This study examined the dynamic characteristics of upper airway collapse at soft palate level in patients with obstructive sleep apnea/hypopnea syndrome（OSAHS） by using dynamic 3-Dimensional（3-D） CT imaging.A tota...This study examined the dynamic characteristics of upper airway collapse at soft palate level in patients with obstructive sleep apnea/hypopnea syndrome（OSAHS） by using dynamic 3-Dimensional（3-D） CT imaging.A total of 41 male patients who presented with 2 of the following symptoms,i.e.,daytime sleepiness and fatigue,frequent snoring,and apnea with witness,were diagnosed as having OSAHS.They underwent full-night polysomnography and then dynamic 3-D CT imaging of the upper airway during quiet breathing and in Muller＇s maneuver.The soft palate length（SPL）,the minimal cross-sectional area of the retropalatal region（mXSA-RP）,and the vertical distance from the hard palate to the upper posterior part of the hyoid（hhL） were compared between the two breathing states.These parameters,together with hard palate length（HPL）,were also compared between mild/moderate and severe OSAHS groups.Association of these parameters with the severity of OSAHS [as reflected by apnea hypopnea index（AHI） and the lowest saturation of blood oxygen（LSaO2）] was examined.The results showed that 31 patients had severe OSAHS,and 10 mild/moderate OSAHS.All the patients had airway obstruction at soft palate level.mXSA-RP was significantly decreased and SPL remarkably increased during Muller＇s maneuver as compared with the quiet breathing state.There were no significant differences in these airway parameters（except the position of the hyoid bone） between severe and mild/moderate OSAHS groups.And no significant correlation between these airway parameters and the severity of OSAHS was found.The position of hyoid was lower in the severe OSAHS group than in the mild/moderate OSAHS group.The patients in group with body mass index（BMI）≥26 had higher collapse ratio of mXSA-RP,greater neck circumference and smaller mXSA-RP in the Muller＇s maneuver than those in group with BMI26（P0.05 for all）.It was concluded that dynamic 3-D CT imaging could dynamically show the upper airway changes at soft palate level in OSAHS patients.All the OSAHS patients had airway obstruction of various degrees at soft palate level.But no correlation was observed between the airway change at soft palate level and the severity of OSAHS.The patients in group with BMI≥26 were more likely to develop airway obstruction at soft palate level than those with BMI26.展开更多
BACKGROUND:Airway foreign bodies(AFBs)is an interdisciplinary area between emergency medicine,pediatrics and otolaryngology.It is a life-threatening condition that is not infrequently seen;however,it is poorly covered...BACKGROUND:Airway foreign bodies(AFBs)is an interdisciplinary area between emergency medicine,pediatrics and otolaryngology.It is a life-threatening condition that is not infrequently seen;however,it is poorly covered in medical literature.Accidental aspiration of an element into airways is a widespread clinical scenario among children under 3 years,predominantly males.Moreover,it is the leading cause of infantile deaths and the fourth one among preschool children.DATA RESOURCES:A systemic search was conducted in July 2015 using Pub Med/Pub Med Central Database of The National Center for Biotechnology Information(NCBI)(http://www.ncbi.nlm.nih.gov/).A total of 1 767 articles were identified and most of them were meta-analyses,systematic reviews,and case series.Those thoroughly discussing assessment and management of AFBs were retrieved.RESULTS:AFBs episodes may be either witnessed or missed.Presence of a witness for the inhalation is diagnostic.The later usually present with persistent active cough.A classical triad of paroxysmal cough,wheezing,and dyspnoea/decreased air entry was reported,though many presentations have inconsistent findings.Hence,diagnosis requires high index of clinical suspicion.Flexible fibro-optic bronchoscopy is the gold standard of diagnosis,whereas inhaled objects are best retrieved by rigid bronchoscopes.CONCLUSIONS:Close supervision of pediatrics is the hallmark of prevention.Caregivers should ensure a safe surrounding milieu,including the toys their offspring play with.Immediate complications result from direct obstruction or injury by the inhaled object.Alternatively,prolonged lodging traps air and induces inflammatory response causing atelectesis and pneumonia,respectively.展开更多
Objective In order to achieve immediate relief of central airway obstruction caused by malignant tumor after interventional therapy, we observed the efficacy and safety of cryorecanalization after cryosurgery via fle...Objective In order to achieve immediate relief of central airway obstruction caused by malignant tumor after interventional therapy, we observed the efficacy and safety of cryorecanalization after cryosurgery via flexible bronchoscope.展开更多
Teratomas are congenital tumors that derive from all 3 germ layers. Most teratomas of the head and neck present in the pediatricage group. We report a case of a 5-month-old infant who presented with a teratoma showing...Teratomas are congenital tumors that derive from all 3 germ layers. Most teratomas of the head and neck present in the pediatricage group. We report a case of a 5-month-old infant who presented with a teratoma showing possible obstruction of the airway. The tumor was successfully resected under general anesthesia. The postoperative course was uneventful, and she was fine at a 3-year follow-up.展开更多
