Bronchial Aspiration of Capsule Endoscope.

Capsule endoscope aspiration is an increasingly reported complication, potentially responsible for respiratory distress and asphyxia. This adverse event is primarily managed by rigid bronchoscopy when spontaneous expulsion does not occur. This complication is all the more detrimental to patients as it can delay or jeopardize further digestive exploration. We report direct repositioning of the capsule in the stomach at the same time as bronchoscopy, thus making second-line gastrointestinal endoscopy needless.

Giant Cell Tumor of Cervical Spine Presenting as Acute Asphyxia: Successful Surgical Resection After Down-Staging With Denosumab.

STUDY DESIGN: Case report and literature review. OBJECTIVE: To describe treatment of a unique case of acute airway obstruction by a large C7 giant cell tumor (GCT) with preoperative denosumab followed by surgical resection, and review the literature on this rare entity. SUMMARY OF BACKGROUND DATA: Standard treatment for GCTs includes surgical resection or curettage and packing. Large lesions in the spine may require preoperative therapy with denosumab, a human monoclonal antibody to RANKL, to facilitate surgery. It is highly unusual for GCT arising in cervical spine to present with acute asphyxia (requiring tracheostomy). METHODS: We report a patient with large C7 GCT that caused tracheal compression with almost complete airway obstruction requiring emergency intubation. RESULTS: The tumor responded to subcutaneously administered denosumab with marked decrease in size and relief of symptoms. Increased tumor mineralization in response to therapy facilitated subsequent successful surgical tumor resection. The patient remains symptom-free 2 years after surgery without tumor recurrence. CONCLUSION: Denosumab can shrink the size of large GCTs, providing symptom relief before surgery and facilitate tumor resection. LEVEL OF EVIDENCE: 5.

Peripheral neurolymphomatosis with tracheal asphyxia: a case report and literature review.

BACKGROUND: Neurolymphomatosis (NL) is an extremely rare disease and tracheal asphyxia due to NL has not been previously reported. CASE PRESENTATION: A 54-year-old Chinese woman with a history of diffuse large B-cell lymphoma in her first complete remission developed peripheral neuropathy and tracheal asphyxia. Neurolymphomatosis involving the right brachial plexus and the right vagus nerve was demonstrated by PET/CT, but not by MRI. She underwent urgent tracheotomy and impact chemotherapy using rituximab combined with high dose methotrexate and involved field radiotherapy. She achieved a second complete remission. CONCLUSION: PET/CT plays valuable role in differentiating NL from other neuropathies in patients with lymphoma. Complete remission can be achieved in NL due to large B-cell lymphoma.

[Lethal course following overlooked foreign body in the airway]. / Letalt forløb efter overset fremmedlegeme i luftvejen.

A 52-year-old previously healthy woman suffered death from choking. Asphyxia after aspiration of a foreign body is a well-known, but frequently overlooked cause of sudden death. We describe a case in which a foreign body in the airway was initially overlooked. Early recognition and treatment might have altered the outcome.

Origin of the cannula for tracheotomy during the middle ages and Renaissance.

The purpose of this article was to trace the historical origin of the inserted cannula during tracheotomy. Tracheotomy is mentioned in most ancient medical texts, but the origin of cannula insertion into the windpipe is unclear. We reviewed the incunabula and Renaissance texts reporting the utilization of surgical cannulas and tracheotomy. The incunabula disclosed extended use of surgical cannulas during the middle ages and Renaissance. Although tracheotomy was advocated in acutely suffocating patients for a disease of the throat termed squinantia or angina, the first report of the procedure was found only at the end of the middle ages and a second during the middle Renaissance. The introduction of cannula use in tracheotomy was supported by a semantic misinterpretation by Antonio Musa Brasavola. The historical origin for tracheotomy in the middle ages and Renaissance is conflicting. Antonio Brasavola wrongly interpreted Avicenna's oral cannula introduced into the windpipe for angina. This misinterpretation allowed Giulio Casserio to draw the first curved cannula introduced for used during tracheotomy.

Surgical management of Gerhardt syndrome.

Adduction bilateral vocal fold immobility syndrome may be due by both recurrent laryngeal nerves paralysis--Gerhardt syndrome--and all intrinsic laryngeal muscles paralysis--Riegel syndrome. Etiology of Gerhardt syndrome is thyroid surgery, intubation's maneuver, trauma, neurological disorders, extrala-ryngeal malignancies. The manifestations of Gerhardt syndrome are inspiratory dyspnea and slightly influenced voicing by paramedian vocal folds paralysis with an important narrowing of the airway at the glottic level. The surgical procedures for enlargement of the glottic space can be classified in many ways and their major characteristics are: changes at the glottic level; surgical approach: open neck or endoscopic, with or without opening of the mucosal lining; the need for tracheostomy; the equipment used. The aim of this review is to expound the variety of interventions through the last century marked by the development of the diagnostic methods, the anesthesia and the surgical armament with sophisticated instruments and technologies.

Compression of the medulla oblongata and acute respiratory failure caused by rupture of a thrombosed large aneurysm of the anterior inferior cerebellar artery.

