Search

Inspired by Jackass (a tv-show about self-injuring stunts), some friends topped off a drinking party with live fishes from their aquarium. After the goldfishes had gone down smoothly, a bronze catfish was ingested. Unaware of the morphology and anti-predator behaviour of this species, a healthy but intoxicated 28-year-old man got a surprise. The catfish erected and locked the spines of its pectoral fins and got lodged in the hypopharynx. After several hours, he presented himself at the emergency department with dysphonia and dysphagia. The fish had to be removed endoscopically. Intubation and admittance to the intensive care unit was necessary due to laryngeal oedema. Two weeks postoperatively, the patient made a full recovery and donated the fish to the Natural History Museum Rotterdam. The publicity generated by public exhibition of the ‘do-not-swallow-fish’ emphasised the official Jackass warning: ‘.. do not attempt any of the stunts you’re about to see’.

Diffuse idiopathic skeletal hyperostosis (DISH), also known as Forestier's disease, is a noninflammatory disease and is characterized by ossification of the anterolateral aspect of vertebral bodies, mostly in thoracic part of the spine. Although, usually, DISH is asymptomatic, in rare cases osteophytes located in the cervical part of the spine can cause otolaryngological manifestations, such as dysphagia (most common), hoarseness and stridor. In differential diagnosis of upper respiratory tract symptoms, we should consider DISH. We present case of 82 years old male patient with acute dyspnea, who was diagnosed with osteophytes of C4-C7 vertebral bodies. In this case conservative therapy was not efficient, therefore successful surgical treatment was performed.

Introduction Laryngeal oedema caused by acquired angioedema due to C1-inhibitor deficiency (C1-INH-AAE) is a life-threatening condition. The swelling is bradykinin mediated and will not respond to the usual treatment with antihistamines, corticosteroids, or epinephrine. Instead, kallikrein-bradykinin-targeted therapies should be used promptly to prevent asphyxiation. Case presentation A 43 years old female presented at the Hereditary Angioedema Centre reporting a one-year history of peripheral, facial, and neck oedema. Treatment with antihistamines and corticosteroids had been ineffective. Laboratory results showed complement level deficiencies and monoclonal gammopathy characterised as immunoglobulin M. An abdominal ultrasound revealed splenomegaly. A bone marrow biopsy was normal. Based on these data, the diagnosis of C1-INH-AAE associated with monoclonal gammopathy of uncertain significance (MGUS) was made. As C1-INH-AAE can present with life-threatening, standard treatment-resistant laryngeal oedema, an emergency care treatment plan was proposed, and the patient was advised to present to the emergency department (ED) with this medical letter. Based on these recommendations, three laryngeal attacks were successfully treated in the ED with recombinant human C1-inhibitor (two attacks) and fresh frozen plasma (one attack). After these episodes, the patient was prescribed prophylactic treatment with antifibrinolytics. No further angioedema attacks were reported by the patient at the 18 months follow-up visit. Conclusions Because angioedema of the upper airways is a life-threatening condition, recognising the specific type of swelling by the emergency physician is critical in providing immediate and effective treatment to reduce the associated risk of asphyxiation. C1-INH-AAE being a rare disorder, patients should have available an emergency care treatment plan with recommendations of acute treatment possibilities.

Objective To evaluate clinical usefulness of ultrasound images of the upper airway in order to check correct laryngeal mask placement. Material and methods A prospective observational study was conducted on patients scheduled for abdominal surgery under general anaesthesia, in whom the patency of the upper airway was ensured using an Ambu®AuraGain™ laryngeal mask. An ultrasound scan was performed of the upper-airway in the cranio-caudal direction and with longitudinal scans in the anterior midline and parasagittal axis, in three moments: before, after inserting and after removing the mask. All recorded images were evaluated for a second time by an expert radiologist in upper-airway ultrasound. Subsequently, the ultrasound data were related to the clinical difficulty of the insertion and presence of air leaks. Results Data were collected from 30 patients (20 females and 10 males) being operated on for abdominal hysterectomy (15), eventroplasty (6), uterine myomectomy (3), and umbilical (4) and inguinal herniorrhaphy (2). The blind insertion of the masks did not present difficulties in 24 (80%) patients. Air leakage was detected in eight (26.7%) patients, which was moderate in seven cases and severe in one. The ultrasound findings confirmed good mask placement in 22 (73.3%) patients. Anatomical airway changes after laryngeal mask extraction were only observed in three (12%) patients, all of them minor. There was a statistically significant association (p Conclusions Upper-airway ultrasound is a useful diagnostic method to evaluate laryngeal mask placement. Laryngeal oedema was not observed after removal of the device.

