Laryngeal Edema Research Articles

Analysis of morphological characteristics of laryngeal tuberculosis based on electronic laryngoscopy and image-enhanced endoscopy

Objective: To explore and summarize the morphological features of laryngeal tuberculosis under electronic laryngoscopy and image-enhanced endoscopy (i-scan). Methods: A retrospective analysis was conducted on the data of 31 patients diagnosed with laryngeal tuberculosis at the Second Affiliated Hospital of Zhejiang University School of Medicine from January 2014 to June 2024, encompassing the morphological features of electronic laryngoscopy and i-scan endoscopy, histopathological features, and supplementary clinical examination results. Descriptive statistical methods were employed for the analysis. Results: Thirty-one patients were diagnosed with laryngeal tuberculosis, including 25 males and 6 females, aged from 21 to 84 years old, with an average age of 57 years old, and the disease course was from 1 to 12 months with an average of 3 months. The clinical symptoms included hoarseness in 27 cases, foreign body sensation in the pharynx in 2 cases, and sore throat in 2 cases. Twenty-six cases involved a single site, including 24 cases of the vocal cords, 1 case of the ventricular bands, and 1 case of the epiglottis; 5 cases involved multiple sites, including 2 cases of the vocal cords and the interarytenoid area, 2 cases of the aryepiglottic fold and the epiglottis, and 1 case of the aryepiglottic fold, the ventricular bands and the epiglottis. Eighteen patients showed a single morphology type under electronic laryngoscopy, including 4 cases of the edematous exudative type, 5 cases of the ulcerative type, and 9 cases of the granulation hyperplasia type. Edema, ulcer, and granulation hyperplasia can coexist and transit between each other. A total of 13 cases presented with two or more morphological types, with the edematous exudative type, the ulcerative type, and the granulation hyperplasia type occurred 7, 9, and 10 times respectively. Twenty-two patients had active or chronic pulmonary tuberculosis, while 9 patients had normal lung imaging. The laryngeal tissue biopsy pathology of 21 patients was chronic granuloma, and 10 patients were chronic granuloma with caseous necrosis; among them, 19 cases completed the Ziel-Neelsen staining (7 cases were positive for acid-fast bacilli), and 3 cases completed the polymerase chain reaction (PCR) (All were positive). Twenty cases completed the T-cell assay for tuberculosis infection (19 cases were positive), 15 cases completed the sputum smear (6 cases were positive), 18 cases were tested for antinuclear antibody (6 cases were positive), and 14 cases completed the erythrocyte sedimentation rate (4 cases were positive). Six patients underwent i-scan examination. In cases of ulcerative laryngeal tuberculosis without granulation hyperplasia in the surrounding tissues, i-scan revealed an abundance of abundant slightly thickened and tortuous oblique and dendritic blood vessels around the ulcer. If the pseudomembrane in the deep ulcer was thick, the blood vessel shadow was not visible. In shallow ulcers, there were areas of deep congestion and scattered dot-shaped blood vessel shadowst with uneven distribution; in cases of laryngeal tuberculosis with coexistence of the edematous exudative type and the granuloma type, i-scan visualized laryngeal cord edema with white exudates on the surface. Beneath the laryngeal cord exudates, there were scattered dot-shaped and irregularly distorted linear blood vessel shadows with uneven distribution, and tortuous, oblique, and dendritic blood vessels were observed around the lesion. In granuloma-type laryngeal tuberculosis, i-scan demonstrated that the area of granulation hyperplasia around the ulcer focus was significantly congested, characterized by scattered thick dot-shaped blood vessel shadows and irregularly distorted linear blood vessel shadows. Conclusions: Laryngeal tuberculosis presents as the edematous exudative type, the ulcerative type, and the granulation hyperplasia type under electronic laryngoscopy, and these types can coexist and interact. i-scan endoscopy can reveal detailed microvascular morphology and other subtle morphological characteristics. The identification and summary of these morphological characteristics are beneficial for the early detection and diagnosis of laryngeal tuberculosis.

Hereditary angioedema in children: Review and practical perspective for clinical management.

