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Maeda K, Yamamoto Y, Ohuchi M, Sakashita T, Shiohara M, Namura T, Shintaku M, Matsuura E, Takashima H. Pathological evidence of demyelination in the recurrent laryngeal, phrenic, and oculomotor nerves in Charcot-Marie-Tooth disease 4F. eNeurologicalSci 2021; 25:100358. [PMID: 34993357 DOI: 10.1016/j.ensci.2021.100358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 07/05/2021] [Accepted: 07/11/2021] [Indexed: 11/22/2022] Open
Abstract
We present pathology of the peripheral nerves of a patient with Adult-onset Charcot-Marie-Tooth disease 4F caused by periaxin gene mutation p.D651N. The patient was a 72-year-old woman. She had hoarseness and underwent continuous positive airway pressure therapy at night due to sleep apnea. The patient died abruptly. Remarkable demyelination with tomacula formation was found in the phrenic nerve, vagal nerve, recurrent laryngeal nerve, and oculomotor nerves. The cause of death could have been insufficient reactivity to the aspiration or sudden onset of bilateral vocal cord palsy. We must pay attention to respiratory function and cranial nerve palsies in hereditary demyelinating neuropathies.
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Gut L, Bernet S, Huembelin M, Mueller M, Baechli C, Koch D, Nebiker C, Schuetz P, Mueller B, Christ E, Ebrahimi F, Kutz A. Sex-Specific Differences in Outcomes Following Thyroidectomy: A Population-Based Cohort Study. Eur Thyroid J 2021; 10:476-485. [PMID: 34950600 PMCID: PMC8647072 DOI: 10.1159/000510618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 06/28/2020] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Numbers of thyroidectomies and awareness of postoperative quality measures have both increased. Potential sex-specific variations in clinical outcomes of patients undergoing thyroidectomy are controversial. OBJECTIVE The aim of this study was to investigate sex-specific differences in outcomes following thyroidectomy. METHODS This is a population-based cohort study of all adult patients undergoing either hemi- or total thyroidectomy in Switzerland from 2011 to 2015. The primary outcome was all-cause 30-day readmission rate. The main secondary outcomes were intensive care unit (ICU) admission, surgical re-intervention, in-hospital mortality, length of hospital stay (LOS), postoperative calcium disorder, vocal cord paresis, and hematoma. RESULTS Of 16,776 patients undergoing thyroidectomy, the majority of patients undergoing thyroidectomy were female (79%), with a median age of 52 (IQR 42-64) years. Within 30 days after the surgery, male patients had significantly higher rates of hospital readmission (adjusted risk ratio [RR] 1.38; 95% confidence interval [95% CI] 1.11-1.72, p = 0.008) and higher risks for postoperative ICU admission (RR 1.25; 95% CI, 1.09-1.44, p = 0.003) than female patients. There were no significant differences among sexes in the LOS, rates of surgical re-interventions, or in-hospital mortality. While postoperative calcium disorders due to hypoparathyroidism were less prevalent among male patients (RR 0.63; 95% CI, 0.54-0.72, p < 0.001), a 2-fold higher incidence rate of postoperative hematoma was observed (RR 1.93, 95% CI, 1.51-2.46, p < 0.001). CONCLUSIONS Male patients undergoing thyroidectomy have higher 30-day hospital readmission and ICU admission rates. Following surgery, male patients revealed higher rates of neck hematoma, while hypocalcemia was more frequent among female patients.
