Trauma of the Larynx and Cervical Esophagus

2021 ◽  
Author(s):  
David Young ◽  
Andrew Tkaczuk
Keyword(s):  
Quality Of Life ◽  
Caustic Ingestion ◽  
Airway Compromise ◽  
Rare Occurrence ◽  
Upper Aerodigestive Tract ◽  
Initial Management ◽  
Personal Experiences ◽  
Life Threatening

Upper aerodigestive tract trauma is rare occurrence, but can have devastating consequences. Immediate complications including airway compromise can be life threatening and complicate resuscitative efforts. Long-term sequelae can significantly affect a patient’s quality of life by limiting one’s ability to breathe, phonate, and/or swallow. This review provides an overview of upper aerodigestive trauma, where many of these injuries occur concomitantly, but this text is divided into three main categories of: laryngeal framework, upper aerodigestive perforation, and adult caustic ingestion. The initial management of these injuries can be reflexive and mundane, but also are frequently nuanced and challenging, where personal experiences in management of these patients results in mastery.  This review contains 9 figures, 4 tables and 82 references.  Keywords: Laryngeal trauma, laryngeal facture, esophageal perforation, caustic ingestion

scholarly journals Adrenal Insufficiency - Aetiology, Diagnosis and Treatment

2015 ◽  
Vol 3 (1) ◽  
pp. 36-47
Author(s):  
Nazma Akter ◽  
Nazmul Kabir Qureshi
Keyword(s):  
Quality Of Life ◽  
Adrenal Insufficiency ◽  
Presenting Symptoms ◽  
Life Saving ◽  
Life Threatening ◽  
Diagnostic Work ◽  
Work Up ◽  
Term Management

Adrenal insufficiency is caused by either primary adrenal failure or by hypothalamic-pituitary impairment of the corticotropic axis. Adrenal insufficiency, first codified in 1855 by Thomas Addison, remains relevant in 2014 because of its lethal nature. Though, it is a rare disease but is life threatening when overlooked. Main presenting symptoms such as fatigue, anorexia and weight loss are nonspecific, thus diagnosis is often delayed. The diagnostic work-up is well established but some pitfalls remain. The diagnosis is adequately established by the 250 ?g ACTH (adrenocorticotropic hormone) stimulation test in most cases. Glucocorticoids provide life saving treatment but long-term quality of life is impaired, perhaps because therapy is not given in a physiologic way. Dehydroepiandrosterone-replacement therapy has been introduced that could help to restore quality of life. It may be useful in pubertal girls, but not in adults. Monitoring of glucocorticoid-replacement is difficult due to lack of objective methods of assessment and is therefore largely based on clinical grounds. Thus, long-term management of patients with adrenal insufficiency remains a challenge, requiring an experienced specialist. DOI: http://dx.doi.org/10.3329/dmcj.v3i1.22238 Delta Med Col J. Jan 2015; 3(1): 36-47

scholarly journals Considerations for Continuing Semielective and Emergency Otolaryngological Procedures During the COVID-19 Pandemic

2020 ◽  
Vol 100 (1) ◽  
pp. 19-25
Author(s):  
Sarina K. Mueller ◽  
Maximilian Traxdorf ◽  
Konstantinos Mantsopoulos ◽  
Antoniu-Oreste Gostian ◽  
Matti Sievert ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Emergency Surgery ◽  
Transmission Rate ◽  
Medical Personnel ◽  
Human Beings ◽  
Threatening Condition ◽  
Long Time ◽  
Life Threatening

