Management of Laryngeal Airway in Reinke's Edema: An Anesthetic Overview

ABSTRACT Reinke's edema (RE) is a benign polypoidal lesion of the vocal folds. The vocal folds show a white and translucent edema, confined into the superficial lamina propria. The lesions usually affect both vocal folds with fusiform appearance and even mobile during phonation. Hoarseness of voice is the most common clinical presentation in RE. Reinke's edema is often associated with smoking habit, gastroesophageal reflux, and voice abuse. It usually occurs in middle-aged male or postmenopausal women who have a long-term history of smoking. We hereby report a case of a large polypoidal RE who presented with ventilation difficulties during general anesthesia using positive pressure mask ventilation. How to cite this article Swain SK, Sahu MC. Management of Laryngeal Airway in Reinke's Edema: An Anesthetic Overview. Int J Otorhinolaryngol Clin 2017;9(1):35-37.

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Reinke's Edema: Phonatory Mechanisms and Management Strategies

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348949710600701 ◽

1997 ◽

Vol 106 (7) ◽

pp. 533-543 ◽

Cited By ~ 68

Author(s):

Steven M. Zeitels ◽

Glenn W. Bunting ◽

Robert E. Hillman ◽

Traci Vaughn

Keyword(s):

Lamina Propria ◽

Fundamental Frequency ◽

Vocal Fold ◽

Management Strategies ◽

Vocal Folds ◽

Vocal Fold Vibration ◽

Reinke’S Edema ◽

Subglottal Pressure ◽

Almost All ◽

Superficial Lamina

Reinke's edema (RE) has been associated typically with smoking and sometimes with vocal abuse, but aspects of the pathophysiology of RE remain unclear. To gain new insights into phonatory mechanisms associated with RE pathophysiology, weused an integrated battery of objective vocal function tests to analyze 20 patients (19 women) who underwent phonomicrosurgical resection. Preoperative stroboscopic examinations demonstrated that the superficial lamina propria is distended primarily on the superior vocal fold surface. Acoustically, these individuals have an abnormally low average speaking fundamental frequency (123 Hz), and they generate abnormally high average subglottal pressures (9.7 cm H20). The presence of elevated aerodynamic driving pressures reflects difficulties in producing vocal fold vibration that are most likely the result of mass loading associated with RE, and possibly vocal hyperfunction. Furthermore, it is hypothesized that in the environment of chronic glottal mucositis secondary to smoking and reflux, the cephalad force on the vocal folds by the subglottal driving pressure contributes to the superior distention of the superficial lamina propria. Surgical reduction of the volume of the superficial lamina propria resulted in a significant elevation in fundamental frequency (154 Hz) and improvement in perturbation measures. In almost all instances, both the clinician and the patient perceived the voice as improved. However, these patients continued to generate elevated subglottal pressure (probably a sign of persistent hyperfunction) that was accompanied by visually observed supraglottal strain despite the normalsized vocal folds. This finding suggests that persistent hyperfunctional vocal behaviors may contribute to postsurgical RE recurrence if therapeutic strategies are not instituted to modify such behavior.

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A Case of Multiple Chemical Sensitivities: Cognitive Therapy for Somatization Disorder and Metaworry

Journal of Cognitive Psychotherapy ◽

10.1891/jcop.17.3.267.52532 ◽

2003 ◽

Vol 17 (3) ◽

pp. 267-277 ◽

Cited By ~ 1

Author(s):

Scott Temple

Keyword(s):

Cognitive Therapy ◽

Unusual Case ◽

Clinical Presentation ◽

Somatization Disorder ◽

Case Conceptualization ◽

Marital Problems ◽

Multiple Chemical Sensitivities ◽

Common Clinical Presentation ◽

History Of ◽

Multiple Chemical

“Multiple chemical sensitivities” has become an increasingly common clinical presentation to physicians, though it is infrequently seen by psychotherapists. This case report describes a 61-year-old woman who presents with a long history of chemical sensitivities, that led to a somatization disorder with debilitating agoraphobia, depression, and marital problems. Features of a variety of anxiety disorders are present, as are metacognitions that required an unusual case conceptualization. A cognitive therapy case conceptualization and treatment are described, which address the highly idiosyncratic clinical presentation of this patient.

