ABSTRACT
To demonstrate the role of oral acyclovir in monthly regimes after microdebrider assisted excision in 3 patients with adult recurrent respiratory papillomatosis (ARRP). Three patients with ARRP who presented to a tertiary referral hospital in stridor were initially treated with a tracheostomy in order to secure airway. On further evaluation by videolaryngoscopy extensive bilateral laryngeal papillomatosis was noted with history of similar conditions in the past for which they were repeatedly operated. They were admitted and underwent Microlaryngeal surgery and laryngeal microdebrider assisted surgery under general anesthesia. Post operatively a course of oral acyclovir at 800 mg/5 times/day for 5 days was administered. On repeat assessment with videolaryngoscopy at monthly intervals a complete remission of the disease was noted with no residual disease at the end of 1 year in 2 cases. One case had a recurrence. Renal parameters were monitored periodically. It may be concluded that the action of anti viral drugs at regular intervals in addition to a short course of oral steroids lead to rapid recovery and prevented latent virus activation within the laryngo tracheal system hence maintaining long term improvement. This can avoid multiple laryngeal surgeries, repeated respiratory emergencies and risk for malignant transformation in the future thereby reducing morbidity and effect on quality of life.
ABSTRACT
During routine dissection in an adult male cadaver, the presence of long segment near complete tracheal rings associated with variation in the second (V2) of right vertebral artery (VA) and third (V3) segments of the left VA was encountered. This case report highlights the normal lifespan of an individual despite anatomical variations that are reported to be incompatible with life. Congenital complete and near-complete tracheal rings are extremely rare tracheal deformities, and long-segment occurrences of these variations are usually incompatible with life. They are reported to be associated with cervical chondrogenic anomalies and craniosynostotic syndromes.In the same cadaver the left VA entered the foramen transversarium (FT) of C6 vertebra and exited through the FT of the axis. It formed a loop below the arch of atlas and entered the vertebral canal between the atlas and axis, completely bypassing the FT of the atlas. A branch from the loop divided into two branches, one of which supplied the dorsal ramus of C1, the other ending in the surrounding neck musculature. The right VA was normal, except that it entered the FT of C5 vertebra bypassing C6 vertebra. It was noted that the calibre of the VA on the left side was considerably more than that on the right. Variations in the vertebrobasilar system have a potential clinical impact, since they are the feed arteries of the brain (AU)
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Subject(s)
Humans , Vertebral Artery/abnormalities , Vascular Malformations , Trachea/abnormalities , Cervical Atlas/abnormalities , Cervical Vertebrae/abnormalitiesABSTRACT
Respiratory fungal infections are usually found in immunocompromised individuals who have received either long-term steroid therapy or broad-spectrum anti-microbial therapy or have a non-resolving underlying chronic disease. These infections are seen as a part of bronchopulmonary fungal infections, and their isolated and primary occurrence as laryngeal diseases is highly uncommon. Laryngeal fungal infections can also mimic various diseases, such as gastroesophageal reflux disease, granulomatous diseases, leukoplakia, and carcinoma, thereby misleading the treating team from correct diagnosis and management. It is therefore important to identify the lesion at the earliest point possible to avoid morbid or life-threatening consequences. We report a case of isolated laryngeal candidiasis in an immunocompetent Indian male with an unusual presentation mimicking laryngeal carcinoma. The clinical and histological features are highlighted with a review of relevant literature to demonstrate the possibility of such an isolated fungal lesion, even in an immunocompetent individual.
