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At least 1,243 records · Page 69Linked to original sources
PubMed1996

Extensive resection with selective cerebral perfusion for a lung cancer invading the aortic arch.

An extensive operation for lung cancer invading the aortic arch is reported. A 66-year-old man presented the recent onset of hoarseness. Chest computed tomography and magnetic resonance imaging demonstrated a tumor of the Botallo lymph node invading the aortic arch. Left pneumonectomy with combined resection of the aortic arch was performed with the use of brain-isolated cardiopulmonary bypass. The aortic arch was resected and replaced by an artificial graft. Pathological examination revealed a primary lesion of adenocarcinoma in the left upper lobe and contiguous lymph node involvement, pT4N2M0. He was discharged and followed as an outpatient, however he died of miswallowing 10 months later. Such an extensive operation may be of value in selected patients.

Adenocarcinoma↗
PubMed2003

Recurrent respiratory papillomatosis.

A 6-year-review of patients who presented with recurrent respiratory papillomatosis (RRP) to our hospital from January 1996 to December 2001 was carried out. Ten cases were identified, of which six were juvenile-onset RRP. Hoarseness was the most common symptom, noted in nine (90%) patients. Other clinical presentations included cough, stridor and aphonia. All patients had glottic papillomas; two had multiple sites of involvement. One patient underwent a tracheostomy that revealed papillomas over the trachea, bronchus and lung parenchyma. Half of the patients were Chinese. Of the six cases of juvenile-onset RRP, three patients were Malay, two Chinese and one Indian. Three Chinese and one German patient had adult-onset RRP. Among the juvenile-onset RRP cases, the mean age at presentation was 2 years, while for adult-onset RRP, it was 42 years. Juvenile-onset RRP was more common in females. There were more papillomas over more sites in patients with juvenile-onset RRP than with adult-onset disease. Subglottic involvement was noted in the juvenile-onset RRP cases. All patients were treated with CO2 laser therapy, but there was complete remission of the papillomas in only two cases.

Adolescent↗
PubMed2003

Cancer of the larynx.

In Europe, laryngeal cancer accounts for only 2-5% of all cancers, the incidence being much higher among males than among females. Smoke and alcohol represent the major behavioural risk factors. Several carcinogens, occupations and vitamin deficiencies have been associated with laryngeal cancer. A genetic susceptibility to environmental risk factors and carcinogens is recognized. Hoarseness is the main symptom for which patients call for medical consultation. Mucosa is the most common histologic site of the primary lesions considered in the present chapter. Nodal involvement, the site and volume of the primary tumour, and some genes expression represent the major prognostic factors. A high death rate for not cancer-related events is to be pointed out. The loco-regional extent of the disease determines the success of cure. Surgery and radiotherapy represent the main therapeutic options. The choice between these two procedures is often controversial.

Female↗
PubMed1998

Cervicothoracic approach for total mesoesophageal dissection in cancer of the thoracic esophagus.

BACKGROUND: The clinical significance of lymph node involvement along the recurrent laryngeal nerves in cancer of the thoracic esophagus is still controversial. Although these lymph nodes are anatomically located in a well-defined compartment (proximal mesoesophagus), appropriate procedures for dissecting them are not well established. STUDY DESIGN: We retrospectively investigated clinical results over the past 10 years in 276 patients who underwent systematic dissection of cervical, mediastinal, and upper abdominal lymph nodes. We routinely performed the cervical procedure before thoracotomy for total dissection of the proximal mesoesophagus and to minimize the operative risk. RESULTS: All macroscopically recognizable lesions were resected in 94% of the patients. The hospital mortality rate was 2.5%. Recurrent nerve palsy developed in 59 patients, but it was successfully managed without prolonged hoarseness in 50 of them. The recurrent nerve node group was most frequently involved (frequency of 25% in superficial cancer, 57% in non-superficial cancer). Supradiaphragmatic lymph node involvement was limited to the recurrent nerve nodes in 25% of the patients with positive supradiaphragmatic node. The 5-year survival rate in patients with positive recurrent nerve nodes was 34%. CONCLUSIONS: Dissection of the recurrent nerve lymph nodes is essential for curative esophagectomy even in the early phase of cancer invasion. Our cervicothoracic approach for total dissection of the proximal mesoesophagus yielded acceptable outcomes.

