Neonatal Upper Airway Assessment by Awake Flexible Laryngoscopy

Awake flexible laryngoscopy (AFL) provides simple and quick assessment of both the structure and function of the upper airway. To determine its value in neonates, a prospective study was carried out over 2 years of 110 neonates (80 term, 30 premature) under 6 weeks of age (corrected for prematurity) presenting with symptoms suggestive of upper airway disease who underwent AFL performed by the author. A diagnosis was made in 79 cases, while no cause was found for the symptoms in 31. The commonest diagnoses were vocal cord paralysis (29; bilateral 16, unilateral 13), nasal stenosis (9), laryngomalacia (9), glossoptosis (7), subglottic stenosis (6), and choanal atresia (5; bilateral 2, unilateral 3). The AFL was repeated in 31 neonates and the condition was found to be stable in 16, improved in 8, resolved in 2, and progressed in 1, and an additional diagnosis was made in 4. Endoscopy under general anesthesia with or without corrective surgery was performed in 15 neonates (7 also having repeat AFL). The diagnosis was confirmed in 14 and an additional tracheal abnormality was found in 1. The AFL was complicated by cyanosis in 2 neonates and epistaxis in 1, but all complications resolved with minimal intervention. These data suggest that the neonatal upper airway can be relatively safely and reliably assessed by AFL performed by an experienced clinician.

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Practice and Impact of Multidisciplinary Tumor Boards on Patient Management: A Prospective Study

Journal of Global Oncology ◽

10.1200/jgo.2016.004960 ◽

2017 ◽

Vol 3 (3) ◽

pp. 242-249 ◽

Cited By ~ 19

Author(s):

Raghid N. Charara ◽

Firas Y. Kreidieh ◽

Rania A. Farhat ◽

Karine A. Al-Feghali ◽

Katia E. Khoury ◽

...

Keyword(s):

Breast Cancer ◽

Decision Making ◽

Head And Neck ◽

Patients With Cancer ◽

Medical Oncologists ◽

Tumor Boards ◽

Management Plans ◽

A Prospective Study ◽

And Function ◽

Made In

Purpose Multidisciplinary tumor boards (MTBs) have become commonplace. The use, attendance, and function of MTBs need continued assessment and improvement. Methods We prospectively recorded and assessed all cases presented at MTBs between October 2013 and December 2014. Data were collected before and during each MTB. Data were analyzed using SPSS for Windows version 23 (SPSS, Chicago, IL). Results Five hundred three cases were presented: 234 cases (46%) at GI cancer MTBs, 149 cases (29.6%) at breast cancer MTBs, 69 cases (13.7%) at thoracic/head and neck cancer MTBs, and 51 cases (10.7%) at neuro-oncology MTBs. A total of 86.7% of MTB cases were presented to make plans for management. Plans for upfront management were made in 67% of the breast cancer cases, 63% of GI cases, 59% of thoracic/head and neck cases, and 49% of neuro-oncology cases. Three hundred ninety-four cases (78.3%) were presented by medical oncologists, whereas only 74 cases (14.7%) were presented by surgeons, and 10 cases (2%) were presented by radiation oncologists. The majority of MTBs, with the exception of the neurosurgery MTBs, were led by medical oncologists. Surgeons presented the least number of cases but attended the most, and their contributions to discussions and decision making were essential. Conclusion MTBs enhance the multidisciplinary management of patients with cancer. Upfront multidisciplinary decision making should be considered as an indicator of benefit from MTBs, in addition to changes in management plans made at MTBs. Increasing the contributions of surgeons to MTBs should include bringing more of their own cases for discussion.

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Choanal atresia and secondary nasopharyngeal stenosis in a dog

Journal of the American Animal Hospital Association ◽

10.5326/15473317-34-6-497 ◽

1998 ◽

Vol 34 (6) ◽

pp. 497-501 ◽

Cited By ~ 32

Author(s):

BR Coolman ◽

SM Marretta ◽

BC McKiernan ◽

JF Zachary

Keyword(s):

Nasal Cavity ◽

Surgical Intervention ◽

Choanal Atresia ◽

Upper Airway ◽

Airway Disease ◽

Scar Tissue ◽

Endoscopic Examination ◽

Intact Male ◽

Temporary Relief

A 20-month-old, intact male shih tzu was evaluated for chronic upper airway disease. Endoscopic examination established a diagnosis of choanal atresia, a developmental anomaly of the posterior nasal cavity. Although surgical intervention provided temporary relief, stenosis of the nasopharynx by obstructive scar tissue was confirmed within four weeks. A permanent tracheostomy provided long-term relief of the respiratory difficulty. This is the first report of choanal atresia or nasopharyngeal stenosis in a dog.

