scholarly journals Paradoxical movements of the epiglottis: A rare cause of respiratory obstruction and its surgical treatment

2014 ◽  
Vol 67 (7-8) ◽  
pp. 252-254 ◽  
Author(s):  
Karol Canji ◽  
Slobodan Mitrovic ◽  
Vera Beljin
Keyword(s):  
Surgical Treatment ◽  
Argon Plasma ◽  
Vocal Folds ◽  
Subtotal Resection ◽  
Physical Effort ◽  
Everyday Activities ◽  
Breathing Disorders ◽  
Patient Reported ◽  
Plasma Scalpel ◽  
Endotracheal Anesthesia

Introduction. The aim of this paper was to present a rare disorder of epiglottis function as a cause of breathing disorders and a manner of dealing with this problem. Case report. A 59-yearold male patient had breathing disorders in the form of short cessations of breathing two months after a cardiac surgery. He could not tolerate even a slight physical effort. Indirect laryngoscopy and video endoscopy performed with a rigid endoscope indicated paradoxical movements of epiglottis, which closed the entrance to the larynx and caused short cessations of breathing. The patient underwent a subtotal resection of the epiglottis with an argon plasma scalpel. Directoscopy of the larynx was performed under general endotracheal anesthesia. After three weeks, the patient was without any difficulties. The check-up examination after three months showed a small remaining part of the epiglottis. There were no paradoxical movements of the vocal folds; the left vocal fold was shorter, with a loose edge, and the posterior region of the glottis tilted to the left in phonation. The patient reported no breathing disorders three months after the operation. Discussion. Airway obstruction can be reduced significantly by surgical treatment of a soft or hanging epiglottis. Subtotal resection by argon plasma scalpel resulted in termination of breathing disorders in the patient described in this paper, and it enabled him to continue his normal everyday activities. Conclusion. Paradoxical movements of the epiglottis are a rare cause of breathing disorders. Resection of the epiglottis is a method which gives good therapeutic results.

Malignant melanoma of nasal mucosa, ethmoid and frontal sinuses endoscopically resected in the combined transnasal and trans-paralateronasal approach

ORL ro ◽  
2016 ◽  
Vol 3 (1) ◽  
pp. 44-49
Author(s):  
Bogdan Mocanu ◽  
Daniel Mirea ◽  
Silviu Oprescu ◽  
Anca Vișan ◽  
Mihai Tușaliu ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Malignant Melanoma ◽  
Nasal Obstruction ◽  
Nasal Mucosa ◽  
Treatment Plan ◽  
Subtotal Resection ◽  
External Nose ◽  
Frontal Process ◽  
Advanced Stages ◽  
Frontal Sinuses

Introduction. The primitive malignant melanoma of nasal mucosa and paranasal sinus is a rare tumor of uncertain etiology, with unpredictable biologic behavior and bad prognosis. Unlike skin melanomas, there are no risk factors and the disease is frequently manifested in older patients, whose clinical otorhinolaryngology complaints are normally non-specific and ranges from nasal obstruction to rhinorrhea and epistaxis. Unfortunately, this disease is diagnosed basically in advanced stages which makes the surgery difficult. Objective. To report a case of primitive malignant melanoma of nasal mucosa, ethmoid and frontal sinuses, that was diagnosed in 2015. It was performed a subtotal resection in another hospital in 24.08.2015, with a large local reccurence. Report. Our patient was a 78-year-old woman with bilateral nasal obstruction, light epistaxis and unilateral rhinorrhea. The ENT, CT and  MRI exams showed a tumour with important, invasion of the nasal cavity structures (billateral nasal bones, left frontal process of the maxilla, the superior midpoint of the nasal septum, bilateral middle and superior turbinates, left ethmoid and bilateral frontal sinuses). The patient was submited for surgery: total macroscopic resection in the combined endoscopic approach; transnasal and modified lateral rhinotomy with titaniul plates reconstruction of the external nose architecture. Conclusions. Malignant melanomas of nasal mucosa are, in general, diagnosed in advanced stages. Their histological characteristics in the mucosa makes difficult the surgical treatment, which is one of the most efficient options, because they are resistant to chemo and radiotherapy. The early diagnosis and a good surgical treatment plan are the best option for this tumor nowadays.  

scholarly journals Effect of erenumab on functional outcomes in patients with episodic migraine in whom 2–4 preventives were not useful: results from the LIBERTY study