Carcinoma, Squamous Cell↗
PubMed2001

The surgical airway.

Traumatic airway injuries are rare in children, partly due to their unique anatomy. The larynx is well protected from direct blows behind the mandibular arch, and only a small portion of the trachea is unprotected above the manubrium due to the relatively short neck. Furthermore, the tracheobronchial tree is less prone to injuries as compared with adults due to its elasticity. A high index of suspicion is thus needed to adequately diagnose and manage pediatric airway injuries. Laryngotracheal injuries in particular may present with discreet initial symptoms that if undiagnosed may rapidly progress to loss of airway. The most important signs of laryngeal injury include hoarseness and subcutaneous emphysema. Tracheobronchial injuries often present with dramatic symptoms, the most common being pneumothorax, which does not resolve after placement of chest tube, or large persistent air leaks. Endoscopy is mandatory on suspicion of injury to the larynx, trachea, or bronchi. CT scan may be helpful in determining the extent of injury to the larynx. Correct management of the airway in laryngotracheal injuries has a direct impact on morbidity and mortality. Endotracheal intubation over a flexible bronchoscope during spontaneous ventilation and in halothane anesthesia is the method of choice in children, but it should be performed in the operating room with the possibility of emergency tracheotomy. Cricothyroidotomy should be avoided in all laryngotracheal injuries because this method may aggravate the injury. Most laryngotracheal injuries in children can be conservatively managed. Extensive injuries, including displaced fractures of the cartilage, injuries to the recurrent nerves, and laryngotracheal separation, require surgical intervention. Injuries to bronchi and the thoracic trachea that do not cause a persistent air leak, and where the lungs expand completely after insertion of chest tubes, may be managed conservatively. All other injuries to the tracheobronchial tree should be repaired surgically as soon as feasible. Induction of anesthesia and opening of the chest may make ventilation difficult and are best managed by selective intubation of the contralateral lung. Long-term outcome after laryngeal, tracheal, and bronchial injuries in children, if managed swiftly and accurately, is usually excellent unless other injuries are present. The final result is improved by early recognition and early surgical intervention. These children need to be followed endoscopically for months and sometimes years in order to diagnose and treat stenoses as soon as they occur. Long-term pulmonary function has been shown to be excellent. Children with bilateral recurrent nerve paralysis may not fully recover voice or airway.

Airway Obstruction↗
PubMed1995

Hyalinosis cutis et mucosae. Review with a case report.

Hyalinosis cutis et mucosae (lipoid proteinosis) is a rare disorder characterized by hyaline and lipid deposits in the skin and mucous membrane of the oral cavity, upper respiratory tract, and internal organs. It usually appears in infancy with hoarseness. This disorder is particularly interesting because of its rarity and wide range of clinical manifestations. We report a case that demonstrated manifestations of lipoid proteinosis.

Adult↗
PubMed2006

Inlet patch of gastric mucosa in upper esophagus causing chronic cough and vocal cord dysfunction.

