A Prospective Study to Determine Clinico-Etiological Factors in Hoarseness of Voice.

Hoarseness of voice is a very common symptom and needs thorough clinical examination and investigation to determine the underlying cause in every patient. The spectrum of the symptom ranges from minor infections to life threating malignancies. Acute onset causes may be due to secondary viral infections, voice abuse, smoking, trauma to the larynx during thyroid surgeries. Chronic onset may be due to vocal polyp, vocal cord nodules, laryngeal papillomatosis, laryngeal neoplasms, tumours of the vocal cord, functional dysphonia, smoking, gastro-oesophageal reflux, malignancy of thyroid, oesophagus, lungs and neurological involvement by systemic disease like diabetes and TB. We wanted to evaluate the common causes of hoarseness of voice.METHODSThis was a longitudinal study conducted among 100 patients with benign laryngeal lesions attending the Department of ENT-HNS of Rajarajeswari Medical College and Hospital, from 1st December 2015 to 31st November 2016. A detailed history including information on patient’s demographics, clinical presentation, history of trauma, along with history of associated medical and surgical condition was obtained. A thorough systemic examination and laryngeal examination was done.RESULTSMale:Female ratio was noted to be 1.7:1. Labourers constituted the single largest group of patients comprising of about 36% of cases. Three fourth of patients were from the rural area. Duration of hoarseness ranged from 1 day (acute onset) to 5 yrs. (mean - 3 months). Septic foci in oral cavity and oropharynx were noted in 42% cases. Apart from change in voice other common symptoms were cough, fever and vocal fatigue. Signs of chronic laryngitis were noted in majority of the cases (22%).CONCLUSIONSThe spectrum of etiological factors for hoarseness varies from minor functional voice disorders to major pathological conditions such as malignancy. Septic foci are important predisposing factor for chronic laryngitis.

Dolor abdominal de origen orgánico en niños y adolescentes / Abdominal pain of organic origin in children and adolescents

El dolor abdominal constituye un motivo frecuente de consulta de niños y adolescentes. Éste puede ser de origen orgánico o funcional. En menores las causas son predominantemente orgánicas, y en los mayores de 5 años sólo el de 33 por ciento tiene este origen, y el 67 por ciento es funcional. Mediante una anamnesis acuciosa y un examen físico completo, el clínico podrá hacer una aproximación diagnóstica y orientar la solicitud de exámenes de manera dirigida. El objetivo de este artículo es entregar las herramientas semiológicas para lograr este objetivo.

Abdominal pain is a frequent complain of children and adolescents. This may have an organic or functional origin. In preschool children the causes are predominantly organic, and in those older than 5 years only percent have this origin, and 67 per cent are functional. Through a diligent history and physical examination, the clinician may make a proper approach to diagnosis and ask for complementary tests, if neccesary, in a target manner The aim of this article is to provide the semiologic tools to achieve this goal.

Relationship between esophageal visceral hyperesthesia and expression of substance P in LES of patients with non-erosive gastro-oesophageal reflux disease / 解放军医学杂志

Objective To investigate the correlations between esophageal visceral hyperesthesia and the expression of substance P (SP) immunoreactive fibers in the lower esophageal sphincter (LES). Methods Esophageal sensitivity to mechanical stimuli was measured by esophageal barostat. The Bernstein acid infusion test was used to evaluate the esophageal sensitivity to intraesophageal perfusion of 0.1mol/L HCl .The distribution and expression of SP positive fibers within mucosal layer of LES were detected by immonohistochemical staining techniques. Results In comparison with control group, the initial perception threshold and maximally tolerated pain threshold of NERD patients were significantly reduced (P

Cerebral evoked potentials response to esophageal mucosal acid exposure and distention in patients with non-erosive gastro-oesophageal reflux disease / 中华消化杂志

Objective To investigate characteristics and alternation of cerebral evoked potentials (CEP) response to esophageal mucosal acid exposure and distention in patients with non-erosive gastro-oesoph- ageal reflux disease (NERD) and in healthy subjects,and to study the mechanism of visceral hypersensitivity in NERD.Methods Twenty-one NERD patients and 10 volunteers were recruited.Mechanical distention stimulation and acid perfusion of the esophagus were performed using the balloon-affixed and polyvinyl multi- lumen catheter.First,maximally tolerated pain thresholds of all subjects were recorded,then esophageal mechanical stimulation with a 75% of maximal tolerated intensity and a frequency of 0.2 Hz was performed altogether 64 times by means of a computer-controlled barostat.The alternation of esophageal CEP was recorded before and after acid perfusion with a multichannel international 10-20 system of electroencephalography. Experimental data was analyzed by student's t-test and one way analysis of variance.Results Esophageal mu- cosal distention may evoke recognizable and reproducible and multi-peak CEP.The latencies for N1,P1 and N2 in volunteers were (246?77),(388?84)and (502?78) ms,CEP morphology of NERD patients was charac- terized by randomly distributed patterns,and the latencies for N1 ,P1 and N2 were (192?46),(293?76) and (440?79)ms,significantly shorter for mechanical stimulation compared with those of control group respectively (all P value

Effect of cisapride on oesophageal pH monitoring and symptoms in children with gastro-oesophageal reflux disease.

The effect of cisapride on oesophageal pH monitoring and symptoms was studied in seven children with gastro-oesophageal reflux disease. They were treated with cisapride in a dose of 0.2 mg/kg/ very six hours. The comparative analysis of oesophageal pH monitoring between before and after the six-week treatment period showed significant improvements in the percentage of time pH<4, the number of reflex episodes (P=0.06). The symptoms, including pneumonia, cyanosis and asthma, were improved in all but one patient. The patients tolerated cisapride without any side effects.

Incidence of gastro-esophageal and-hypopharyngeal reflux during gynecological laparoscopy: laryngeal mask vs tracheal tube / 中华麻醉学杂志

Objective To compare the incidence of gastro-esophageal and -hypopharyngeal reflux during gynecological laparoscopy performed under general anesthesia and mechanical ventilation with tracheal intubation (TT) and laryngeal mask airway (LMA) .Methods Sixty ASA Ⅰ or Ⅱ patients aged 18-60 yrs with BMI 0.05 ) . Conclusion In low risk patients the incidence of gastro-esophageal regurgitation is comparable in patients undergoing gynecological laparoscopy in head-down position under general anesthesia and mechanical ventilation using either LMA or TT.