<b><span style="font-family:Verdana;">Background:</span></b><span style="font-family:Verdana;"> Some anesthetized patients present with expiratory airway obstruct...<b><span style="font-family:Verdana;">Background:</span></b><span style="font-family:Verdana;"> Some anesthetized patients present with expiratory airway obstruction (EAO) during mask ventilation (MV). EAO may occur more frequently among edentulous patients for whom a firmer grip of the mask and the mandible is needed to avoid gas leakage. We compared EAO grades before and after denture removal and identified predictors of EAO during MV in edentulous patients. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">One hundred and eight denture-wearing edentulous patients were anesthetized, their mouths were wrapped with film, their nasal masks and mandibles were held with two hands, and their lungs were ventilated in a pressure-controlled mode. Their dentures were subsequently removed, mouths were re-wrapped, and nasal MV was reapplied. EAO was graded based on capnography waveforms as follows: Grade I, normal waveform (no obstruction);II, loss of the alveolar plateau of the wave</span><span style="font-family:Verdana;">form (partial obstruction);and III, no waveform (total obstruction). EAO</span><span style="font-family:Verdana;"> grades were compared before and after denture removal. Predictive demographic variables for occurrence of total EAO were identified using a multivariate analysis. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">The proportions of Grades I, II, and III were 43.5%, 26.9%, and 29.6% when dentures were worn and 35.2%, 15.7%, and 49.1%, respectively, when dentures were removed. A significant difference was observed in EAO grades before and after denture removal (</span><i><span style="font-family:Verdana;">P</span></i><span style="font-family:Verdana;"> = 0.000034). Age ≥</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">75 years (adjusted odds ratio 3.41;95% confidence interval 1.31</span><span style="font-family:Verdana;"> - </span><span style="font-family:Verdana;">8.87;</span><i><span style="font-family:Verdana;">P</span></i><span style="font-family:Verdana;"> = 0.012) and body mass index ≥</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">25 kg/m</span><sup><span style="vertical-align:super;font-family:Verdana;">2 </span></sup><span style="font-family:Verdana;">(adjusted odds ratio 2.61;95% confidence interval 1.07</span><span style="font-family:Verdana;"> - </span><span style="font-family:Verdana;">6.40;</span><i><span style="font-family:Verdana;">P</span></i><span style="font-family:Verdana;"> = 0.036) were independently associated with an increased incidence of total EAO in patients with their dentures removed. </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">Denture removal impaired expiratory upper airway patency in edentulous patients, particularly in older or obese patients, during MV.</span>展开更多
Interventional pulmonology(IP)represents a rapidly growing and developing subspecialty within pulmonary medicine.To the intensivist,given the elaborate undertakings with respect to airway,lung and pleural disease mana...Interventional pulmonology(IP)represents a rapidly growing and developing subspecialty within pulmonary medicine.To the intensivist,given the elaborate undertakings with respect to airway,lung and pleural disease management-IP has shown an increasing presence and remain a major ally in the care of these pa-tients.Thus,an understanding of the different roles that IP could offer to the intensivist is of prime importance in the multi-disciplinary care of the complex patients within the intensive care units,particularly in relation to lung,airway and pleural diseases.This review article will explore the different intersections of IP in critical care and discuss the applications of this discipline within the highly complex critical care environment.展开更多
Hereditary angioedema (HAE) is a rare,autosomal dominant inherited disorder with an incidence of approximately 1 in 50,000.Among its various tapes,HAE with normal C1 inhibitor levels (HAE-nC1-INH)is exceptionally rare...Hereditary angioedema (HAE) is a rare,autosomal dominant inherited disorder with an incidence of approximately 1 in 50,000.Among its various tapes,HAE with normal C1 inhibitor levels (HAE-nC1-INH)is exceptionally rare.^([1]) HAE symptoms include recurrent episodes of skin and mucosal edema that can occur anywhere in the body.^([1-4]) Laryngeal edema is life-threatening,as it can lead to airway obstruction and potentially fatal suffocation.^([1-3])Edema of the gastrointestinal mucosa may cause abdominal pain,vomiting,and symptoms that are often misdiagnosed as acute abdomen.^([1-4]) This study included four patients,including one with HAE-nC1-INH (genetic testing revealed a heterozygous mutation in the KNG1 gene (c.1404G>C:p.Q468H)) and three with HAE due to C1 inhibitor deficiency (HAE-C1-INH).This case series aims to increase knowledge of HAE by illustrating its diverse clinical presentations and emphasizing features that may prompt clinical suspicion and facilitate timely diagnosis.展开更多
Pregnant women sometimes have thyroid disease, and thus goiter;however, it does not become so large to the extent that the goiter obstructs the air way, causing respiratory symptoms. Here, we report such a case. A 27-...Pregnant women sometimes have thyroid disease, and thus goiter;however, it does not become so large to the extent that the goiter obstructs the air way, causing respiratory symptoms. Here, we report such a case. A 27-year-old woman with large goiter presented with life threatening stridor at 37 weeks. <span style="font-family:Verdana;">After a multidisciplinary-team discussion, we performed caesarean section</span><span style="font-family:Verdana;"> plus thyroidectomy, which resulted in good outcomes. Histological examination revealed hyperplasia and not malignancy. The postoperative course was uneventful. The mother and infant were healthy.</span>展开更多
The nasogastric tube(NGT) has become a frequently used device to alleviate gastrointestinal symptoms. Nasogastric tube syndrome(NTS) is an uncommon but potentially life-threatening complication of an indwelling NGT. N...The nasogastric tube(NGT) has become a frequently used device to alleviate gastrointestinal symptoms. Nasogastric tube syndrome(NTS) is an uncommon but potentially life-threatening complication of an indwelling NGT. NTS is characterized by acute upper airway obstruction due to bilateral vocal cord paralysis. We report a case of a 76-year-old man with NTS, induced by an indwelling long intestinal tube. He was admitted to our hospital for treatment of sigmoid colon cancer. He underwent sigmoidectomy to release a bowel obstruction, and had a long intestinal tube inserted to decompress the intestinal tract. He presented acute dyspnea following prolonged intestinal intubation, and bronchoscopy showed bilateral vocal cord paralysis. The NGT was removed immediately, and tracheotomy was performed. The patient was finally discharged in a fully recovered state. NTS be considered in patients complaining of acute upper airway obstruction, not only with a NGT inserted but also with a long intestinal tube.展开更多
