Successful management of subglottic stenosis in pregnancy

2021 ◽  
Vol 14 (3) ◽  
pp. e236466
Author(s):  
Shenghao Fang ◽  
Poonam Pai B H
Keyword(s):  
Multidisciplinary Approach ◽  
Postoperative Management ◽  
Subglottic Stenosis ◽  
Routine Practice ◽  
Shortness Of Breath ◽  
Successful Management ◽  
The Past ◽  
Surgical History ◽  
History Of ◽  
In Pregnancy

Evaluation and management of subglottic stenosis in pregnancy is challenging. It often is not only a multidisciplinary approach between obstetricians, otolaryngologists (ENT surgeons) and anesthesiologists, but also requires a thorough understanding of possible foreseen complications by the patient as well. Hence, whenever we are presented with a challenging case requiring multidisciplinary approach involving team of physicians from different specialties, it is routine practice to huddle regarding the preoperative, intraoperative and postoperative management and care. We present a case of a 37-year-old woman with a known history of idiopathic subglottic stenosis, 16 weeks’ pregnant, G4P1, with a surgical history significant for two previous subglottic dilations in the past and who now presented with an audible stridor and shortness of breath on activity. We highlighted the unique challenges encountered and the corresponding management adopted. This is a case of successful management of symptomatic worsening of subglottic stenosis managed during pregnancy.

Idiopathic subglottic stenosis in a young female patient

2021 ◽  
Vol 14 (5) ◽  
pp. e241525
Author(s):  
Benjamin Pomerantz ◽  
Michael Pomerantz ◽  
Arkadiy Finn
Keyword(s):  
Balloon Dilatation ◽  
Young Female ◽  
Rigid Bronchoscopy ◽  
Pulmonary Function Testing ◽  
Subglottic Stenosis ◽  
Productive Cough ◽  
Shortness Of Breath ◽  
History Of ◽  
One Year ◽  
Function Testing

A previously healthy 30-year-old woman presented with 3 years of progressive shortness of breath and audible wheezing. One year prior to presentation, she developed a chronic non-productive cough. Pulmonary function testing revealed flattened inspiratory and expiratory peaks, characteristic of an extrathoracic fixed tracheal obstruction. Bronchoscopy confirmed subglottic stenosis (SGS). She had no history of intubation, tracheostomy or evidence of a systemic inflammatory illness. She was diagnosed with idiopathic SGS and referred for rigid bronchoscopy with balloon dilatation resulting in improvement in her symptoms.

Rhabdomyolysis: An evidence-based approach

2021 ◽  
pp. 175114372110507
Author(s):  
Sarah Burgess
Keyword(s):  
Fluid Overload ◽  
Kidney Injury ◽  
Community Acquired Pneumonia ◽  
Evidence Based ◽  
Shortness Of Breath ◽  
Past Medical History ◽  
Urine Dipstick ◽  
The Past ◽  
Acting Insulin ◽  
History Of

A 76-year-old lady was found on the floor following a fall at home. She was uninjured, but unable to get up, and had been lying on the floor for roughly 18 hours before her son arrived. She had been unwell for the past 3 days with a cough and shortness of breath. She had a past medical history of diabetes, hypertension, hypercholesterolaemia and atrial fibrillation (AF). On examination, she was alert but distressed, clinically dehydrated, febrile and tachycardic. She was treated for community acquired pneumonia with co-amoxiclav and was fluid resuscitated with Hartmann’s solution. Her hyperkalaemia was treated with 50 mL of 50% glucose containing 10 units of rapid-acting insulin. Her creatinine kinase (CK) on admission was 200,000, and she had an acute kidney injury (AKI). Urine dipstick was positive for blood. However, her renal function continued to deteriorate over the succeeding 48 h, when she required renal replacement therapy (RRT) due to fluid overload and anuria.

scholarly journals Acute Stridor and Respiratory Failure due to Retrosternal Subglottic Stenosis of Unknown Origin

2013 ◽  
Vol 2013 ◽  
pp. 1-4
Author(s):  
Tharindu Vithanage ◽  
Gerben Keijzers ◽  
Nicola Jane Willis ◽  
Tara Cochrane ◽  
Linda Smith
Keyword(s):  
Respiratory Failure ◽  
Multidisciplinary Approach ◽  
Unknown Origin ◽  
Subglottic Stenosis ◽  
Upper Respiratory Tract ◽  
Shortness Of Breath ◽  
Oral Antibiotics ◽  
Night Sweats ◽  
Upper Respiratory ◽  
Tone Of Voice