Introduction: During the COVID-19 pandemic, worldwide over 600,000 human beings died due to the cause of the disease. In order to deescalate the transmission rate and to avoid crush loading the countries medical health systems social distancing, face masks, and lockdowns have been considered essential by the majority of governments. Whereas some countries have highly reduced or completely stopped otorhinolaryngological procedures, other countries have continued selected surgeries. The objective of this study was to analyze procedures and outcomes of continuing semielective and emergency surgeries during the COVID-19 pandemic. Methods: Retrospective analysis of n = 750 patients who received semi-elective or emergency surgery between March 26 and June 16, 2020, in the Otolaryngology Department of the Friedrich-Alexander-University of Erlangen-Nürnberg. All patients were screened for COVID symptoms and swabbed for SARS-CoV-2 prior to surgery. Results: Of the n = 750 patients, n = 699 patients received semielective surgery and n = 51 emergency surgery. For 27 patients, the swab result could not be awaited due to a life-threatening condition. In these cases, surgery was performed in full protective equipment. No patient was tested positive during or after the surgery (follow-up 45 to 127 days). No member of the medical personnel showed symptoms or was tested positive after contact with patients. Due to the continuation of surgeries, patients’ lives were saved and improvement of long-term quality-of-life and outcomes is anticipated. Conclusions: Continuing selected otorhinolaryngological surgeries is crucial for patients’ health, survival, and long-time quality of life, yet, the protection of the medical personnel has to be granted.

Principles of palliative care

2018 ◽  
Vol 11 (12) ◽  
pp. 676-679
Author(s):  
Joshua Getty
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Symptom Control ◽  
Management Options ◽  
Initial Management ◽  
Factors Affecting ◽  
Dying Patients ◽  
Life Threatening ◽  
The Individual

Palliative care traditionally focused on symptom-control in dying patients, but has recently evolved to include care of life-threatening or limiting conditions by optimising the benefits of treatment and considering other ways to improve the quality of life for patients. This is achieved through holistic consideration of physical, psychosocial and spiritual factors affecting the individual patient. The aim of this article is to explore these factors and initial management options.

scholarly journals A Case of Intractable Hiccup Treated by Acupuncture and Moxibustion

2021 ◽  
Vol 5 (6) ◽  
pp. 22-24
Author(s):  
Hui Sun ◽  
Yufeng Bi ◽  
Changchun Ji ◽  
Qinlang Liu
Keyword(s):  
Quality Of Life ◽  
Western Medicine ◽  
Treatment Method ◽  
Systemic Diseases ◽  
Curative Effect ◽  
Acupuncture And Moxibustion ◽  
Intractable Hiccup ◽  
Life Threatening

Hiccup is a syndrome characterized by continuous sound in the throat, short and frequent sound, and difficult to stop [1]. Although the disease is not life-threatening, it seriously affects the quality of life of patients. Long term intractable hiccup will also have an impact on the psychology of patients and bring great trouble to patients. Hiccup is equivalent to diaphragmatic spasm in western medicine and involves a variety of systemic diseases [2]. At present, the treatment of this disease includes drugs and nerve block, but the curative effect and prognosis are not ideal. Acupuncture and moxibustion, as a green and simple treatment method, has unique curative effect in the treatment of hiccup. Now the test of one case of intractable hiccup caused by ineffective treatment is as follows.

scholarly journals Global open-label extension: 24-month data of patisiran in patients with hattr amyloidosis

2021 ◽  
Author(s):  
Wilson Marques Jr ◽  
David Adams ◽  
Alejandra González- Duarte ◽  
Elizabeth Mauricio ◽  
Thomas Brannagan ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Disease Progression ◽  
Phase 2 ◽  
Efficacy And Safety ◽  
Open Label ◽  
Phase 3 ◽  
Open Label Extension ◽  
Life Threatening

Introduction: Hereditary transthyretin-mediated (hATTR) amyloidosis is a progressive, life- threatening disease. The efficacy and safety of patisiran has been demonstrated in Phase 3 (APOLLO) and Phase 2 Open-Label Extension (OLE) studies in patients with hATTR amyloidosis with polyneuropathy. Objective: To describe interim 24-month efficacy and safety analyses of the ongoing Global OLE study. Methods: International OLE study (NCT02510261) in eligible patients who completed parent studies, including APOLLO patients randomized to placebo (APOLLO/placebo, n=49) or patisiran (APOLLO/patisiran, n=137) and Phase 2 OLE patients (n=25). Results: As of 10/07/2019, 178/211 patients had 24-month assessments. Safety profile remained consistent with previous studies. After 24 months of additional patisiran treatment in the OLE, durable improvement was seen for mNIS+7 (mean change [SEM]) in APOLLO/patisiran (-4.9 [2.1]) and Phase 2 OLE (-5.9 [2.1]) groups vs. parent study baselines. Norfolk QOL-DN continued to show durable improvement in APOLLO/patisiran patients (-2.4 [2.4]) following additional 24- months treatment. In the Global OLE, APOLLO/placebo patients experienced halting of disease progression and quality of life (QOL) improvement compared to Global OLE baseline after 24 months of patisiran (mNIS+7: +0.1 [3.3], Norfolk QOL-DN: -4.1 [3.3]), although they had progressed relative to APOLLO baseline (mNIS+7: +26.3 [5.0], Norfolk QOL-DN: +15.8 [4.5]) given progression while on placebo in APOLLO. Conclusion: Patients with long-term exposure to patisiran continue to demonstrate durability of efficacy. Despite marked progression on placebo during APOLLO, previously untreated patients continue to exhibit halting of disease progression and QOL improvement following 24 months of patisiran. Patisiran continues to demonstrate a positive benefit:risk profile.

