93,540,890 publications found
Sort by
Exercise induced laryngeal prolapse in elite atheletes – “curable asthma”

Exercise induced laryngeal prolapse closely mimics exercise induced asthma (EIA) and exercise induced vocal cord dysfunction. Patients with exercise induced laryngeal prolapse (EILP) present with dyspnea and chest tightness during exercise. However, these symptoms are due to a subtotal occlusion of the larynx resulting from mucosal edema prolapsing from the aryepiglottic folds into the endolarynx. On visualization with laryngoscopy, abnormal movement of the arytenoid region is visualized. We describe six elite atheletes referred to our center with refractory EIA despite maximal asthma therapy including bronchodilators, inhaled corticosteroids and leukotriene antagonists. Spirometry after exercise with flow-volume loops revealed a truncation of the inspiratory limb and a typical pattern of variable extrathoracic obstruction. Subsequently fiberoptic laryngoscopy during maximal exertion - coinciding with the onset of severe respiratory distress (extreme dyspnea and audible stridor), revealed edema and collapse of the aryepiglottic folds anteriorly over the vocal cords. The prolapsed edemtous tissue partially obscured vision of the vocal cords and resulted in glottic obstruction. EILP is an important differential diagnosis to EIA and exercise induced vocal cord dysfunction. Evaluation of laryngeal motion in patients with refractory EIA is important as surgical correction utilizing laser laryngoplasty can “cure” their condition. This entails removing superfluous supraglottic mucosal tissue in the aryepiglottic folds. Four of the athletes underwent laser laryngoplasty and remain symptom-free. They are again able to perform at “gold medal” levels in their respective sports.

Relevant
Attachment insecurity and attachment disorder

Editor's note Attachment problems can be divided into two broad categories. First, attachment insecurity and disorganization characterize patterns of child/caregiver relationship that represent risk factors for later psychopathology. Second, so-called attachment disorders are categorical disorders of disrupted attachment usually associated with early social deprivation, neglect or maltreatment. These latter include both disinhibited attachment disorder, which reveals itself in indiscriminate sociability, and inhibited attachment disorder. In cases of attachment insecurity, various forms of intervention with parents appear to have effectiveness in increasing parental sensitivity but their impact on attachment per se is less clear cut. These interventions appear to work best when they are relatively brief and specifically target caregiver sensitivity. In more severe cases, especially those involving attachment disorder, interventions may require placement of the children in adoptive homes. ‘Holding therapy’ lacks empirical support and may pose serious risk to children. Introduction Child attachment refers to particular key characteristics of the relationship between child and specific caregiver that are known to be strongly associated with social development and mental health. Research on normative patterns of attachment in infancy find that attachment insecurity (including ‘disorganization’) is a relative psychosocial risk factor for later development and is best conceptualized as a developmental risk variable on Axis V of a multiaxial classification (Green & Goldwyn, 2002). Two less common forms of developmental disturbance associated with severe disruption or absence of early attachment relationships are recognized as Axis 1 clinical disorders in both DSM and ICD systems, although neither has yet received robust empirical validation.

Relevant