Respiratory failure due to subglottic stenosis is a rare but serious condition. A 22-year-old male presented to the emergency department (ED) with shortness of breath, stridor, and change in tone of voice. The patient did not complain of B-symptoms (fever, weight loss, and night sweats). In the week before this presentation, he was diagnosed with an upper respiratory tract infection with associated bronchospasm and discharged on oral antibiotics and inhaled salbutamol without effect. He developed hypercapnic respiratory failure in the ED after a coughing episode. A normal nasopharyngoscopic examination and a subtle mediastinal abnormality on chest radiograph lead to a working diagnosis of retrosternal subglottic obstruction. The complexities of his airway management and suggestions for multidisciplinary approach are discussed.

scholarly journals An Indonesian Pregnant Woman with Lung Cancer and Liver Metastasis : A Case Report

2018 ◽  
Vol 12 (2) ◽  
pp. 67
Author(s):  
Vito Filbert Jayalie ◽  
Dimas Priantono ◽  
Zulkifli Amin
Keyword(s):  
Lung Cancer ◽  
Pregnant Woman ◽  
Multidisciplinary Approach ◽  
Stage Iv ◽  
Small Cell ◽  
Shortness Of Breath ◽  
Special Issue ◽  
Small Cell Lung ◽  
Cancer In Pregnancy ◽  
In Pregnancy

Background: Lung cancer in pregnancy is a rare disease compared to other types of cancer. However, special issue should be applied in order to maximize benefit for mother without harming the fetus.Methods: We present a case of 37-year-old, five months pregnant woman who came to the hospital with chief complain of shortness of breath. Later on, she was found to have a stage IV Non-Small Cell Lung Cancer (NSCLC) with adenocarcinoma subtype.Result: This may be the first lung cancer in pregnancy reported in Indonesia. Being a developing country, several challenges emerged before diagnosing patient of having lung cancer.Conclusion: Careful considerations along with multidisciplinary approach are necessary to provide the best care for the patient.

Thoracoscopic-Assisted Ventriculo-Azygous Shunt Placement for the Treatment of Hydrocephalus

2015 ◽  
Vol 11 (4) ◽  
pp. 491-494 ◽  
Author(s):  
Jonathan Pace ◽  
Gabriel A Smith ◽  
Andrea Pannunzio ◽  
Brian D. Rothstein ◽  
Alan Markowitz ◽  
...  
Keyword(s):  
Multidisciplinary Approach ◽  
Shunt Revision ◽  
Neurosurgical Procedures ◽  
Shortness Of Breath ◽  
Azygous Vein ◽  
Shunt Placement ◽  
Cerebrospinal Fluid Diversion ◽  
History Of ◽  
Shunt Dependence

Abstract BACKGROUND Cerebrospinal fluid diversion is one of the most frequent neurosurgical procedures across the world and can be challenging in select patients who fail standard distal drainage sites. OBJECTIVE To present the case of a woman after failing peritoneal, pleural, and atrial distal drainage sites who underwent a thoracoscopic-assisted ventriculo-azygous vein shunt placement. METHODS A 32-year-old woman presented to our hospital with long-standing history of hydrocephalus and shunt dependence. She had failed peritoneal and atrial shunts secondary to infection, scarring, and clot formation. At presentation, she had a pleural shunt in place and developed a large pleural effusion with shortness of breath. RESULTS She was taken to the operating room where a thoracoscopic-assisted ventriculo-azygous vein shunt was placed through a mini-thoracotomy. Postoperatively, she has not required a shunt revision in >2 years of follow-up. CONCLUSION When other distal sites fail, our case report illustrates a novel surgical technique capable of being performed through a multidisciplinary approach.

scholarly journals Successful use of CPAP in a pregnant patient with COVID-19 pneumonia

2021 ◽  
Vol 14 (3) ◽  
pp. e238055
Author(s):  
Maxine Reindorf ◽  
Joseph Newman ◽  
Tejas Ingle
Keyword(s):  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Pregnant Patient ◽  
Shortness Of Breath ◽  
Short History ◽  
Trial Treatment ◽  
History Of ◽  
Robust Evidence ◽  
In Pregnancy

A 35-year-old nurse, who was 27 weeks pregnant at the time, was admitted to hospital with a short history of cough, fever and worsening shortness of breath. Oral and nasopharyngeal swabs were positive for SARS-CoV-2 on real-time viral PCR. During her admission, her breathing further deteriorated and she developed type 1 respiratory failure. A decision was made to trial treatment with continuous positive airway pressure (CPAP) as a means of avoiding intubation. The patient tolerated this well and made rapid improvements on this therapy. She was quickly weaned off and fully recovered before being discharged home. This case highlights the potential for CPAP to be used as a means of avoiding mechanical ventilation and iatrogenic preterm birth in COVID-19 pneumonia in pregnancy. Furthermore, it highlights the need for robust evidence to support this treatment.