OBJECTIVE: To investigate the effects of Yiqibushenhuoxue decoction on stable chronic obstructive pulmonary disease(COPD) by observing its influences on patients' quality of life and airway inflammation.METHODS: S...OBJECTIVE: To investigate the effects of Yiqibushenhuoxue decoction on stable chronic obstructive pulmonary disease(COPD) by observing its influences on patients' quality of life and airway inflammation.METHODS: Seventy patients with stable COPD were randomly divided into a treatment group(n=35) treated with Yiqibushenhuoxue decoction plus Seretide and a control group(n=35) treated with Seretide only.The dosage of Yiqibushenhuoxue decoction was 100 mL each time, twice a day, and the dosage of Seretide was salmeterol 50 μg/fluticasone 250 μg twice a day. Both groups were treated for 12 weeks. Before and after the treatment, St George's respiratory disease questionnaire(SGRQ)scores,forced expiratory volume,and forced expiratory volume in 1 second/forced vital capacity(FEV1/FVC)were measured.RESULTS:The SGRQ scores in both groups were significantly lower than those before treatment(P<0.05). After treatment, the total SGRQ scores and each subscore in the treatment group were significantly lower than those in the control group(P<0.05). The percentage of the predicted FEV1% and FEV1/FVC were higher in both groups, but no statistical differences were detected from before to after the treatment or between the two groups(P>0.05).CONCLUSION: Yiqibushenhuoxue decoction could significantly decrease the SGRQ scores in patients with stable COPD, which suggests that it is able to improve patient symptoms.展开更多
Interventional bronchoscopy has developed rapidly in the management of lung cancer. Besides ablativeresection of various modalities and balloon dilation/stent placement, which have been widely used in themanagement of...Interventional bronchoscopy has developed rapidly in the management of lung cancer. Besides ablativeresection of various modalities and balloon dilation/stent placement, which have been widely used in themanagement of malignant central airway obstruction, bronchoscopic brachytherapy and transbronchoscopic local injection of drugs are also developing. For early-stage peripheral lung cancer,transbronchoscopic ablation and the assisted localization of preoperative peripheral lung nodules bybronchoscopy are the new techniques. In addition, interventional bronchoscopy can manage complications related to lung cancer. Overall, interventional bronchoscopy has been an indispensable componentin the treatment of lung cancer and has vast space for development. The review summarizes the recentupdates.展开更多
BACKGROUND: Urgent airway management is one of the most important responsibilities of otolaryngologists, often requiring a multidisciplinary approach. Urgent surgical airway intervention is indicated when an acute air...BACKGROUND: Urgent airway management is one of the most important responsibilities of otolaryngologists, often requiring a multidisciplinary approach. Urgent surgical airway intervention is indicated when an acute airway obstruction occurs or there are intubation difficulties. In these situations, surgical tracheostomy becomes extremely important.METHODS: We retrospectively studied the patients who underwent surgical tracheostomy from 2011 to 2014 by an otolaryngologist team at the operating theater of the emergency department of a tertiary hospital. Indications, complications and clinical evolution of the patients were reviewed.RESULTS: The study included 56 patients(44 men and 12 women) with a median age of 55 years. The procedure was performed under local anesthesia in 21.4% of the patients. Two(3.6%) patients were subjected to conversion from cricothyrostomy to tracheostomy. Head and neck neoplasm was indicated in 44.6% of the patients, deep neck infection in 19.6%, and bilateral vocal fold paralysis in 10.7%. Stridor was the most frequent signal(51.8%). Of the 56 patients, 15 were transferred to another hospital. Among the other 41 patients, 21 were decannulated(average time: 4 months), and none of them were cancer patients. Complications occurred in 5(12.2%) patients: hemorrhage in 3, surgical wound infection in 1, and cervico-thoracic subcutaneous emphysema in 1. No death was related to the procedure.CONCLUSION: Urgent tracheostomy is a life-saving procedure for patients with acute airway obstruction or with diffi cult intubation. It is a safe and effective procedure, with a low complication rate, and should be performed before the patient's clinical status turns into a surgical emergency situation.展开更多
BACKGROUND Tracheal tumors are relatively rare in adults and uncommon in children.Tracheal neurilemmoma is a rare condition in adults that usually affects middle-aged people,but it can also occur in children.Because t...BACKGROUND Tracheal tumors are relatively rare in adults and uncommon in children.Tracheal neurilemmoma is a rare condition in adults that usually affects middle-aged people,but it can also occur in children.Because the clinical presentation is nonspecific and insidious,diagnosis is often delayed.The most common symptoms in these patients are stridor or wheezing(especially positional)and cough.A few patients are misdiagnosed and mistakenly treated for asthma.CASE SUMMARY A 10-year-old girl was admitted to our unit with a 2-mo history of recurrent cough,dyspnea,and tachypnea.Her condition was more severe after exercise.Her symptoms progressed despite treatment with inhaled fluticasone/salmeterol.Flexible electronic laryngoscopy showed a red,smooth,and round mushroomshaped mass in the trachea,about 1 cm below the vocal cords.The surface of the mass was covered with several small and discontinuous blood vessels.About 90%of the tracheal lumen was occupied by the mass.A multidisciplinary operation was performed.The surgically resected mass was diagnosed as benign neurilemmoma by immunohistochemical analysis.CONCLUSION Intratracheal neurilemmoma is fairly rare in children.The main symptoms include coughing,wheezing,and dyspnea.The tumor’s size,location,and degree of intratracheal and extratracheal invasion can be measured by chest computed tomography.The main treatment strategies used for tracheal neurilemmoma are surgical resection and endoscopic excision.Long-term follow-up is warranted for the evaluation of outcomes and complications.展开更多
