Laryngeal Radiation Fibrosis: A Case of Failed Awake Flexible Fibreoptic Intubation

Awake fibreoptic intubation is accepted as the gold standard for intubation of patients with an anticipated difficult airway. Radiation fibrosis may cause difficulties during the intubation procedure. We present an unusual severe case of radiation induced changes to the larynx, with limited clinical symptoms, that caused failure of the fibreoptic intubation technique. A review of the known literature on radiation fibrosis and airway management is presented.

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Dexmedetomidine in the Management of Awake Fiberoptic Intubation

The Open Anesthesia Journal ◽

10.2174/2589645801913010001 ◽

2019 ◽

Vol 13 (1) ◽

pp. 1-5 ◽

Cited By ~ 3

Author(s):

Aniello Alfieri ◽

Maria B. Passavanti ◽

Sveva Di Franco ◽

Pasquale Sansone ◽

Paola Vosa ◽

...

Keyword(s):

Airway Management ◽

Difficult Airway ◽

Practice Guidelines ◽

Gold Standard ◽

Fibreoptic Intubation ◽

Patient Comfort ◽

Fiberoptic Intubation ◽

Difficult Airway Management ◽

Patient Discomfort ◽

Awake Fiberoptic Intubation

Awake Fibreoptic Intubation (AFOI) is, nowadays, the gold standard in predicted difficult airway management. Numerous practice guidelines have been developed to assist clinicians facing with a difficult airway. If conducted without sedation, it is common that this procedure may lead to high patient discomfort and severe hemodynamic responses. Sedation is frequently used to make the process more tolerable to patients even if it is not always easy to strike a balance between patient comfort, safety, co-operation, and good intubating conditions. In the last years, many drugs and drug combinations have been described. This minireview aims to discuss the evidence supporting the use of Dexmedetomidine (DEX) in the AFOI management.

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Radiation-induced changes in the differentiation pattern of fibroblasts: The major cause of radiation fibrosis?

European Journal of Cancer ◽

10.1016/0959-8049(93)91838-c ◽

1993 ◽

Vol 29 ◽

pp. S217

Author(s):

H.P. Rodemann

Keyword(s):

Radiation Fibrosis ◽

Radiation Induced ◽

Differentiation Pattern ◽

Induced Changes

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Space Radiation-Induced Alterations in the Hippocampal Ubiquitin-Proteome System

International Journal of Molecular Sciences ◽

10.3390/ijms22147713 ◽

2021 ◽

Vol 22 (14) ◽

pp. 7713

Author(s):

Alyssa Tidmore ◽

Sucharita M. Dutta ◽

Arriyam S. Fesshaye ◽

William K. Russell ◽

Vania D. Duncan ◽

...

Keyword(s):

Spatial Memory ◽

Memory Performance ◽

Space Radiation ◽

Label Free ◽

Proteomic Profiling ◽

Neurocognitive Deficits ◽

Male Wistar Rats ◽

Radiation Induced ◽

Induced Changes

Exposure of rodents to <20 cGy Space Radiation (SR) impairs performance in several hippocampus-dependent cognitive tasks, including spatial memory. However, there is considerable inter-individual susceptibility to develop SR-induced spatial memory impairment. In this study, a robust label-free mass spectrometry (MS)-based unbiased proteomic profiling approach was used to characterize the composition of the hippocampal proteome in adult male Wistar rats exposed to 15 cGy of 1 GeV/n 48Ti and their sham counterparts. Unique protein signatures were identified in the hippocampal proteome of: (1) sham rats, (2) Ti-exposed rats, (3) Ti-exposed rats that had sham-like spatial memory performance, and (4) Ti-exposed rats that impaired spatial memory performance. Approximately 14% (159) of the proteins detected in hippocampal proteome of sham rats were not detected in the Ti-exposed rats. We explored the possibility that the loss of the Sham-only proteins may arise as a result of SR-induced changes in protein homeostasis. SR-exposure was associated with a switch towards increased pro-ubiquitination proteins from that seen in Sham. These data suggest that the role of the ubiquitin-proteome system as a determinant of SR-induced neurocognitive deficits needs to be more thoroughly investigated.

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Secrets to a successful awake fibreoptic intubation (AFOI) on a patient with odentogenous abscess

BMJ Case Reports ◽

10.1136/bcr-2020-238600 ◽

2021 ◽

Vol 14 (2) ◽

pp. e238600

Author(s):

Ming Kai Teah ◽

Esther Huey Ring Liew ◽

Melvin Teck Fui Wong ◽

Tat Boon Yeap

Keyword(s):

Tracheal Intubation ◽

Airway Management ◽

Difficult Airway ◽

Patient Outcomes ◽

Fibreoptic Intubation

Awake fibreoptic intubation (AFOI) is an established modality in patients with anticipated difficulty with tracheal intubation. This case demonstrates that with careful and meticulous preparations, AFOI can lead to improved airway management and excellent patient outcomes. A 38-year-old woman presented with severe trismus secondary to odentogenous abscess was identified preoperatively as having a potential difficult airway. AFOI was performed successfully using combined Spray-As-You-Go and dexmedetomidine technique.

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Impact of [18F]FDG-PET and [18F]FLT-PET-Parameters in Patients with Suspected Relapse of Irradiated Lung Cancer

Diagnostics ◽

10.3390/diagnostics11020279 ◽

2021 ◽

Vol 11 (2) ◽

pp. 279

Author(s):

Tine N. Christensen ◽

Seppo W. Langer ◽

Gitte Persson ◽

Klaus Richter Larsen ◽

Annemarie G. Amtoft ◽

...

Keyword(s):

Lung Cancer ◽

Overall Survival ◽

Fdg Pet ◽

Tumor Volume ◽

High Dose ◽

Flt Pet ◽

Pet Ct ◽

Radiation Induced ◽

Fdg Pet Ct ◽

Induced Changes

Radiation-induced changes may cause a non-malignant high 2-deoxy-2-[18F]fluoro-d-glucose (FDG)-uptake. The 3′-deoxy-3′-[18F]fluorothymidine (FLT)-PET/CT performs better in the differential diagnosis of inflammatory changes and lung lesions with a higher specificity than FDG-PET/CT. We investigated the association between post-radiotherapy FDG-PET-parameters, FLT-PET-parameters, and outcome. Sixty-one patients suspected for having a relapse after definitive radiotherapy for lung cancer were included. All the patients had FDG-PET/CT and FLT-PET/CT. FDG-PET- and FLT-PET-parameters were collected from within the irradiated high-dose volume (HDV) and from recurrent pulmonary lesions. For associations between PET-parameters and relapse status, respectively, the overall survival was analyzed. Thirty patients had a relapse, of these, 16 patients had a relapse within the HDV. FDG-SUVmax and FLT-SUVmax were higher in relapsed HDVs compared with non-relapsed HDVs (median FDG-SUVmax: 12.8 vs. 4.2; p < 0.001; median FLT-SUVmax 3.9 vs. 2.2; p < 0.001). A relapse within HDV had higher FDG-SUVpeak (median FDG-SUVpeak: 7.1 vs. 3.5; p = 0.014) and was larger (median metabolic tumor volume (MTV50%): 2.5 vs. 0.7; 0.014) than the relapsed lesions outside of HDV. The proliferative tumor volume (PTV50%) was prognostic for the overall survival (hazard ratio: 1.07 pr cm3 [1.01–1.13]; p = 0.014) in the univariate analysis, but not in the multivariate analysis. FDG-SUVmax and FLT-SUVmax may be helpful tools for differentiating the relapse from radiation-induced changes, however, they should not be used definitively for relapse detection.

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