scholarly journals Anesthesia and airway management in a patient with acromegaly and tracheal compression caused by a giant retrosternal goiter: a case report

2021 ◽  
Vol 49 (4) ◽  
pp. 030006052199954
Author(s):  
Xiaohui Sun ◽  
Chan Chen ◽  
Ruihao Zhou ◽  
Guo Chen ◽  
Chunling Jiang ◽  
...  
Keyword(s):  
Airway Management ◽  
Anesthetic Management ◽  
Management Strategies ◽  
Topical Anesthesia ◽  
Emergency Plan ◽  
Progressive Dyspnea ◽  
Retrosternal Goiter ◽  
Cervical Approach ◽  
History Of ◽  
Right Lobe

A giant retrosternal goiter can lead to compression of vital organs in the mediastinum with high risk of acute cardiorespiratory decompensation. Additionally, patients with acromegaly are prone to developing severe airway obstruction and ventilation difficulties during anesthetic induction, leading to hypoxia and an increased partial pressure of carbon dioxide. Therefore, more comprehensive airway management strategies are needed. We herein describe a 57-year-old man with acromegaly and severe tracheal obstruction caused by a giant retrosternal goiter. He presented with a 1-week history of progressive dyspnea and was scheduled to undergo right lobe thyroidectomy and retrosternal goiter thyroidectomy. We created a comprehensive emergency plan for a difficult airway, including regional and topical anesthesia for awake endotracheal intubation, sevoflurane inhalation, small doses of midazolam and sufentanil to increase tolerance, self-made extended-length tracheostomy, video laryngoscope-assisted fiber-optic bronchoscopy, extracorporeal membrane oxygenation, and surgical tracheostomy. Importantly, tetracaine was inhaled through an atomizer, and a laryngotracheal topical anesthesia applicator was used to spray the larynx with 1% tetracaine to reduce stimulation during intubation. The giant goiter was successfully removed through the cervical approach. A carefully designed airway management strategy and close communication among a multidisciplinary operation team are the basis of perioperative anesthetic management for these patients.

scholarly journals Nocardia farcinica meningitis in a patient with high-grade astrocytoma

2019 ◽  
Vol 13 (09) ◽  
pp. 854-857
Author(s):  
Elahe Nasri ◽  
Hamed Fakhim ◽  
Aleksandra Barac ◽  
Saber Yousefi ◽  
Kouros Aghazade ◽  
...  
Keyword(s):  
Ct Scan ◽  
Nocardia Farcinica ◽  
High Grade Astrocytoma ◽  
Perilesional Edema ◽  
Progressive Dyspnea ◽  
Alveolar Infiltrate ◽  
History Of ◽  
Right Lobe ◽  
The Right ◽  
Astrocytoma Grade Iii

We describe a case of 91-year-old male with astrocytoma who developed meningitis caused by Nocardia farcinica. He had a past medical history of anaplastic astrocytoma grade III. Endocranial computed tomography (CT) scan revealed mass lesion in the left occipital region associated with perilesional edema, without evidence of midline shift issue. The analyses of cerebrospinal fluid (CSF) revealed neutrophilic pleocytosis, hyperproteinorrachia and hypoglycorrhachia. Combined antimicrobial therapy was initiated (vancomycin, meropenem, acyclovir). CSF culture revealed Nocardia farcinica. Susceptibility testing revealed intermediate sensitivity to meropenem and antibiotic treatment was switched to trimethoprim-sulfamethoxazole and imipenem. After 7 days of treatment the patient developed progressive dyspnea. The chest CT scan revealed bilateral pleural effusion and alveolar infiltrate mostly in the right lobe. Ceftriaxone was added to the therapy, but the outcome was lethal. Nocardia spp. should be considered as differential diagnosis in the patients with brain tumor or meningitis in the setting of immune suppression and corticosteroid use. CSF cultures should be incubated longer with aim to allow fastidious organisms to grow, such as Nocardia spp.

Young Male with Bilateral ICA Dissection: Beyond CADISS Trial

2021 ◽  
pp. 251660852098428
Author(s):  
Vikas Bhatia ◽  
Chirag Jain ◽  
Sucharita Ray ◽  
jay Kumar
Keyword(s):  
Management Strategies ◽  
Young Male ◽  
Acute Onset ◽  
The Body ◽  
Artery Dissection ◽  
Cervical Artery Dissection ◽  
Stroke Study ◽  
History Of

Objective: To report a case of young male with stroke and bilateral internal carotid artery (ICA) dissection. Background: Cervical Artery Dissection in Stroke Study trial has provided some insight on management of patients with ICA dissection. However, there is a need to modify the management strategies as per specific clinical scenario. Design/Methods: Case report and literature review. Results: A 45-year-old male presented with 1 month old history of acute onset numbness of right half of the body with slurring of speech. Computed tomography angiography showed complete occlusion of left cervical ICA just beyond origin with presence of fusiform dilatation and spiral flap in right extracranial cervical ICA. The patient was started on antiplatelets and taken for endovascular procedure using 2-mesh-based carotid stents. Patient was discharged after 3 days on antiplatelet therapy. At 1-year follow-up, there were no fresh symptoms. Conclusion: This case emphasizes the role of successful endovascular management of carotid dissection in a young male. These clinical situations may not be fully represented in trials, and a case-based approach is required.

