Cirugía transoral en cáncer de laringe estadificado T1-T2 / Transoral surgery in T1-T2 staged laryngeal cancer

Se realizó un estudio prospectivo y descriptivo, incluyendo 103 pacientes que fueron tratados por cáncer de laringe en etapa inicial (T1-T2) con cirugía transoral. De ellos, 55 se diagnosticaron en estadio T1, 16 en estadio T1-b y 32 en estadio T2. El control local inicial (CLI) en pacientes con tumores malignos de laringe estadificados T1 fue 91%, el control local con rescate (CLR) 96%, la preservación de la función de la laringe (PFL) 93% y la sobrevida específica 96%. En T1-b, el CLI fue 81%, el CLR 94%, la PFL 94% y la sobrevida específica 94%. En T2, el CLI fue 63%, el CLR 94%, la PFL 72% y la sobrevida específica 78%. La cirugía transoral en cáncer de laringe con T inicial tiene resultados oncológicos similares a otros tratamientos (cirugía externa o radioterapia), pero consideramos que es la mejor opción por su baja morbilidad, menor duración del tratamiento, y porque deja abiertas todas las posibilidades para tratar posibles recurrencias. (AU)

A prospective and descriptive study was conducted, including 103 patients who were treated for early stage laryngeal cancer (T1-T2) with transoral surgery. Of these, 55 were diagnosed in stage T1, 16 in stage T1-b and 32 in stage T2. The initial local control (CLI) in patients with malignant T1 laryngeal tumors was: 91%, local control with rescue (CLR) 96%, preservation of larynx function (PFL) 93% and specific survival 96%. In T1-b the CLI was 81%, the CLR 94%, the PFL 94% and the specific survival 94%. In T2 the CLI was 63%, the CLR 94%, the PFL 72% and the specific survival 78%. Transoral surgery in laryngeal cancer with initial T has oncological results similar to other treatments (external surgery or radiotherapy), but we consider that it is the best option because of its low morbidity, shorter duration of treatment, and because it leaves open all the possibilities to treat possible recurrences. (AU)

Angulação do osso hioide e segurança da deglutição pós-laringectomia parcial horizontal supracricóidea e cricohioidoepiglotopexia / Hyoid bone angle and swallowing safety post supracricoid horizontal partial laryngectomy and cricohyoidoepiglottopexy

RESUMO Objetivo investigar o possível impacto da angulação do osso hioide na segurança da deglutição de pacientes submetidos à laringectomia supracricóidea. Métodos série de casos de 13 adultos, entre 48 e 79 anos, majoritariamente homens (n=11), submetidos à laringectomia supracricóidea em pós-operatório inferior ou igual a dez meses. Realizaram videofluoroscopia da deglutição de 5 ml de líquido fino, 5 ml de alimento pastoso e sólido, em livre oferta. A medida do ângulo do osso hioide foi definida por duas linhas: uma tangente à margem superior do corpo do osso hioide e uma tangente ao ponto mais inferior de sua margem inferior, paralela ao plano horizontal da imagem. O desfecho de aspiração durante o exame seguiu a escala desenvolvida por Rosenbek et al. (1996). Resultados Dos 13 pacientes, 5 apresentaram aspiração silente e 8 não apresentaram aspiração. Dos 5 indivíduos com aspiração, apenas 1 manteve preservadas ambas as cartilagens aritenoides em sua reconstrução e a angulação do osso hioide foi abaixo de 60º, em todos os casos. Dos 8 indivíduos sem aspiração laringotraqueal, a maioria (n=5) apresentava as duas cartilagens aritenoides em sua reconstrução e a angulação do osso hioide foi acima de 60º, em todos os casos. Conclusão uma angulação maior que 60º do osso hioide parece favorecer a proteção das vias aéreas inferiores e promover maior segurança do mecanismo de deglutição.

