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PubMed2005

Diabetes insipidus caused by isolated intracranial metatstases in patient with breast cancer.

We present a case of late recurrence of breast cancer manifested with diabetes insipidus caused by isolated intracranial metastases. A 57-year-old postmenopausal woman was diagnosed with breast cancer and underwent radical mastectomy, without any adjuvant therapy. Seventeen years later, she presented with polyuria, polydipsia, weight loss, weakness, diffuse bone pain, hoarseness and mild dyspnoea. Cranial CT revealed several dural masses in the frontal, parietal and occipital lobes and along the falx cerebri. The diagnosis of central diabetes insipidus without impairment of anterior pituitary function was based on the clinical symptoms, laboratory tests and imaging findings. The patient was successfully treated with desmopressin acetate and letrozole, and remained alive and ambulating 22 months after initial presentation with diabetes insipidus.

Antineoplastic Agents↗
PubMed2006

Vocal dysperiodicities estimation by means of adaptive long-term prediction.

An adaptive formulation of the long-term bidirectional linear predictive analysis is proposed in the context of the acoustic assessment of disordered speech. Vocal dysperiodicities are summarized by means of a signal-to-dysperiodicity ratio (SDR) marker. It is shown that performing an adaptive forward and backward long-term linear prediction of each speech sample and retaining the minimal prediction error energy as a cue of vocal dysperiodicity results in an SDR that correlates with the perceived degree of hoarseness. The coefficients of the time-varying long-term linear predictive model are estimated by means of the recursive least squares algorithm. The corpora comprise sustained vowels and French sentences produced by male and female normophonic and dysphonic speakers. A perceptual assessment of speech samples, which rests on comparative judgments, is used to evaluate the ability of the acoustic marker to predict subjective measures of voice quality. Experimental results show that the adaptive approach gives rise to high correlations for sustained vowels as well as for sentences.

Case-Control Studies↗
PubMed2003

Mycotic aneurysm of the aortic arch due to Salmonella.

We report the successful treatment of a 79-year-old man with an extremely rare mycotic aneurysm of the aortic arch due to Salmonella. The patient presented with persistent fever, hoarseness, and hemosputum. Computed tomography showed a large saccular aneurysm with a hazy aortic wall in the aortic arch. We conducted emergency total arch replacement, debriding surrounding infectious tissue. Cultures from the aneurysm grew Salmonella enteritidis. Infection recurred 1 week postoperatively, requiring open irrigation and omentum transposition. These surgical procedures, along with appropriate antibiotics, brought infection under control.

Aged↗
PubMed2003

Pediatric otolaryngologic manifestations of gastroesophageal reflux disease.

In adults, an estimated 4% to 10% of chronic, nonspecific laryngeal disease seen in otolaryngologic clinics is associated with gastroesophageal reflux disease (GERD). Although no such estimates exist in children, many investigators have reported extraesophageal manifestations of GERD, of which the most common is the association of GERD with asthma and chronic cough. A variety of signs and symptoms of otolaryngologic disease also have been attributed to GERD, including hoarseness, laryngitis, chronic rhinitis, sinusitis, globus pharyngeus, recurrent croup, laryngomalacia, stridor, subglottic stenosis, otalgia, vocal cord granulomas, and oropharyngeal dysphagia. However, proof of the association between these manifestations of otolaryngologic disease and GERD is sparse. Furthermore, the manifestations of otolaryngologic disease often occur in the absence of such classic systems of GERD as heartburn or chest pain. This review explores the role of GERD in otolaryngologic disease in children.

Age Factors↗
PubMed1990

Prolonged ambulatory esophageal pH monitoring in the evaluation of gastroesophageal reflux disease.

Gastroesophageal reflux disease is a common problem that frequently presents with atypical complaints including nausea, hiccups, globus sensation, chest pain, hoarseness, coughing, or various pulmonary complaints. Diagnosis may be difficult, as these patients often do not have radiographic or endoscopic evidence of esophagitis. In these difficult cases, prolonged esophageal pH monitoring provides an accurate method of quantitating acid reflux parameters and correlating symptoms with reflux episodes in an outpatient setting. Current equipment is compact, durable, and not difficult to use or extremely expensive. Data analysis, with a particular emphasis on acid-exposure time (total, upright, supine), reliably discriminates between abnormal and normal subjects but it is not a perfect "gold standard" for gastroesophageal reflux disease. Indications for esophageal pH monitoring include: (1) atypical symptoms of acid reflux with normal endoscopy, (2) typical reflux symptoms unresponsive to medical therapy, and (3) the follow-up of reflux disease after either medical or surgical therapy. This test is currently performed primarily by gastroenterologists, but we believe many other groups may find this technology helpful. To meet these expanding applications, test refinements are necessary, particularly easier methods of placing the pH probe and better standards for defining abnormal pH parameters in older patients. The future for esophageal pH monitoring is bright. This technology has the potential to do for the diagnosis of gastroesophageal reflux disease what endoscopy has done for the diagnosis of peptic ulcer disease.