2021 ◽  
pp. jnnp-2020-324396
Author(s):  
Michel Lanteri-Minet ◽  
Peter J Goadsby ◽  
Uwe Reuter ◽  
Shihua Wen ◽  
Peggy Hours-Zesiger ◽  
...  
Keyword(s):  
Functional Outcomes ◽  
Impact Test ◽  
Work Productivity ◽  
Placebo Treatment ◽  
Episodic Migraine ◽  
Activity Impairment ◽  
Everyday Activities ◽  
Point Reduction ◽  
Patient Reported ◽  
Headache Impact

ObjectiveTo evaluate the effect of erenumab on patient-reported, functional outcomes in patients with episodic migraine (EM) in whom 2–4 preventives were not useful from the Phase 3b LIBERTY study.MethodsAs previously reported, 246 patients with EM with 2–4 prior failed preventives were randomised 1:1 to subcutaneous erenumab 140 mg or placebo every 4 weeks for 12 weeks. This analysis evaluated Migraine Physical Function Impact Diary (MPFID), Headache Impact Test (HIT-6) and Work Productivity and Activity Impairment (WPAI) scores at Week 12. P values were nominal without multiplicity adjustment.ResultsErenumab significantly improved MPFID-Physical Impairment (PI) and Everyday Activities (EA) scores versus placebo (treatment difference (TD) (95% CI) MPFID-PI: −3.5 (−5.7 to –1.2) (p=0.003); MPFID-EA: −3.9 (−6.1 to –1.7)) (p<0.001) at 12 weeks. Patients on erenumab were more likely to have a ≥5-point reduction in MPFID score (OR vs placebo (95% CI) MPFID-EA: 2.1 (1.2 to 3.6); MPFID-PI: 2.5 (1.4 to 4.5)). A similar trend was observed for HIT-6 (TD: −3.0; p<0.001); significantly higher proportions of patients on erenumab reported a ≥5-point reduction (OR (95% CI): 2.4 (1.4 to 4.1)). In three out of four WPAI domains, erenumab showed improvement versus placebo.ConclusionAt 12 weeks, erenumab was efficacious on functional outcomes in patients with EM in whom 2–4 preventives were not useful.Trial registration detailsClinicalTrials.gov identifier: NCT03096834.

scholarly journals Reported dyspnea and fatigue using different scales during the physical effort in COPD

2017 ◽  
Vol 30 (2) ◽  
pp. 207-217 ◽  
Author(s):  
Alaís Camargo Corcioli ◽  
Bruna Varanda Pessoa-Santos ◽  
Glaucia Nency Takara ◽  
Valéria Amorim Pires Di Lorenzo ◽  
Mauricio Jamami
Keyword(s):  
Perceived Exertion ◽  
Random Order ◽  
Chronic Obstructive ◽  
Test Results ◽  
Peripheral Oxygen Saturation ◽  
Physical Effort ◽  
Obstructive Pulmonary Disease ◽  
Therapy Choice ◽  
Patient Reported ◽  
Positive Correlations

Abstract Introduction: Therapy choice and its progression for patients with Chronic Obstructive Pulmonary Disease (COPD) should be based on their symptoms and clinical condition according to reports of dyspnea and fatigue. Therefore patient-reported scales have presented a key role during the communication with the patient. Objective: To verify if patients with COPD prefer the Modified Borg Scale (MBS), Visual Analogue Scale (VAS), Glasses Scale (GS), Faces Scale (FS) or Ratings of Perceived Exertion (RPE) during the six-minute walk test(6MWT), and to compare and correlate the scales with each other, with peripheral oxygen saturation (SpO2) and heart rate (HR). Methods: 28 patients with COPD (50% had mild to moderate COPD and 50% had severe to very severe) were evaluated by a respiratory and cognitive assessment. Additionally, they performed the 6MWT, in which the scales were applied simultaneously (random order) and patients reported their preference in the end of the test. Results: 57% of patients were illiterate or presented incomplete primary education and most of them (67%) chose the FS or GS. Significant positive correlations were observed between instruments for both dyspnea and fatigue in the end of the 6MWT, which the strongest was between MBS and FS (r = 0.95). Nevertheless, there was no correlation between the scales and SpO2 and HR. Conclusion: As the majority of patients preferred pictured to numerical scales we suggest their use as a resource for therapeutic evaluation; MBS might be replace by FS, even though they have different scores and not scaled proportionally. However, this change must be carefully considered because there is the risk of dubious interpretation.

