Spontaneous hemopneumothorax in an adolescent with COVID-19.

As coronavirus disease 2019 (Covid-19) continues to spread world-wide, new symptoms associated with the disease continue to appear. Common manifestations include fever, shortness of breath, and gastrointestinal illness. In addition, COVID is known to induce coagulopathy. Here, we present the case of a 17-year-old male who presented with a massive hemopneumothorax and was found to incidentally be positive for Covid-19. We suspect that he had a primary pneumothorax from a bleb and the hemothorax could've been induced by the coagulopathic state induced by COVID infection.

Laryngopharyngeal reflux disease in singers: Pathophysiology, clinical findings and perspectives of a new patient-reported outcome instrument.

PURPOSE OF REVIEW: Laryngopharyngeal reflux (LPR) is an inflammatory disease associated with the development of voice disorder and vocal fold lesions. The occurrence of LPR in professional voice users as singers can have a dramatic impact of daily life. The aims of this paper is to review the current literature about the pathophysiological mechanisms underlying the development of voice disorder, especially in singers, and to propose a new patient-reported outcome instrument to assess complaints of these patients. RECENT FINDINGS: Many clinical and experimental studies reported that LPR leads to the development of significant macroscopic and microscopic histological changes in the mucosa of the vibratory margin of the vocal folds. Epithelial cell dehiscence, microtraumas, Reinke's space modifications, inflammatory infiltrates, mucosal drying, and epithelial thickening are associated with LPR. These histological changes may modify the biomechanical properties of the vocal fold tissue leading to hoarseness. In practice, singers with LPR may have normal or discretely pathological speaking voice but impaired singing voice (vocal fatigue, hoarseness, and loss of range). To date, the literature about the specific LPR signs and symptoms in singers is almost non-existent. However, singers are at high risk to present LPR because of necessary air support involving higher intra-abdominal pressure, increased stress due to career management and uncomfortable schedules, late meals just before sleep, bad nutrition habits like increased intake of citrus products, fats foods and spicy foods. PERSPECTIVES: The lack of clinical singer-reported outcome instrument may decrease the management of LPR in singers. In this context, the LPR Study Group of Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS) developed a new instrument to precisely assess symptoms related to LPR in singing voice. This instrument will be validated and could be used in clinical practice in voice centers.

The development of new clinical instruments in laryngopharyngeal reflux disease: The international project of young otolaryngologists of the International Federation of Oto-rhino-laryngological Societies.

INTRODUCTION: To analyze the epidemiological characteristics of placebo controlled randomized trials (RCTs) that evaluated the effectiveness of medical treatments over placebo in laryngopharyngeal reflux (LPR). MATERIAL AND METHODS: PubMed, Cochrane database, and Scopus were assessed for subject headings using the PRISMA recommendations. Placebo RCTs published between 1990 and 2018 describing clinical evolution throughout LPR treatment were extracted and analyzed for evidence-based level, number of patients, inclusion and exclusion criteria, gender, age, symptoms and signs used as therapeutic outcomes, and treatment schemes. RESULTS: The database search identified 15 placebo RCTs with a total of 763 patients. The mean age of patients was 48.59 years and 52.68% of patients were female. Among the 15 placebo RCTs, 9 have demonstrated a partial or total superiority of a medical treatment over placebo. Most of authors based the LPR diagnosis on symptoms and signs without additional examination. Our analysis reveals an important heterogeneity between studies with regard to the diagnosis criteria, treatment schemes and signs and symptoms used as therapeutic outcomes. Many commonly reported signs and symptoms related to LPR were not used as therapeutic outcomes. Half of the authors did not prescribe diet and behavioral changes along the treatment. CONCLUSION: The controversy in the RCTs about the superiority of medical treatment over placebo in LPR disease is probably due to discrepancies in the diagnosis method, exclusion criteria, therapeutic schemes and the lack of comprehensive tools for the assessment of signs and symptoms. In this context, the LPR Study Group of Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies developed two new instruments to precisely assess signs and symptoms throughout the treatment. These two instruments could be used in future trials comparing medical treatment over placebo in LPR disease.

Change of signs, symptoms and voice quality evaluations throughout a 3- to 6-month empirical treatment for laryngopharyngeal reflux disease.