Ambulatory Care↗
PubMed1976

Management of thyroid nodules in the elderly.

Eleven malignant thyroid tumors were found in 100 consecutive patients more than sixty years old having thyroid operations. Based on preoperative findings, these 100 patients could be separated into two groups according to high and low risk for malignancy. Clinical manifestations in the high risk group were presence of a discrete cold thyroid nodule, hoarseness, dysphagia, an enlarging mass, or palpable ipsilateral cervical adenopathy; and in the low risk group, asymptomatic multinodular goiter, diffusely enlarged glands with elevated antithyroid antibody titers, and a family history of goiter. All eleven patients with malignant thyroid tumors were found in the sixty-six patients considered at high risk, whereas no malignant lesions were found in the low risk patients. Six of the malignant thyroid tumors were undifferentiated and in three of these a thyroid nodule had been present for more than fifteen years. There were no operative deaths and only one significant complication, a recurrent laryngeal nerve injury. Thyroidectomy is indicated for elderly patients with thyroid nudules who have features of the high risk group, whereas patients in the low risk group can be safely followed.

Age Factors↗
PubMed1982

Carcinoma of the subglottic larynx.

Primary epidermoid carcinoma of the subglottic region is extremely rare. Review of the tumor registry at Memorial Sloan-Kettering Cancer Center over the past 25 years showed only 16 patients who could be classified as having primary carcinomas arising in the subglottic larynx. Their ages ranged from 33 to 77 years. There were 13 men and 3 women. The most common symptom was hoarseness of voice (13 patients), followed by respiratory difficulty, and hemoptysis. One patient had stage I disease, two had stage II disease, five had stage III disease, and eight patients had stage IV disease. The thyroid gland was commonly involved in T4 lesions. Thirteen patients underwent total laryngectomy and 3 had partial laryngectomy. Thirteen patients were followed for more than 5 years. There was one postoperative death. One patient who had recurrence of tumor in the neck died 6 months later. One patient died after 1 year due to local recurrence and carotid rupture. One patient with initial bilateral metastatic neck nodes died from progressive, rapid, diffuse metastasis within 6 months. The 5 year determinate cure rate was, therefore, 70 percent (10 of 14). Herein, we have attempted to study the natural history of primary tumors of the subglottic region and elucidate causes of treatment failure. It appears that wide-field laryngectomy in conjunction with appropriate thyroidectomy and tracheoesophageal groove node dissection is the optimal initial treatment. Postoperative radiotherapy should be considered in advanced cases.

Adult↗
PubMed1987

Cranial nerve injuries during carotid endarterectomy.

Our experience with patients undergoing carotid endarterectomy over a 10 year period has been retrospectively reviewed. Nerve injuries were detected by reviewing postoperative progress and clinic notes. One hundred twenty-nine procedures were performed on 112 patients, 12 of whom (9.3 percent) sustained major nerve injuries. These included five vagal nerve injuries causing ipsilateral vocal cord paralysis and hoarseness, four injuries of the marginal mandibular nerve, and three injuries of the hypoglossal nerve. Evidence of nerve dysfunction was not present preoperatively. None of the patients with nerve injury sustained a stroke as a result of carotid operation. Vocal cord paralysis was documented by indirect laryngoscopy. The incidence of cranial nerve injury during carotid endarterectomy appears to be higher than expected, particularly if asymptomatic patients are investigated; however, most injuries are transient and result not from transection but from trauma during dissection, retraction, and clamping of the vessels. The pertinent anatomy and techniques for preventing these injuries have been reviewed.

Carotid Artery Diseases↗
PubMed1990

Intrathoracic tumors of the vagus nerve.

Two patients had resection of a middle mediastinal neurilemmoma of the vagus nerve. Twenty-seven other neurogenic tumors of the intrathoracic vagus are reviewed. These tumors are generally asymptomatic except for hoarseness in an occasional patient.

Adult↗
PubMed1990

Clinical experience with minitracheostomy.