A 65-year-old female presented with an extremely rare case of a ruptured thrombosed large aneurysm of the anterior inferior cerebellar artery (AICA) in which a local hematoma compressed the medulla oblongata and caused acute respiratory failure. She first presented with dizziness, general fatigue, and nausea 2 months before admission. She was hospitalized for intense general fatigue, nausea, and occipitalgia. Computed tomography and T(1)-weighted magnetic resonance imaging showed a heterogeneous lesion around the right cerebello-medullary cistern. Angiography revealed a fusiform aneurysm of the right AICA. Asphyxia occurred 4 days after admission and the patient underwent an emergency operation. No subarachnoid hematoma was present, but a hematoma around the ruptured portion markedly compressed the medulla oblongata. The medulla oblongata was adequately decompressed after subtotal removal of the aneurysm. The patient's respiratory status and consciousness level recovered after the operation.

Ingestion of a voice-master prosthesis followed by a potentially fatal aspiration.

Various complications are associated with the use of indwelling voice prostheses. We present problems faced by a patient with his Voice-Master prosthesis, the ingestion of the prosthesis followed by a potentially fatal aspiration. The Voice-Master is unique in that in can be re-inserted. The safety strap is removed after primary insertion once the prosthesis is secure. However, during re-insertions this safety mechanism is no longer present. Therefore we recommend the placement of a temporary stitch or tie to minimize the risks of ingestion or aspiration of the prosthesis during re-insertions.

[Giant compressive mediastinal lipoma: a case report]. / Lipome géant compressif du médiastin: a propos d'un cas.

Mediastinal lipoma is a rare mesenchymatous fatty tumor in child. Usually asymptomatic, it can cause asphyxiation. The authors report the case of an 18 month-baby-girl referred to us by the pediatric department for asphyxiation. The chest X ray was evocative of a mediastinal tumor. A sudden cardiorespiratory failure leads us to perform thoracotomy. A fatty tumor was found compressing the heart and the left lung. It was easily extirpated. The postoperative recovery was uneventful. Light microscopy showed a lipoma. This compressive form shows the severity of the mediastinal lipoma when it reaches a large size. The literature on this rare pathology is reviewed.

Asphyxiating tracheal bronchogenic cyst.

We report on a 7-month old infant with severe respiratory distress secondary to a paratracheal bronchogenic cyst. Respiratory relief was achieved by transtracheal puncture of the cyst. Surgical removal of the cyst was performed 1 week later because of radiological evidence of reaccumulation of fluid.

Dynamic thoracoplasty for asphyxiating thoracic dystrophy.

The life-saving procedures to expand the chests of infants born with Jeune asphyxiating thoracic dystrophy provide a static solution incapable of responding to the growth demands of thriving patients. We describe an instrument that provided a dynamic solution for an infant, where an initial methyl methacrylate midsternotomy spacer placed at 4 months of age was followed at 11 months with recurrence of his difficulties. At 8 months after the second operation the patient was stable and thriving with no recurrence of symptoms. The instrument modifications, limitations, and possible complications are described.

Obstructive fibrinous tracheal pseudomembrane. A potentially fatal complication of tracheal intubation.

A series of 10 consecutive cases presenting an obstructive fibrinous tracheal pseudomembrane (OFTP) as a complication of endo-tracheal intubation is presented. The patients developed a thick tubular, rubber-like, whitish pseudomembrane moulding the tracheal wall as a result of short-duration endotracheal intubation. This pseudomembrane firmly adhered to the tracheal wall at the site of the endotracheal cuff. Shortly after extubation, partial detachment of the proximal part of the pseudomembrane produced intermittent positional acute respiratory failure due to valve-manner tracheal obstruction. Immediate mechanical ablation was curative in nine patients, without secondary development of tracheal stenosis. One patient died from acute asphyxiation. The history and the pathological findings of these cases support the hypothesis that this lesion represents an early stage of ischemic tracheal wall injury related to the cuff pressure. Pulmonary physicians should be alerted on this poorly known complication of endotracheal intubation.

Complications after microsurgical tissue transfer in the head and neck region.

In recent years, the use of microsurgically re-anastomosed free transplants has become a proven technique for the reconstruction of defects in the head and neck region, which is demanding from both aesthetic and functional points of view. A retrospective catamnestic study on 227 free tissue transfers in the Department for Oral and Maxillofacial Surgery at the University of Tübingen showed good healing with relatively low failure rates of the transplants used. A significant proportion of local complications, arising postoperatively, was to some degree due to pre-existing medical conditions, tumour-specific pretreatments and the particular wound-healing situation found in head and neck interventions. The highest relative rate of complications at the site of origin was seen amongst osteomuscular transplants (20%) whilst (fascio) cutaneous and visceral transplants were found to result in a low percentage of problems (4%). In contrast, the healing of iliac crest transplants was accompanied by various local complications in 12% of the cases, slightly higher than 20% amongst (fascio) cutaneous and abdominal transplants and well above 30% for latissimusdorsi and scapular transplants. General complications, in particular of a respiratory and/or psychiatric nature, were found in 23% of the patients.