Adenoid hypertrophy associated with high morbidity in children. However, in severe cases surgery recommended, some medical treatments are effective too. This study is based on effect of nasal steroid spray, mometasone...Adenoid hypertrophy associated with high morbidity in children. However, in severe cases surgery recommended, some medical treatments are effective too. This study is based on effect of nasal steroid spray, mometasone, in decreasing upper airway obstruction and other symptoms of adenoid hypertrophy. In a clinical trial study 51 children with adenoid hypertrophy divided in two groups： 2-4 years old and 5-11 years old. Each patient receive nasal momethasone （one puff each nostril twice a day） for 3 months and their symptoms evaluated before treatment, 3 months after treatment initiation and 3 months after stop it with questionnaire and lateral neck radiography. Decreasing in all symptoms score and upper airway obstruction was statistically significant in both groups 3 months after treatment and its effect maybe stable for next 3 months. Nasal momethasone spray is effective in decreasing adenoid size and severity of symptoms of adenoid hypertrophy and this response is more obvious in 2-4 years old children.展开更多
Chronic obstructive pulmonary disease(COPD)is a heterogeneous disease characteristic of small airway inflammation,obstruction,and emphysema.It is well known that spirometry alone cannot differentiate each separate com...Chronic obstructive pulmonary disease(COPD)is a heterogeneous disease characteristic of small airway inflammation,obstruction,and emphysema.It is well known that spirometry alone cannot differentiate each separate component.Computed tomography(CT)is widely used to determine the extent of emphysema and small airway involvement in COPD.Compared with the pulmonary function test,small airway CT phenotypes can accurately reflect disease severity in patients with COPD,which is conducive to improving the prognosis of this disease.CT measurement of central airway morphology has been applied in clinical,epidemiologic,and genetic investigations as an inference of the presence and severity of small airway disease.This review will focus on presenting the current knowledge and methodologies in chest CT that aid in identifying discrete COPD phenotypes.展开更多
Muscle rigidity is one of the common complications caused by fentanyl and its derivatives.1＇2 The classical clinical manifestation of opioids-induced muscle rigidity is increased truncal muscle tone,which can lead to...Muscle rigidity is one of the common complications caused by fentanyl and its derivatives.1＇2 The classical clinical manifestation of opioids-induced muscle rigidity is increased truncal muscle tone,which can lead to difficult ventilation.1-3 However,faciocervical rigidity following fentanyl is rare.Here we present a rare case of face and neck rigidity following intravenous fentanyl and complete upper airway obstruction in consequence of glottic closure in a patient with co-existing vocal cord paralysis.Keywords：muscle rigidity; airway obstruction; glottic closure; vocal cord paralysis展开更多
Objectives To characterize the prethrombotic state ( PTS) in elderly Chinese patients with obstructive sleep apnea hypopnea syndrome (OSAHS) and the effect of nasal continuous positive airway pressure (nCPAP) ventilat...Objectives To characterize the prethrombotic state ( PTS) in elderly Chinese patients with obstructive sleep apnea hypopnea syndrome (OSAHS) and the effect of nasal continuous positive airway pressure (nCPAP) ventilation on their PTS.Methods Forty-one elderly patients with moderate and severe OSAHS were enrolled into the OSAHS group and underwent nCPAP treatment. Their blood samples were drawn at 6:00 am and 4:00 pm before and during nCPAP treatment, respectively, to test hemocrit, platelet aggregation (PAG), whole blood viscosity (WBV), plasma fibrinogen (fng), prothrombin time (PT) and activated partial thromboplastin time (APTT). All blood factors were also tested in a control group consisting of 32 healthy elderly Chinese with neither OSAHS nor cerebrocardiac vascular disease.Results In the OSAHS group there was a significantly higher hemocrit, WBV, fng, and a significantly shorter PT and APTT at 6:00 am compared to 4:00 pm before nCPAP treatment, while there was no significant difference among all blood test factors between 6:00 am and 4:00 pm on day 30 of the nCPAP treatment. In the OSAHS group, the hemocrit, WBV, PAG and plasma fng were significantly lower and the PT and APTT were significantly longer at 6:00 am on day 30 of the nCPAP treatment compared to 6:00 am before the nCPAP treatment. A significantly lower hemocrit, but a much longer PT and APTT were observed at 4:00 pm on day 30 of the treatment, compared with 4:00 pm before the treatment. No significant difference among the blood test factors was found between 6:00 am and 4:00 pm blood in the control group or between the control and OSAHS groups after 30 days of nCPAP treatment.Conclusion In elderly Chinese OSAHS patients, PTS could be effectively eliminated by nCPAP treatment.展开更多