ABSTRACT Purpose to investigate the possible impact of hyoid bone angulation on swallowing safety in patients undergoing supracricoid laryngectomy. Methods the case series comprised 13 adults, between 48 and 79 years-old, male in its majority (n=11), within ten months or less post-supracricoid laryngectomy and cricohyoidoepiglottopexy. All volunteers were submitted to videofluroscopy at rest and during swallowing of 5 ml of thin fluid, 5 ml of pureed consistency and dry solid food. Images were captured in lateral view. The hyoid angle was taken at rest and defined by two lines: a tangent to the upper margin of the body of the hyoid bone and a horizontal line, tangent to the lowest point of its lower margin. The aspiration was assessed using the scale developed by Rosenbek et al. (1996). Results five cases had silent aspiration and eight had no aspiration. In the group with silent aspiration, only one individual had both arytenoid cartilages preserved, while all individuals had the hyoid bone angle below 60º. In the group without aspiration, five individuals had both cricoarytenoids preserved, while all cases had the average hyoid bone angle above 60º. Conclusion the hyoid bone being at an angle greater than 60º seemed to increase the protection of the lower airways, promoting a safer swallowing mechanism.

TBC Epiglótica como causa infrecuente de Odinofagia. Reporte de caso / Epiglottic TB as an uncommon cause of Odynophagia. Case report

Introducción: la tuberculosis epiglótica constituye una entidad rara, cuya frecuencia ha experimentado un aumento en los últimos años, secundaria al desarrollo de nuevos métodos diagnósticos y el incremento en la esperanza de vida. Típicamente se presenta en personas inmunocomprometidas, siendo más frecuentes los casos secundarios a una infección primaria pulmonar. Presentación de caso: paciente adulto mayor que consulta por odinofagia y pérdida de peso de varios meses de evolución, se diagnosticó el cuadro inicialmente como una infección respiratoria alta. Al no presentar mejoría es referido al servicio de gastroenterología donde se realizó endoscopia digestiva alta, en la que se evidenció una lesión granulomatosa a nivel de epiglotis. Por histopatología se confirma diagnóstico de tuberculosis. Conclusiones: la tuberculosis epiglótica es una entidad rara, representando menos del 1% de las causas de tuberculosis extra pulmonar.

Analysis of Obstruction Site in Obstructive Sleep Apnea Patients Based on Videofluoroscopy

BACKGROUND AND OBJECTIVES: Upper airway obstruction can occur at the soft palate, tongue base, or epiglottis among obstructive sleep apnea (OSA) patients. Detection of these obstruction sites is very important for choosing a treatment modality for OSA. The purpose of this study was to evaluate the obstruction site of OSA patients and its association with mouth opening and head position. SUBJECTS AND METHOD: Forty-eight consecutive patients with suspicion of OSA were enrolled and underwent videofluoroscopy to evaluate the obstruction site, as well as polysomnography. Obstruction site, mouth opening, and head position were evaluated on videofluoroscopy, and their association was analyzed. RESULTS: According to the videofluoroscopy, 47 (97.9%) of 48 patients showed an obstruction in the soft palate, while 24 (50.0%) were located in the tongue base and 14 (29.2%) in the epiglottis. Multiple obstructions were observed in many patients. Mean apnea-hypopnea index was higher among patients with tongue base obstruction (42.3±26.7) compared to those without obstruction (26.4±21.2, p=0.058). However, epiglottis obstruction did not influence apnea-hypopnea index. Mouth opening did not show any association with tongue base obstruction (p=0.564), while head flexion was highly associated (p<0.001). CONCLUSION: Half of patients with OSA have tongue base obstruction, which worsens the apnea-hypopnea index. Head flexion is associated with tongue base obstruction, while mouth opening is not.

A Clinical Study of Acute Epiglottitis: Retrospective Review of 315 Patients in Korea / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Acute epiglottitis is a life-threatening condition that can result in airway obstruction. The present study reports clinical features, management and patient outcomes in an acute epiglottitis. SUBJECTS AND METHOD: Included in our retrospective study were 315 patients who were admitted with the diagnosis of acute epiglottitis between January 2006 and July to the department Otolaryngology-Head and Neck surgery, Hallym University Sacred Heart Hospital 2018. The diagnosis of acute epiglottitis was established by confirmation of inflamed epiglottis using laryngoscope or computed tomography. RESULTS: Among 315 patients, 89 cases (28%) and 83 cases (26%) were found in the fifth and fourth decades, respectively. The mean age of patients was 45.0±13.94 years. The male to female ratio was 1.33:1. A total of 75 patients (23.8%) had co-morbidities, with hypertension (13.6%) being the most common. Fever was relatively uncommon, whereas most patients complained of sore throat. Ceftriaxone was the most common empirical antibiotic regimen prescribed and the use of steroids did not affect the length of hospital stay. Nine patients required airway intervention, including eight who underwent endotracheal intubation and one emergency tracheostomy. In patients who need airway intervention, systolic blood pressure, body temperature, respiratory rate, heart rate, white blood cells and the proportion of dyspnea were significantly higher in comparison to the patients without airway intervention. CONCLUSION: Although acute epiglottitis often has nonspecific symptoms, it may lead to sudden dyspnea and unstable vital signs, so an in-depth understanding of this disease is needed.