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Affiliation(s)
- Lara Gut
- Division of Endocrinology, Diabetes, and Metabolism, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Selina Bernet
- Division of Endocrinology, Diabetes, and Metabolism, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Monika Huembelin
- Division of Endocrinology, Diabetes, and Metabolism, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Magdalena Mueller
- Division of Endocrinology, Diabetes, and Metabolism, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Ciril Baechli
- Division of Endocrinology, Diabetes, and Metabolism, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Daniel Koch
- Division of Endocrinology, Diabetes, and Metabolism, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Christian Nebiker
- Department of Surgery, Cantonal Hospital of Aarau, Aarau, Switzerland
| | - Philipp Schuetz
- Division of Endocrinology, Diabetes, and Metabolism, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Beat Mueller
- Division of Endocrinology, Diabetes, and Metabolism, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Emanuel Christ
- Division of Endocrinology, Diabetes, and Metabolism, University Hospital Basel, Basel, Switzerland
| | - Fahim Ebrahimi
- Division of Endocrinology, Diabetes, and Metabolism, University Hospital Basel, Basel, Switzerland
- University Center for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital, Basel, Switzerland
- *Fahim Ebrahimi, Division of Endocrinology, University Hospital Basel, Petersgraben 4, CH 4031 Basel (Switzerland),
| | - Alexander Kutz
- Division of Endocrinology, Diabetes, and Metabolism, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
- Division of Endocrinology, Diabetes, and Metabolism, University Hospital Basel, Basel, Switzerland
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Fung MMH, Lang BHH. A prospective study comparing the midline and lateral trans-laryngeal ultrasonography approaches in vocal cord assessment before and after thyroid and neck surgeries. Am J Surg 2021; 223:676-680. [PMID: 34238589 DOI: 10.1016/j.amjsurg.2021.06.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 06/27/2021] [Indexed: 01/11/2023]
Abstract
INTRODUCTION It is unclear if placing an ultrasound probe along each thyroid cartilage lamina (i.e. the lateral approach) can improve vocal cord (VC) visualization over in the midline (i.e. the midline approach) in trans-larygeal ultrasonography (TLUSG). This study compared VC visualization rates and diagnostic accuracy between the two approaches. METHODS Consecutive patients undergoing surgery had their VCs assessed by the two TLUSG approaches and flexible laryngoscopy within the same session. VC visualization rates and diagnostic accuracy of each approach were calculated and compared. RESULTS Ninety patients (or 180 VCs) were analyzed. The lateral approach had significantly better overall VC visualization rate than the midline approach (93.3% vs. 82.2%, p=<0.001), especially for males (75.0% vs. 33.3%, p = 0.002). Both approaches had comparable accuracy (100% vs. 99.4%). CONCLUSIONS The lateral approach should be preferred because of the significantly better VC visualization rate and comparable accuracy to the midline approach.
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Affiliation(s)
- Matrix Man Him Fung
- Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Brian Hung-Hin Lang
- Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China.
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Escudier A, Giabicani E, Neven B, Gouache E, Blanchard M, Isapof A, Nougues MC, Freihuber C. Paroxysmal strabismus and stridor acquired in childhood: Do not overlook calcemia! Arch Pediatr 2020; 27:104-106. [PMID: 31955955 DOI: 10.1016/j.arcped.2019.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 12/30/2019] [Indexed: 01/21/2023]
Abstract
Hypocalcemia is known to induce stridor but was rarely reported to cause strabismus. We report the case of a 4-year-old girl who presented with paroxysmal stridor and strabismus with diplopia, persisting for several weeks. Severe hypocalcemia (1.25 mmol/L) was finally diagnosed and was related to hypoparathyroidism, which was the first manifestation of autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED) in this patient. Strabismus and stridor both resolved after normalization of calcemia. This case report is a rare observation of paroxysmal strabismus caused by hypocalcemia and it highlights the importance of calcium monitoring in any situation of atypical neurological symptoms.