Hereditary angioedema (HAE) in children has specific features and requires multidisciplinary management. We performed a literature search and underwent in-depth discussions to provide practical tools for physicians. HAE is a rare, life-threatening genetic disorder. Its epidemiology is poorly documented in children. Clinical manifestations usually appear during childhood or early adolescence. Classical signs, often preceded by prodromal symptoms, include transient, localized, non-pitting, non-pruritic swelling of deep dermal/subcutaneous or mucosal/submucosal tissues, leading to oedema of the extremities, face, lips, tongue, trunk and genitals, recurring gastrointestinal symptoms and laryngeal edema possibly causing asphyxiation and death. Diagnosis is often delayed due to low awareness in the medical community, and particularly challenging in case of isolated abdominal crises or atypical presentation and in neonates or infants. It relies on biological tests (measurement of serum/plasma levels of C1INH function, C1INH protein, and C4), genetic testing in selected cases, and imaging for differential diagnosis of acute abdominal crises. Main differential diagnosis for peripheral oedema is mast cell-mediated oedema that accounts for 95% of angioedema in clinical practice. Quality of life can be significantly impaired. Disease management includes treatment of attacks, short-term and long-term prophylaxis, psychological support, avoidance of triggers, patients' and parents' education and coordination of all stakeholders, ideally within a specialized healthcare network. New plasma kallikrein inhibitors, namely lanadelumab (subcutaneous route) and berotralstat (oral route) have facilitated long-term prophylaxis thanks to improved usability. Diagnostic and treatment of HAE are particularly challenging in children and require specific management by multiple stakeholders.

Radiotherapy with cetuximab or durvalumab for locoregionally advanced head and neck cancer in patients with a contraindication to cisplatin (NRG-HN004): an open-label, multicentre, parallel-group, randomised, phase 2/3 trial

Management of patients with locoregionally advanced head and neck squamous cell carcinoma (HNSCC) when cisplatin is contraindicated is controversial. We aimed to assess whether radiotherapy with concurrent and adjuvant durvalumab would improve outcomes compared with radiotherapy with cetuximab. NRG-HN004 was designed as an open-label, multicentre, parallel-group, randomised, phase 2/3 trial with safety lead-in conducted at 89 academic and community medical centres in North America. Eligible patients were aged 18 years or older with American Joint Committee on Cancer 8th edition stage III-IVB p16-negative HNSCC or unfavourable stage I-III p16-positive oropharyngeal or unknown primary carcinoma, who had a contraindication to cisplatin (Eastern Cooperative Oncology Group [ECOG] performance status 2, renal or hearing impairment, peripheral neuropathy, aged at least 70 years with moderate or severe comorbidity, or aged younger than 70 years with severe comorbidity). Patients were randomly assigned (2:1) by permuted block randomisation (multiples of 6) to intravenous durvalumab 1500 mg starting 2 weeks before radiotherapy then every 4 weeks starting week 2 of radiotherapy (seven cycles) or intravenous cetuximab 400 mg/m2 1 week before radiotherapy then 250 mg/m2 weekly beginning week 1 of radiotherapy (eight cycles), with intensity-modulated radiotherapy (70 Gy in 35 fractions over 7 weeks). Stratification factors were tumour and nodal stage, ECOG performance status and comorbidity, and primary site and p16 status. The phase 2 primary endpoint was progression-free survival in the intention-to-treat population. There was one prespecified interim futility analysis at 50% of progression-free survival information. If the observed hazard ratio was 1·0 or more, favouring cetuximab, early stopping would be considered. Extended follow-up analysis was post hoc. This trial is registered with ClinicalTrials.gov, NCT03258554, and is closed to enrolment. Following a ten-patient safety lead-in, the phase 2 trial enrolled 190 patients from March 12, 2019, to July 30, 2021, 186 of whom were randomly assigned (123 to durvalumab and 63 to cetuximab). Median age was 72 years (IQR 64-77), 30 (16%) patients were women and 156 (84%) were men. Phase 2 accrual was suspended in July 30, 2021, following an interim futility analysis, and permanently closed in Sept 1, 2022. The phase 3 part of the trial was not conducted. At a median follow-up of 2·3 years (IQR 1·9-3·1) for the extended follow-up (data cutoff July 31, 2023; post-hoc analysis), 2-year progression-free survival was 50·6% (95% CI 41·5-59·8) in the durvalumab group versus 63·7% (51·3-76·1) in the cetuximab group (hazard ratio 1·33 [95% CI 0·84-2·12]; p=0·89). Adverse events were similar in both groups. The most common grade 3-4 adverse events were dysphagia (26 [22%] of 119 patients in the durvalumab group vs 18 [30%] of 61 patients in the cetuximab group), lymphopenia (33 [28%] vs 20 [33%]), and oral mucositis (13 [11%] vs 11 [18%]). Four (3%) patients in the durvalumab group and one (2%) in the cetuximab group died from treatment-related adverse events (death not otherwise specified, laryngeal oedema, lung infection, and respiratory failure in the durvalumab group and sudden death not otherwise specified in the cetuximab group). Our findings suggest that durvalumab did not improve outcomes compared with cetuximab in patients with HNSCC with contraindications to cisplatin. Further trials are needed to define the standard of care for this population. US National Cancer Institute and AstraZeneca.