Accidental Choking Deaths with Octopus minor and Octopus ocellatus / 대한법의학회지

In Korea, small octopus (Octopus minor) and webfoot octopus (Octopus ocellatus) are food items and fatal laryngeal choking due to ingestion of live octopus is not uncommon. We recently encountered two autopsy cases of accidental choking on small octopus and webfoot octopus. Case 1 involved a 58-year-old fisherman who ingested two live webfoot octopuses in his fishing boat and collapsed. He was immediately taken to the hospital but died. During autopsy, one of the webfoot octopuses was found between his pharynx and esophagus; it was obstructing the epiglottis and upper esophagus. His blood alcohol concentration was 0.140%. Case 2 involved a 55-year-old man who ingested an intact body part of a small octopus and was found dead in his house. He had a history of cerebral infarction and angina pectoris. During autopsy, an intact body part of the small octopus was found to be lodged in the laryngeal inlet.

Awake fiberoptic nasotracheal intubation for patients with difficult airway

Awake fiberoptic nasotracheal intubation is a useful technique, especially in patients with airway obstruction. It must not only provide sufficient anesthesia, but also maintain spontaneous breathing. We introduce a method to achieve this using a small dose of fentanyl and midazolam in combination with topical anesthesia. The cases of 2 patients (1 male, 1 female) who underwent oral maxillofacial surgery are reported. They received 50 µg of fentanyl 2–3 times (total 2.2–2.3 µg/kg) at intervals of approximately 2 min. Oxygen was administered via a mask at 6 L/min, and 0.5 mg of midazolam was administered 1–4 times (total 0.02–0.05 mg/kg) at intervals of approximately 2 min. A tracheal tube was inserted through the nasal cavity after topical anesthesia was applied to the epiglottis, vocal cords, and into the trachea through the fiberscope channel. All patients were successfully intubated. This is a useful and safe method for awake fiberoptic nasotracheal intubation.

Normative Temporal Data of Hyolaryngeal Movements during Swallowing / 대한연하장애학회지

OBJECTIVE: This study evaluated the temporal variables of hyolaryngeal movements during normal swallowing using kinematic analysis of the video fluoroscopic swallowing study (VFSS) to present the normal cut-off values of those variables. METHODS: Seventy-five healthy volunteers (17 men, 58 women) without swallowing dysfunctions were recruited to examine the swallowing of 2-ml diluted barium by a VFSS. Kinematic analysis was conducted by digitization of video files for movements of hyolaryngeal structures, including the vocal cords, hyoid bone, and epiglottis during normal swallowing. The time points and duration of hyolaryngeal movements were measured. The time points were the start point, maximal point, and the end point of the LE (Laryngeal Elevation), HE (Hyoid Excursion), and EF (Epiglottic Folding). The durations of LE, HE, and EF were obtained by subtracting the time of the start point from the time of the maximal point. The onset time of LE was defined as the reference time point (0 sec). The upper and lower limits of the 95% confidence interval were adopted as the normal cut-off values for the temporal variables of hyolaryngeal movements after transformation to a normal distribution. If a transformation formula to a normal distribution was not found in a variable, the values of the 2.5–97.5 percentile were adopted. RESULTS: The cut-off values of the maximal and end points of the LE were 0.281 to 0.916 sec, and 0.830 to 2.205 sec, respectively. The cut-off values of the start, maximal and end points of the HE were −0.233 to 0.400 sec, 0.320 to 0.874 sec, and 0.889 to 2.055 sec, respectively. The cut-off values of the start, maximal, and end points of the EF were 0.017 to 0.483 sec, 0.364 to 1.055 sec, and 0.774 to 1.773 sec, respectively. The cut-off values of the duration of LE, HE, and EF were 0.281 to 0.916 sec, 0.258 to 0.767 sec, and 0.255 to 0.787 sec, respectively. CONCLUSION: This study presented the normal cut-off values of temporal variables of hyolaryngeal movements during normal swallowing. This study can serve as a basis for classifying and analyzing the patterns of patients with dysphagia.

