Primary aspergillosis of vocal cord: Long-term inhalational steroid use can be the miscreant

Takotsubo cardiomyopathy (TCMP) is an important, though under-recognised, syndrome which mimics acute coronary syndrome (ACS) presenting with similar clinical, biochemical and ECG features. A 68-year-old man was referred as ACS for emergency coronary angiography; however, a history of lethargy, weight loss and electrolyte abnormalities prompted further investigations. Angiography was postponed, adrenal insufficiency confirmed and steroid replacement commenced. Echocardiography demonstrated reduced left ventricular (LV) function (45%) with regional wall motion abnormalities, although angiography confirmed unobstructed arteries. Steroid replacement induced a rapid improvement in symptoms and LV function. Few cases of TCMP associated with adrenal insufficiency have been reported. This appears to be the first case describing TCMP precipitated by new-onset secondary adrenal insufficiency following long-term steroid use in a male patient, and highlights the importance of considering TCMP in patients presenting with suspected ACS. Here, prompt recognition and treatment of a serious underlying disorder prevented a potentially life-threatening Addisonian crisis.

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Diagnostic and Therapeutic Long-term Management of Eosinophilic Esophagitis— Current Concepts and Perspectives for Steroid Use

Clinical and Translational Gastroenterology ◽

10.1038/s41424-018-0074-8 ◽

2018 ◽

Vol 9 (12) ◽

pp. e212 ◽

Cited By ~ 14

Author(s):

Thomas Greuter ◽

Jeffrey A. Alexander ◽

Alex Straumann ◽

David A. Katzka

Keyword(s):

Eosinophilic Esophagitis ◽

Steroid Use ◽

Term Management

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S183 – Intracordal Fat Assessment after Injection Laryngoplasty

Otolaryngology ◽

10.1016/j.otohns.2008.05.357 ◽

2008 ◽

Vol 139 (2_suppl) ◽

pp. P137-P137

Author(s):

Tuan-Jen Fang ◽

Chao-Jan Wang ◽

Hsueh-Yu Li

Keyword(s):

Vocal Cord ◽

Vocal Cord Paralysis ◽

Upper Airway ◽

Fat Injection ◽

Long Term Outcomes ◽

Autologous Fat ◽

The Mean ◽

Fat Volume ◽

Unilateral Vocal Cord Paralysis

Objectives Autologous fat injection for unilateral vocal cord paralysis is a popular procedure for immediate symptoms control, but uneven long-term outcomes were reported. Most authors believed that the continual resorption of injected fat was the cause of voice degradation. A long-term residual fat volume was evaluated. Methods We retrospectively reviewed the patients following autologous fat injection for symptomatic unilateral vocal cord paralysis from 2002 Aug to 2006 July. The patients accepted head and neck computed tomogragphy (CT) evaluation following surgery were included. A three-dimensional reconstruction of the images of larynx and upper airway was performed on the work station (Vitrea® 2, version 3.9). The volume of intracordal fat was then calculated. Results 5 males and 15 females of the mean age 49 were enrolled. The mean duration from lipoinjection surgery to the CT study is 23.0 months (12–50 months). The injection fat was found in all study cases. The estimated fat volume ranged from 0.01 to 0.75 ml with a mean 0.33 ml. Compare with the injected fat volume, a mean 27.5% fat survived. The correlation between residual fat volume rate and duration of follow-up is not significant. Conclusions The intracordal fat volume didn't decline from time. Long-term intracordal injected fat diminished but survived in all cases. The degradation may be caused by absorption or immediate extrusion from injection wound. An over-correction and prevention of extrusion postoperatively would improve the long-term outcomes.