One of the standard treatments in laryngeal cancer is radiotherapy (RT). Many short- and long-term complications can occur in the region that has received radiotherapy. Definitive treatment of the emerging complications is still debatable, and treatment is challenging for radiation oncologists and ear nose throat specialists. Recently, hyperbaric oxygen treatment (HBOT) has become a promising alternative for the treatment of these complications. The aim of this report is to discuss the effectiveness of HBOT in the treatment of late-term RT-related potential complications in a patient with laryngeal cancer. We applied HBOT for a 58-year-old male patient with laryngeal cancer for the treatment of laryngeal oedema, and dyspnoea that developed one year after RT. In a decompression chamber at 2.4 atm pressure, the patient was made to breath 100% oxygen with a mask for 90 minutes. At the beginning, HBOT was planned for 30 days; however, it was terminated upon improvement of the symptoms at the 19th session. The symptoms, which developed one year after RT, were relieved completely with HBOT, and the patient is maintaining his life without any complaint under our control. The HBOT can be an alternative treatment for late-term complications developed after radiotherapy. It can be especially used for laryngeal oedema, and dyspnoea related to the field of radiotherapy.

espanolObjetivo: describir las principales complicaciones asociadas a la cirugia de reseccion laringotraqueal e identificar los cuidados de Enfermeria orientados a reducir las complicaciones asociadas. Metodo: revision narrativa, se buscaron articulos en las bases de datos: Pubmed, CINAHL, Cochrane Library Plus y Cuiden, con los terminos libres: “estenosis laringotraqueal”, “estenosis traqueal”, “complicaciones”, “cirugia” y “cuidados”. Limitados en idioma: ingles o espanol, edades superiores a 18 anos y publicados en los ultimos 10 anos. Resultados: de un total de 143 articulos encontrados, 12 fueron seleccionados. Se identificaron las complicaciones postoperatorias: las anastomoticas (formacion de tejido de granulacion, re-estenosis, separacion de la anastomosis o la aparicion de fistula); y las no anastomoticas (edema laringeo y la disfuncion glotica). Cuidados derivados de la revision: mantenimiento de la hiperflexion cervical temporal, evitar las nauseas y los vomitos, fomentar la movilizacion y la deambulacion, y el control de los signos de alarma. Mediante estos cuidados se pretende reducir las variaciones inapropiadas de la practica y promover una atencion de calidad basada en la evidencia cientifica. Conclusiones: la necesidad de estandarizar los cuidados enfermeros a estos pacientes es fundamental para conseguir llevar a cabo un manejo optimo y seguro para evitar complicaciones asociadas y disminuir el consumo de recursos sanitarios. El personal enfermero es un pilar importante para detectar estas complicaciones de forma precoz, ayudar a prevenir su aparicion y favorecer a la autonomia del personal de Enfermeria. EnglishObjective: to describe the main complications associated with laryngotracheal resection surgery, and to identify the Nursing care measures required to reduce the complications associated. Method: a narrative review. There was a search for articles in the following databases: Pubmed, CINAHL, Cochrane Library Plus and Cuiden, with the free terms: “estenosis laringotraqueal” (“laryngotracheal stenosis”), “estenosis traqueal” (“tracheal stenosis”), “complicaciones” (“complications”), “cirugia” (“surgery”) and “cuidados” (“care”). Limited in language: English or Spanish; >18 years and published in the last 10 years. Results: twelve (12) articles were selected from the 143 articles found. Post-surgical complications were identified: anastomotic (granulation tissue formation, restenosis, anastomosis separation or development of fistula); and non-anastomotic (laryngeal oedema and glottic insufficiency). Care measures derived from the review: sustained temporary cervical hyperflexion, prevention of nausea and vomiting, encouraging mobility and ambulation, and control of warning signs. These care measures are intended to reduce any inappropriate variations in practice, and promote quality care based on scientific evidence. Conclusions: there is an essential need to standardize the nursing care for these patients, in order to achieve an optimal and safe management to avoid any complications associated and reduce the use of healthcare resources. Nursing staff plays an important role in the early detection of these complications, to help preventing their development, and to encourage the autonomy of the Nursing staff.