OBJECTIVE: To assess the usefulness of voice quality measurements as a treatment outcome in patients with laryngopharyngeal reflux (LPR)-related symptoms. DESIGN: Prospective uncontrolled multi-centre study. MATERIAL AND METHODS: A total of 80 clinically diagnosed LPR patients with a reflux finding score (RFS)>7 and a reflux symptom index (RSI)>13 were treated with pantoprazole and diet recommendations during 3 or 6 months, according to their evolution. RSI; RFS; blinded Grade, Roughness, Breathiness, Asthenia, Strain and Instability (GRBASI) and aerodynamic and acoustic measurements were evaluated at baseline, 3 months (n = 80), and 6 months (n = 41) post-treatment. We conducted a correlation analysis between the adherence to the diet, and the evolution of both signs and symptoms and between videolaryngostroboscopic signs and acoustic measurements. RESULTS: Reflux symptom index, RFS, perceptual voice quality evaluations (dysphonia, roughness, strain and instability), and aerodynamic and acoustic measurements (ie, percent jitter and percent shimmer) were significantly improved at 3 months post-treatment but not at 6 months. Percent jitter was the most useful outcome for evaluating the clinical evolution of patients throughout the treatment course. A significant relationship between globus sensation and posterior commissure hypertrophy was documented; both seemed to significantly improve from 3 to 6 months. The correlation analysis revealed correlations between adherence to diet recommendations and the improvement of symptoms and between posterior commissure granulation severity and acoustic measurement impairments. CONCLUSION: Voice quality improved in a manner similar to both signs and symptoms throughout a 6-month empirical treatment with better improvement the 3 first months. Voice quality assessments can be used as indicators of treatment effectiveness in patients with LPR-related symptoms.

The effect of meconium exposure on the expression and differentiation of amniotic fluid mesenchymal stem cells.

BACKGROUND: The goal of this study was to determine if exposure to meconium would alter the phenotype of amniotic fluid mesenchymal stem cells (AF-MSCs) and the ability of these cells to be differentiated into distal airway type cells. METHODS: Meconium was collected, lyophilized and resuspended in PBS at 3 different concentrations (high, medium, and low). AF-MSCs were cultured in the presence of this meconium suspension for 8 hours and then analyzed for changes in gene expression. Additionally, AF-MSCs exposed to meconium were differentiated for 14 days using modified small airway growth medium (mSAGM) and gene expression was determined. As a spontaneous differentiation control, meconium exposed AF-MSCs were cultured in amniotic fluid stem cell medium (AF medium). RESULTS: After 8 hours of exposure in culture, AF-MSCs had increased expression of distal airway genes aquaporin 5 (AQP5) and surfactant protein c (SPC) when cultured in AF medium containing meconium. These gene expression levels were similar to that of AF-MSCs that were differentiated in mSAGM for 14 days. Furthermore, there was an up regulation of pluripotency genes NANOG and OCT4 in response to low meconium concentration for 8 hours. Following 14 days of culture in mSAGM, there was an upregulation of TTF1, SPC and AQP5 expression in the control, as well as in the low and medium meconium exposed groups indicating that these cells were still able to be differentiated. High meconium concentration did, however, appear to influence the level of distal airway gene expression after 14 days in mSAGM. After 14 days in AF medium, there was significant downregulation in pluripotency and mesenchymal markers as well as distal airway gene expression in all groups. CONCLUSION: The phenotype of AF-MSCs is modulated by meconium exposure; however, the cells were still able to differentiate into distal airway gene and protein expression. This result supports the hypothesis that progenitor cells exist in the amniotic fluid and the presence of meconium may affect their initial phenotype. However, these cells were still able to be differentiated to a distal lung phenotype.

Long-term Results of 18 Fat Injections in Unilateral Vocal Fold Paralysis.