Initial Proof-of-Concept Study on Immediate Effects of External Advanced Pneumatic Compression on Pharyngeal and Laryngeal Internal Lymphedema Using a Fluoroscopic Measurement Tool.

External and internal head and neck cancer related lymphedema (HNCRL) is a common consequence of radiation treatment (RT). Currently, internal HNCRL can be clinically assessed endoscopically using a visuoperceptual, ordinal rating scale. Use of fluoroscopy to identify and measure internal HNCRL has been explored but is not widely used in clinical practice. Advanced Pneumatic Compression (APC) has shown external HNCRL reduction after a single treatment, whereas internal HNCRL reduction has not yet been assessed. Fluoroscopic lateral scouts and TIMS Review software (TIMS Medical) were used to assess immediate internal HNCRL measures of 30 HNC patients with RT history following a single APC treatment. Pre and post external measures were also obtained. Paired t-test was used to assess changes in pre and post measures. A post-treatment survey was completed. All 30 patients had both immediate external and internal HNCRL reductions, and all reductions were statistically significant. All reported positive benefit. A single, external APC treatment immediately impacted the extent of pharyngeal and laryngeal edema in post-radiated HNC survivors. Fluoroscopy can be a clinically useful and complementary modality to detect, surveil, and measure internal HNCRL.

A Study of Causes and Clinicopathological Changes of Patients Presented with Hoarseness of Voice in the ENT Department of Hilla Teaching General Hospital, Babylon, Iraq

Abstract Background: Hoarseness of voice (HOV) is defined as abnormal changes in the quality of voice. It may be caused by many diseases related to the upper aerodigestive tract system. Proper knowledge about the causes and clinicopathological changes leading to HOV is very important for the early detection and treatment of the causative pathology. Objective: To investigate the causes, incidence, age, occupation, and sex predilection for HOV. Materials and Methods: This prospective study was carried out on 200 patients referred to the Eyes, Nose, and Throat (ENT) Department of Hilla Teaching General Hospital, Babylon, Iraq, from September 2017 to September 2019 complaining of HOV for more than 10 days. The ENT examination was conducted using a fiberoptic flexible laryngoscope. Radiological examination by plain X-ray of the neck and chest, computed tomography scans of the head, neck, and chest, and a direct laryngoscopy exam. Under general anesthesia, and biopsy is taken from suspected pathology (if needed). Results: Out of 200 patients, the age group between 31 and 40 years was most commonly seen. Laborers occupation 30% farmers 35% were the major groups affected. Smoking habits were found in 40% of patients with HOV. The most common causes of HOV were acute and chronic laryngitis, including acute viral laryngitis, acute voice abuse, laryngeal trauma after thyroid surgery, vocal cord (VC) nodules, laryngeal polyps, and laryngeal edema. The second most frequent causes are neoplastic growths in the larynx (mostly supraglottic) and hypopharynx. The least frequent causes of HOV are seen due to congenital pathologies such as laryngomalacia and congenital VC palsy. Conclusion: Proper and detailed history, good ENT examination, and the investigation of patients with HOV are important factors in the early detection and treatment of causative pathology.

Eleven cases of laryngeal edema after tisagenlecleucel infusion: a 3-year single center retrospective study of CD19-directed chimeric antigen receptor T-cell therapy for relapsed and refractory B-cell lymphomas.

