Tos persistente y neuropatía laríngea / Persistent cough and laryngeal neuropathy

RESUMEN La tos persistente es un síntoma de consulta frecuente, de origen multifactorial, que involucra a diferentes especialidades como la neumología, la gastroenterología y la otorrinolaringología. Sus causas más frecuentes son la descarga nasal posterior, tos como variante del asma y reflujo gastroesofágico/faringolaríngeo. Una vez descartadas dichas causas, cobran importancia los trastornos sensoriales del nervio vago, una entidad relativamente nueva que también es conocida como neuropatía laríngea sensitiva. En la neuropatía laríngea, una injuria a nivel neuronal aferente del reflejo de la tos produce un estado de hipersensibilidad laríngea en la que estímulos normalmente ignorados (que no producen respuesta tusígena) comienzan a gatillar el reflejo. Las características clínicas de la tos y el descarte de las causas más frecuentes permite llegar a este diagnóstico. Su tratamiento tiene como objetivo la modulación de las vías neuronales alteradas basándose en 3 pilares: educación sobre la patología, recomendaciones conductuales (higiene vocal, estrategias de reducción de tos) y los fármacos entre los que se usan los inhibidores de bomba de protones, mucolíticos y neuromoduladores.

ABSTRACT Persistent cough is a common symptom for medical consultation, it is of multifactorial origin and involves different specialties such as pneumology gastroenterology and otorhinolaryngology. The most frequent causes are postnasal drip, cough variant asthma and gastroesophageal/pharyngolaryngeal reflux. Once these causes are discarded the vagus nerve sensory disorder becomes of importance, it is a relatively new entity also known as laryngeal sensitive neuropathy. In the laryngeal neuropathy, an injury in the afferent neuronal pathway of the cough reflex produces laryngeal hypersensitivity in which normally ignored stimulus (i.e. do not cause cough) start to trigger the reflex. The clinical features of the cough and the rule out of the most frequent causes allow the diagnosis. The objective of the treatment is to modulate the altered neuronal pathways based on 3 pillars: education regarding the pathology, behavioral recommendations (vocal hygiene, cough reduction strategies) and drugs among which proton pump inhibitors, mucolytics and neuromodulators are used.

Evaluation of salivary and serum anti-helicobacter pylori in Egyptian patients with H. pylori related gastric disorders

Helicob acter pylori is a common and important transmissible bacterial human pathogen. Although several diagnostic tests are available for the detection of H. pylori infection, all of them have both advantages and disadvantages, and none can be considered as a single gold standard. Serological methods analyzing [serum and saliva] by using enzyme immunoassays, which are simple, reproducible and inexpensive, can detect either antigen or antibody. This study evaluated the frequency of anti- H. pylori serum and salivary antibodies positivity among Egyptian patients with gastric disorders and the validity of salivary, serum serological tests for diagnosis of H, pylori, comparing this with gold standard tests performed on endoscopy biopsy. This prospective, case-controlled study included 45 Egyptian patients who attended Ain Shams University Hospitals Cairo, Egypt between January 2013 and June 2013. There were 29 males and 16 females their mean age was 51.78 +/- 7 [range 18-60]. Among the ulcerogenic drugs, Aspirin was the most common drug [46.7%].The evidence revealed the sensitivity of Rapid Urease Test [RUT] was 100%, specificity was 71.4%, Positive Predictive value [PPV] was 88.6% and Negative Predictive value [NPV] was 100%. The sensitivity of serum IgG was 68.97% and specificity was 42.86%; while the sensitivity of serum IgA was 89.6% and the specificity was 50%. Correlating the salivary IgG results with H. pylori status diagnosed by culture, salivary IgG succeeded to diagnose 19 cases from the 31 positive H. pylori patients with a sensitivity of 63.33% and specificity of 92.86% whereas the results of salivary IgA showed a sensitivity of 80% and specificity of 92.86%