Influence of Supraglottic Swallow on Swallowing Kinematics: Comparison between the Young and the Elderly / 대한연하장애학회지

OBJECTIVE: This study was conducted to evaluate the influence of supraglottic swallowing maneuver on swallowing kinematics using kinematic analysis of a videofluoroscopic swallowing study (VFSS). METHOD: Twenty healthy volunteers (10 in a young group ( < 40 years) and 10 in an elderly group (≥60 years)), participated in this study. After structured instruction by a skilled physician, the subjects swallowed 5 ml of diluted barium in the neutral position without any swallowing maneuvers, as well as with supraglottic swallow maneuver under digital videofluoroscopy, three times each. Kinematic analysis was conducted by digitization of video files for movements of hyolaryngeal structures, including the hyoid bone, larynx, arytenoid, and epiglottis. We measured the maximum displacements and velocities of the hyolaryngeal structures during swallowing. RESULT: The most remarkable change in supraglottic swallow was the maximum vertical displacement (mm) of the hyoid bone during swallowing in both groups (11.5±3.34–19.7±6.88 in the young group, P=0.009; 13.4±2.13–22.8±5.35 in the elderly group, P < 0.001). For velocity variables, patterns of change differed between the young and elderly groups. In the young group, the maximum vertical velocities of the larynx and arytenoid were decreased (P < 0.05), but in the elderly group, the maximum 2D velocity of hyoid bone, maximum horizontal and 2D velocity of the larynx and maximum horizontal velocity of the arytenoid were increased (P < 0.05). There were no significant differences in changes between the young and elderly groups. CONCLUSION: This study showed that supraglottic swallow could affect hyolaryngeal movements, particularly vertical hyoid movement, during swallowing. Beneficial kinematic changes in supraglottic swallow were more pronounced in the elderly group. Therefore, supraglottic swallow may contribute to swallowing improvement by enhancing hyolaryngeal movements during swallowing, in addition to laryngeal closure.

A Case of Laryngeal Lipoma Arising at the Free Margin of the Vocal Cord

Lipomas are benign tumors and most commonly occurs in trunk, upper extremities and lower extremities. About 13–15% of lipomas are located in the head and neck area. However, lipomas of larynx are very rare and only about 100 cases have been reported. Laryngeal lipomas occur mainly in epiglottis, aryepiglottic fold and false vocal cords, which have adipose tissue. Author experienced an unusual presentation of laryngeal lipoma. Tumor seemed to be located in the supraglottis in the preoperative laryngoscopy, but it was found to be located at the free margin of the true vocal cord. To date, only one case has been reported in the world literature. We report this case with a review of the literature.

3D-Printed Nose-to-Larynx Airway Model, Preliminary Study / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Flexible fiberscopy is essential in the examination of the nose to larynx airway. However, the instrument is sensitive to manipulation and can sometimes be damaged when excessive external force is applied. In addition, patients can be injured during fiberscopic examination. In this regard, a airway model mimicking the human airway passage was developed for the education of fiberscopy to minimize the danger to both patient and fiberscope. MATERIALS AND METHOD: Neck CT data was used to 3D-print the airway model. Using the 3D doctor software, the outlines of the air-filled cavities were extracted. The outline data was modified to make the inside of the outline empty and the outside filled with 3D ink resin. The airway data was used to 3D-print the replica in three pieces, which were then assembled into one. Flexible laryngoscopic examination of nose to larynx was performed using the nose-to-larynx airway model, and for a male patient enrolled in the study. Virtual endoscopy was performed using the same CT data. The examination data were then compared frame by frame with regards to the shapes and positions of nasal inlet, inferior turbinate, torus tubarius, hypopharynx, epiglottis and vocal cord. RESULTS: The airway model was very similar in shape and position of the anatomic landmarks compared with real human airway examined by the fiberscope. CONCLUSION: The results of 3D-printed airway model showed similar shapes as the real human airway, and real time endoscopy could be done using the model. This technique can be extended to make models of tubed organs such as the intestine or the bronchial tree.