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Development of postoperative laryngeal edema in patients undergoing craniotomy for elective intracranial tumor excision: A prospective, observational, preliminary study

BackgroundIntracranial tumor surgeries require different head and surgical positions as well as large fluid administration, which can cause laryngeal edema (LE) and increased morbidity. But there are no studies regarding its incidence in this patient population. As these patients often receive steroids for reducing peri-tumoral edema, which can also reduce LE, we hypothesized that incidence of LE in patients undergoing intracranial tumor resection in various positions might not be high. Thus, this prospective, observational study aimed to find LE incidence, as assessed by cuff leak test (CLT) in these patients. MethodsAmerican Society of Anesthesiologists- Physical Status I/II, patients (18–60 yrs) undergoing elective intracranial tumor resection were included after atraumatic tracheal intubation under standard general anesthetic technique. Cuff leak volume (CLV) was measured in supine position before start of surgery (CLVb) and completion (CLVc) of surgery. CLV <110 ml was considered to indicate LE. Important parameters were noted and patients were followed till discharge from the hospital. ResultsSeventy-three patients with male preponderance (58.9 %) participated in study. Number of patients operated in supine, lateral, prone and sitting positions were 34, 16, 14 and 09, respectively. CLV decreased significantly in lateral and supine positions (p <0.01). Only, 02(2.74 %) patients had CLVc <110 ml; both were male patients operated in supine position with head rotation. Anesthetic duration and intraoperative fluid administration were comparable across surgical positions. No postextubation stridor was seen in any patient. ConclusionWe found that optimal intraoperative care of patients undergoing excision of intracranial tumors resulted in a low postoperative LE incidence (2.74 %) as detected by CLT at completion of surgery. However larger studies are required to further elaborate this issue.

7502 Patient Suffering from Laryngeal Edema in the Setting of Hypothyroidism

7502 Patient Suffering from Laryngeal Edema in the Setting of Hypothyroidism

Assessment of emergency physicians’ awareness and knowledge of hereditary angioedema

Aims: Hereditary angioedema can occur with life-threatening attacks of severe laryngeal edema, and epinephrine is insufficient in the treatment of attacks. We sought an answer to the question, 'Do emergency physicians, who frequently encounter angioedema cases that are so important for the emergency department, have sufficient awareness about this issue?' Methods: In this study, the online questionnaire was conducted among physicians working in adult emergency departments between April and August 2022. The questionnaire form consisted of two parts. The first part contained three questions about medical experience, academic degree, and encounter with hereditary angioedema patients. The second part of the questionnaire contained seven questions about the diagnosis and treatment of hereditary angioedema. Results: A total of 103 physicians working in emergency departments participated in the survey. The proportion of physicians is as follows: The percentage of physicians with less than 15 years of experience was 92.2%. Research assistants represented the largest group of participants at 51.5%. When asked "What is not a symptom of hereditary angioedema?" Only 40.6% of physicians could answer the question correctly. While 39.8% of physicians thougt that epinephrine and antihistamines were useful in treating these attacks, 53.4% felt that epinephrine and antihistamines were not. While there was a difference in hereditary angioedema awareness between the group with more than 15 years of professional experience and the group with less experience, there was no meaningful difference between research assistants, specialists, and academicians. According to this survey, professional experience was important, but academic title did not make a difference in terms of disease awareness. Conclusion: It is necessary to increase the awareness of emergency physicians about hereditary angioedema, which can cause fatal attacks and whose diagnosis and treatment are different from other angioedemas.

Clinical profile and management of pediatric hereditary angioedema in resource-constrained settings: our experience from a single centre in North India.