BACKGROUND: An inlet patch of gastric mucosa in the upper esophagus is usually an incidental, congenital finding found during upper gastrointestinal tract endoscopy. Although it has been reported to cause dysphagia, strictures, adenocarcinoma, and webs, it has never been associated with cough and vocal cord dysfunction. OBJECTIVE: To report the first case of a patient with an inlet patch of gastric mucosa in the upper esophagus as the cause of a particularly troublesome, chronic cough that was initially missed on 2 upper endoscopies. METHODS: The patient is a 50-year-old man with a 7-year history of chronic cough associated with hoarseness, shortness of breath, and globus sensation. For diagnostic evaluation, pulmonary function tests, chest computed tomography, rhinolaryngoscopy, upper gastrointestinal tract endoscopy, and histologic examinations were performed. RESULTS: A multidisciplinary approach revealed several possible causes for the chronic cough, including vocal cord dysfunction, postnasal drip syndrome, allergic rhinitis, and mild gastroesophageal reflux disease that was only partially responsive to therapy. The results of 2 initial upper gastrointestinal tract endoscopies were interpreted as normal. A third endoscopy detected an inlet patch of gastric mucosa in the upper esophagus. Treatment with a high-dose histamine type 2 receptor antagonist and a proton pump inhibitor alleviated the patient's symptoms. CONCLUSIONS: An inlet patch of gastric mucosa in the upper esophagus is not uncommon, but it is often overlooked or believed to be an incidental, congenital finding. This is the first report, to our knowledge, of an inlet patch resulting in a troublesome, chronic cough.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed2006

Vocal cord dysfunction concurrent with a nutcracker esophagus and the role of gastroesophageal reflux disease.

BACKGROUND: Psychological disorders were originally thought to be the sole cause of vocal cord dysfunction (VCD). Subsequently, other organic diseases, including structural laryngeal abnormalities, have also been reported to be associated with VCD. OBJECTIVES: To describe the first patient with VCD concurrent with a nutcracker esophagus and to establish the association between VCD and gastroesophageal reflux disease (GERD) by using the Bernstein test. METHODS: Symptom assessments, neuropsychiatric evaluations, fiberoptic laryngoscopy, pulmonary function tests, allergic skin prick tests, radiographs of the chest and sinuses, esophageal manometry (including 24-hour ambulatory esophageal pH monitoring), and the Bernstein test were performed. RESULTS: A 36-year-old woman had dyspnea, hoarseness, chest pain, and wheezes without relief for a decade. Neuropsychiatric evaluations disclosed mild depression. Fiberoptic laryngoscopy showed posterior laryngitis and paradoxical vocal cord adduction with audible inspiratory stridor. Pulmonary function tests showed attenuation of the inspiratory limb with notching in both flow-volume loops and a mid-vital capacity expiratory to inspiratory flow ratio of 4. All the symptoms except chest pain were improved dramatically by speech therapy and empirical treatment for GERD. Esophageal manometry revealed a nutcracker esophagus; 24-hour ambulatory esophageal pH monitoring demonstrated multiple short reflux episodes. The Bernstein test was conducted, and all the manifestations were reproduced with 0.1 N hydrochloric acid but not with isotonic sodium chloride infusion. CONCLUSIONS: This is the first human case report confirming that GERD can trigger an acute attack of VCD and may induce chest pain as a nutcracker esophagus in patients with VCD. It strengthens this association and expands our knowledge of diverse manifestations of this clinical entity.

Adult↗
PubMedDate not supplied

Laryngoscopy and pharyngeal pH are complementary in the diagnosis of gastroesophageal-laryngeal reflux.