Protection and functional repair of vagus nerve during the operation of cervical vagal paraganglioma / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To explore the clinical anatomy and the methods to protect or reconstruct the continuity and function of vagus nerve during the operation of cervical vagal paraganglioma.@*METHOD@#Six cases of vagal paraganglioma were reviewed. All tumors were identified to wrap the cervical vagus nerve stem and excised during surgery. The operative modality was to trace the vagus nerve stem inside the tumor as far as possible, to reconstruct the continuity by way of vagus nerve anastomosis (3/6) or alternatively, other motor nerve transplantation (3/6). Postoperative treatment included steroid, neurotrophic medication and voice and swallowing rehabilitation.@*RESULT@#Two cases of the recurrent paraganglioma experienced aspiration during swallowing preoperatively and no aspiration after surgery. Choking was gradually reduced in four recurrent cases half to one year postoperatively. Hoarseness was improved in five cases (5/6) half to one year postoperatively, while one case remained prolonged obvious hoarseness. Three months postoperatively, the vocal cord fibrillation at the tumor-related side was observed during pronunciation in the end-to-end anastomosis cases (3/6), sublingual nerve-transplanted case (1/6) and deep cervical nerve-transplanted cases (1/6) under fiberoptic laryngoscope, and the mobility was even more obvious at the time of half an year postoperatively. While in another deep cervical nerve-transplanted case (1/6), the vocal cord demonstrated no obvious fibrillation.@*CONCLUSION@#To carefully identify and preserve the vagus nerve fibers as much as possible during the operation of cervical vagal paraganglioma could significantly eliminate postoperative hoarseness and aspiration. End-to-end anastomosis, deep cervical nerve or sublingual nerve transplantation to resume the continuity of vagus nerve may improve the mobility of vocal cord thus the quality of voice and swallowing.

Managements of vagal paragangliomas: a report of 11 cases / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To study the clinical characters, diagnosis, surgical outcomes and treatment strategies of vagal paraganglioma (VP).</p><p><b>METHODS</b>A retrospective review was performed on 11 patients with VP confirmed by surgery and pathology between January 2000 and July 2010.</p><p><b>RESULTS</b>Although the combined application of ultrasonography, enhanced computed tomography (CT), magnetic resonance imaging (MRI) and digital subtraction angiography (DSA), the preoperative diagnostic accuracy rate was only 27.2%. All patients were managed by surgical resection (one malignant case with postoperative radiotherapy). All patients either had or developed a vagal palsy and additional cranial nerve or sympathetic nerve deficits were sustained in 8 patients after operation. With a median follow-up time of 41 months (range: 4 - 132 months), one case lost and the others survived without local recurrence or distant metastasis.</p><p><b>CONCLUSIONS</b>VP are rare and liable to misdiagnose. For increasing the preoperative diagnosis rate of VP, the combined application of imaging tests is important and clinicians and radiologists should also enhance the awareness of this disease. Postoperative complications including nerve injury are inevitable and individual treatment is required.</p>

[ case repost: vagal paraganglioma with neck mass presentation]

Paragangliomas are neoplasms that arise from paraganglionic "bodies" of the autonomic nervous system. These paraganglia are distributed symmetrically and segmentally in the para-axial regions of the trunk and are typically related to arterial vasculature and cranial nerves of the ontogenetic gill arches. We repot a case of vagal paraganglioma with all diagnostic therapeutic approach which has not been reported previously in this manner

Transient ischaemic attacks due to a pulsating mass in the neck produced after incision and drainage of parapharyngal abscess

Carotid endarterectomy is the most commonly performed vascular surgical procedure. One of the complications of carotid endarterectomy is Pseudoaneurysm of the carotid artery frequently managed by endo-vascular technique. Pseudoaneurysm caused by other aetiological factors is rare entity. Penetrating trauma and neck surgery are known but very rare causes of pseudo aneurysm of the carotid artery. We have successfully managed a case of carotid artery pseudoaneurysm caused by incision and drainage of parapharyngeal abscess. This surgery also leads to the palsy of right vagus nerve causing complete hoarseness of voice. The patient presented with Transit Ischaemic Attacks [TIA] and amurosis fugos. Resection of aneurysm and reconstruction of right carotid artery lead to complete recovery. Vocal cord palsy was managed by Vox implant injection leading to full recovery

Isolated velopalatine paralysis associated with parvovirus B19 infection / Paralisia velopalatina isolada associada a infecção por parvovírus B 19

A case of isolated velopalatine paralysis in an 8-year-old boy is presented. The symptoms were sudden-onset of nasal speech, regurgitation of liquids into the nose and dysphagia. Brain MRI and cerebrospinal fluid examination were normal. Infectious serologies disclosed an antibody arrangement towards parvovirus B19 that was typical of recent infection. In the absence of other positive data, the possibility of a correlation between the tenth nerve palsy and parvovirus infection is discussed.

Apresentamos um caso de paralisia velopalatina isolada, num menino de 8 anos, que se manifestou por voz nasalada, regurgitação de líquidos pelo nariz e disfagia, de início súbito. A ressonância magnética encefálica e o estudo do líquido cefalo-raquidiano foram normais. O perfil serológico dos anticorpos anti-parvovírus B19 era típico de infecção recente. Na ausência de outros dados positivos, discute-se a possibilidade de uma correlação entre a parésia do X nervo e a infecção por parvovírus.

