1/15. Laryngeal papillomatosis presenting as acute airway obstruction in a child.Upper airway obstruction, regardless of cause, can masquerade or be misdiagnosed as lower airway disease in children. In such cases, therapeutic trials of antibiotics, bronchodilators, and over-the-counter medications for symptom relief routinely fail; however, the original diagnosis often goes unchallenged. If the obstructive process is progressive, then acute occlusion of the airway may occur, rapidly leading to suffocation and death if resuscitation is unsuccessful. Outlined in this report is the case of a young female with a history of asthma, poorly responsive to outpatient treatment, who presented with respiratory arrest. The cause of the respiratory collapse was later identified as a large laryngeal papilloma, a condition rarely encountered by emergency physicians.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/15. eikenella corrodens: a clinical problem.E corrodens occurs as a significant clinical infection more frequently than suspected or cultured at the present time. It is essential that the dentist or physician work closely with the laboratory clinician in order to use proper techniques for its isolation. Inconsistencies between in vitro disk sensitivity and clinical drug response are noted. Because of clinical response, the clinician must carefully follow the patient's daily progress to recognize antibiotic treatment failure so that combination therapy or appropriate incision and drainage procedures may be initiated.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/15. Laryngeal tuberculosis: an important diagnosis.The incidence of laryngeal tuberculosis is increasing worldwide. To ensure early diagnosis it is important for physicians and otolaryngologists to recognize its cardinal signs and symptoms. We present two recent cases of laryngeal tuberculosis that presented to our department. We outline potential pitfalls in diagnosis, and highlight the importance of obtaining a tissue diagnosis. The literature is reviewed, and the treatment options outlined.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/15. An unusual way of tracheal stoma cleaning could end up with foreign body aspiration in a laryngectomized patient.We report a case of a laryngectomized patient who accidentally aspirated a wooden stick through his tracheal stoma in highly unusual circumstances. He was in a habit of cleaning secretions of upper airway with a wooden stick covered with cotton on the tip soaked in olive oil, via tracheostomy. After applying topical aerolized lidocaine spray through the tracheostomy stoma a flexible video-brochoscopy was performed and a tree twig over 11 cm in length was removed. The patient's symptoms were resolved by a bronchoscopy. With experience and availability of accessories, the removal of the foreign body using flexible bronchoscope under local anesthesia can be performed safely and successfully. This case suggests that the physicians and otolaryngologists should educate their laryngectomized patients about stomal care and discuss any potential life-threatening situation they might encounter.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/15. Semi-automated voice evaluation.This report describes a voice evaluation procedure that in some way parallels the audiologic tests used for hearing and has multiple uses both clinically and in research. It uses a simultaneous eight-channel input, is not difficult to use, requiring between 12 and 25 minutes to administer, and provides the physician with a printout in standardized form before the patient leaves the room. This three-page report includes 15 abstracted or calculated values, normal ranges by sex for each value, notes that draw attention to deviations from the normal, a summary profile, a graphic representation of the evaluation, and raw data waveforms.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/15. Upper airway obstruction from AIDS-related Kaposi's sarcoma.Kaposi's sarcoma occurs in the head and neck region, commonly in patients with the acquired immunodeficiency syndrome. This tumor may also involve oromucosal surfaces, but only rarely leads to upper airway obstruction. When such obstruction develops, the emergency physician must be aware of the attendant problems of surgical manipulation and radiotherapy.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/15. Lymphangiomas of the larynx in infants and children. A survey of pediatric lymphangioma.Lymphangiomas are uncommon benign congenital lymphatic tumors of childhood. They are found in all parts of the body structure, but rarely occur in the larynx. This paper reviews charts of 160 patients with cystic hygroma (lymphangiomata) of whom ten had extensive involvement of the larynx. A benign but nevertheless challenging tumor, its treatment demands the patience and skill of the surgeon. The lesion is more common in the white patient, and 40% appear in the newborn. Fifty percent present by the end of the first year of life, and 75% by the end of the second. The onset is uncommon in the older child and a rare occurrence in the adult. The treatment of lymphangiomata is surgical excision, and is more difficult when in the larynx. Laser surgery has been most helpful when the lesion is in the laryngeal complex. Considering the extreme difficulties which lymphangioma present to the child and to the physician, the ultimate results of all forms of conservative surgical therapy can be rewarding. Excessive or radical surgery will not necessarily guarantee complete elimination of disease and may be harmful.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/15. Approach to supraglottitis.In my experience, steroids have no use in the management of ACSOL once the airway is secured, and may actually prolong and complicate the infectious process. The main use of antibiotics is probably for preventing systemic complications such as pneumonia and meningitis. It is possible, however, that neither drug can alter the natural course of this disease and may just hasten its expected inconsequential resolution. The key to successful management of acute supraglottitis is early recognition and prompt provision of airway assistance when indicated. This potentially fatal disease occurs in adults as well as children. To my knowledge, most deaths occur after the patient arrives at the hospital, when there is hesitation and indecision about the need for airway intervention. Whenever signs of UAO appear, artificial airway should be provided promptly, regardless of the eventual diagnosis. Those physicians who try all means to avoid intubation or tracheotomy early in the process may be cautioned that complications from either procedures are just a risk, while airway obstruction in most cases of ACSOL is a certainty. Finally, the examiner assessing patients with possible obstructive laryngitis, supraglottic, or subglottic, should first and foremost decide whether an airway is needed and should defer all diagnostic guesswork and laboratory data processing until the airway is secured.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/15. Bilateral vocal cord paralysis due to laryngeal carcinoma in Parkinson's disease.A laryngeal carcinoma presenting as severe dyspnea and stridor due to bilateral vocal cord paralysis was found in a 66-year-old man who had been suffering from Parkinson's disease (PD) for twenty years. Although laryngeal carcinoma is a common cause of bilateral vocal cord paralysis, patients with PD have been suspected to have a low cancer incidence, and this may be the first case report. therapeutics have extended the survival of patients with PD, and the possibility of developing vocal cord paralysis. Thus, it is important for the physician to be aware that this condition may be caused by carcinoma even in PD cases.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/15. radiation induced carcinoma of the larynx.A squamous cell carcinoma presented in a 20 year old female nonsmoker three years after receiving a high dosage of radiation therapy to the base of the skull, face and entire neuroaxis and intense combination chemotherapy for a parameningeal rhabdomyosarcoma of the paranasal sinuses is reported. The larynx received a dose of about 3,500 rads over an eight week period. This dosage in conjunction with the associated intense chemotherapy regimen given to the patient may explain the appearance of a radiation induced tumor in an unusually short latent period. This certainly represents a risk in young patients in whom an aggressive combined approach is taken and the physician should be aware of.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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