Objective To assess renal function in patients with obstructive sleep apnea syndrome (OSAS) during two nights when they were untreated and treated with continuous positive airway pressure (CPAP). Methods Tubular fu...Objective To assess renal function in patients with obstructive sleep apnea syndrome (OSAS) during two nights when they were untreated and treated with continuous positive airway pressure (CPAP). Methods Tubular function was estimated on the basis of the renal lithium clearance and its derived formulae, urinary osmolality, osmolal clearance and free water clearance; while glomerular function was evaluated by endogenous creatinine clearance. Twenty patients with OSAS and sixteen normal controls were studied. Results The untreated patients with OSAS had significantly lower fractional proximal tubular sodium reabsorption (59.1%±7.1%,P<0.001 vs controls), lower fractional distal tubular sodium reabsorption (93.8%±1.7%, P<0.05 vs controls) and urinary osmolality (573.0±107.9 mosm·kg 1 , P<0.05 vs controls). The absolute distal tubular reabsorption rate of sodium and osmolal clearance in the untreated patients were higher 47.0±26.0 mmol·L 1 and 25.0±4.1 ml·L 1 ; P< 0.01 and P<0.05 respectively vs controls). During CPAP treated nights all abnormal renal function indexes in the OSAS patients restored to normal control values (P>0.05). Conclusions The natriuresis and diuresis of OSAS patients were due to the decrease in proximal and distal tubular sodium reabsorption and in tubular concentration ability during their nocturnal sleep and were returned to normal by CPAP therapy.展开更多
文摘This study examined the dynamic characteristics of upper airway collapse at soft palate level in patients with obstructive sleep apnea/hypopnea syndrome（OSAHS） by using dynamic 3-Dimensional（3-D） CT imaging.A total of 41 male patients who presented with 2 of the following symptoms,i.e.,daytime sleepiness and fatigue,frequent snoring,and apnea with witness,were diagnosed as having OSAHS.They underwent full-night polysomnography and then dynamic 3-D CT imaging of the upper airway during quiet breathing and in Muller＇s maneuver.The soft palate length（SPL）,the minimal cross-sectional area of the retropalatal region（mXSA-RP）,and the vertical distance from the hard palate to the upper posterior part of the hyoid（hhL） were compared between the two breathing states.These parameters,together with hard palate length（HPL）,were also compared between mild/moderate and severe OSAHS groups.Association of these parameters with the severity of OSAHS [as reflected by apnea hypopnea index（AHI） and the lowest saturation of blood oxygen（LSaO2）] was examined.The results showed that 31 patients had severe OSAHS,and 10 mild/moderate OSAHS.All the patients had airway obstruction at soft palate level.mXSA-RP was significantly decreased and SPL remarkably increased during Muller＇s maneuver as compared with the quiet breathing state.There were no significant differences in these airway parameters（except the position of the hyoid bone） between severe and mild/moderate OSAHS groups.And no significant correlation between these airway parameters and the severity of OSAHS was found.The position of hyoid was lower in the severe OSAHS group than in the mild/moderate OSAHS group.The patients in group with body mass index（BMI）≥26 had higher collapse ratio of mXSA-RP,greater neck circumference and smaller mXSA-RP in the Muller＇s maneuver than those in group with BMI26（P0.05 for all）.It was concluded that dynamic 3-D CT imaging could dynamically show the upper airway changes at soft palate level in OSAHS patients.All the OSAHS patients had airway obstruction of various degrees at soft palate level.But no correlation was observed between the airway change at soft palate level and the severity of OSAHS.The patients in group with BMI≥26 were more likely to develop airway obstruction at soft palate level than those with BMI26.
文摘BACKGROUND:Airway foreign bodies(AFBs)is an interdisciplinary area between emergency medicine,pediatrics and otolaryngology.It is a life-threatening condition that is not infrequently seen;however,it is poorly covered in medical literature.Accidental aspiration of an element into airways is a widespread clinical scenario among children under 3 years,predominantly males.Moreover,it is the leading cause of infantile deaths and the fourth one among preschool children.DATA RESOURCES:A systemic search was conducted in July 2015 using Pub Med/Pub Med Central Database of The National Center for Biotechnology Information(NCBI)(http://www.ncbi.nlm.nih.gov/).A total of 1 767 articles were identified and most of them were meta-analyses,systematic reviews,and case series.Those thoroughly discussing assessment and management of AFBs were retrieved.RESULTS:AFBs episodes may be either witnessed or missed.Presence of a witness for the inhalation is diagnostic.The later usually present with persistent active cough.A classical triad of paroxysmal cough,wheezing,and dyspnoea/decreased air entry was reported,though many presentations have inconsistent findings.Hence,diagnosis requires high index of clinical suspicion.Flexible fibro-optic bronchoscopy is the gold standard of diagnosis,whereas inhaled objects are best retrieved by rigid bronchoscopes.CONCLUSIONS:Close supervision of pediatrics is the hallmark of prevention.Caregivers should ensure a safe surrounding milieu,including the toys their offspring play with.Immediate complications result from direct obstruction or injury by the inhaled object.Alternatively,prolonged lodging traps air and induces inflammatory response causing atelectesis and pneumonia,respectively.
文摘Objective In order to achieve immediate relief of central airway obstruction caused by malignant tumor after interventional therapy, we observed the efficacy and safety of cryorecanalization after cryosurgery via flexible bronchoscope.
文摘Teratomas are congenital tumors that derive from all 3 germ layers. Most teratomas of the head and neck present in the pediatricage group. We report a case of a 5-month-old infant who presented with a teratoma showing possible obstruction of the airway. The tumor was successfully resected under general anesthesia. The postoperative course was uneventful, and she was fine at a 3-year follow-up.