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Distraction Osteogenesis in the Treatment of Craniofacial Anomalies: Applications and Outcomes

Perspectives of the ASHA Special Interest Groups ◽

10.1044/2020_persp-20-00055 ◽

2020 ◽

Vol 5 (6) ◽

pp. 1469-1481 ◽

Cited By ~ 1

Author(s):

Joseph A. Napoli ◽

Carrie E. Zimmerman ◽

Linda D. Vallino

Keyword(s):

Distraction Osteogenesis ◽

Bone Growth ◽

Upper Airway ◽

Craniofacial Anomalies ◽

Craniofacial Skeleton ◽

Facial Skeleton ◽

Psychosocial Impairment ◽

And Function ◽

Correct Structure

Purpose Craniofacial anomalies (CFA) often result in growth abnormalities of the facial skeleton adversely affecting function and appearance. The functional problems caused by the structural anomalies include upper airway obstruction, speech abnormalities, feeding difficulty, hearing deficits, dental/occlusal defects, and cognitive and psychosocial impairment. Managing disorders of the craniofacial skeleton has been improved by the technique known as distraction osteogenesis (DO). In DO, new bone growth is stimulated allowing bones to be lengthened without need for bone graft. The purpose of this clinical focus article is to describe the technique and clinical applications and outcomes of DO in CFA. Conclusion Distraction can be applied to various regions of the craniofacial skeleton to correct structure and function. The benefits of this procedure include improved airway, feeding, occlusion, speech, and appearance, resulting in a better quality of life for patients with CFA.

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Multiplexed Genetic Analysis Using an Expanded Genetic Alphabet

Clinical Chemistry ◽

10.1373/clinchem.2004.034330 ◽

2004 ◽

Vol 50 (11) ◽

pp. 2019-2027 ◽

Cited By ~ 36

Author(s):

Scott C Johnson ◽

David J Marshall ◽

Gerda Harms ◽

Christie M Miller ◽

Christopher B Sherrill ◽

...

Keyword(s):

Newborn Screening ◽

Cftr Gene ◽

Transmembrane Conductance Regulator ◽

Transmembrane Conductance ◽

Genetic Tests ◽

Wide Range ◽

Additional Base ◽

A Prospective Study ◽

Cystic Fibrosis Transmembrane ◽

Made In

Abstract Background: All states require some kind of testing for newborns, but the policies are far from standardized. In some states, newborn screening may include genetic tests for a wide range of targets, but the costs and complexities of the newer genetic tests inhibit expansion of newborn screening. We describe the development and technical evaluation of a multiplex platform that may foster increased newborn genetic screening. Methods: MultiCode® PLx involves three major steps: PCR, target-specific extension, and liquid chip decoding. Each step is performed in the same reaction vessel, and the test is completed in ∼3 h. For site-specific labeling and room-temperature decoding, we use an additional base pair constructed from isoguanosine and isocytidine. We used the method to test for mutations within the cystic fibrosis transmembrane conductance regulator (CFTR) gene. The developed test was performed manually and by automated liquid handling. Initially, 225 samples with a range of genotypes were tested retrospectively with the method. A prospective study used samples from >400 newborns. Results: In the retrospective study, 99.1% of samples were correctly genotyped with no incorrect calls made. In the perspective study, 95% of the samples were correctly genotyped for all targets, and there were no incorrect calls. Conclusions: The unique genetic multiplexing platform was successfully able to test for 31 targets within the CFTR gene and provides accurate genotype assignments in a clinical setting.

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Role of Taste Receptors as Sentinels of Innate Immunity in the Upper Airway

Journal of Pathogens ◽

10.1155/2018/9541987 ◽

2018 ◽

Vol 2018 ◽

pp. 1-8 ◽

Cited By ~ 8

Author(s):

Neil N. Patel ◽

Alan D. Workman ◽

Noam A. Cohen

Keyword(s):

Airway Epithelium ◽

Taste Receptor ◽

Upper Airway ◽

Airway Disease ◽

G Protein Coupled Receptors ◽

Innate Immune ◽

Taste Receptors ◽

Taste Sensation ◽

G Protein Coupled

Evidence is emerging that shows taste receptors serve functions outside of taste sensation of the tongue. Taste receptors have been found in tissue across the human body, including the gastrointestinal tract, bladder, brain, and airway. These extraoral taste receptors appear to be important in modulating the innate immune response through detection of pathogens. This review discusses taste receptor signaling, focusing on the G-protein–coupled receptors that detect bitter and sweet compounds in the upper airway epithelium. Emphasis is given to recent studies which link the physiology of sinonasal taste receptors to clinical manifestation of upper airway disease.