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Affiliation(s)
- A Escudier
- Service de Neurologie Pédiatrique, AP-HP, GHUEP, Hôpital Armand Trousseau, 75012 Paris, France.
| | - E Giabicani
- Hôpitaux de Paris (APHP), Hôpital Armand Trousseau, Explorations Fonctionnelles Endocriniennes, 75012 Paris, France; Sorbonne Université, Inserm, UMR_S 938 Centre de Recherche Saint Antoine, Assistance Publique, 75012 Paris, France
| | - B Neven
- Service d'Immuno-Hématologie, APHP, Hôpital Necker-Enfants malades, 75015 Paris, France; Sorbonne Paris Cité, Institut Imagine, Université Paris Descartes, 75015 Paris, France
| | - E Gouache
- Service d'Hématologie Pédiatrique, AP-HP, GHUEP, Hôpital Armand Trousseau, 75012 Paris, France
| | - M Blanchard
- Service d'Oto-Rhino-Laryngologie, AP-HP, Hôpital Necker-Enfants malades, 75015 Paris, France
| | - A Isapof
- Service de Neurologie Pédiatrique, AP-HP, GHUEP, Hôpital Armand Trousseau, 75012 Paris, France; Service de Neuropédiatrie et Centre de Référence des Pathologies Neuromusculaires "Nord/Est/Ile-de-France", GRC ConCer-LD, Sorbonne Universités, UPMC Univ Paris 06, Hôpital Trousseau, AP-HP, FILNEMUS, 75012 Paris
| | - M-C Nougues
- Service de Neurologie Pédiatrique, AP-HP, GHUEP, Hôpital Armand Trousseau, 75012 Paris, France; Service de Neuropédiatrie et Centre de Référence des Pathologies Neuromusculaires "Nord/Est/Ile-de-France", GRC ConCer-LD, Sorbonne Universités, UPMC Univ Paris 06, Hôpital Trousseau, AP-HP, FILNEMUS, 75012 Paris
| | - C Freihuber
- Service de Neurologie Pédiatrique, AP-HP, GHUEP, Hôpital Armand Trousseau, 75012 Paris, France; Sorbonne Université, GRC ConCer-LD, Hôpital Armand Trousseau, 75012, Paris, France
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North L, Sulman C. Subcutaneous emphysema and vocal fold paresis as a complication of a dental procedure. Int J Pediatr Otorhinolaryngol 2019; 124:76-78. [PMID: 31170557 DOI: 10.1016/j.ijporl.2019.05.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 05/22/2019] [Accepted: 05/23/2019] [Indexed: 11/16/2022]
Abstract
Third molar extraction is a common oral surgery performed in the pediatric population. Here we report a case of extensive subcutaneous emphysema of the orbital, masticator, parapharyngeal, retropharyngeal spaces, bilateral carotid and visceral spaces, and pneumomediastinum after third molar extraction with turbine drill. This was treated with intubation for airway protection, transoral drainage, and intravenous antibiotics. After discharge the patient reported persistent dysphonia and was found to have left vocal fold paresis. This was likely related to extensive pneumomediastum causing injury to the recurrent laryngeal nerve. This is the first report of cervicofacial emphysema leading to vocal cord paresis after third molar extraction, demonstrating the importance of serial clinical monitoring in these cases.
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Affiliation(s)
- Lauren North
- Medical College of Wisconsin Affiliated Hospitals, 8701 W Watertown Plank Rd, Milwaukee, WI, 53226, USA.
| | - Cecille Sulman
- Children's Hospital of Wisconsin, 9000 W. Wisconsin Ave, PO Box 1997, Milwaukee, WI 53201, USA.
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Zavala H, Roby BB, Day A, Bostrom B, Sidman J, Chinnadurai S. Vincristine-induced vocal cord paresis and paralysis in children. Int J Pediatr Otorhinolaryngol 2019; 123:1-4. [PMID: 31048222 DOI: 10.1016/j.ijporl.2019.04.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 04/01/2019] [Accepted: 04/01/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To describe three new cases of vincristine-induced vocal cord paresis or paralysis (VIVCPP) in children and to review the diagnosis and management of this neuropathy. METHODS Retrospective case series. Diagnosis of VIVCPP was confirmed by laryngoscopy in all children. RESULTS Less than 20 cases of VIVCPP in children have been previously documented in the literature. Of the three children in our case series, one had unilateral vincristine-induced vocal cord paresis and two had bilateral VIVCPP. The first two patients each had two separate episodes of paresis, lasting 4 months and 1 month respectively. In the last patient, whose medical course was complicated by many additional factors, vocal cord paralysis persisted for over three years. CONCLUSIONS Clinicians must evaluate children with suspected VIVCPP for concomitant symptoms and signs of vincristine neuropathies and examine the vocal cords via laryngoscopy. The effects of vincristine neurotoxicity can be waxing and waning, demonstrate delayed onset and persist well beyond drug cessation. Further studies are needed to identify effective neuroprotectants and delineate appropriate vincristine dosing in patients with vincristine neurotoxicity and cancer.
