Clinical analysis of arytenoid cartilage reposition with snake mouth forceps for the arytenoid cartilage dislocation / 临床耳鼻咽喉头颈外科杂志

OBJECTIVES@#To investigate the clinical effect of the arytenoid cartilage reposition using snake mouth reduction forceps under general anesthesia.@*METHODS@#Data of twenty-six cases accepted arytenoid cartilage reposition under intravenous general anesthesia were analyzed, nineteen cases accepted laryngeal CT scan and cricoarytenoid joint reconstruction, all patients underwent endolaryngeal muscle electromyography examination. According to the position of cartilage dislocation prompted by laryngoscope and CT, the arytenoid cartilage was repositoned under the visual laryngoscope using special snake mouth reduction forceps. If bilateral arytenoid cartilage were still asymmetrically at the end of the surgery, patients needed repeated reposition 1 to 2 times 1 week after operation. The efficacy was evaluated 4 weeks later.@*RESULTS@#All patients had a hoarse and breathing voice preoperative. Under laryngoscope, there were different degrees of vocal cord movement disorders accompanied by incomplete glottis closure, 22 cases happened in left side and 4 in right side. The arytenoid cartilage was dislocated anteromedially in 25 cases and posterolaterally in 1 case. CT showed that 15 cases of arytenoid cartilage were tilted anteromedially; the interval of the cricoarytenoid joint was widened. In axial CT images, there were no direct signs of the arytenoid cartilage dislocation in the 4 cases, but the abnormal position was seen in the reconstruction images. The laryngeal electromyography indicated that 7 cases were abnormal, duration of motor unit potential were visible and the raising potential were mixed. There were 4 patients with normal voice in the first day after surgery, and 19 cases underwent twice and 3 cases underwent three times surgery. Vioce became normal in 4 weeks. Swallowing pain and bucking were all disappeared. Vocal cords movement were recovered to normal level in 25 cases. In 1 case with neck strangulation, the vocal cord movement was slightly worse than health side, but significantly better than that before operation.@*CONCLUSIONS@#The arytenoid cartilage reposition using snake mouth reduction forceps under general anesthesia was an effective method for the treatment of the cricoary-tenoid joint dislocation.

Neonatal Cow’s Milk Protein Allergy with Sepsis Like Initial Symptom / 天津医药

Objective To summarize the diagnosis and treatment in neonatal cow’s milk protein allergy (CMPA) with sepsis like initial symptom. Methods CMPA patients with the sepsis like initial symptom (n=10) were selected in our hospital from July 2009 to December 2013. History data, clinical manifestation, laboratory results and the treatment outcome of them were retrospectively analyzed. Results Among these 10 cases, 6 have family history of allergy. Main clinical mani-festations include skin, gastrointestinal symptoms and 1 case of anaphylactic shock. IgE mediated 6 cases with acidophilic cells count of (1.40±0.17)×109/L (5%); The rest 4 cases were not mediated by IgE, with acidophilic cells count of (0.71± 0.08)×109/L (0.02-0.03). Blood cultures were all negative;Blood leukocyte count is (24.5±3.3)×109/L;Rod nucleus granulo-cyte/neutrophils count is (0.161±0.035) ×109/L;The platelet count is (655±39)×109/L;Blood interleukin (IL)-6 is 0.31-0.93μg/L;C reactive protein (CRP) is 85-144 mg/L. All 10 cases were with extensively hydrolyzed formular or amino acid formu-lar feeding. Then their clinical symptoms improved or disappeared significantly and the inflammatory indexes returned to nor-mal. Conclusion It is necessary to make the differential diagnosis between sepsis and neonatal CMPA,which is accompa-nied by increased platelet and acidophil. The most effective treatment of neonatal CMPA is hypoallergenic formular replace-ment therapy.