A 2.4-kg, six-year-old, sterilised, male Pomeranian presented with dyspnoea that had begun two years prior and slowly progressed. Pharyngoscopy identified a redundant laryngopharyngeal mucosal fold that was being aspirated cranially into the laryngeal opening causing upper airway obstruction. A diode laser was used to resect the fold. Postoperative laryngeal oedema necessitated the use of a tracheostomy tube for just over two days. Otherwise, the dog made an uneventful recovery. To the authors’ knowledge, this is the first report of a redundant laryngopharyngeal mucosal fold resulting in upper airway obstruction in a dog.

Tracheostomy is one of the most frequent procedures performed in intensive care unit (ICU) patients. It has many advantages like patient’s comfort, early movement from the ICU, and shorter ICU and hospital stay. Of the various techniques, we practice bedside open procedure tracheostomy for ICU patients considering the safety and cost effectiveness. Aim: To observe the common indications and timing of tracheostomy in our circumstances. Method: This cross-sectional study was carried out in 11 ICUs of Dhaka city from January 2008 to June 2015. All ICU patients, irrespective of age and sex , whose tracheostomy were done after admission in ICU at bedside by the principal author with associates were included in this study. Result: Bedside conventional tracheostomy was done in 345 ICU patients during the study period. Among them, 65% were male and 35% were female. Mean age of the patients was 44.30. Common indications for tracheostomy were cerebro-vascular disease (36%), laryngeal oedema (20%), advanced malignancy (16%), and trauma (12%). Only 54 patients had complications like hemorrhage (6%), surgical emphysema (3%), tube displacement (3%), wound infection (2%) and pneumothorax (1%). Conclusion: Bedside conventional tracheostomy is safe and efficient with low morbidity. Mortality is not worse and may be improved with earlier provision, especially in head-injured and critically ill medical patients. The timing of tracheostomy continues to be individualized, and should include daily weaning assessment, and can generally be made within 7 days of endotracheal intubation. Bangladesh Crit Care J September 2016; 4 (2): 65-68

Objective: Hereditary angioedema due to C1 inhibitor deficiency (C1-INH-HAE) is a rare autosomal dominant disease caused by mutations in the SERPING1 gene. It can affect many regions in the body, but potentially life-threatening laryngeal oedemas are of concern. Methods: Twenty-three subjects from two families were recruited for clinical data evaluation and molecular analysis at General Hospital Šibenik, Croatia. Results: Decreased levels of C1 inhibitor were detected in 12 adult patients and three young asymptomatic persons. The same novel deletion of two nucleotides on exon 3 (c.74_75delAT) was identified in all of them. A history of laryngeal oedema was present in 10 patients (83%), and all patients reported laryngeal attacks at least once a year. The delay in diagnosis decreased noticeably from the first to the last generation. Conclusions: We identified a novel causative mutation in SERPING1 in several affected members of two apparently unrelated families with a high frequency of laryngeal oedema. Molecular analysis of large C1-INH-HAE families will provide new insights on the genotype-phenotype relationship. Key messages Hereditary angioedema due to C1 inhibitor deficiency is a rare autosomal dominant disease caused by mutations in the SERPING1 gene, and laryngeal oedema is of concern because it can cause death by asphyxiation. A novel causative mutation in SERPING1, a deletion of two nucleotides on exon 3 (c.74_75delAT), was identified in several affected members of two apparently unrelated families with a high frequency of laryngeal oedema. Molecular analysis of large C1-INH-HAE families will provide new insights on the genotype-phenotype relationship because it appears that the mutation type may affect disease severity.