Effect of Vallecular Ballooning in Stroke Patients With Dysphagia

OBJECTIVE: To investigate the improvement of dysphagia after balloon dilatation and balloon swallowing at the vallecular space with a Foley catheter in stroke patients. METHODS: This study was conducted between May 1, 2012 and December 31, 2015, and involved 30 stroke patients with complaints of difficulty in swallowing. All patients underwent videofluoroscopic swallowing study (VFSS) before and after vallecular ballooning. VFSS was performed with a 4 mL semisolid bolus. For vallecular ballooning, two trainings were performed for at least 10 minutes, including backward stretching of the epiglottis and swallowing of a balloon located in the vallecular space, by checking the movement of the Foley catheter tip in real time using VFSS. RESULTS: After examination of the dysphagia improvement pattern before and after vallecular ballooning, laryngeal elevation (x-axis: pre 2.62±1.51 mm and post 3.54±1.93 mm, p=0.038; y-axis: pre 17.11±4.24 mm and post 22.11±3.46 mm, p=0.036), pharyngeal transit time (pre 5.76±6.61 s and post 4.08±5.49 s, p=0.043), rotation of the epiglottis (pre 53.24°±26.77° and post 32.45°±24.60°, p<0.001), and post-swallow pharyngeal remnant (pre 41.31%±23.77% and post 32.45%±24.60%, p=0.002) showed statistically significant differences. No significant difference was observed in the penetration-aspiration scale score (pre 4.73±1.50 and post 4.46±1.78, p=0.391). CONCLUSION: For stroke patients with dysmotility of the epiglottis and post-swallowing residue, vallecular ballooning can be considered as an alternative method that can be applied without risk of aspiration in dysphagia treatment.

Classification and Management in Patients with Laryngomalacia

Laryngomalacia is the most common congenital anomaly that causes inspiratory stridor and airway obstruction in the newborn. Symptoms begin to appear after weeks of age, become worse at 4-8 months, improve between 8-12 months, and usually heal naturally at 12-18 months. Despite these common natural processes, the symptoms of the disease can be very diverse and, in severe cases, require surgical treatment. The diagnosis can be made by suspicion of clinical symptoms and direct observation of the larynx with the spontaneous breathing of the child. Typical laryngeal features include omega-shaped epiglottis, retroflexed epiglottis, short aryepiglottic fold, poor visualization of the vocal folds, and edema of the posterior glottis, including inspiratory supra-arytenoid tissue prolapse. In this review, we discuss the classification and treatment based on symptoms and laryngoscopic findings in patients with laryngomalacia.

Learning curve of skilled anesthesiologists for endotracheal intubation using Optiscope™

BACKGROUND: Optiscope™ is a semi-rigid fiberscope for endotracheal intubation. A camera attached to the distal end of the stylet shows the laryngeal view through an adjustable LCD-monitor attached at the handle. The aim of this study was to evaluate the learning curve of skilled anesthesiologists in the use of Optiscope™. METHODS: Eighty-patients with normal airways were randomly assigned to four anesthesiologists, who did not have previous experience of intubation with Optiscope™. After induction of general anesthesia, the four investigators performed 20 intubations each, using the Optiscope™. Time to intubation (TTI), number of intubation attempts, and reasons of prolonged TTI were evaluated. RESULTS: The success rate of intubation was 98.8%. The TTI was significantly faster in 16th–20th patients (35.0 s, interquartile range 27.3–41.4) than in the first 10 patients (54.1 s, interquartile range 31.2–75.5) (P = 0.006). All patients after the 16th intubation were intubated at the first attempt. Frequent problems encountered were difficulty in getting the stylet tip under the epiglottis, and mucous secretion obscuring the laryngeal anatomy. CONCLUSIONS: Optiscope™ is an effective device for endotracheal intubation. About 15 intubations in patients with normal airways provided clinically adequate experience to the skilled anesthesiologists. Additional maneuver of airway opening such as jaw thrust and sufficient removal of oral secretion, are suggested to reduce TTI.

Learning curve of skilled anesthesiologists for endotracheal intubation using Optiscope™