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Large Animal Models of Vascularized Composite Allotransplantation: A Review of Immune Strategies to Improve Allograft Outcomes

Frontiers in Immunology ◽

10.3389/fimmu.2021.664577 ◽

2021 ◽

Vol 12 ◽

Author(s):

Abraham J. Matar ◽

Rebecca L. Crepeau ◽

Gerhard S. Mundinger ◽

Curtis L. Cetrulo ◽

Radbeh Torabi

Keyword(s):

Animal Models ◽

Ex Vivo ◽

Solid Organ Transplantation ◽

Tolerance Induction ◽

Large Animal ◽

Solid Organ ◽

Large Animal Models ◽

Large Animals ◽

And Function ◽

Made In

Over the past twenty years, significant technical strides have been made in the area of vascularized composite tissue allotransplantation (VCA). As in solid organ transplantation, the allogeneic immune response remains a significant barrier to long-term VCA survival and function. Strategies to overcome acute and chronic rejection, minimize immunosuppression and prolong VCA survival have important clinical implications. Historically, large animals have provided a valuable model for testing the clinical translatability of immune modulating approaches in transplantation, including tolerance induction, co-stimulation blockade, cellular therapies, and ex vivo perfusion. Recently, significant advancements have been made in these arenas utilizing large animal VCA models. In this comprehensive review, we highlight recent immune strategies undertaken to improve VCA outcomes with a focus on relevant preclinical large animal models.

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Complications and Pitfalls in Maxillofacial Trauma

Journal of Postgraduate Medicine Education and Research ◽

10.5005/jp-journals-10028-1108 ◽

2014 ◽

Vol 48 (2) ◽

pp. 91-97

Author(s):

Vidya Rattan ◽

Sachin Rai ◽

Shikha Yadav

Keyword(s):

Treatment Failure ◽

Surgical Procedure ◽

Treatment Plan ◽

Surgical Techniques ◽

Maxillofacial Trauma ◽

Trauma Surgeon ◽

Form And Function ◽

Fixation Devices ◽

And Function ◽

Made In

ABSTRACT Complications and pitfalls are unavoidable sequel of any surgical procedure. Although advances have been made in surgical techniques and fixation devices, these are far from ideal. The aim of trauma surgeon is to restore the patient to pre-injury form and function, but it may not be possible in each and every case. Treatment failure and poor outcome in a case of severe maxillofacial trauma is not uncommon. This is mainly dependent upon the extent of injury, delay in management, improper diagnosis, wrong treatment plan, poor execution of a treatment plan, wrong choice of fixation devices, inexperience of the surgeon and inability to seek help from other specialists, etc. The objective of this article is to discuss and analyze common complications and pitfalls along with the various methods and modalities to prevent and manage it. How to cite this article Rattan V, Rai S, Yadav S. Complications and Pitfalls in Maxillofacial Trauma. J Postgrad Med Edu Res 2014;48(2):91-97.

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The overlap between bronchiectasis and chronic airway diseases: state of the art and future directions

European Respiratory Journal ◽

10.1183/13993003.00328-2018 ◽

2018 ◽

Vol 52 (3) ◽

pp. 1800328 ◽

Cited By ~ 41

Author(s):

Eva Polverino ◽

Katerina Dimakou ◽

John Hurst ◽

Miguel-Angel Martinez-Garcia ◽

Marc Miravitlles ◽

...

Keyword(s):

Respiratory Infections ◽

Upper Airway ◽

Airway Disease ◽

Chronic Obstructive ◽

Future Directions ◽

Obstructive Pulmonary Disease ◽

Airway Diseases ◽

Recurrent Respiratory Infections ◽

Sputum Production ◽

Syndromic Approach

Bronchiectasis is a clinical and radiological diagnosis associated with cough, sputum production and recurrent respiratory infections. The clinical presentation inevitably overlaps with other respiratory disorders such as asthma and chronic obstructive pulmonary disease (COPD). In addition, 4–72% of patients with severe COPD are found to have radiological bronchiectasis on computed tomography, with similar frequencies (20–30%) now being reported in cohorts with severe or uncontrolled asthma. Co-diagnosis of bronchiectasis with another airway disease is associated with increased lung inflammation, frequent exacerbations, worse lung function and higher mortality. In addition, many patients with all three disorders have chronic rhinosinusitis and upper airway disease, resulting in a complex “mixed airway” phenotype.The management of asthma, bronchiectasis, COPD and upper airway diseases has traditionally been outlined in separate guidelines for each individual disorder. Recognition that the majority of patients have one or more overlapping pathologies requires that we re-evaluate how we treat airway disease. The concept of treatable traits promotes a holistic, pathophysiology-based approach to treatment rather than a syndromic approach and may be more appropriate for patients with overlapping features.Here, we review the current clinical definition, diagnosis, management and future directions for the overlap between bronchiectasis and other airway diseases.

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