Anesthetic management of a patient with a history of Batista procedure for dilated cardiomyopathy undergoing gastric surgery

2006 ◽  
Vol 20 (3) ◽  
pp. 227-230 ◽  
Author(s):  
Aki Honda ◽  
Tamie Arai ◽  
Maki Akiyama ◽  
Eriko Masuda ◽  
Mizuka Kobayashi ◽  
...  
Keyword(s):  
Dilated Cardiomyopathy ◽  
Anesthetic Management ◽  
Gastric Surgery ◽  
History Of ◽  
Batista Procedure

Improving patient safety through optimisation of airway management strategies

2017 ◽  
Vol 12 ◽  
pp. 17
Author(s):  
T.H. Pedersen ◽  
R. Greif ◽  
M. Kleine-Brueggeney ◽  
C. Riggenbach ◽  
L. Theiler
Keyword(s):  
Patient Safety ◽  
Airway Management ◽  
Management Strategies

scholarly journals Variation in Out-of-Hospital Cardiac Arrest Management

2016 ◽  
Vol 2016 ◽  
pp. 1-3 ◽  
Author(s):  
Jason M. Jones ◽  
Joseph A. Tyndall ◽  
Christine M. Van Dillen
Keyword(s):  
Cardiac Arrest ◽  
Airway Management ◽  
Prehospital Care ◽  
Management Strategies ◽  
Retrospective Chart Review ◽  
Airway Device ◽  
Care Providers ◽  
One Airway ◽  
Time And Energy ◽  
Hospital Cardiac Arrest

Objective. To evaluate variation in airway management strategies in one suburban emergency medical services system treating patients experiencing out-of-hospital cardiac arrest (OHCA). Method. Retrospective chart review of all adult OHCA resuscitation during a 13-month period, specifically comparing airway management decisions. Results. Paramedics demonstrated considerable variation in their approaches to airway management. Approximately half of all OHCA patients received more than one airway management attempt (38/77 [49%]), and one-quarter underwent three or more attempts (25/77 [25%]). One-third of patients arrived at the emergency department with a different airway device than initially selected (25/77 [32%]). Conclusion. This study confirmed our hypothesis that paramedics’ selection of ventilation strategies in cardiac arrest varies considerably. This observation raises concern because airway management diverts time and energy from interventions known to improve outcomes in OHCA management, such as cardiopulmonary resuscitation and defibrillation. More research is needed to identify more focused airway management strategies for prehospital care providers.

scholarly journals Acute Pancreatitis Associated With Peritoneal Migration of Grass Awn in Two Dogs

2017 ◽  
Vol 67 (4) ◽  
pp. 587-592 ◽  
Author(s):  
Simonetta Citi ◽  
Tommaso Mannucci ◽  
Francesca Pedala’ ◽  
Iacopo Vannozzi ◽  
Massimo Vignoli
Keyword(s):  
Acute Pancreatitis ◽  
Foreign Body ◽  
Clinical Signs ◽  
Blood Analysis ◽  
Full Resolution ◽  
History Of ◽  
Right Lobe ◽  
One Year ◽  
Grass Awn

AbstractA 12 year old male Fox Terrier (case 1) and a one year old female Poodle (case 2) were presented with a history of dysorexia and vomiting, and case 2 also with distress associated with eating. Both dogs were diagnosed with acute pancreatitis based on clinical signs, blood analysis and ultrasonography which revealed the presence of a vegetable foreign body in the proximity of the pancreatic right lobe. Laparatomy enabled the gramineae awns to be removed which led to full resolution of clinical signs. We believe that these are the first reported cases of acute pancreatitis due to grass awns.

scholarly journals Cervical approach for retro-sternal goiter reaching the arch of aorta

2021 ◽  
Author(s):  
Mohamed Tarek Hafez ◽  
Mostafa M. Abdelmaksoud ◽  
Shadi Awny ◽  
Alaa Jamjoom ◽  
Abdullah Mashat ◽  
...  
Keyword(s):  
Total Thyroidectomy ◽  
Medical Center ◽  
Academic Medical Center ◽  
Thyroid Tissue ◽  
Median Sternotomy ◽  
Thoracic Inlet ◽  
Cervical Incision ◽  
Academic Medical ◽  
Retrosternal Goiter ◽  
Cervical Approach