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Letter by Hobai Regarding Article, “Long-Term Anabolic-Androgenic Steroid Use Is Associated With Left Ventricular Dysfunction”

Circulation Heart Failure ◽

10.1161/circheartfailure.110.958744 ◽

2010 ◽

Vol 3 (6) ◽

Author(s):

Ion A. Hobai

Keyword(s):

Left Ventricular Dysfunction ◽

Ventricular Dysfunction ◽

Left Ventricular ◽

Anabolic Androgenic Steroid ◽

Steroid Use ◽

Androgenic Steroid

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Predicting intentions for long-term anabolic-androgenic steroid use among men: A covariance structure model.

Psychology of Addictive Behaviors ◽

10.1037/0893-164x.20.3.234 ◽

2006 ◽

Vol 20 (3) ◽

pp. 234-240 ◽

Cited By ~ 13

Author(s):

Tom Hildebrandt ◽

James Langenbucher ◽

Sasha Carr ◽

Pilar Sanjuan ◽

Steff Park

Keyword(s):

Covariance Structure ◽

Anabolic Androgenic Steroid ◽

Structure Model ◽

Steroid Use ◽

Androgenic Steroid ◽

Covariance Structure Model

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Laryngeal Dysfunction following Prolonged Intubation

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348947908800405 ◽

1979 ◽

Vol 88 (4) ◽

pp. 474-478 ◽

Cited By ~ 40

Author(s):

Robert E. Whited

Keyword(s):

Vocal Cord ◽

Medical Center ◽

Recovery Phase ◽

Clinical Findings ◽

Posterior Commissure ◽

Prolonged Intubation ◽

Vocal Cord Paresis ◽

The Many ◽

The University

Prolonged endotracheal intubation in the adult is becoming more popular with the advent of “soft” tubes and cuffs. The many deleterious effects of such long-term intubation on the laryngotrachea have been extensively discussed in the literature. However, only sporatic attention has been given to vocal cord paresis or paralysis. The University of Cincinnati Medical Center experience with postintubation patients has shown that cord mobility disturbances are relatively common. Sixteen patients are presented who have had similar clinical findings and course following extubation. The clinical picture is that of a symmetrical vocal cord paresis or paralysis associated with arytenoid and posterior commissure edema and erythema. Vocal cord position is most often median or paramedian. A spontaneous recovery over days to weeks is the usual course. During the recovery phase cord movement most often remains symmetrical; however, full motion may occur in one cord before the other. In all patients abduction was most limited and slowest to return. In this series the most significant effect has been aspiration. Two patients developed a posterior commissure stenosis. This entity is believed to be due to inflammation initiated by the tube and its movement against the posterior half of the endolarynx. In particular, inflammatory involvement of the cricoarytenoid joints and interarytenoid region best explain the clinical course. When mucosal ulcerations and granulation tissue are superimposed on the immobilized cords interarytenoid scarring may lead to chronic stenosis.

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Corniculate-Cuneiform Flap for Reconstruction in the Extended Vertical Partial Laryngectomy

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348949810700407 ◽

1998 ◽

Vol 107 (4) ◽

pp. 297-300 ◽

Cited By ~ 6

Author(s):

Mark S. Persky ◽

Angela Damiano

Keyword(s):

Vocal Cord ◽

Preliminary Data ◽

Tumor Recurrence ◽

Voice Quality ◽

Partial Laryngectomy ◽

Arytenoid Cartilage ◽

Laryngeal Closure

The extended vertical partial laryngectomy involves removal of the vocal cord and adjacent arytenoid cartilage. Arytenoid sacrifice predisposes the patient to postoperative aspiration, since adequate laryngeal closure during swallowing cannot be accomplished. Various techniques have been previously described for reconstruction of this defect. We present five patients who had reconstruction of this area with a local, mucosally based corniculate-cuneiform flap. All patients were decannulated, had no long-term aspiration, maintained socially acceptable voice quality, and had no tumor recurrence with a minimum of 3 years of follow-up. Our preliminary data suggest that this flap can be used in previously irradiated patients. The corniculate-cuneiform flap is an effective method of reconstruction in patients undergoing an extended vertical partial laryngectomy.

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