Objective This study aimed to describe preliminary experiences associated with removal of tracheobronchial foreign bodies (TFBs) by cystourethroscopy (CU). Methods We performed a retrospective analysis of 127 paediatric cases of TFB removal by CU at our centre from January 2009 to August 2016. Data that were extracted from the medical records included age, sex, location and nature of the TFBs, operation time, and complications. Results All TFBs were successfully removed by CU. The mean time of the procedure was 3.38 ± 2.86 minutes. A total of 102 (80.31%) patients had successful removal of TFBs by CU during the initial trial, 19 (14.96%) were successfully treated in the second trial, and six (4.72%) required a third trial. Otolaryngologists with 2, 5, and 7 years of professional CU training showed a mean TFB removal time of 3.38 ± 2.13, 3.40 ± 3.60, and 3.37 ± 2.86 minutes, respectively. In the operations, oxygen saturation fell below 90% at an average occurrence of 0.39 times, but no patients showed a decrease below 85%. Only one patient experienced laryngeal oedema after the procedure. Conclusion CU is a useful technique and minimizes complications and operational risks during removal of paediatric TFBs.

Although LCZ 696 (Sacubutril/valsartan) induced angioedema is rare, itshazardousness is linked to their predominant oropharyngeal localization which can be life threatening in case of upper airway obstruction due to a tongue or laryngeal swelling, we report a new case of fatal laryngeal angioedema induced by LCZ 696.

We describe an unusual case of drowning in fluid other than water in an industrial setting. A 26-year-old man was working in an industry which performs surface treatment of mechanical steel parts with quenching oil. He fell into the quenching oil (which was hot due to immersion of red hot metal parts), and as he was working alone in the particular section, there was a fatal outcome. A medico-legal autopsy was performed. The causes of death were found to be multiple, with the association of drowning, extensive superficial burns and asphyxia due to laryngeal oedema. To our knowledge, it is the first report of drowning in hot quenching oil, and only nine previous observations of drowning in industrial environments have been reported in the international literature. Even though rare, these kinds of accidental deaths can be prevented in dangerous industries with proper precautions and strict adherence to standard operating procedures.

Anaphylaxis is a severe, life-threatening allergic reaction. The most common form of anaphylaxis is a type I hypersensitivity reaction involving immunoglobulin E-mediated activation of mast cells and basophils as a result of exposure to drugs, food, latex, insect venom and other allergens. Anaphylaxis can present in a variety of forms, however it is a medical emergency and immediate treatment of symptoms such as laryngeal oedema, bronchospasm and hypotension in particular are needed. As well as antihistamines and steroids, adrenaline is administered through intramuscular injections. It has a rapid onset and short duration of action. Patients at risk of anaphylaxis should carry a self-administered adrenaline auto-injector with them at all times to be injected intramuscularly in an emergency situation. Although there are cautions to be aware of when administering adrenaline, there are no absolute contraindications to its use in a life-threatening situation.

Hereditary angio-oedema (HAE) is characterized by recurrent, localized, non-pitting, non-pruritic, non-urticarial oedema. Nearly all patients experience skin swelling as a feature of HAE. There may be painful abdominal attacks, accompanied by nausea and vomiting. The disease is life-threatening should laryngeal oedema occur. HAE results from a deficiency or dysfunction of C1 inhibitor, a plasma protein with an important role in regulating the contact, complement and fibrinolytic systems. Effective management of HAE should include a plan for treatment of attacks, as well as routine and preprocedure prevention. Acute and prophylactic therapy with C1 inhibitor therapy for correcting the underlying deficiency in HAE is a valuable option.