文摘<b><span style="font-family:Verdana;">Background:</span></b><span style="font-family:Verdana;"> Some anesthetized patients present with expiratory airway obstruction (EAO) during mask ventilation (MV). EAO may occur more frequently among edentulous patients for whom a firmer grip of the mask and the mandible is needed to avoid gas leakage. We compared EAO grades before and after denture removal and identified predictors of EAO during MV in edentulous patients. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">One hundred and eight denture-wearing edentulous patients were anesthetized, their mouths were wrapped with film, their nasal masks and mandibles were held with two hands, and their lungs were ventilated in a pressure-controlled mode. Their dentures were subsequently removed, mouths were re-wrapped, and nasal MV was reapplied. EAO was graded based on capnography waveforms as follows: Grade I, normal waveform (no obstruction);II, loss of the alveolar plateau of the wave</span><span style="font-family:Verdana;">form (partial obstruction);and III, no waveform (total obstruction). EAO</span><span style="font-family:Verdana;"> grades were compared before and after denture removal. Predictive demographic variables for occurrence of total EAO were identified using a multivariate analysis. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">The proportions of Grades I, II, and III were 43.5%, 26.9%, and 29.6% when dentures were worn and 35.2%, 15.7%, and 49.1%, respectively, when dentures were removed. A significant difference was observed in EAO grades before and after denture removal (</span><i><span style="font-family:Verdana;">P</span></i><span style="font-family:Verdana;"> = 0.000034). Age ≥</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">75 years (adjusted odds ratio 3.41;95% confidence interval 1.31</span><span style="font-family:Verdana;"> - </span><span style="font-family:Verdana;">8.87;</span><i><span style="font-family:Verdana;">P</span></i><span style="font-family:Verdana;"> = 0.012) and body mass index ≥</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">25 kg/m</span><sup><span style="vertical-align:super;font-family:Verdana;">2 </span></sup><span style="font-family:Verdana;">(adjusted odds ratio 2.61;95% confidence interval 1.07</span><span style="font-family:Verdana;"> - </span><span style="font-family:Verdana;">6.40;</span><i><span style="font-family:Verdana;">P</span></i><span style="font-family:Verdana;"> = 0.036) were independently associated with an increased incidence of total EAO in patients with their dentures removed. </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">Denture removal impaired expiratory upper airway patency in edentulous patients, particularly in older or obese patients, during MV.</span>
文摘Interventional pulmonology(IP)represents a rapidly growing and developing subspecialty within pulmonary medicine.To the intensivist,given the elaborate undertakings with respect to airway,lung and pleural disease management-IP has shown an increasing presence and remain a major ally in the care of these pa-tients.Thus,an understanding of the different roles that IP could offer to the intensivist is of prime importance in the multi-disciplinary care of the complex patients within the intensive care units,particularly in relation to lung,airway and pleural diseases.This review article will explore the different intersections of IP in critical care and discuss the applications of this discipline within the highly complex critical care environment.
基金supported by the National Social Science Fund of China (19VJX168)。
文摘Hereditary angioedema (HAE) is a rare,autosomal dominant inherited disorder with an incidence of approximately 1 in 50,000.Among its various tapes,HAE with normal C1 inhibitor levels (HAE-nC1-INH)is exceptionally rare.^([1]) HAE symptoms include recurrent episodes of skin and mucosal edema that can occur anywhere in the body.^([1-4]) Laryngeal edema is life-threatening,as it can lead to airway obstruction and potentially fatal suffocation.^([1-3])Edema of the gastrointestinal mucosa may cause abdominal pain,vomiting,and symptoms that are often misdiagnosed as acute abdomen.^([1-4]) This study included four patients,including one with HAE-nC1-INH (genetic testing revealed a heterozygous mutation in the KNG1 gene (c.1404G>C:p.Q468H)) and three with HAE due to C1 inhibitor deficiency (HAE-C1-INH).This case series aims to increase knowledge of HAE by illustrating its diverse clinical presentations and emphasizing features that may prompt clinical suspicion and facilitate timely diagnosis.
文摘Pregnant women sometimes have thyroid disease, and thus goiter;however, it does not become so large to the extent that the goiter obstructs the air way, causing respiratory symptoms. Here, we report such a case. A 27-year-old woman with large goiter presented with life threatening stridor at 37 weeks. <span style="font-family:Verdana;">After a multidisciplinary-team discussion, we performed caesarean section</span><span style="font-family:Verdana;"> plus thyroidectomy, which resulted in good outcomes. Histological examination revealed hyperplasia and not malignancy. The postoperative course was uneventful. The mother and infant were healthy.</span>
文摘The nasogastric tube(NGT) has become a frequently used device to alleviate gastrointestinal symptoms. Nasogastric tube syndrome(NTS) is an uncommon but potentially life-threatening complication of an indwelling NGT. NTS is characterized by acute upper airway obstruction due to bilateral vocal cord paralysis. We report a case of a 76-year-old man with NTS, induced by an indwelling long intestinal tube. He was admitted to our hospital for treatment of sigmoid colon cancer. He underwent sigmoidectomy to release a bowel obstruction, and had a long intestinal tube inserted to decompress the intestinal tract. He presented acute dyspnea following prolonged intestinal intubation, and bronchoscopy showed bilateral vocal cord paralysis. The NGT was removed immediately, and tracheotomy was performed. The patient was finally discharged in a fully recovered state. NTS be considered in patients complaining of acute upper airway obstruction, not only with a NGT inserted but also with a long intestinal tube.