OBJECTIVE: The purposes of this study were to assess the long-term efficacy of medialization laryngoplasty via injection of autologous fat in patients with unilateral laryngeal paralysis, and to discuss the results based on the volume of fat injected and the size of the initial glottic gap. STUDY DESIGN: This was a retrospective study with clinical reevaluation of 18 patients treated for unilateral laryngeal paralysis at Liège University Hospital between April 1, 2011, and December 1, 2014. METHOD: The voice examination included subjective scales (GRBAS and the Voice Handicap Index), a report on acoustic and aerodynamic voice parameters, and laryngostroboscopic assessment of glottic closure and mucosal wave (T0: preoperative; T1: immediate postoperative; T2: >1 year). RESULTS: The median follow-up duration was 19 months. We observed a significant improvement in maximum phonation time; mean flow rate; jitter; the Voice Handicap Index; the G, R, B, and A subscales of the GRBAS-I; and glottic closure at T1. These parameters remained stable over time, without any significant difference except for shimmer and glottic closure between T1 and T2. Regardless of the volume of fat injected and the magnitude of the initial glottic gap, we did not see any significant difference from one assessment time to another. CONCLUSION: Medialization laryngoplasty by means of the injection of autologous fat is a safe, effective surgical technique for patients with unilateral laryngeal paralysis regardless of the size of the initial glottic gap. The results are maintained longer than 1 year, and no evidence of significant resorption of the fat was found in our study over a period of 12-58 months. The volume of fat injected does not seem to affect the functional results.

[Laryngeal involvements in systemic diseases : a discussion based on a case report.] / Manifestations laryngées des maladies de système : cas clinique.

Systemic diseases can affect the larynx. The most common laryngeal involvements, although often unknown, consist in inflammatory laryngitis, laryngeal ulcers, cricoarytenoid arthritis, recurrent laryngeal nerve paresis and subglottic stenosis. The clinical case we report is more uncommon, but representative of autoimmune diseases : vocal folds bamboo nodes in a young female patient, age 34, suffering from active rheumatoid arthritis. In the present article, we detail the current knowledge of this pathology and later discuss different laryngeal involvements of systemic diseases by lesion type et their management.

Les maladies de système peuvent affecter le larynx. Leurs manifestations laryngées les plus fréquentes, bien qu'elles soient souvent méconnues, sont les laryngites inflammatoires, les ulcères laryngés, les arthrites crico-aryténoïdiennes, les parésies récurrentielles et les sténoses sousglottiques. Le cas clinique que nous rapportons ici est plus rare, mais caractéristique des maladies auto-immunes : des noeuds de bambou des cordes vocales chez une jeune patiente de 34 ans souffrant d'une polyarthrite rhumatoïde. Dans cet article, nous détaillons les connaissances actuelles sur cette pathologie et discutons ensuite les différentes manifestations laryngées des maladies de système par type de lésion et leur prise en charge.

Health-related quality of life in Colombia: reference values of the EORTC QLQ-C30.

There are normative data of the quality of life (QoL) questionnaire EORTC QLQ-C30 (the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire) for several European countries and Korea, but not for Latin America. The aim of this study was to provide these normative values for the general population in Colombia and to assess differences in terms of age and sex. For that reason, a sample of 1500 representatively selected individuals of the Colombian population completed the EORTC QLQ-C30 form. Results showed that mean scores of the Colombian population are similar to those obtained in European countries; whereas the mean values from a Korean study were lower (worse QoL). Age and sex differences were found in several scales and symptom items. Linear regression analyses were calculated to help quantify the influence of age and gender on QoL. Men reported better functioning and less symptoms than women on all scales, and older individuals reported worse global scores in terms of functioning and lower QoL than younger ones. In sum, the normative values presented can be used to assess QoL scores of Latin American cancer patients and to compare groups of patients with unequal age and sex distributions.

[Clinical vignette for the medical school student: jugular foramen syndrome]. / La vignette diagnostique de l'etudiant. Syndrome du trou déchiré postérieur (foramen jugulaire).

Cranial neuropathies are frequent and their semiological analysis is the basis of the diagnostic workup. This is even more true in the case of multiple cranial neuropathies. We here propose a diagnostic exercise in the case of a simultaneous cranial nerves IX (glossopharyngeal), X (vagus) and XI (spinal) deficit. This case exemplifies that knowledge of nervous anatomy and physiology is the basis of the semiology of the nervous system.

A tissue-engineered model of fetal distal lung tissue.