Minitracheostomy is a technique to assist in the removal of airway secretions while maintaining glottic function. A flanged, reclosable cannula 4.0 mm in internal diameter is inserted through the cricothyroid membrane into the trachea. Sixty procedures were performed in 56 patients from July 1988 to June 1989. Indications for placement included excessive postoperative secretions (46/60), difficulty with endotracheal suctioning (4/60), preoperative secretions (4/60), postpneumonic secretions (5/60), and acute airway obstruction (1/60). Successful intratracheal placement was possible in all instances, and the device was well tolerated. Major intratracheal bleeding necessitating endotracheal intubation occurred in 2 patients. Minor complications included local hematoma (5 patients), subcutaneous emphysema (2 patients), and hoarseness (1 patient). No deaths occurred. Cannulas remained in place for one day to 35 days. Removal resulted in closure within 48 hours. No adverse laryngeal effects were seen. A successful result, not requiring other invasive methods to remove secretions, was obtained in 43 (72%) of the 60 procedures. Minitracheostomy is a useful adjunct for secretion removal in the hospitalized patient.

Bronchi↗
PubMed1991

Airway complications in relapsing polychondritis.

To analyze the importance of airway involvement in relapsing polychondritis, an illustrative case report is presented and 62 patients reported in the literature with serious airway complications are reviewed. There were 47 female and 17 male patients, with an average age of 40.3 years (range, 2 to 73 years). Patients were seen with hoarseness, breathlessness, cough, stridor, wheezes, and tenderness over laryngotracheal cartilages. Respiratory tract involvement was confirmed by conventional radiography, tomography, computed tomography, dynamic pulmonary function tests, and bronchoscopy. Corticosteroids and antiinflammatory and immunosuppressive agents were used in these patients. Tracheostomy was performed in 18 patients. Death occurred in 13 patients despite tracheostomy or corticosteroid therapy, or both. A detailed analysis of the clinical, radiological, and pulmonary function studies is presented, with emphasis on upper airway mechanics. The medical and surgical management options are reviewed, including the use of endotracheal prosthesis and extraluminal splinting in dynamic airway collapse.

Adolescent↗
PubMed1994

Replacement of entire aorta from aortic valve to bifurcation during one operation.

A 68-year-old patient presented with an extensive aortic aneurysm extending from the aortic valve to the aortic bifurcation associated with severe continuous pain, dysphagia, and hoarseness. Because of the risk of impending rupture and an "elephant trunk" procedure not being an option, the entire aorta from the aortic valve to the aortic bifurcation was replaced during one operation using deep hypothermia with circulatory arrest and retrograde perfusion of the brain through the jugular veins. Seven months after the operation the patient walks more than 3 km a day and lives a normal life. The operative repair is presented.

Aged↗
PubMed1976

Beclomethasone dipropionate aerosol and oropharyngeal candidiasis.

In a survey of 400 consecutive patients with chronic asthma treated with beclomethasone dipropionate aerosol (up to 400 mug/day) the prevalence of oropharyngeal thrush was 4-5%. The prevalence of this complication was not significantly related to sex, age, duration of treatment with beclomethasone or concurrent treatment with prednisolone. Yeasts were isolated from throat swabs in about 60% of all patients and in 48% of normal controls. Thus, although a diagnosis of oropharyngeal thrush was recorded only when the presence of characteristic lesions in the pharynx was associated with a positive culture, there was a large number of patients and controls without thrush who harboured yeasts in the throat. One in 3 patients with thrush complained of sore throat or hoarseness, but 1 in 4 patients without thrush had similar symptoms. These findings suggest that, although treatment with beclomethasone dipoprionate aerosol undoubtedly can cause oropharyngeal thrush, this condition is not an inevitable result of colonization of the oropharynx by yeasts, nor is it necessarily associated with symptoms.

Adolescent↗
PubMed1979

The perceptual identity and characteristics of aging in normal male adult speakers.

Twenty untrained male and 20 untrained female listeners were requested to judge the age of 46 male speakers from samples of conversational speech. Thirty-seven samples were judged similarly by the two groups and were therefore provided as listening stimuli for ten male and ten female speech pathologists. Through an a posteriori schema, speech pathologists were required to specify the salient features of speech judged as being characteristic of each speaker's perceived age. The results of the study indicated that untrained listeners used similar perceptual sets to judge age until after the fiftieh year of life. Regardless of sex, listeners tended to underestimate the age of the speakers. Male and female speech pathologists viewed low pitch and hoarseness as being the most salient features of speech for the speakers. Qualitative analysis revealed that the most prominent features indicated by speech pathologists could be classified according to pitch, quality, articulation, and rate of speech.