Abstract Background: Although the retrosternal goiters are characterized by the protrusion of at least 50% of the thyroid tissue below the level of the thoracic inlet, their definite definition is still controversial. Total thyroidectomy for retrosternal goiter has a great challenge and mostly requires an experienced thyroid surgeon. Excision could be possible through a cervical incision in most cases, though Sternotomy remains an option. Patients and Methods: We report fourteen patients who presented to our academic medical center between 2016 and 2019 with large thyroid goiters and retrosternal extension proven by computerized tomography scan of the neck, presented in both Mansoura University Oncology Center, Egypt and East Jeddah Hospital, Saudi Arabia from 2016 to 2019. Results: Fourteen cases with retrosternal goiter been undergone total thyroidectomy through a cervical incision without the need for median sternotomy, although the thoracic surgeon was stand-by in three cases. Six patients were found to have a malignancy in the post-operative histopathological assessment.CONCLUSION: Surgical procedures for most all retrosternal goiters can be completed successfully using a cervical approach; however, a sternotomy is required in a small number of such patients.

Rectal carcinoma metastatic to the thyroid gland

1996 ◽  
Vol 110 (2) ◽  
pp. 192-195 ◽  
Author(s):  
Thomas W. Mesko ◽  
Julie Friedman ◽  
Harry Sendzischew ◽  
Daniel D. Nixon
Keyword(s):  
Thyroid Gland ◽  
Rectal Carcinoma ◽  
Secondary Malignancy ◽  
Prior History ◽  
Low Back ◽  
Metastatic Adenocarcinoma ◽  
History Of ◽  
Right Lobe ◽  
The Right ◽  
History Of Cancer

AbstractClinically evident metastases to the thyroid gland are rarely found antemortem. A case of a 59-year-old woman with a history of rectal carcinoma, who presented with low back pain and a mass in the right lobe of her thyroid gland, is presented. The tumour of the thyroid was found to be metastatic adenocarcinoma from her previous rectal cancer. Other synchronous metastases were noted in her lumbar spine and kidneys.The clinical finding of metastases to the thyroid gland is rare, particularly from a colorectal primary. One must consider, however, the possibility of a tumour of the thyroid gland representing a secondary malignancy in any patient with a prior history of cancer.

Abstract 13030: Causes of Cardiovascular and Non-cardiovascular Mortality in the Ischemia Trial

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Mandeep S Sidhu ◽  
Karen P Alexander ◽  
Zhen Huang ◽  
Sean M O’Brien ◽  
Bernard R Chaitman ◽  
...  
Keyword(s):  
Management Strategies ◽  
Multivariable Analysis ◽  
International Study ◽  
Factors Associated ◽  
Clinical Events ◽  
All Cause Mortality ◽  
History Of ◽  
Multivariable Analyses ◽  
Clinical Events Committee

Background: In the ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) trial, all-cause mortality was similar in patients with stable ischemic heart disease (SIHD) randomized to invasive (INV) and conservative (CON) management strategies. This analysis details specific causes of cardiovascular (CV) and non-CV mortality by treatment group. Methods: In ISCHEMIA, 289 deaths occurred after a median follow-up of 3.2 years; 145 (5.6%) in INV and 144 (5.6%) in CON (HR 1.05, CI 0.83-1.32). Deaths were adjudicated by an independent Clinical Events Committee as CV, non-CV with or without a CV contributor or undetermined. The protocol defined CV death as deaths from CV causes, non-CV causes with CV contributor, and cause undetermined; non-CV death was defined as death from non-CV causes without a CV contributor. Multivariable analyses were used to identify factors associated with cause-specific death. Results: CV death was similar between groups [INV 92 (3.6%), CON 111 (4.3%); HR 0.87 (CI 0.66, 1.15)], but INV had more non-CV death [INV 53 (2.0%), CON 33 (1.3%); HR 1.63 (CI 1.06, 2.52)]; fewer undetermined deaths [INV 12 (0.5%) and CON 26 (1.0%); HR 0.48 (0.24, 0.95)] and more malignancy deaths [INV 41 (1.6%), CON 20 (0.8%); HR 2.11 (1.24, 3.61)]. In multivariable analysis, risk factors associated with CV death were age [HR 1.42 (CI 1.19-1.70) per 10-year increase], diabetes [HR 1.39 (CI 1.03-1.87)], history of heart failure [HR 1.96 (CI 1.33-2.91)], and eGFR [HR 1.18 (CI 1.11-1.26) per 5-ml/min decrease below 80ml/min]. Factors associated with non-CV death were age [HR 2.31 (CI 1.75-3.03) per 10-year increase] and randomization to INV [HR 1.76 (CI 1.13-2.75)]. Conclusions: In ISCHEMIA, all-cause mortality was similar for the INV and CON strategies. Excess non-CV deaths in INV with a higher number of deaths from malignancy but a higher number of undetermined deaths in CON requires further evaluation.

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