Individual Replacement Therapy (IRT) with a Pasteurized C1-Inhibitor Concentrate Compared to Prophylaxis with Danazol in Patients with Hereditary Angioedema (HAE) - a Prospective Study.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 1028-1028 ◽  
Author(s):  
Wolfhart Kreuz ◽  
Inmarculada Martinez-Saguer ◽  
Emel Aygoeren-Puersuen ◽  
Eva Rusicke ◽  
Thomas Klingebiel
Keyword(s):  
Quality Of Life ◽  
Side Effects ◽  
Replacement Therapy ◽  
Hereditary Angioedema ◽  
Parvovirus B19 ◽  
Laryngeal Edema ◽  
C1 Inhibitor ◽  
Life Threatening

Abstract Attenuated androgens like danazol are the current treatment of choice for long-term prophylaxis in patients with hereditary angioedema (HAE), who may experience life-threatening acute attacks. Unfortunately, this group of drugs bears the risk of severe side effects (e.g. depression, weight gain, hirsutism, transaminase elevations, liver adenoma and carcinoma, headaches, hypertension, menstrual abnormalities). Objectives: We therefore explored the option to administer a pasteurized, plasma-derived C1-Inhibitor concentrate (C1-INH, Berinert®P) for individual replacement therapy (IRT) in patients with HAE in whom danazol induced severe side effects, was not effective or was contraindicated (e.g. children, pregnant women). Methods: Prospective, observational, intra-individual cross over study, comparing efficacy, safety and quality of life of danazol (prophylaxis) vs. C1-INH (IRT) in 23 patients suffering from severe HAE. Results: Mean annual attack frequency decreased from 48.8 ± 37.1 (danazol) to 8.1 ± 22.1 (C1-INH); p<0.001. All patients who received pasteurized C1-INH were free of life threatening attacks (laryngeal edema) or adverse events, which did occur under long-term prophylaxis with danazol (Fig.). In addition, all quality of life parameters improved significantly; p<0.001. During the entire 20-year observation period with C1-INH in all patients there was no transmission of HIV type 1/2, hepatitis A-, B-, C-, G-viruses, or parvovirus B19. Conclusions: Compared to danazol, IRT with pasteurized C1-INH in patients with severe HAE significantly reduces the frequency of HAE attacks, especially of life-threatening attacks, and significantly improves the quality of life.

Thinking Beyond Language: Intervention for Severe Aphasia

2009 ◽  
Vol 19 (1) ◽  
pp. 15-22 ◽  
Author(s):  
Nina Simmons-Mackie
Keyword(s):  
Quality Of Life ◽  
Communication Training ◽  
Language Intervention ◽  
Specific Training ◽  
Environmental Support ◽  
Total Communication ◽  
Communication Partners

Abstract Purpose: This article addresses several intervention approaches that aim to improve life for individuals with severe aphasia. Because severe aphasia significantly compromises language, often for the long term, recommended approaches focus on additional domains that affect quality of life. Treatments are discussed that involve increasing participation in personally relevant life situations, enhancing environmental support for communication and participation, and improving communicative confidence. Methods: Interventions that have been suggested in the aphasia literature as particularly appropriate for people with severe aphasia include training in total communication, training of communication partners, and activity specific training. Conclusion: Several intervention approaches can be implemented to enhance life with severe aphasia.

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