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Giant Endometrial Polyp in a Postmenopausal Woman without Hormone/Drug Use and Vaginal Bleeding

Case Reports in Obstetrics and Gynecology ◽

10.1155/2014/518398 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4

Author(s):

Betül Ünal ◽

Selen Doğan ◽

Fatma Şeyda Karaveli ◽

Tayup Şimşek ◽

Gülgün Erdoğan ◽

...

Keyword(s):

Postmenopausal Woman ◽

Drug Use ◽

Vaginal Bleeding ◽

Clinical Presentation ◽

Histopathological Examination ◽

Uterine Cavity ◽

Endometrial Polyp ◽

Lower Back ◽

History Of

The objective of this study is to determine and discuss the causes of a giant endometrial polyp in a postmenopausal woman without hormone/drug use and to submit interesting clinical presentation. Here we report a seventy-year-old female patient who was admitted to our hospital with lower back pain. There were no other complaints from her. Physical examination was normal. For further examination, computed tomography was performed and a heterogeneous mass, with a diameter of 10×9 centimeters, was detected in the uterine cavity. Hysterectomy because of suspected endometrial cancer was performed. Histopathological examination showed us a giant endometrial polyp with edematous and focal fibrotic stroma, large thick walled blood vessels between normal sized and cystically dilated endometrial glands. To the best of our knowledge, this is the first report of a giant endometrial polyp which is unrelated to use of drugs such as tamoxifen and raloxifene; however, based on the history of the patient it may be associated with long-term consumption of thyme, which is a kind of phytoestrogen.

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Placenta previa and its effect on maternal and fetal outcome: retrospective observational study

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20212656 ◽

2021 ◽

Vol 10 (7) ◽

pp. 2720

Author(s):

Durgavathi Kothapalli ◽

Kameswari Kolluru

Keyword(s):

Risk Factor ◽

Clinical Presentation ◽

Placenta Previa ◽

Fetal Outcome ◽

Previous Pregnancy ◽

Multiparous Women ◽

Age Of Diagnosis ◽

Common Clinical Presentation ◽

History Of ◽

Term Labour

Background: Placenta previa is a condition in which placenta get implanted in the lower uterine segment or cervix, which is a major risk factor for postpartum haemorrhage and morbidity and mortality of the mother and neonate used to increase. Based on literature survey we have designed with an objective to study the risk factors for placenta previa and feto-maternal outcome in cases of placenta previa.Methods: Based on selection criteria 100 singleton deliveries with placenta previa that took place in the department of obstetrics from December 2017 to December 2020 were enrolled and there medical records were considered for analysis. From medical record details of patients like age, duration of gestation, parity, clinical presentation, details of current and previous pregnancy, history of warning bleeding and gestational age of diagnosis of placenta previa.Results: Regarding risk factor for placenta previa 48% patients have history of previous LSCS, 22% patients have history of previous abortions. Regarding anti partum complication bleeding PV was present in 24% patients, pre-term labour was present in 46% patients, PIH was present in 10% patients, and abnormal presentation was present in 14 % patients.Conclusions: From our study we can conclude that placenta previa is common in multiparous women in third decade of life and commonly detected at 36 weeks. Bleeding per vagina was most common clinical presentation and LCSC is common risk factor followed by history of previous abortions. Preterm labour was most common ante partum complication and bleeding per vagina comes next to it. Regarding neonatal outcome most of the neonate was normal without complications.

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Clinical and biochemical profile of malaria: retrospective observational study from a tertiary centre

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20182115 ◽

2018 ◽

Vol 5 (3) ◽

pp. 634

Author(s):

Kirankumar Meti ◽

Rajendrakumar Parakh ◽

Kiran Aithal ◽

Hemamalini G.

