RESUMO
Physicians specializing in dysphagia are needed in modern intensive care medicine. Long-term intubation is associated with aspiration and swallowing disorders. Early and standardised dysphagia management should be initiated during a patient's stay on intensive care unit. A clinically experienced, interdisciplinary team is required to provide optimal care for critically ill patients with dysphagia. Intensive care physicians should therefore know about basics in dysphagiology.
Assuntos
Cuidados Críticos/métodos , Transtornos de Deglutição/terapia , Medicina Interna , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/mortalidade , Endoscopia , Tecnologia de Fibra Óptica , Humanos , Comunicação Interdisciplinar , Colaboração Intersetorial , Intubação Intratraqueal/efeitos adversos , Equipe de Assistência ao Paciente , Pneumonia Aspirativa/etiologia , Pneumonia Aspirativa/prevenção & controle , Análise de SobrevidaRESUMO
Arytenoid subluxation is a well-known cause of hoarseness due to incomplete glottic closure with intact inferior laryngeal nerves after severe laryngeal trauma. We report the case of a young man presenting after laryngeal blunt trauma with hoarseness, easy fatigue during phonation, marked difficulty with his high-pitch and singing voice and decreased phonation time, but intact function of both inferior laryngeal nerves, intact endolaryngeal mucosa sensibility and normal CT scans of the larynx and the neck. Due to the asymmetric anteromedial position of the right arytenoid with incomplete glottic closure, the primary diagnosis was arytenoid subluxation, and the patient was referred for instantaneous relocation therapy. The stroboscopic and electromyographic diagnosis of a unilateral paresis of the external branch of the right superior laryngeal nerve caused the therapy to be changed. Without repositioning, the patient had a total recovery of voice quality when the paresis receded 2 months later. In conclusion, the unilateral paresis of the external branch of the superior laryngeal nerve after laryngeal blunt trauma is reported here for the first time. Although the clinical findings are familiar sequelae of thyroid surgery, they may be misdiagnosed as arytenoid subluxation after laryngeal blunt trauma. Stroboscopy and electromyography permitted the correct diagnosis.
Assuntos
Cartilagem Aritenoide/lesões , Doenças do Sistema Nervoso Autônomo/diagnóstico , Rouquidão/etiologia , Luxações Articulares/complicações , Doenças da Laringe/diagnóstico , Traumatismos do Nervo Laríngeo , Paralisia das Pregas Vocais/complicações , Adulto , Doenças do Sistema Nervoso Autônomo/complicações , Diagnóstico Diferencial , Eletromiografia , Rouquidão/diagnóstico , Humanos , Doenças da Laringe/complicações , Laringoscopia , MasculinoRESUMO
The results of 150 placental scans are reported, using 99mTc erythrocytes, 113mIn gelatine and 113mIn tranferrin. Accuracy was checked at surgery and compared with ultra sound findings. In 62% of patients, the indications for placental scintigraphy was suspicion of placenta praevia because of bleeding in late pregnancy. In 38% placental localisation was performed for amniocentesis for Rh incompatibility. Localisation of the placenta was accomplished in 98.6% by scanning and in 95% by ultra sound. Accuracy of scanning was 94% and ultra sound 70%. Placental scanning is at present the most accurate method for a placental localisation and should therefore be used when an accurate diagnosis cannot be achieved by other techniques.