Adult↗
PubMed1981

Bronchoscopy in childhood.

One hundred and seventeen patients underwent 183 bronchoscopies with no fatalities. Thirteen patients had complications related to their bronchoscopy and not the underlying disease state. Only the 33 patients with a diagnosis of foreign body aspiration had a high (88%) correlation of the preoperative diagnosis or condition and the postoperative findings. Fifty-one of the 117 patients had normal bronchoscopies and the number of normal bronchoscopies in patients who had wheezing, croup, hoarseness, stridor, and chronic cough was high. Assessing justification for bronchoscopies despite the negative correlation of pre- and postoperative diagnosis is difficult due to many factors, including pediatrician and parental anxiety, and the recognized consequences of missing a foreign body or other lesion in the airway of a child. Using liberal criteria for justification. fewer than 10% of the patients in this series had an unwarranted bronchoscopy, and the safety of the procedure would indicate that bronchoscopy in a pediatric medical center should be performed with minimal clinical justification.

Bronchoscopy↗
PubMed1987

The psychiatric and social characteristics of patients with functional dysphonia.

Of 121 consecutive outpatients seen in an ENT clinic who received a diagnosis of functional dysphonia, 71 who were referred to the speech therapy department were interviewed. Sixty one (86%) were women, and the mean age of the group was 47.6 yr. The commonest voice disorder was huskiness or hoarseness, and only five patients had a pure 'whispering' dysphonia. There was little evidence of major psychiatric disorder in the group: eight patients had a past psychiatric history; two had histrionic personality disorder, and 22 (33%) had clinically diagnosable mood disorders which were mainly anxiety/tension states. This descriptive study formed the background for an investigation of the psychosocial stressors preceding onset of functional dysphonia.

Adolescent↗
PubMed1995

Neurodegenerative course in ceramidase deficiency (Farber disease) correlates with the residual lysosomal ceramide turnover in cultured living patient cells.

Farber's lipogranulomatosis is an inborn lipid storage disease characterized by tissue accumulation of ceramide due to deficient activity of lysosomal ceramidase. Symptoms include painful swelling of joints, subcutaneous nodules, a hoarse cry, hepatosplenomegaly and nervous system dysfunction of markedly variable degree. In most cases the neural dysfunction rather than the general dystrophy, seems to limit the duration of Farber disease. We examined whether the severity can be shown as a function of ceramide turnover by lysosomal ceramidase. The lysosomal degradation of sphingomyelin-derived ceramide was studied in situ in patient skin fibroblasts and lymphoid cells loaded with LDL-associated radioactive sphingomyelin. We could show for the first time a significant correlation between the ceramide accumulated in situ and the severity of Farber disease. Our method provides an alternative means for determining ceramide degradation by lysosomal ceramidase, but in intact cells. The relatively simple method is at least of the same diagnostic use for Farber disease as the in vitro assay of acid ceramidase using cell homogenates and may also have some prognostic use.

Acid Ceramidase↗
PubMed1983

A 26-week inhalation toxicity study with formaldehyde in the monkey, rat, and hamster.

This inhalation study involved simultaneous exposure of five groups of 6 male Cynomolgus monkeys, 20 male and 20 female Fischer 344 rats, and 10 male and 10 female Syrian golden hamsters for 22 hr per day, 7 days per week for 26 weeks to formaldehyde gas. The cumulative mean exposure concentrations were 0, 0, 0.19, 0.98, and 2.95 ppm for the two control groups, low-, mid-, and high-level exposure groups, respectively. There was no treatment-related mortality during the study. In monkeys, the most significant findings were hoarseness and congestion and squamous cell metaplasia in the nasal turbinates of the 2.95-ppm exposure group. There were no signs of toxicity in the lower-level exposure groups. In the rat, the only observations of possible responses to exposure were found in the 2.95-ppm exposure group. These findings consisted of squamous metaplasia in the nasal turbinates, decreased body weights starting during the second week of the study, and decreased liver weights. In contrast to monkeys and rats, hamsters did not show any significant responses to exposure even at 2.95 ppm. It was concluded that nearly continuous exposure of monkeys and rats for six months at a level of 2.95 ppm of formaldehyde clearly elicited an effect while exposures below this level did not appear to demonstrate an effect. It further appeared that the monkey and rat were more sensitive to formaldehyde exposure than the hamster.

Animals↗