Pharyngeal pH monitoring and laryngoscopy are routinely used to diagnose gastroesophageal-laryngeal reflux as a cause of respiratory symptoms. Although their use seems intuitive, their ultimate diagnostic value is yet to be defined. We studied 10 asymptomatic (control) subjects and 76 patients with respiratory symptoms. Both patients and control subjects were given a symptom questionnaire. Each underwent direct laryngoscopy using the reflux finding score (RFS) to grade laryngeal injury, esophageal manometry, and 24-hour esophagopharyngeal pH monitoring. The patients were then classified as RFS+, if the score was greater than 7, and pharyngeal reflux (PR)+, if they had more than one episode of PR detected during pH monitoring. The most common symptoms reported by patients were hoarseness (87%), cough (53%), and heartburn (50%). Control subjects had a significantly lower RFS (2.1 vs. 9.6, P < 0.01) and fewer episodes of PR (0.2 vs. 3.4, P < 0.01), than patients. None of the control subjects had more than one episode of PR during a 24-hour period. Fifty patients (66%) were RFS+ and 26 (34%) were RFS-. Thirty-two patients (42%) were PR+ and 44 (58%) were PR-. Fifteen patients had a normal RFS and no PR (group I = RFS-/PR-). Forty patients had discordance between the laryngoscopic findings and the pH monitoring (group II = RFS-/PR+ or RFS+/PR-). Twenty-one patients had both an abnormal RFS and PR (group III = RFS+/PR+). Patients in group III had significantly higher heartburn scores and distal esophageal acid exposure. Eighty-three percent of patients in group III but only 44% in group I improved their respiratory symptoms as a result of antireflux therapy. An abnormal PR or RFS differentiates patients with laryngeal symptoms from control subjects. Agreement between PR and RFS helps establish or refute the diagnosis of gastroesophageal reflux as a cause of laryngeal symptoms. Patients who are RFS+ and PR- may have laryngeal injury from another source, whereas patients who are RFS- and PR+ may not have acid entering the larynx, despite the presence of PR. Patients who are RFS+ and PR+ have more severe gastroesophageal reflux disease and their reflux causes laryngeal damage. Laryngoscopy and pharyngeal pH monitoring should be considered complementary studies in establishing the diagnosis of laryngeal injury induced by gastroesophageal reflux. ( J GASTROINTEST SURG 2002;6:189-194.)

Case-Control Studies↗
PubMed2006

Laryngopharyngeal reflux: A literature review.

Laryngopharyngeal reflux (LPR) is a common condition encountered in otolaryngological practice in the United Kingdom. It is one of the most important aetiological factors for many inflammatory disorders of the upper aerodigestive tract. The presentations are diverse and include chronic hoarseness, sensation of a foreign body in the throat, sore throat, dysphagia, postnasal drip, excessive throat mucous, chronic cough and throat clearing. LPR patients may not complain of heartburn. Although LPR is common, its diagnosis may not be easy, as its symptoms are non specific and the laryngeal findings are not always associated with symptom severity. This article discusses an overall view of LPR in terms of pathophysiology, clinical presentation, diagnosis and treatment

Diagnosis, Differential↗
PubMedDate not supplied

Vocal assessment in patients submited to CO2 laser cordectomy.

AIM: To evaluate voice outcomes in patients with early glottic carcinoma treated by CO2 laser cordectomy. METHOD: 15 patients with glottic Tis and T1 squamous cell carcinoma treated with CO2 laser were analyzed. The assessment consisted of perceptual voice analysis, objective voice evaluation and video-laryngo-stroboscopic exam. In addition, patients rated their voices and completed the Voice related Quality of Life (VR-QOL) questionnaire. The results were compared with those obtained in a matched control group. RESULTS: Most of the patients presented some degree of hoarseness on perceptual voice analysis, mainly rough and breathy voices. Their acoustic evaluation compared with the control group showed a small increase in fundamental frequency, but with no statistically significant difference, and the values of jitter, shimmer and noise to harmonic ratio were worse and statistically significant. As regards to videolaryngo-stroboscopic findings, better results were achieved in the less extensive resection group. Patients have had minimal repercussion in their life quality in respect to voice. CONCLUSIONS: In spite of voice alterations in patients submitted to cordectomy by CO2 laser, functional results are acceptable, with minimal repercussion in their quality of life.

Adult↗
PubMed1976

Rhabdomyoma of the hypopharynx and larynx. Report of two cases and a review of the literature.

Two cases of extracardiac rhabdomyoma are reported in a 54-year-old man with unexplained difficulty in breathing and in a 39-year-old man with a prolonged history of hoarseness. Attention is drawn to the necessity of doing hypopharyngo-and laryngoscopy in such cases. One tumour was found in the left vallecula in the hypopharynx and the other on the left vocal cord. The literature and the histological findings in 53 cases are reviewed. It appears that this rare tumour is most frequently found in muscles derived from the pharyngeal arches. A total of 40 cases have been diagnosed during the last decade, and this increase is likely to continue in the future. It may turn out that extra-cardiac rhabdomyoma is not so rare as was first presumed.