BIiochemical Markers in Pregnancy Associated with Sj�gren�s Syndrome and Thrombophilia

2018 ◽  
Vol 69 (8) ◽  
pp. 2300-2303
Author(s):  
Anca Daniela Braila ◽  
Adrian Neacsu ◽  
Anca Emanuela Musetescu ◽  
Elena Luminita Vircan ◽  
Alesandra Florescu ◽  
...  
Keyword(s):  
Multidisciplinary Approach ◽  
Personal History ◽  
Obstetrics And Gynecology ◽  
Maternal History ◽  
Immune Mediated ◽  
Multisystemic Disease ◽  
History Of ◽  
One Year ◽  
Neonatal Monitoring ◽  
In Pregnancy

Sj�gren�s syndrome (SS) is a multisystemic disease mainly characterized by the hypofunction of the lachrymal and salivary glands and can be either primary or secondary, when related to other autoimmune pathologies. We present the case of a 35-year-old female admitted in the Department of Obstetrics and Gynecology for pregnancy monitoring. The patient had a personal history of a spontaneous abortion one year prior to admission at 5 months of gestation and a maternal history of SS. A multidisciplinary approach with solid obstetrical, rheumatological and neonatal monitoring is essential for best outcomes of the mother and fetus. An early detection of maternal and fetal immune-mediated threats and judicious use of medication is essential in women with autoimmune diseases who plan conceiving.

scholarly journals Graves hyperthyroidism in pregnancy: a rare presentation

2019 ◽  
Vol 8 (10) ◽  
pp. 4104
Author(s):  
Priyanka Garg ◽  
Romi Bansal ◽  
Roushali .
Keyword(s):  
Sleep Disturbances ◽  
Fetal Loss ◽  
Rare Presentation ◽  
Fetal Demise ◽  
Present Patient ◽  
Male Baby ◽  
The Past ◽  
Life Threatening ◽  
History Of ◽  
In Pregnancy

Hyperthyroidism in pregnancy is much less common occurring in 0.1-0.2% of women with Grave’s disease being the most common cause accounting for 90% of the cases. It is important to diagnose hyperthyroidism in pregnancy because fetal loss in untreated patients is high and may even be life threatening for the mother. We are presenting a case of 29 years old G3P2L1 who presented to our emergency with amenorrhea of 7 months and history of loose stools for the last 20 days. It was associated with generalized weakness. She also had history of palpitations, weight loss and sleep disturbances. She was a known case of hyperthyroidism for the past 1-2 years and was already taking anti-thyroid drugs. B/L exophthalmos was apparently present. Patient was severly anaemic with haemoglobin of 5.5gms/dl. Ultrasound showed fetal demise at 28weeks. Patient was given 3 units of blood transfusion and was induced with prostaglandins. She delivered a dead male baby weighing 1.2kgs. Her postpartum period was uneventful. Timely diagnosis of graves hyperthyroidism and its optimal treatment throughout pregnancy is vital in reducing maternal, fetal and neonatal complications. 

Evidence-Informed Policy from an International Perspective

2018 ◽  
Vol 678 (1) ◽  
pp. 62-70 ◽  
Author(s):  
Thomas Chupein ◽  
Rachel Glennerster
Keyword(s):  
Development Policy ◽  
Scale Up ◽  
International Perspective ◽  
Routine Practice ◽  
Policy Makers ◽  
Randomized Controlled ◽  
The Past ◽  
Policy Debates ◽  
The World ◽  
History Of

This article discusses the history of randomized controlled trials (RCTs) in development economics and the ways in which their use has shaped disciplinary practices and development policy over the past two decades. We first explain how increased use of academic-run RCTs internationally has led to important methodological breakthroughs that have advanced our knowledge of human behavior as well as changes in how research is conducted, including routine practice of in-field apprenticeships for young researchers and the establishment of robust research infrastructure in numerous developing countries around the world. We then explore three ways in which the scale-up of evidence-informed programs and policies based on findings from RCTs have achieved real-world impact, giving examples for each. These include how rigorous evidence can help to resolve contentious policy debates; enable policy-makers to assess external validity of findings and draw lessons across contexts; and support institutionalization of evidence use in various types of organizations.

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