基金Supported by a Planned Project of Cultivating Innovative Personnel Fund of Heilongjiang University of Chinese MedicineChunhui Planning Project Fund of Chinese Ministry of Education(No.Z2010045)
文摘OBJECTIVE: To investigate the effects of Yiqibushenhuoxue decoction on stable chronic obstructive pulmonary disease(COPD) by observing its influences on patients' quality of life and airway inflammation.METHODS: Seventy patients with stable COPD were randomly divided into a treatment group(n=35) treated with Yiqibushenhuoxue decoction plus Seretide and a control group(n=35) treated with Seretide only.The dosage of Yiqibushenhuoxue decoction was 100 mL each time, twice a day, and the dosage of Seretide was salmeterol 50 μg/fluticasone 250 μg twice a day. Both groups were treated for 12 weeks. Before and after the treatment, St George's respiratory disease questionnaire(SGRQ)scores,forced expiratory volume,and forced expiratory volume in 1 second/forced vital capacity(FEV1/FVC)were measured.RESULTS:The SGRQ scores in both groups were significantly lower than those before treatment(P<0.05). After treatment, the total SGRQ scores and each subscore in the treatment group were significantly lower than those in the control group(P<0.05). The percentage of the predicted FEV1% and FEV1/FVC were higher in both groups, but no statistical differences were detected from before to after the treatment or between the two groups(P>0.05).CONCLUSION: Yiqibushenhuoxue decoction could significantly decrease the SGRQ scores in patients with stable COPD, which suggests that it is able to improve patient symptoms.
文摘Interventional bronchoscopy has developed rapidly in the management of lung cancer. Besides ablativeresection of various modalities and balloon dilation/stent placement, which have been widely used in themanagement of malignant central airway obstruction, bronchoscopic brachytherapy and transbronchoscopic local injection of drugs are also developing. For early-stage peripheral lung cancer,transbronchoscopic ablation and the assisted localization of preoperative peripheral lung nodules bybronchoscopy are the new techniques. In addition, interventional bronchoscopy can manage complications related to lung cancer. Overall, interventional bronchoscopy has been an indispensable componentin the treatment of lung cancer and has vast space for development. The review summarizes the recentupdates.
文摘BACKGROUND: Urgent airway management is one of the most important responsibilities of otolaryngologists, often requiring a multidisciplinary approach. Urgent surgical airway intervention is indicated when an acute airway obstruction occurs or there are intubation difficulties. In these situations, surgical tracheostomy becomes extremely important.METHODS: We retrospectively studied the patients who underwent surgical tracheostomy from 2011 to 2014 by an otolaryngologist team at the operating theater of the emergency department of a tertiary hospital. Indications, complications and clinical evolution of the patients were reviewed.RESULTS: The study included 56 patients(44 men and 12 women) with a median age of 55 years. The procedure was performed under local anesthesia in 21.4% of the patients. Two(3.6%) patients were subjected to conversion from cricothyrostomy to tracheostomy. Head and neck neoplasm was indicated in 44.6% of the patients, deep neck infection in 19.6%, and bilateral vocal fold paralysis in 10.7%. Stridor was the most frequent signal(51.8%). Of the 56 patients, 15 were transferred to another hospital. Among the other 41 patients, 21 were decannulated(average time: 4 months), and none of them were cancer patients. Complications occurred in 5(12.2%) patients: hemorrhage in 3, surgical wound infection in 1, and cervico-thoracic subcutaneous emphysema in 1. No death was related to the procedure.CONCLUSION: Urgent tracheostomy is a life-saving procedure for patients with acute airway obstruction or with diffi cult intubation. It is a safe and effective procedure, with a low complication rate, and should be performed before the patient's clinical status turns into a surgical emergency situation.
文摘BACKGROUND Tracheal tumors are relatively rare in adults and uncommon in children.Tracheal neurilemmoma is a rare condition in adults that usually affects middle-aged people,but it can also occur in children.Because the clinical presentation is nonspecific and insidious,diagnosis is often delayed.The most common symptoms in these patients are stridor or wheezing(especially positional)and cough.A few patients are misdiagnosed and mistakenly treated for asthma.CASE SUMMARY A 10-year-old girl was admitted to our unit with a 2-mo history of recurrent cough,dyspnea,and tachypnea.Her condition was more severe after exercise.Her symptoms progressed despite treatment with inhaled fluticasone/salmeterol.Flexible electronic laryngoscopy showed a red,smooth,and round mushroomshaped mass in the trachea,about 1 cm below the vocal cords.The surface of the mass was covered with several small and discontinuous blood vessels.About 90%of the tracheal lumen was occupied by the mass.A multidisciplinary operation was performed.The surgically resected mass was diagnosed as benign neurilemmoma by immunohistochemical analysis.CONCLUSION Intratracheal neurilemmoma is fairly rare in children.The main symptoms include coughing,wheezing,and dyspnea.The tumor’s size,location,and degree of intratracheal and extratracheal invasion can be measured by chest computed tomography.The main treatment strategies used for tracheal neurilemmoma are surgical resection and endoscopic excision.Long-term follow-up is warranted for the evaluation of outcomes and complications.