International audience; BACKGROUND: Acute allergic reactions often occur in out-of-hospital settings, and some of these reactions may cause death in the short term. However, initial diagnosis, management and processing of acute allergic reactions by Medical Emergency Dispatch Centres are not documented. The aim of the present study was to describe acute allergic reactions and their management by a Medical Emergency Dispatch Centre. METHODS: A prospective study was conducted from 20 August 2006 to 5 November 2006 on incoming calls for acute allergic reactions to the Medical Emergency Dispatch Centre for the Hauts de Seine (Paris West suburb, France). The agreement between initial diagnosis (made by dispatching physician) and final diagnosis (made by the physician who later examined the patient), and between initial and final severity, were evaluated using Cohen's weighted κ coefficient. RESULTS: 210 calls were included. The diagnoses made by the dispatching physician were: in 58.1% of cases urticaria, in 23.8% angioedema, in 13.3% laryngeal oedema, and in 1.9% anaphylactic shock. The agreement between initial and final diagnoses was evaluated by a κ coefficient at 0.44 (95% CI 0.26 to 0.61) and the agreement between initial and final severity was evaluated using a κ coefficient at 0.37 (95% CI 0.24 to 0.50). CONCLUSIONS: Only moderate agreement is highlighted between the initial severity assessed by the dispatching physician and the final severity assessed by the physician later examining the patient. This demonstrates the need to develop a tool for assessing severity of acute allergic reactions for dispatching physicians in Medical Emergency Dispatch Centres.

Primary abnormalities are congenital and include stenotic nares and elongated soft palate, either one of which results in upper airway obstruction and chronic increased negative pressure. This causes inflammation and stretching of soft tissue and eventual laryngeal saccule eversion, laryngeal oedema and, in severe cases, laryngeal collapse. Three stages of laryngeal collapse have been described (Table 1).

A total of 7 families with hereditary angioneurotic oedema (HANE) have been found in Finland. Six HANE patients have died from laryngeal oedema, 27 patients with diagnosed HANE are alive and 21 members have a haematological abnormality typical of HANE, i.e. a deficiency of the inhibitor of the activated first component of complement (C1-INH), but no manifest symptoms. The largest family has 363 living members, 303 of whom were investigated for C1-INH, C4 and C3. Fourteen patients had HANE, 18 relatives were symptomless but had C1-INH deficiency, and 3 members of the family had died from laryngeal oedema. In two families only one case of HANE was diagnosed, the parents in both cases being symptomless with normal C1-INH levels. All patients who had died from laryngeal oedema and 10 of the 27 HANE patients still alive had a typical triad of paroxysmal abdominal pain, peripheral oedema and laryngeal oedema. Six patients have had abdominal attacks alone, three peripheral oedema alone and two only laryngeal oedema. The age at onset of symptoms was 1-51 years. Three patients, who have received continuous methyltestosterone therapy, had hardly any symptoms during the treatment. Thirteen patients have received tranexamic acid, either during an attack or continuously, with positive effects in all except two. Cinnarizine treatment was beneficial in three out of four cases, both when given continuously or during an attack.

This report describes the clinical and investigative findings in a 31-year-old man with Hunter's syndrome, showing evidence of severe multisystem involvement. Papilloedema has been present for at least 8 years with no evidence of progressive visual impairment. His most serious and life-threatening complications are laryngeal oedema and tracheal narrowing, which both compromise his respiratory function and constitute a major anaesthetic risk.

Hintergrund Wespenstichverletzungen konnen aufgrund generalisierter Reaktionen sowie der odematosen Verlegung der oberen Atemwege lebensgefahrlich sein. Aufgrund eigener Beobachtungen und medialer Berichte sollten die Folgen der „Wespenplage“ im Jahr 2004 fur den HNO-Bereich untersucht werden.

European Annals of Otorhinolaryngology, Head and Neck Diseases - Vol. 131 - N° 5 - p. 323-324