In extending our previous studies toward development of an engineered distal lung tissue construct (M. J. Mondrinos, S. Koutzaki, E. Jiwanmall, M. Li, J. P. Dechadarevian, P. I. Lelkes, and C. M. Finck. Tissue Eng 12: 717-728, 2006), we studied the effects of exogenous fibroblast growth factors FGF10, FGF7, and FGF2 on mixed populations of embryonic day 17.5 murine fetal pulmonary cells cultured in three-dimensional collagen gels. The morphogenic effects of the FGFs alone and in various combinations were assessed by whole mount immunohistochemistry and confocal microscopy. FGF10/7 significantly increased epithelial budding and proliferation; however, only FGF10 alone induced widespread budding. FGF7 alone induced dilation of epithelial structures but not widespread budding. FGF2 alone had a similar dilation, but not budding, effect in epithelial structures, and, in addition, significantly enhanced endothelial tubular morphogenesis and network formation, as well as mesenchymal proliferation. The combination of FGF10/7/2 induced robust budding of epithelial structures and the formation of uniform endothelial networks in parallel. These data suggest that appropriate combinations of exogenous FGFs chosen to target specific FGF receptor isoforms will allow for control of lung epithelial and mesenchymal cell behavior in the context of an engineered system. We propose that tissue-engineered fetal distal lung constructs could provide a potential source of tissue or cells for lung augmentation in pediatric pulmonary pathologies, such as pulmonary hypoplasia and bronchopulmonary dysplasia. In addition, engineered systems will provide alternative in vitro venues for the study of lung developmental biology and pathobiology.

Laryngeal dysfunction after thyroid surgery: diagnosis, evaluation and treatment.

Because of the close anatomical relationships between thyroid gland and laryngeal nerves, sensory-motor impairment of the laryngeal functions is a well known possible complication of thyroid surgery. Laryngeal nerve paralysis can present with various and often associated symptoms like dysphagia, aspiration, voice alteration or dyspnea. Several examination procedures are mandatory to perform a complete neuro-laryngeal evaluation: rigid and flexible video-stroboscopy will assess the abductor, adductor and tensor functions in breathing, sniffing, talking and eventually singing tasks. Laryngeal electromyography (LEMG), despite its technical difficulties, brings valuable objective and pronostic informations. Aerodynamic assessment of voice production and objective acoustic voice evaluation are important for patients' follow-up, especially for voice professionals like teachers and singers. Treatment of laryngeal sensory-motor nerve paralysis can be conservative, with the help of speech therapy. Early surgical treatment is indicated in cases with severe functional problems like aspiration pneumonia, disabling breathy hypophonia, ineffective cough, disabling dyspnea. Surgical therapy at 6 to 9 months after injury is indicated in patients who demonstrate evidence of denervation or little activity on LEMG and have a poor response to a reasonable trial of speech therapy. Many surgical procedures are available. Depending on the type of neuro-laryngeal deficit, the main and more widely used techniques are: injection laryngoplasty, medialization thyroplasty, arytenoid adduction, arytenoidopexy, crico-thyroid approximation, endoscopic laser cordotomy and re-innervation procedures.

[Vocal fold structure and speech pathologies]. / Structure cordale et pathologies vocales.

Our knowledge of vocal fold structure has profoundly evolved since the description by M. Hirano in 1974 of the laminar organization of the connective tissue of the human vocal fold, the lamina propria. The molecular composition of the extracellular matrix (ECM) of the lamina propria is essential in determining the viscoelastic properties of the tissue. This is particularly true in the superficial layer of the lamina propria (also called Reinke's space). With the epithelium, Reinke's space constitutes the vocal fold main vibrator. In normal subjects, the jelly like structure of the Reinke's space is due to a very loose fibrous scaffolding and to a balance between the interstitial proteins of the ECM: Proteoglycans like decorin and hyaluronic acid and glycoproteins like fibronectin. Vibratory trauma leads, in disease states, to molecular modification of the extracellular matrix of Reinke's space resulting in benign cordal lesions like nodules, submucosal fibrosis and vocal folds scars. Improving the knowledge of the homeostasis of Reinke's space ECM can lead to improvement of the therapeutic and prevention strategies of vocal fold benign lesions. The main histologic and viscoelastic characteristics, as well as surgical treatment of cordal nodular lesions and scars are described. The recent researches in the field of regeneration of Reinke's space are evoked.

Knowledge and attitudes towards preimplantation genetic diagnosis in Germany.