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Affiliation(s)
- Hanan Zavala
- ENT and Facial Plastic Surgery, Children's Minnesota, 2525 Chicago Avenue, Minneapolis, MN, 55455, United States
| | - Brianne Barnett Roby
- ENT and Facial Plastic Surgery, Children's Minnesota, 2525 Chicago Avenue, Minneapolis, MN, 55455, United States; Department of Otolaryngology, University of Minnesota Medical School, 420 Delaware St SE, Minneapolis, MN, 55455, United States
| | - Andrew Day
- ENT and Facial Plastic Surgery, Children's Minnesota, 2525 Chicago Avenue, Minneapolis, MN, 55455, United States; Department of Otolaryngology, University of Minnesota Medical School, 420 Delaware St SE, Minneapolis, MN, 55455, United States; Department of Otolaryngology, University of Texas- Southwestern School of Medicine, 2001 Inwood Rd, Dallas, TX, 75390, United States
| | - Bruce Bostrom
- Hematology & Oncology, Children's Minnesota, 2525 Chicago Avenue, Minneapolis, MN, 55455, United States
| | - James Sidman
- ENT and Facial Plastic Surgery, Children's Minnesota, 2525 Chicago Avenue, Minneapolis, MN, 55455, United States; Department of Otolaryngology, University of Minnesota Medical School, 420 Delaware St SE, Minneapolis, MN, 55455, United States
| | - Sivakumar Chinnadurai
- ENT and Facial Plastic Surgery, Children's Minnesota, 2525 Chicago Avenue, Minneapolis, MN, 55455, United States.
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Woo S, Lau S, Yoo E, Shaul D, Sydorak R. Thoracoscopic versus open repair of tracheoesophageal fistulas and rates of vocal cord paresis. J Pediatr Surg 2015; 50:2016-8. [PMID: 26392058 DOI: 10.1016/j.jpedsurg.2015.08.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 08/24/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND/PURPOSE The purpose of this study was to investigate the rates of vocal cord paresis/paralysis (VCP) in patients treated for esophageal atresia (EA) with and without fistula performed thoracoscopically versus open. METHODS A retrospective review of EA cases performed from 2008 to 2014 in an integrated health care system was performed. RESULTS A total of 31 cases of EA were performed by 6 surgeons at 4 different institutions. Seventeen cases were performed thoracoscopically, whereas 14 cases were performed open. In the thoracoscopic group, the average gestational age (weeks) of the patient was significantly higher 38.3 vs. 35.2 (p=0.016) as well as the average birth weight (grams) 2843 vs. 2079 (p=0.005). There was no difference in the postoperative length of stay, rates of anastomotic stricture, leak, or tracheomalacia. There were 10 cases of vocal cord paresis, 9 from the thoracoscopic group and one from the open group (p=0.007). Of the 10 cases of VCP, 6 were unilateral (left sided) and 4 were bilateral. Of the 10 cases, 6 resolved, 2 resulted in permanent paralysis, and 2 are currently still being evaluated. CONCLUSIONS Thoracoscopic repair of EA appears to have higher rates of VCP. The results are thought to be from thoracoscopic dissection of the esophagus high into the thoracic inlet.
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Affiliation(s)
- Sunee Woo
- Department of Surgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| | - Stanley Lau
- Department of Surgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| | - Edward Yoo
- Department of Surgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| | - Donald Shaul
- Department of Surgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| | - Roman Sydorak
- Department of Surgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA.
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