Adult↗
PubMed1978

Rhabdomyosarcoma of the larynx. Report of two cases and a review of the literature.

The rhabdomyosarcoma is a relatively rare tumour form. Two cases in the larynx--a site which is extremely rare--are reported. So far, only 9 cases have been described and documented, and of one of our cases seems to be the first of the alveolar type found at this site. Diagnostic and differential-diagnostic considerations are discussed. Hoarseness is the commonest and earliest symptom. As stated by most authors, the treatment should be radical operation, often with laryngectomy, supplemented by irradiation and chemotherapy.

Adolescent↗
PubMed1978

Epidermolysis bullosa and its E.N.T. manifestations. Two case reports.

The present paper describes two rare cases of epidermolysis bullosa dystrophica (recessive), one with oesophageal stricture and another with laryngeal stenosis, along with other usual features of the disease. Different views on the line of treatment of the oesophageal stricture as a complication of this dreadful disease are discussed. Replacement of the strictured oesophagus by coloplasty may be contemplated in the first case, if the patient develops increasing dysphagia. In the second case, with cicatrical stenosis of the larynx and hoarseness of voice which is a rare complication of the disease, not reported in the literature so far, a tracheostomy is contemplated when the child develops acute respiratory distress. These two cases are under observation.

Adult↗
PubMed1979

Behçet's disease of the oesophagus.

A forty-two-year-old man known to have Behçet's disease (two major and two minor symptoms) (Mason and Baines, 1969) presented with dysphagia, hoarseness and regurgitation of food. This was subsequently found to be due to a tracheo-oesphageal fistula consequent upon an area of Behçet's ulceration in the oesophagus. The fistula was excised, the defects in the trachea and oesophagues repaired, and the patient's recovery was uneventful.

Adult↗
PubMed1981

Laryngeal malignant lymphoma--an entity?

Five patients with laryngeal lymphoma who presented at the Royal National Throat, Nose and Ear Hospital between 1953 and 1979 are described. The literature is reviewed and it is found that 40 cases have been previously reported. A modification of a previous clinical classification is presented. Long-term hoarseness as a presenting symptom, and difficulty in making the diagnosis is emphasized. It is found that most cases are supraglottic, non-ulcerated, pale laryngeal masses. There is no sex or age preference and Hodgkin's lymphoma has not been described in the larynx. A significant number of cases are, and remain localized to the larynx, and consequently have a good prognosis with radiation therapy. However, careful evaluation by experts, and long-term follow-up is emphasized.

Aged↗
PubMed1983

Tuberculous granuloma of the epiglottis.

A case of tuberculous granuloma of the epiglottis is presented. The presenting symptoms were hoarseness and painful dysphagia, and the laryngoscopic appearances resembled carcinoma. Histological examination of the biopsy material was diagnostic, emphasising the difficulty of diagnosis in the general population.

Epiglottis↗
PubMed1986

Surgical treatment of Reinke's oedema (long-term results).

The purpose of this investigation was to evaluate the extent to which voice quality recovers and is retained in the long term, and the incidence of recurrence of Reinke's oedema, in patients treated by stripping of the vocal cords. Of 120 patients treated consecutively over an eight-year period, 111 comprised the follow-up investigation group. Only 19 per cent had a normal voice. The remaining 81 per cent had voice problems, and of these, 68 per cent displayed obvious hoarseness, with recurrence of Reinke's oedema in 58 per cent. It is concluded that the long term curative effect of this traditional treatment is over-estimated, and that the elimination of various etiological factors, particularly habitual tobacco smoking and voice abuse, is of prime importance.

Adult↗