文摘Adenoid hypertrophy associated with high morbidity in children. However, in severe cases surgery recommended, some medical treatments are effective too. This study is based on effect of nasal steroid spray, mometasone, in decreasing upper airway obstruction and other symptoms of adenoid hypertrophy. In a clinical trial study 51 children with adenoid hypertrophy divided in two groups： 2-4 years old and 5-11 years old. Each patient receive nasal momethasone （one puff each nostril twice a day） for 3 months and their symptoms evaluated before treatment, 3 months after treatment initiation and 3 months after stop it with questionnaire and lateral neck radiography. Decreasing in all symptoms score and upper airway obstruction was statistically significant in both groups 3 months after treatment and its effect maybe stable for next 3 months. Nasal momethasone spray is effective in decreasing adenoid size and severity of symptoms of adenoid hypertrophy and this response is more obvious in 2-4 years old children.
基金This work was supported by the grants from the National Key Research and Development Program of China(No.2018YFC1313602)Major International(Regional)Joint Research Project(No.81820108001)+5 种基金National Natural Science Foundation of China(No.81670029)Jiangsu Key Principal Investigator of Medicine(No.ZDRCA2016018)Project 333 for Cultivation of Young and Middle-aged Leading Talents(No.BRA2019078)Jiangsu Key Program of Social Development(No.BE2015651)Nanjing Key Project of Science and Technology(No.2019060002)(to L.Zhou)Xuzhou Administration of Science and Technology(No.KC20082).
文摘Chronic obstructive pulmonary disease(COPD)is a heterogeneous disease characteristic of small airway inflammation,obstruction,and emphysema.It is well known that spirometry alone cannot differentiate each separate component.Computed tomography(CT)is widely used to determine the extent of emphysema and small airway involvement in COPD.Compared with the pulmonary function test,small airway CT phenotypes can accurately reflect disease severity in patients with COPD,which is conducive to improving the prognosis of this disease.CT measurement of central airway morphology has been applied in clinical,epidemiologic,and genetic investigations as an inference of the presence and severity of small airway disease.This review will focus on presenting the current knowledge and methodologies in chest CT that aid in identifying discrete COPD phenotypes.
文摘Muscle rigidity is one of the common complications caused by fentanyl and its derivatives.1＇2 The classical clinical manifestation of opioids-induced muscle rigidity is increased truncal muscle tone,which can lead to difficult ventilation.1-3 However,faciocervical rigidity following fentanyl is rare.Here we present a rare case of face and neck rigidity following intravenous fentanyl and complete upper airway obstruction in consequence of glottic closure in a patient with co-existing vocal cord paralysis.Keywords：muscle rigidity; airway obstruction; glottic closure; vocal cord paralysis
文摘Objectives To characterize the prethrombotic state ( PTS) in elderly Chinese patients with obstructive sleep apnea hypopnea syndrome (OSAHS) and the effect of nasal continuous positive airway pressure (nCPAP) ventilation on their PTS.Methods Forty-one elderly patients with moderate and severe OSAHS were enrolled into the OSAHS group and underwent nCPAP treatment. Their blood samples were drawn at 6:00 am and 4:00 pm before and during nCPAP treatment, respectively, to test hemocrit, platelet aggregation (PAG), whole blood viscosity (WBV), plasma fibrinogen (fng), prothrombin time (PT) and activated partial thromboplastin time (APTT). All blood factors were also tested in a control group consisting of 32 healthy elderly Chinese with neither OSAHS nor cerebrocardiac vascular disease.Results In the OSAHS group there was a significantly higher hemocrit, WBV, fng, and a significantly shorter PT and APTT at 6:00 am compared to 4:00 pm before nCPAP treatment, while there was no significant difference among all blood test factors between 6:00 am and 4:00 pm on day 30 of the nCPAP treatment. In the OSAHS group, the hemocrit, WBV, PAG and plasma fng were significantly lower and the PT and APTT were significantly longer at 6:00 am on day 30 of the nCPAP treatment compared to 6:00 am before the nCPAP treatment. A significantly lower hemocrit, but a much longer PT and APTT were observed at 4:00 pm on day 30 of the treatment, compared with 4:00 pm before the treatment. No significant difference among the blood test factors was found between 6:00 am and 4:00 pm blood in the control group or between the control and OSAHS groups after 30 days of nCPAP treatment.Conclusion In elderly Chinese OSAHS patients, PTS could be effectively eliminated by nCPAP treatment.
文摘Objective To assess renal function in patients with obstructive sleep apnea syndrome (OSAS) during two nights when they were untreated and treated with continuous positive airway pressure (CPAP). Methods Tubular function was estimated on the basis of the renal lithium clearance and its derived formulae, urinary osmolality, osmolal clearance and free water clearance; while glomerular function was evaluated by endogenous creatinine clearance. Twenty patients with OSAS and sixteen normal controls were studied. Results The untreated patients with OSAS had significantly lower fractional proximal tubular sodium reabsorption (59.1%±7.1%,P<0.001 vs controls), lower fractional distal tubular sodium reabsorption (93.8%±1.7%, P<0.05 vs controls) and urinary osmolality (573.0±107.9 mosm·kg 1 , P<0.05 vs controls). The absolute distal tubular reabsorption rate of sodium and osmolal clearance in the untreated patients were higher 47.0±26.0 mmol·L 1 and 25.0±4.1 ml·L 1 ; P< 0.01 and P<0.05 respectively vs controls). During CPAP treated nights all abnormal renal function indexes in the OSAS patients restored to normal control values (P>0.05). Conclusions The natriuresis and diuresis of OSAS patients were due to the decrease in proximal and distal tubular sodium reabsorption and in tubular concentration ability during their nocturnal sleep and were returned to normal by CPAP therapy.