Keyword(s):

Platelet Count ◽

Total Bilirubin ◽

Clinical Presentation ◽

Febrile Illness ◽

Albumin Level ◽

Chronic Viral Hepatitis ◽

Tertiary Centre ◽

Common Clinical Presentation ◽

History Of ◽

Cirrhosis Of Liver

Background: Malaria is one of the common causes of acute febrile illness in tropical countries. Malaria presents with varied manifestations. This retrospective study carried to know the clinical profile and laboratory abnormalities seen in malaria patients.Methods: The data was collected retrospectively from 1st January to 31st December 2017. Inclusion criteria: all fever cases above 15 years of age of both the sexes diagnosed as malaria by peripheral smear examination and malaria card test. Exclusion criteria: combined malaria with other fevers such as dengue, chikangunya. Fever cases negative for malaria tests. Malaria cases with history of chronic kidney disease, chronic liver disease such as cirrhosis of liver, chronic viral hepatitis, liver abscess, and chronic illness such as rheumatoid arthritis, diabetes, and hypertension. The data regarding the clinical presentation of patients and laboratory values such as hemoglobin, total leukocytecount, platelet count, total bilirubin, SGOT, SGPT, albumin values collected and analyzed with tables and percentage.Results: A total of 57 malaria cases were analyzed, 71.9 % males, 28.1% were females. The commonest age group was between 15- 30 years (61.4%). 29 patients (50.9%) had P. vivax, 20 patients (35.1%) P. falciparum and 8 patients (14%) mixed infection. The most common clinical presentation was fever with chills (100%) followed by vomiting (68.4%), splenomegaly (56.1%), headache (45.6%), pain abdomen (43.9%).19 cases (33.3%) had hemoglobin less than 10gm/dl; 42 cases (73.6%) had thrombocytopenia; 46 cases (80.7%) had urea ≥30mg/dl; 14 cases (24.6%) had creatinine ≥1.4; 26 cases (45.6%) had total bilirubin >1.2mg/dl ; 17 cases (29.8%) had SGOT >45 IU; 33 cases (57.9%) had SGPT > 45 IU and 32 cases (56.1%) had albumin level ≤3.5gm/dl.Conclusions: In the study malaria due to P. vivax was more common than P. falciparum, malaria affected young adults, males more than females. Reduced hemoglobin and platelet count, deranged liver and renal function and reduced serum albumin seen commonly in malaria.

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Clinico- etiological profile of acute poisoning and intoxication in children in western Nepal

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20213723 ◽

2021 ◽

Vol 8 (10) ◽

pp. 1643

Author(s):

Love K. Sah ◽

Munu Mahat ◽

Prince Pareek ◽

Ram P. Pokhrel ◽

Reema Garegrat

Keyword(s):

Clinical Presentation ◽

Signs And Symptoms ◽

Acute Poisoning ◽

Acute Onset ◽

Accidental Poisoning ◽

Emergency Physicians ◽

Medical College ◽

Different Types ◽

Common Clinical Presentation ◽

History Of

Background: Pediatric poisoning is a common emergency. The present study was done to assess the incidence, clinico-etiological profile of acute poisoning and intoxication in children.Methods: This study was conducted in the Department of Pediatrics, Lumbini Medical College and Teaching Hospital, Nepal in which children aged less than 18 years, with history of consumption of poison accompanied or unaccompanied by container or poison or with doubtful history of consumption of poison but with definite signs and symptoms of acute poisoning we included. We also included children with history of bites by poisonous creatures like snakes, scorpions, bees and insects or with doubtful history of bites due to poisonous creatures but with definite acute onset of signs and symptoms locally or systemically.Results: In the present study, during the study duration, 68 children were included. The most common age group of included children was 1 to 5 years (59%). Accidental poisoning was reported in 93% of the cases, while the rest had suicidal poisonings. The most common type of poison used were different types of pesticides (46%). We observed that vomiting was the most common clinical presentation (79%). In our study sample, arrival of 46% of the children was delayed by 30 minutes to 2 hours. Majority of the patients arrived in the afternoon to the hospital (51%).Conclusions: The findings of the present study would enable emergency physicians to identify clinical features of common poisonings among children, which would enable manage the cases better.