Ratos espontaneamente hipertensos e neuropatias periféricas / Spontaneously hypertensive rats and peripheral neuropathies

RESUMO: Modelo do Estudo: O presente estudo é uma revisão de literatura sobre o modelo de hipertensão espontânea e as conseqüências da hipertensão para o sistema nervoso periférico, somático e autonômico.Importância do problema: Hipertensão é o principal fator de risco para acidente vascular cerebral e demência vascular, por causar importantes mudanças cerebrovasculares, tornando o cérebro propenso a infartos, microaneurismas e isquemias. As principais mudanças causadas no sistema nervoso central (SNC) pela hipertensão, incluem: diminuição do volume cerebral, aumento no volume dos ventriculos e perda neuronal. Além das alterações no cérebro, a hipertensão causa outros danos que culminam em uma série de alterações patológicas renais e outras doenças, as quais sustentam a elevação da pressão arterial, aumento da freqüência cardíaca, e aumento da resistência vascular periférica. O rato espontaneamente hipertenso (SHR) é reconhecido como um excelente modelo de hipertensão experimental e pode servir como modelo de estudos clínicos da hípertensão essencial humana. Embora esse modelo tenha sido bastante explorado em termos fisiológicos, estudos morfológícos, quaneo presentes, se limitam aos vasos. Mesmo quando nervos periféricos foram estudados morfologicamente nesses animais, os vasos epineurais, perineurais e endoneurais foram o alvo do estudo. Raros são os estudos que envolvem as fibras nervosas nesse modelo de hipertensão.Comentários: Recentemente, estudamos as alterações do nervo depressor aórtíco (NDA) em SHR. Nossos resultados mostraram redução do tamanho das fibras mielínicas e redução do tamanho e número das fibras amielínicas, comparados aos controles normotensos da linhagem Wistar-Kyoto. Outro estudo recente do nosso laboratório mostrou que, embora os níveis pressóricos dos SHR machos, bem como a freqüência cardíaca, sejam muito superiores aos das fêmeas, não há diferença morfológica nos nervos vagos cervicais entre SHR machos e fêmeas. Ainda, fazemos um...

Clinicopathologic study of four cases of vagal paraganglioma / 中华病理学杂志

<p><b>OBJECTIVE</b>To determine if pathologic examination can be useful in both diagnosing cervical paraganglioma and deducing its vagal origin.</p><p><b>METHODS</b>Four cases of vagal paraganglioma were studied by light microscopy and immunohistochemistry, with clinical and radiologic (computerized tomography and/or magnetic resonance imaging) correlation.</p><p><b>RESULTS</b>All patients were females and complained of upper neck mass with symptoms and signs of vagus nerve involvement, such as hoarseness of voice, ipsilateral vocal cord dysfunction and cough induced by drinking or local pressure. Radiological examination showed a tumor mass over the common carotid artery bifurcation, lying between the internal carotid artery and internal jugular vein. On gross inspection, the stump of the resected vagus nerve could be identified, with nerve bundles splaying over the tumor surface. Microscopically, the tumors showed a relatively uniform nesting arrangement (Zellballen pattern) of cells and were associated with rich sinusoidal vessels and fibrous stroma. Multiple myelinated nerve fibers were present in stroma and fibrous capsule of the tumor. Sometimes, invasion of nerve trunk by tumor cells was seen. Immunohistochemically, the tumor cells showed diffuse positivity for chromogranin A, neuron-specific enolase and synaptophysin. There was no expression of cytokeratin. The sustentacular cells and nerve bundles were highlighted by S-100 protein.</p><p><b>CONCLUSION</b>In addition to the microscopic accurate diagnosis of paraganglioma, histopathologists can be of help in deducing the vagal origin of this tumor.</p>

Cervical vagus nerve schwannoma

Schwannomas arising from cervical cranial nerves rarely present as neck swelling. Ultrasonography, computerised tomography, magnetic resonance imaging and fine needle aspiration cytology are helpful in reaching a diagnosis. Surgical excision is the treatment of choice. A case of large cervical vagus nerve schwannoma occurring in a young lady is presented with its management

A Case of Retroperitoneal Schwannoma of the Vagus Nerve / 대한소화기학회지

Schwannomas are benign nerve sheath tumors that originate from any anatomical site. Most schwannomas occur in the head, neck or limbs, but rarely occur in the retroperitoneal space. Furthermore, the schwannoma originating from the vagus nerve of retroperitoneal space is much rare. We experienced a case of retroperitoneal schwannoma of the vagus nerve. A 34-year-old male was refered to our hospital for the evaluation of abdominal mass on ultrasonography. Endoscopic examination revealed submucosal tumor-like lesion on high body of the stomach. Computed tomography (CT) revealed that the stomach was compressed by a solid tumor in the retroperitoneum. On exploratory laparotomy, this mass turned out to be a baseball sized mass in the retroperitoneal space. The mass was excised in an encapsulated state. Histological examination with immunohistochemical stains revealed a schwannoma of the vagus nerve.