Implant density is not related to patient-reported outcome in the surgical treatment of patients with idiopathic scoliosis

2018 ◽  
Vol 100-B (8) ◽  
pp. 1080-1086 ◽  
Author(s):  
A. Charalampidis ◽  
A. Möller ◽  
M-L. Wretling ◽  
T. Brismar ◽  
P. Gerdhem
Keyword(s):  
Surgical Treatment ◽  
Idiopathic Scoliosis ◽  
Patient Reported Outcomes ◽  
Rank Test ◽  
Optimum Number ◽  
Time Of Surgery ◽  
Patient Reported ◽  
Spine Register ◽  
Implant Density

Aims There is little information about the optimum number of implants to be used in the surgical treatment of idiopathic scoliosis. Retrospective analysis of prospectively collected data from the Swedish spine register was undertaken to discover whether more implants per operated vertebra (implant density) leads to a better outcome in the treatment of idiopathic scoliosis. The hypothesis was that implant density is not associated with patient-reported outcomes, the correction of the curve or the rate of reoperation. Patients and Methods A total of 328 patients with idiopathic scoliosis, aged between ten and 20 years at the time of surgery, were identified in the Swedish spine register (Swespine) and had patient reported outcomes including the Scoliosis Research Society 22r instrument (SRS-22r) score, EuroQol 5 dimensions quality of life, 3 level (EQ-5D-3L) score and a Viual Analogue Score (VAS) for back pain, at a mean follow-up of 3.1 years and reoperation data at a mean follow-up of 5.5 years. Implant data and the correction of the curve were assessed from radiographs, preoperatively and a mean of 1.9 years postoperatively. The patients were divided into tertiles based on implant density. Data were analyzed with analysis of variance, logistic regression or log-rank test. Some analyses were adjusted for gender, age at the time of surgery, the flexibility of the major curve and follow-up. Results The mean number of implants per operated vertebra in the low, medium and high-density groups were 1.36 (1.00 to 1.54), 1.65 (1.55 to 1.75) and 1.91 (1.77 to 2.00), respectively. There were no statistically significant differences in the correction of the curve, the SRS-22r total score, EQ-5D-3L index or number of reoperations between the groups (all p > 0.34). In the SRS-22r domains, self-image was marginally higher in the medium implant density group (p = 0.029) and satisfaction marginally higher in the high implant density group (p = 0.034). Conclusion These findings suggest that there is no clear advantage in using a high number of implants per operated vertebra in the surgical treatment of patients with idiopathic scoliosis. Cite this article: Bone Joint J 2018;100-B:1080–6.

A prognostic model for the patient-reported outcome of surgical treatment of carpal tunnel syndrome

2018 ◽  
Vol 58 (6) ◽  
pp. 784-789 ◽  
Author(s):  
Angela Bowman ◽  
Stephan Rudolfer ◽  
Peter Weller ◽  
Jeremy D. P. Bland
Keyword(s):  
Surgical Treatment ◽  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Prognostic Model ◽  
Patient Reported Outcome ◽  
Patient Reported ◽  
Tunnel Syndrome

scholarly journals Patient-reported outcomes after surgical and non-surgical treatment of proximal hamstring avulsions in middle-aged patients

2019 ◽  
Vol 5 (1) ◽  
pp. e000511 ◽  
Author(s):  
Elsa Pihl ◽  
Olof Skoldenberg ◽  
Hans Nasell ◽  
Sven Jonhagen ◽  
Paula Kelly Pettersson ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Treatment Algorithm ◽  
Hamstring Injury ◽  
Middle Aged ◽  
Mri Findings ◽  
Aged Patients ◽  
Patient Reported ◽  
Proximal Hamstring ◽  
Non Surgical Treatment

ObjectivesIn the literature on proximal hamstring avulsions, only two studies report the outcomes of non-surgically treated patients. Our objective was to compare subjective recovery after surgical and non-surgical treatment of proximal hamstring avulsions in a middle-aged cohort.MethodsWe included 47 patients (33 surgically and 14 non-surgically treated) with a mean (SD) age of 51 (±9) years in a retrospective cohort study. Follow-up time mean (SD) of 3.9 (±1.4) years. The outcome variables were the Lower Extremity Functional Scale (LEFS) and questions from the Proximal Hamstring Injury Questionnaire. Outcome variables were adjusted in regression models for gender, age, American Society of Anestesiologits (ASA) classification and MRI findings at diagnosis.ResultsThe baseline characteristics showed no differences except for the MRI result, in which the surgically treated group had a larger proportion of tendons retracted ≥ 2 cm. The mean LEFS score was 74 (SD±12) in the surgically treated cohort and 72 (SD±16) in the non-surgically treated cohort. This was also true after adjusting for confounders. The only difference in outcome at follow-up was the total hours performing physical activity per week, p=0.02; surgically treated patients reported 2.5 hours or more (5.2 vs 2.7).ConclusionThis study on middle-aged patients with proximal hamstring avulsions was unable to identify any difference in patient-reported outcome measures between surgically and non-surgically treated patients. The vast majority of patients treated surgically had complete proximal hamstring avulsions with ≥ 2 cm of retraction. We conclude that to obtain an evidence-based treatment algorithm for proximal hamstring avulsions studies of higher scientific level are needed.

