Cytotoxic agents in the treatment of laryngeal sarcoidosis: a case report and review of the literature.

SUMMARY: Sarcoidosis is a multisystem disease with various clinical manifestations. It is characterized primarily on a histopathologic basis by the presence of noncaseating granulomata. Laryngeal involvement reportedly occurs in 3-5% of cases, and it is typically localized to the supraglottic region. Patients often present with hoarseness, dysphagia, stridor, or dyspnea. Laryngoscopy typically demonstrates a pale, edematous epiglottis studded with nodules. Tissue biopsy reveals the classic noncaseating granuloma; however, the finding is not diagnostic. Sarcoidosis remains a diagnosis of exclusion to be entertained once other verifiable etiologies for granulomatous disease of the larynx, such as TB, syphilis, fungal infection, berylliosis, or Wegener's granulomatosis, have been ruled out. Systemic corticosteroids remain the mainstay of treatment; however, new steroid-sparing therapies that target the inflammatory response of sarcoidosis are currently being investigated. The case history of a patient with laryngeal sarcoidosis who was managed with the immunosuppressant azathioprine (Imuran) is summarized along with a discussion of other treatment options.

Obstructing tracheobronchial schwannoma.

Endotracheal and endobronchial schwannomas are extremely rare tumors of neurogenic origin. These tumors often present late. Common symptoms of hemoptysis and dyspnea result from the size and location of the tumors. Two cases of tracheobronchial schwannoma with proximal airway obstruction are reported. Various diagnostic modalities employed in the evaluation of these tumors are reviewed. Because malignant transformation is exceedingly rare, operative resection of tracheobronchial schwannomas based on the principle of conservation of lung parenchyma is emphasized.

Comparison of data obtained from sedated versus unsedated wireless telemetry capsule placement: does sedation affect the results of ambulatory 48-hour pH testing?

OBJECTIVES: The introduction of 48-hour wireless pH testing provides a novel technique of evaluating persons with suspected reflux disease. The wireless capsule can be placed in a sedated individual at the time of esophagogastroduodenoscopy (EGD) or in an unsedated individual at a time after the initial EGD, at the time of esophageal manometry or at the time of transnasal esophagoscopy. The effect that sedation has on the results of 48-hour wireless pH testing has not been evaluated. PURPOSE: To evaluate the day to day variability and the effect of sedation on the results of 48-hour wireless pH testing. METHODOLOGY: The charts of all patients at a tertiary swallowing center undergoing 48-hour wireless pH testing between June 1, 2003 and December 31, 2004 were retrospectively evaluated. Data concerning study indications, route of pH capsule placement, duration of pH recording, and test results were collected. Day to day variability was evaluated, and the results obtained from persons with sedated and unsedated pH capsule placement were compared. RESULTS: Two hundred and six studies were performed. The indications for the examination were gastroesophageal reflux disease (146/206), chronic cough (36/206), and laryngopharyngeal reflux (24/206). Sixty-two percent (128/206) of the studies were performed without sedation and 38% (78/206) with sedation. The overall reproducibility of the daily pH recordings (day 1 vs. day 2) was 77%. Although some trends were observed, there was no significant association between the use of sedation and any of the reflux parameters on pH testing (P > .05). CONCLUSIONS: The day to day reproducibility of 48-hour wireless pH testing was 77%. Intravenous sedation does not appear to have a significant effect on the results of 48-hour wireless pH testing.