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Jaw involvement in Gaucher disease: a not-so-uncommon feature of a rare disease

BMJ Case Reports ◽

10.1136/bcr-2021-244298 ◽

2021 ◽

Vol 14 (11) ◽

pp. e244298

Author(s):

Simona D'Amore ◽

Navdeep Kumar ◽

Uma Ramaswami

Keyword(s):

Gaucher Disease ◽

Clinical Presentation ◽

Age Of Onset ◽

Radiological Features ◽

Bone Marrow Disease ◽

History Of ◽

Severity Of The Disease ◽

Bone Abnormalities

Gaucher disease is an inborn error of metabolism resulting from the deficiency of the enzyme glucocerebrosidase and consequent accumulation of glucocerebroside within the lysosomes of macrophages. The clinical presentation is very diverse, depending on the age of onset and the severity of the disease, and results from the progressive infiltration of lipid-laden cells in various organs. Common manifestations of Gaucher disease include enlarged liver and/or spleen (hepatosplenomegaly), bone marrow disease (pancytopenia) and bone abnormalities, which are extremely variable and can affect multiple skeletal sites. While bone involvement of long bones and vertebrae is a well-recognised feature of Gaucher disease, jawbone involvement is less commonly noted. Here, we describe a case of a 63-year-old patient with type 1 Gaucher disease with a history of long-term use of bisphosphonates and who had presented with dental pain, with subsequent investigations confirming the radiological features of jaw involvement in Gaucher disease, including periodontal disease.

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Atypical Femoral Fracture in McCune-Albright Syndrome

Journal of Research in Orthopedic Science ◽

10.32598/jrosj.7.3.711.1 ◽

2020 ◽

Vol 7 (3) ◽

pp. 147-152

Author(s):

Salman Ghaffari ◽

◽

Mehran Razavipour ◽

Parastoo Mohammad Amini ◽

◽

...

Keyword(s):

Femoral Fracture ◽

Dynamic Compression ◽

Plate Fixation ◽

Medullary Canal ◽

Mccune Albright Syndrome ◽

Café Au Lait Spots ◽

History Of ◽

Albright Syndrome ◽

Mccune Albright

McCune-Albright Syndrome (MAS) is characterized by endocrinopathies, café-au-lait spots, and fibrous dysplasia. Bisphosphonates are the most prescribed treatment for reducing the pain but their long-term use has been associated with atypical fractures of cortical bones like femur in patients. We present a 23-year-old girl diagnosed with MAS. She had an atypical mid-shaft left femoral fracture that happened during simple walking. She also had a history of long-term use of alendronate. Because of the narrow medullary canal, we used 14 holes hybrid locking plate for the lateral aspect of the thigh to fix the fracture and 5 holes dynamic compression plate (instead of the intramedullary nail) in the anterior surface to double fix it, reducing the probability of device failure. With double plate fixation and discontinuation of alendronate, the complete union was achieved five months after surgery

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European Integration

10.3366/edinburgh/9781474455893.001.0001 ◽

2020 ◽

Author(s):

Johann P. Arnason

Keyword(s):

European Integration ◽

Eastern European ◽

The European Union ◽

Historical Processes ◽

History Of ◽

External Conditions ◽

Eastern European Countries ◽

Totalitarian Regimes ◽

The Eu

Different understandings of European integration, its background and present problems are represented in this book, but they share an emphasis on historical processes, geopolitical dynamics and regional diversity. The introduction surveys approaches to the question of European continuities and discontinuities, before going on to an overview of chapters. The following three contributions deal with long-term perspectives, including the question of Europe as a civilisational entity, the civilisational crisis of the twentieth century, marked by wars and totalitarian regimes, and a comparison of the European Union with the Habsburg Empire, with particular emphasis on similar crisis symptoms. The next three chapters discuss various aspects and contexts of the present crisis. Reflections on the Brexit controversy throw light on a longer history of intra-Union rivalry, enduring disputes and changing external conditions. An analysis of efforts to strengthen the EU’s legal and constitutional framework, and of resistances to them, highlights the unfinished agenda of integration. A closer look at the much-disputed Islamic presence in Europe suggests that an interdependent radicalization of Islamism and the European extreme right is a major factor in current political developments. Three concluding chapters adopt specific regional perspectives. Central and Eastern European countries, especially Poland, are following a path that leads to conflicts with dominant orientations of the EU, but this also raises questions about Europe’s future. The record of Scandinavian policies in relation to Europe exemplifies more general problems faced by peripheral regions. Finally, growing dissonances and divergences within the EU may strengthen the case for Eurasian perspectives.

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