of posttraumatic aneurysm at the level of the thoracic isthmus were operated on. Six of the 18 were women (19-71 years of age) and 12 were men (17-61 years of age). The mean age at the time of injury was, respectively, 22 and 25.8 years and, at the time of operation, 34.5 and 35.5 years. The patients were all involved in a motor vehicle accident, except for 2 (1 falling, 1 crushing). Thirty-nine percent of the patients had no apparent thoracic injury and 89% had associated injuries (bony fractures, craniofacial, visceral and abdominal). Eight of the 18 were asymptomatic at the time of operation, the others had various symptoms (pain, fever, dyspnea, cough, hoarseness, murmur, or hemoptysis). Enlargement of the aortic button was present in every case. Seventeen patients were operated on electively from 4 months to 50 years after the injury. Circumferential rupture was total in 9 patients and partial (2/3 to 9/10) in the others. Complete repair was done by either prosthetic Dacron tube (3), Dacron patch (2), or direct suture (12). Protection by femoro-femoral bypass was used in 3 and simple aortic cross-clamp was used in 14. Mean time of aortic cross-clamp was 36.9 minutes (range, 16-80 min). Among these 17 patients, there was no hospital mortality and no late death. One patient had regressive paraplegia. One patient was submitted to an emergency operation for an intrapulmonary rupture of an infected aneurysm and died in the operating room before completion of the repair.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

Late outcome of percutaneous dilatational tracheostomy in intensive care patients.

OBJECTIVE: Percutaneous dilatational tracheostomy is increasingly practiced in intensive care units and has a low incidence of early complications. The late effects of this procedure are still poorly known and were the focus of this study. DESIGN: Prospective descriptive clinical study. SETTING: Interdisciplinary intensive care unit in a 300-bed teaching hospital. PATIENTS: A consecutive group of critically ill patients who underwent percutaneous tracheostomy between Nov. 90 and March 93, surviving at least 2 months after decannulation. MEASUREMENTS AND RESULTS: There were 17 patients fulfilling the inclusion criteria and 16 of them were seen and examined. The follow-up protocol required a formal standardized patient interview, a physical examination of the stoma site and a fiberoptic laryngotracheoscopy. Results of these sub-tests and overall outcome rating were standardized and expressed as good, moderate or poor. Subjective rating was good in all patients. All denied suffering from any side effects of their tracheostomy. Clinical examination revealed neither stridor nor hoarseness in any of the patients. Most of the scars were whitish and less than 1 cm in length, a few were sunken in, none had adhesions. In 15 patients the clinical result was good and in one, moderate (whitish, sunken-in scar, longer than 2 cm). Ten patients underwent tracheoscopy, while 6 did not. There were no signs of significant stenosis or tracheomalacia. In 8 patients with minor findings results were scored as good, while 2 were classified as moderate (combination of swelling and scar formation of a string-like membrane). The overall rating was good in 13 patients (81%) and moderate in 3 patients (19%). There were no poor outcomes. CONCLUSIONS: Late outcome of percutaneous dilatational tracheostomy in critically ill patients is mostly good. Pending further studies, the use of this technique in intensive care units appears justified.

Adult↗
PubMed1995

Risk factors for laryngeal cancer.

This case-control study comprised 100 histologically verified laryngeal cancer patients and 100 hospital controls matched with cases by sex, age and place of residence. The following variables were tested for their association with cancer of the larynx: marital status, educational level, hard liquor consumption, cigarette smoking, unfavorable working conditions, sudden and frequent temperature changes at work, cold housing, loud speech at work, frequent hoarseness, frequent and persistent cough, persistently swollen neck glands, tonsillectomy and laryngeal surgery. According to conditional logistic regression analysis, significant association with laryngeal cancer was found for unfavourable working conditions for more than 10 years (OR = 4.36; 95% CI = 1.92-9.91), hard liquor consumption for more than 5 years (OR = 2.59; 95% CI = 1.14-5.87), cigarette smoking for more than 10 years (OR = 7.29; 95% CI = 2.41-22.09), tonsillectomy (OR = 4.80; 95% CI = 1.61-14.30) and frequent and persistent cough prior to disease (OR = 8.17; 95% CI = 1.72-38.76).

Adult↗
PubMed1985

Nandrolone decanoate added to tamoxifen in the treatment of advanced breast cancer.

Since 1980 we have been carrying out a prospective randomized trial comparing tamoxifen with the combination of tamoxifen plus nandrolone decanoate in advanced breast cancer. The tamoxifen dose is 30 mg daily and the nandrolone decanoate dose 100 mg i.m. once a week for four weeks and thereafter every other week. 98 post-menopausal patients have been evaluated for the response. The number of patients is 49 in both groups. The overall response rates (CR + PR) to tamoxifen and tamoxifen plus nandrolone decanoate were not significantly different; in the tamoxifen group the response rate was 49% and in the combination group 45%. The mean time to progression in tamoxifen group is over 13 months and in tamoxifen plus nandrolone decanoate group over 12 months. Our results do not suggest a synergistic effect from combining tamoxifen and nandrolone decanoate treatments. The response rates to tamoxifen at different sites of metastases were as follows: bones 47%, soft tissues 56%, and viscera 48%. The respective figures with the combination therapy were 36%, 64%, and 40%. Both treatments were well tolerated and in no patient was withdrawal of the therapy necessary. Mild virilization and hoarseness were experienced by all patients treated with nandrolone decanoate. Side-effects associated with tamoxifen were rare, although five patients experienced nausea and two had hot flushes.

Aged↗