ABSTRACT
El origen autoinmune ocupa el 5.° lugar en la clasificación etiológica de las estenosis laringotraqueales. La enfermedad autoinmune que más se ha asociado a estenosis es la enfermedad de Wegener, pero existen otras enfermedades que también pueden relacionarse con estas. Presentamos un estudio descriptivo, retrospectivo, de 9 casos de estenosis laringotraqueal en pacientes con enfermedad autoinmune. Se trata de 8 mujeres y un hombre, con edad media de 27,9años. Cuatro de los pacientes padecían enfermedad de Wegener, uno colitis ulcerosa y otro púrpura vasculítica. Los otros 3 pacientes solamente eran anticuerpos antinucleares positivos. Tres de los casos fueron tratados únicamente con abordaje endoscópico y los otros 6 necesitaron además cirugía abierta, con resultados respiratorios aceptables. Pensamos que en todos los pacientes con estenosis laringotraqueal se deben estudiar los perfiles inmunológicos, ya que no solo la enfermedad de Wegener se asocia a esta enfermedad (AU)
Autoimmune origin ranks fifth in the etiologic classification of laryngotracheal stenosis. Wegener's disease is the autoimmune illness most associated with stenosis; however, there are other autoimmune diseases that may also be associated with it. A descriptive, retrospective study of 9 cases of laryngotracheal stenosis associated with autoimmune disease was carried out. There were 9 patients (8 females and 1 male) with an average age of 27.9 years. Four of the patients suffered from Wegener's disease, 1 from ulcerative colitis and 1 from purple vasculitis. The other 3 patients only had positive c-ANA. Endoscopic treatment was performed in 3 cases. The other 6 patients required open surgery. Respiratory results were acceptable. Based on our study, we feel that the immunological profiles should be studied in all patients with stenosis, given that not only Wegener's disease is linked to stenosis (AU)
Subject(s)
Humans , Male , Female , Adult , Laryngostenosis/complications , Laryngostenosis/etiology , Laryngostenosis/immunology , Autoimmunity/immunology , Granulomatosis with Polyangiitis/complications , Endoscopy/methods , Tomography, Emission-Computed/methods , Retrospective Studies , Laryngoscopy/methods , Laser Therapy/methods , Adrenal Cortex Hormones/therapeutic use , Cyclophosphamide/therapeutic useABSTRACT
Autoimmune origin ranks fifth in the etiologic classification of laryngotracheal stenosis. Wegener's disease is the autoimmune illness most associated with stenosis; however, there are other autoimmune diseases that may also be associated with it. A descriptive, retrospective study of 9 cases of laryngotracheal stenosis associated with autoimmune disease was carried out. There were 9 patients (8 females and 1 male) with an average age of 27.9 years. Four of the patients suffered from Wegener's disease, 1 from ulcerative colitis and 1 from purple vasculitis. The other 3 patients only had positive c-ANA. Endoscopic treatment was performed in 3 cases. The other 6 patients required open surgery. Respiratory results were acceptable. Based on our study, we feel that the immunological profiles should be studied in all patients with stenosis, given that not only Wegener's disease is linked to stenosis.
Subject(s)
Autoimmune Diseases/complications , Laryngostenosis/etiology , Tracheal Stenosis/etiology , Adult , Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/complications , Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/immunology , Autoimmune Diseases/immunology , Autoimmune Diseases/surgery , Colitis, Ulcerative/complications , Colitis, Ulcerative/immunology , Female , Granulomatosis with Polyangiitis/complications , Granulomatosis with Polyangiitis/immunology , Humans , Laryngoscopy , Laryngostenosis/immunology , Laryngostenosis/surgery , Male , Middle Aged , Retrospective Studies , Tracheal Stenosis/immunology , Tracheal Stenosis/surgery , Young AdultABSTRACT
BACKGROUND: Several functional advantages have been described for the transoral laser supraglottic laryngectomy as compared with open techniques. However, comparative studies have been rarely performed. METHODS: Functional results in 26 patients treated with a transoral approach were retrospectively compared with those of a comparable series of 26 patients who underwent a transcervical approach. RESULTS: The only significant differences found between the two groups were a lesser number of temporary tracheotomies and a shorter time of removal of the nasogastric tube in the laser group. No significant differences were found in the incidence of postoperative complications, hospital stay, and swallowing capacity. CONCLUSIONS: The rate of functional problems after transoral laser surgery did not greatly decrease compared with the rate after the conventional procedure. The mayor advantage of the transoral approach was the lower incidence of temporary tracheotomies.
Subject(s)
Carcinoma, Squamous Cell/surgery , Laryngeal Neoplasms/surgery , Laryngectomy/methods , Laser Therapy/methods , Aged , Female , Follow-Up Studies , Humans , Incidence , Intubation, Gastrointestinal , Laryngoscopy , Length of Stay , Male , Middle Aged , Neck Dissection , Postoperative Complications/epidemiology , Retrospective Studies , Time Factors , Tracheotomy/statistics & numerical data , Treatment OutcomeABSTRACT
The social and psychological impact of dysphagia has not been routinely reported in large studies. We sought to determine the effects of dysphagia on broad measures of the quality of life of patients and to explore the relationship between the psychological handicaps of the condition and the frequency of diagnosis and treatment. A total of 360 patients selected on the basis of known subjective dysphagia complaints, regardless of origin, in nursing homes and clinics in Germany, France, Spain, and the United Kingdom were interviewed using an established questionnaire. Qualitative interviews with a total of 28 health professionals were conducted to improve understanding of the patient data in the context of each country. Over 50% of patients claimed that they were "eating less" with 44% reporting weight loss during the preceding 12 months. Thirty-six percent of patients acknowledged receiving a confirmed diagnosis of dysphagia; only 32% acknowledged receiving professional treatment for it. Most people with dysphagia believe their condition to be untreatable; only 39% of the sufferers believed that their swallowing difficulties could be treated. Eighty-four percent of patients felt that eating should be an enjoyable experience but only 45% actually found it so. Moreover, 41% of patients stated that they experienced anxiety or panic during mealtimes. Over one-third (36%) of patients reported that they avoided eating with others because of their dysphagia. In a largely elderly population that might accept dysphagia as an untreatable part of the aging process, clinicians need to be aware of the adverse effects of dysphagia on self-esteem, socialization, and enjoyment of life. Careful questioning should assess the impact of the condition on each patient's life, and patients should be educated on their choices for treatment in the context of any coexisting illness. Awareness of the condition, diagnostic procedures, and treatment options must be increased in society and among the medical profession.