Jugular foramen schwannomas: a review of 17 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To analysis the clinical presentation, radiological findings, surgical techniques and outcomes of jugular foramen (JF) schwannomas.</p><p><b>METHODS</b>We reviewed our 10-year experience in the surgical treatment of 17 patients suffered from JF schwannomas in Hua Shan Hospital, Shanghai. A total of 8 males and 9 females with a mean age of 42 years underwent surgical procedures. A relative long period of 53-month symptomatic history was shown before surgery. The main clinical presentation are vertigo and hearing difficulty in 10 cases, atrophy of unilateral muscles of tongue in 9 cases, involvement of lower cranial nerve in 8 cases. The classification of tumors was type A (at cerebellopontine angle with minimal enlargement of the JF) in five cases, type B (JF with intracranial extension) in 3 cases, type C (extracranial tumors with JF extension) in 2 cases and type D (dumbbell-shaped with both intra-and extracranial components) in 7 cases.</p><p><b>RESULTS</b>Far lateral approaches were used in 10 cases, retrosigmoid suboccipital approaches were used in 5 cases. Submandibular approaches were selected in other 2 cases. Gross total removal was achieved in 12 cases, and subtotal removal in 5 cases. Follow-up revealed marked improvement from preoperative symptoms in 9 cases and no additional deficits in 3 cases. 5 cases suffered from additional neurological deficits. There were two cases of temporary hoarseness and gradually improved within follow-up. Two patients suffered from swallowing problems as a new deficit. One patient had facial palsy.</p><p><b>CONCLUSIONS</b>JF schwannomas can be surgically treated with relative good outcomes. Surgical approaches should be tailored according to the tumor extension.</p>

Paraganglioma vagal: reporte de caso y revisión de la literatura / Vagal paraganglioma: a case report and review of the literature

Objetivo: Reportar un caso de paraganglioma vagal, diagnosticado y tratado en el Servicio de Angiología del Hospital de Especialidades del Centro Médico "La Raza" y realizar revisión de la incidencia del mismo. Método: Se presenta el caso de una paciente con paraganglioma vagal sometida a resección quirúrgica y radioterapia. Se analizan las manifestaciones clínicas y parámetros utilizados para el diagnóstico de los paragangliomas vagales, así como los criterios de malignidad. Se discute el rol de la radioterapia y secreción hormonal, realizando análisis de la incidencia en el servicio y revisión bibliográfica sobre el tema. Resultados: El caso reportado es de una paciente de 53 años con paraganglioma vagal derecho de hallazgo casual. Sometida a cirugía, se realizó resección parcial y luego radioterapia. La incidencia fue de 1.25 por ciento de todos los paragangliomas tratados en el Servicio de Angiología en un periodo de cuatro años. En la literatura existen reportados 190 casos. Conclusión: El paraganglioma es un muy raro tumor de la base de cráneo generalmente benigno, la presencia de metástasis es el único criterio indiscutible de malignidad, el tratamiento ideal es la resección quirúrgica total.

Laryngeal Electromyography: Clinical Application in Vocal Cord Palsy

Vocal cord paralysis is a comlex disorder which may result from numerous causes. It is often associated with trauma, disease in adjacent tissue, or a generalized neuroligical disorder. Laryngeal EMG is a useful technique for vocal cord paralysis. However it has not been used due to the uncertainties of normal human vocal cord physiology and the technical difficulties in performing these studies. We investigated the pathophysiology of vocal cord paralysis with laryngeal electromyography(LEMG). We studied 20 patients with idiopathic vocal cord paralysis. 6 patients were denervated in the cricothyroid(CT) and 6 patients in the thyroarytenoid(TA), and 3 patients in both CT and TA muscles. These indicated superior laryngeal neuropathy, recurrent laryngeal neuropathy, and proximal laryngeal or vagus neuropathy, respectively. LEMG proved to be a safe and effective procedure in the diagnosis of laryngeal neuropathy, and make it possible to use electromyography as a routine procedure in diagnosis laryngeal paralysis.

Huge neurofibroma of intrathoracic vagus

A case of neurofibroma of the left vagus nerve associated with a Recklinghausen's disease is reported. The review of the literature shows how rare is this type of localisation, only 62 cases are reported since 1926. The authors remind us the absence of specific signs of vagal involvement and mildness of postoperative course of surgical excision