BACKGROUND: Optiscope™ is a semi-rigid fiberscope for endotracheal intubation. A camera attached to the distal end of the stylet shows the laryngeal view through an adjustable LCD-monitor attached at the handle. The aim of this study was to evaluate the learning curve of skilled anesthesiologists in the use of Optiscope™. METHODS: Eighty-patients with normal airways were randomly assigned to four anesthesiologists, who did not have previous experience of intubation with Optiscope™. After induction of general anesthesia, the four investigators performed 20 intubations each, using the Optiscope™. Time to intubation (TTI), number of intubation attempts, and reasons of prolonged TTI were evaluated. RESULTS: The success rate of intubation was 98.8%. The TTI was significantly faster in 16th–20th patients (35.0 s, interquartile range 27.3–41.4) than in the first 10 patients (54.1 s, interquartile range 31.2–75.5) (P = 0.006). All patients after the 16th intubation were intubated at the first attempt. Frequent problems encountered were difficulty in getting the stylet tip under the epiglottis, and mucous secretion obscuring the laryngeal anatomy. CONCLUSIONS: Optiscope™ is an effective device for endotracheal intubation. About 15 intubations in patients with normal airways provided clinically adequate experience to the skilled anesthesiologists. Additional maneuver of airway opening such as jaw thrust and sufficient removal of oral secretion, are suggested to reduce TTI.

Difference in F-18 FDG Uptake After Esophagogastroduodenoscopy and Colonoscopy in Healthy Sedated Subjects / 대한핵의학회잡지

PURPOSE: We aimed to evaluate the difference in fluorodeoxyglucose (FDG) uptake in sedated healthy subjects after they underwent esophagogastroduodenoscopy (EGD) and colonoscopy procedures.METHODS: The endoscopy group (n = 29) included healthy subjects who underwent screening via F-18 FDG positron emission tomography/computed tomography (PET/CT) after an EGD and/or colonoscopy under sedation on the same day. The control group (n = 35) included healthy subjects who underwent screening via PET/CT only. FDG uptake in the tongue, uvula, epiglottis, vocal cords, esophagus, stomach, duodenum, liver, cecum, colon, anus, and muscle were compared between the two groups.RESULTS: Maximum standardized uptake value (SUVmax) in the tongue, pharynx, larynx, and esophagus did not significantly differ between the endoscopy and control groups. In contrast, mean SUVmax in the whole stomach was 18 % higher in the endoscopy group than in the control group (SUVmax: 2.96 vs. 2.51, P = 0.010). In the lower gastrointestinal track, SUVmax from the cecum to the rectum was not significantly different between the two groups, whereas SUVmax in the anus was 20% higher in the endoscopy group than in the control group (SUVmax: 4.21 vs. 3.50, P = 0.002). SUVmax in the liver and muscle was not significantly different between the two groups. Mean volume of the stomach and mean cross section of the colon was significantly higher in the endoscopy group than in the control group (stomach: 313.28 cm³ vs. 209.93 cm³, P < 0.001, colon: 8.82 cm² vs. 5.98 cm², P = 0.001).CONCLUSIONS: EGD and colonoscopy under sedation does not lead to significant differences in SUVmax in most parts of the body. Only gastric FDG uptake in the EGD subjects and anal FDG uptake in the colonoscopy subjects was higher than uptake in those regions in the control subjects.

Kyste valléculaire symptomatique de l'adulte. A propos d'un cas

Les kystes valléculaires encore appelés kystes épiglottiques ou kystes basi-linguaux sont des kystes canalaires qui traduisent l'obstruction et la rétention de mucus au niveau des canaux excréteurs, des glandes sous-muqueuses. Ils peuvent se manifester chez le nouveau-né par une détresse respiratoire aiguë, chez l'adulte ils sont le plus souvent asymptomatiques et sont découverts lors d'une laryngoscopie indirecte ou lors d'une intubation.L'objectif de ce travail était de rapporter un cas de kyste valléculaire symptomatique chez un adulte de 50 ans pris en charge au service d'ORL et de chirurgie cervico-faciale de Hôpital Général de Grand Yoff, Dakar, Sénégal. La nasofibroscopie a objectivé une formation kystique arrondie siégeant au niveau de la vallécule gauche. La tomodensitométrie cervico-faciale a mis en évidence une masse valléculaire gauche hypodense homogène plaquant l'épiglotte contre le plan glottique. Au plan thérapeutique, nous avions effectué une ponction première du kyste suivie de son exérèse complète par électrocoagulation de la base d'implantation. Les suites opératoires étaient simples

Quiste de vallécula como causa de estridor congénito: reporte de un caso y revisión de la literatura / Vallecula cyst as a cause of congenital stridor: case report and literature review