scholarly journals Predictors of Failure After Surgical Treatment of Femoroacetabular Impingement: Results of a Multicenter Prospective Cohort of 621 Hips

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0032
Author(s):  
Jeffrey J. Nepple ◽  
Asheesh Bedi ◽  
Ira Zaltz ◽  
Christopher M. Larson ◽  
Daniel J. Sucato ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Cohort Study ◽  
Surgical Treatment ◽  
Femoroacetabular Impingement ◽  
Revision Surgery ◽  
Patient Reported Outcomes ◽  
Clinical Failure ◽  
Multivariate Logistic Regression ◽  
Multicenter Cohort ◽  
Patient Reported

Objectives: Surgical treatment of femoroacetabular impingement attempts to improve patients’ symptoms through treatment of intra-articular labrochondral pathology and correction of underlying bony deformity. The purpose of the current study was to determine independent predictors of failure after surgical treatment of femoroacetabular impingement in a large prospective multicenter cohort study. Methods: A prospective cohort study of the surgical treatment of FAI was performed. A total of 760 hips undergoing primary surgical treatment of FAI were enrolled across seven surgeons. Patient characteristics, baseline patient reported outcomes (PROs), imaging findings, intraoperative pathology, and surgical treatments were prospectively recorded. A total of 621 hips (81.6%) with minimum one year follow-up were included in the current study (mean 4.3 years). The mHHS was assessed relative to the minimally clinically important difference (MCID, 8 points) and patient acceptable symptom state (PASS, 74 points). Univariate analyses were performed to identify factors significantly associated with failure. Multivariate logistic regression was performed to identify independent predictors of failure. Results: A total of 621 hips undergoing surgical treatment of FAI were assessed at a mean 4.2 years postoperatively. This cohort had a mean age of 29.8 and included 56.8% females. Multivariate logistic regression identified independent predictors of each failure definition. Failure A (THA) was independently associated with increasing age, acetabular microfracture (both p<0.001), and femoral head chondroplasty (p=0.02). Failure B (THA or revision surgery) was independently associated only with lower preoperative mHHS (p<0.001) (p=0.01). A lower failure C (clinical failure) was independently associated with participation in competitive athletics (p=0.01), BMI (p<0.001), and male gender (p<0.001). Conclusion: This large multicenter cohort demonstrates the outcomes of FAI treatment at a mean of 4.3 years postoperative. Rates of THA and revision surgery were 4.0% and 6.9%. An additional 14.8% of patients demonstrates clinical failure based on patient-reported outcomes.

The Past, Present, and Future of Patient-Reported Outcomes in Oncology

2015 ◽  
pp. e616-e620 ◽  
Author(s):  
Laura E. Strong
Keyword(s):  
Patient Reported Outcomes ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Electronic Systems ◽  
Time Commitment ◽  
The Past ◽  
Everyday Activities ◽  
Patient Reported ◽  
Development Technology ◽  
Treatment Research

Patient-reported outcomes capture a unique and important perspective of oncology therapy. Surveys to properly capture patient-reported outcome measures have been under development for more than 2 decades. More recent efforts to understand the clinical significance of patient-reported outcomes, called performance measures, are underway. Patient-reported outcomes can be used in a variety of ways, including therapy decisions for an individual patient, payment for treatment, research into disease progression, or new drug development. Technology has already enabled electronic systems to capture and search patient-reported outcomes and in the future will assist in capturing everyday activities, which, in combination with improved informatics to sort the meaningful and actionable information, will reduce the time commitment for both patients and providers.

scholarly journals Correlation of neural foraminal motion after surgical treatment of cervical radiculopathy with long-term patient reported outcomes

2020 ◽  
Vol 6 (1) ◽  
pp. 18-25
Author(s):  
Yener N. Yeni ◽  
Timothy Baumer ◽  
Daniel Oravec ◽  
Azam Basheer ◽  
Michael J. Bey ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Patient Reported Outcomes ◽  
Cervical Radiculopathy ◽  
Patient Reported
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