BACKGROUND: Preimplantation genetic diagnosis (PGD) is a technique which is often related to emotional debates because of its ethical and social implications. Worldwide there are different forms of legislation; Germany constitutes an interesting case because of the historical background concerning eugenics and dealing with handicapped persons at the time of national socialism. PGD is currently not legal but there are still polarized positions and legalization remains an issue. Studies about the attitudes of the general population towards PGD are rare. METHODS: Data were collected in a representative survey carried out in November 2003. Subjects were 2110 persons in Germany aged 18-50 years. RESULTS AND CONCLUSIONS: Respondents had little knowledge about PGD. There were incorrect assumptions about the diagnostic possibilities and a lack of basic genetic knowledge. A tendency towards a general acceptance of PGD for medical indications was found. Non-medical indications such as sex selection were generally not accepted. It could be observed that respondents who already had a notion about PGD overestimated the diagnostic possibilities and would eventually use PGD in the future more than respondents who had never heard about PGD before.

[Standards, options and recommendations: Good clinical practice in the dietetic management of cancer patients: hospital catering]. / Standards, options et recommandations: Bonnes practiques de diététique en cancérologie: la prestation alimentaire.

CONTEXT: The "Standards, Options and Recommendations" (SOR) project, started in 1993, involves a collaboration between the Federation of the French Cancer Centres (FNCLCC), the 20 French Regional Cancer Centres, some French public university and general hospitals and private Clinics and medical scientific societies. Its main objective is the development of clinical practice guidelines to improve the quality of health care and outcome for cancer patients. The methodology is based on a literature review followed by a critical appraisal by a multidisciplinary group of experts to produce the draft guidelines which are then validated by specialists in cancer care delivery. OBJECTIVES: To develop clinical practice guidelines for hospital catering for cancer patient using the methodology developed by the Standards, Options and Recommendations project. METHODS: Data were identified by a literature search of Medline and the reference lists of experts in the groups. After the guidelines were drafted, they were validated by independent reviewers. RESULTS: The main recommendations are: 1) While taking into consideration the specific needs of cancer patients, the dietician is responsible for the hygiene, the sanitary quality of alimentation, the equilibrium and nutritional quality of the hospital catering. 2) Ordering and distribution of meals, and clearing up afterwards contribute to the quality of hospital catering and the personnel who do this should have time and be willing to listen to the patients. 3) The ordering of meals should be adapted to individual patient's requirements and must take into account the patient's medication. 4) The method of transporting the food chosen by the institution (cold or warm method) should be respected. The personnel responsible should receive regular and specific training to use the method correctly. 5) The intake of patients with nutritional follow-up should be reliably and reproducibly evaluated by the personnel after every meal. 6) Patient satisfaction should be assessed once a year and the results of this assessment used to improve the quality of hospital catering. 7) The dietician is the interface between the accounts department, the medical wards, the hospital catering department and the patients.

Presentation of carcinoma in a patient with a previous operation for Hirschsprung's disease.

The usual complications after a definitive pull-through procedure for Hirschsprung's disease include stricture formation, enterocolitis, bowel obstruction, and, occasionally, wound infection. The authors report a case of mucinous adenocarcinoma arising 32 years later at a stricture site from a previous pull-through procedure.

Isospin tracing: A probe of nonequilibrium in central heavy-Ion collisions

Four different combinations of 9644Ru and 9640Zr nuclei, both as projectile and target, were investigated at the same bombarding energy of 400A MeV using a 4pi detector. The degree of isospin mixing between projectile and target nucleons is mapped across a large portion of the phase space using two different isospin-tracer observables, the number of measured protons and the tritium to 3He yield ratio. The experimental results show that the global equilibrium is not reached even in the most central collisions. Quantitative measures of stopping and mixing are extracted from the data. They are found to exhibit a quite strong sensitivity to the in-medium ( n,n) cross section used in microscopic transport calculations.

A novel diagnosis of left paraduodenal hernia through laparoscopy.

A congenital intraperitoneal hernia, also known as a "paraduodenal hernia," is an extremely rare cause of intestinal obstruction. These hernias, which are caused by variations in intestinal rotation, present with symptoms ranging from intermittent abdominal pain to acute obstruction. Preoperative diagnosis is rare, and conventional treatment is usually by laparotomy. Laparoscopic diagnosis and repair has recently been reported in Japan. We present as case of a left paraduodenal hernia diagnosed and treated laparoscopically and a review of the literature.