El quiste de vallécula congénito es una malformación de vía aérea poco frecuente que se manifiesta principalmente con estridor laríngeo y que puede plantear problemas diagnósticos y terapéuticos complejos, a menudo en situaciones de riesgo vital. Se presenta el caso de un recién nacido de pretérmino (RNPT) de 36 semanas pequeño edad gesta-cional (PEG), portador de un estridor laríngeo congénito y mal incremento pondoestatural que en relación a una infección respiratoria baja, presentó empeoramiento del estridor laríngeo a los 48 días de edad cronológica. Por insuficiencia respiratoria aguda requirió de intubación orotraqueal que no resultó dificultosa. La extubación fue fallida por presentar estridor inspiratorio franco. La nasofibroscopía demostró una lesión de aspecto quístico en base de lengua que desplazaba la epiglotis hacia posterior obstruyendo parcialmente el lumen de la vía aérea. Por laringoscopía directa se realizó marsupialización. Se realiza la revisión bibliográfica y se analiza el caso y su tratamiento.

Congenital vallecular cyst is a rare airway malformation mainly manifested by laryngeal stridor and could generate complex diagnostic and therapeutic problems, often in life-threatening situations. We present the case of a pre-term newborn of 36 weeks small for gestational age, who at 48 days of chronological age showed worsening of a congenital laryngeal stridor in the context of a lower respiratory tract infection associated to low weight gain from birth. For reasons of acute respiratory failure, orotracheal intubation was executed which was not difficult. Extubation was failed because the child presents significant inspiratory stridor. Nasofibroscopy showed a cystic lesion of the tongue base that pushed backward the epiglottis obstructing partially the airway lumen. Marsupialization was performed by direct laryngoscopy. A Bibliographic review was done and the case and its treatment are discuss.

Estenose de esôfago como manifestação de amiloidose esofágica / Stenosis esophagus as expression of systemic amyloidosis

Amiloidose é o depósito anormal extracelular de substância proteica fibrilar, insolúvel, mais comum em idosos, que pode ser resultado de um grande e heterogêneo grupo de transtornos e pode gerar danos e disfunção de variados órgãos potencialmente envolvidos. O envolvimento esofágico da amiloidose é incomum, assim como a epiglote, não é habitualmente foco primário de um linfoma não-Hodgkin (LNH). O presente relato apresenta um caso incomum de amiloidose esofágica relacionada à tuberculose pulmonar e ao linfoma não-Hodgkin de epiglote. Paciente de 79 anos, com queixa de disfagia progressiva e disfonia, há 2 anos. Radiografia contrastada de esôfago revelou estenose com irregularidade da mucosa no 1/3 superior de esôfago e a endoscopia digestiva alta evidenciou lesão infiltrativa e estenosante de esôfago torácico superior e médio, com aspecto neoplásico; porém, anatomopatológico das biópsias evidenciou mucosa escamosa própria do esôfago com acantose, papilomatose, apresentando, abaixo da mucosa, material amorfo eosinofílico e fragmentado que, após aplicação de corantes especiais (Vermelho Congo e Cristal Violeta), revelou tratar-se de depósito amiloide, confirmado por análise imuno-histoquímica. Durante investigação de outros órgãos acometidos, diagnosticado envolvimento linfonodal e pulmonar. Tentado tratamento sintomático do quadro de disfagia com dilatação com vela de Savary, além de uso de colchicina como tentativa de reduzir deposição de amiloide. Mais tarde, em investigação da etiologia da doença, descoberto Linfoma Não-Hodgkin de epiglote e tuberculose pulmonar como possíveis causas da mesma, sendo então encaminhada para tratamento quimioterápico e antituberculínico.

The lack of therapeutic options for celiac disease (CD) has become a relevant issue in the pharmaceutical sector, as a result of the improvement on technical diagnostic serological and the following increase in the number of individuals with confirmed diagnosis for this disease. To date, the only effective therapy to CD is the gluten-free diet, a seemingly simple treatment, but that has enormous repercussions in the social and nutritional habits of the patient. New findings on the complex pathogenic mechanism of CD allowed gradually the development of researches to look for new therapeutic options, among which we can highlight the oral intake of enzymes capable to hydrolyze the gluten, inhibitors of tissue transglutaminase enzyme, inhibitors of intestinal permeability, and tolerance induction of gluten. This study, besides to describing some features of celiac disease and its relationship with the structure of gluten, compiles information from several authors regarding the development of new treatment of this disease, with the goal of identifying therapeutic options that present the biggest advances and, therefore, has the potential to be at the disposal of celiac patients in a near future.