Hereditary angioedema (HAE) is a rare genetic disorder. The pattern of HAE is different in children as compared to adults. There is limited literature from developing countries where all first-line treatments are either unavailable or not easily accessible.Data of children with HAE were retrieved from medical records of patients registered in the Pediatric Immunodeficiency Clinic at our institute.Of the 206 patients with HAE, 61 were diagnosed before the age of 18years. Male: female ratio was 1.1:1. Median age at onset of symptoms and diagnosis were 6.2years (range 1-17years) and 10.7years (range 1.5-18years) respectively. Median delay in diagnosis was 4.9years (range 0-16years). The commonest presentation was facial swelling (51/61) followed by swelling of extremities (47/61). Laryngeal edema and abdominal symptoms were reported in 28/61 and 31/61 patients respectively. Abdominal attacks were found to be less common in children as compared to adults. Most patients in our cohort received fresh-frozen plasma (n = 5/61) as on-demand therapy. Long-term prophylaxis included attenuated androgens (n = 25/61) and tranexamic acid (n = 23/61). Median duration of follow-up was 2242 patient months. One patient died on follow-up in this cohort.This is the largest single-centre cohort of pediatric HAE from resource-constrained settings. Facial attacks were more common, and there were significant delays in diagnosis when the age of onset of symptoms was younger. Gastrointestinal symptoms were less common in children than adults. HIGHLIGHTS: One of the largest single-centre cohorts of pediatric HAE and the only one from resource-constrained settings. There were significant delays in diagnosis when the age of onset of symptoms was younger. Abdominal attacks were found to be less common in children as compared to adults.

Comparative analyses of short- and long-term outcomes between endoscopic submucosal dissection and endoscopic laryngo-pharyngeal surgery for superficial pharyngeal carcinomas.

Endoscopic treatment of superficial pharyngeal carcinomas includes endoscopic submucosal dissection (ESD; usually performed by endoscopists), and endoscopic laryngo-pharyngeal surgery (ELPS; primarily performed by otolaryngologists). Few studies have compared the efficacy of the two techniques in treating superficial pharyngeal carcinomas. In this study, we compared the outcomes of these two techniques to determine the advantages. We retrospectively examined the short- and long-term outcomes of 93 consecutive patients with superficial pharyngeal carcinoma who either underwent an ESD or ELPS between August 2008 and December 2021. There were 35 lesions among 29 patients and 93 lesions among 71 patients in the ESD and ELPS groups, respectively. The ELPS group had a significantly shorter procedure time (121.2 ± 97.4 min vs. 54.7 ± 40.2 min, p<0.01), greater procedure speed (0.10 ± 0.06 min/min vs. 0.30 ± 0.23 min/min, p<0.01), and less laryngeal edema than that of the ESD group. There were no significant differences in the 3-year overall, relapse-free, or disease-specific survival rates between the two groups. Intervention with ESD during ELPS was most commonly required when it was difficult to secure the visual field. There were no differences in batch resection rates or long-term prognoses between the two groups; nevertheless, the ELPS group had a shorter treatment time and less laryngeal edema than the ESD group. However, the treatment of narrow areas, such as the esophageal inlet patch, is a technical limitation of ELPS; thus, ELPS should be combined with ESD techniques.

Clinical Observation of Zero-P System Interbody Fusion Combined with Traditional Chinese Medicine-Directed Drug Delivery Technology for Treating Cervical Spondylotic Myelopathy

Objective: To investigate the clinical efficacy of the Zero-profile fusion cage (Zero-P) combined with Traditional Chinese Medicine-directed drug delivery technique in the treatment of cervical spondylotic myelopathy, and to assess its impact on potential postoperative complications. Methods: 13 patients with cervical spondylotic myelopathy were selected from January 2022 to October 2023. The intraoperative bleeding volume, operation duration, and hospitalization days were recorded, the incidence and improvement of postoperative complications were observed, and the pain index and cervical function index were analyzed, including Visual Analogue Scale (VAS) score, Japanese Orthopedic Association (JOA) score, Neck Disability Index (NDI) index, etc. Results: The operation duration of patients was 65–110 (81.92 ± 13.47) min; mean intraoperative blood loss was 12.30 ± 7.80 ml, and mean postoperative hospital days were 9.62 ± 3.52 days. All patients in this group were followed up over 3 months after surgery, and the study found that the VAS, JOA, and NDI scores improved significantly compared with the preoperative difference (P &lt; 0.01); and the VAS, JOA, and NDI scores 1 month postoperative improved significantly compared with 1 week postoperative (P &lt; 0.01). In addition, the incidence of postoperative complications of the Zero-P system was low, with no incision infection, implant rejection, fracture, displacement, cerebrospinal fluid leakage, recurrent laryngeal nerve injury, and laryngeal edema; one patient had mild dysphagia (7.69%) and nine patients had throat dryness and discomfort (69.23%), which completely disappeared after 1 week of TCM-directed drug treatment and symptomatic treatment. Conclusion: Zero-P system interbody fusion has a significant effect on cervical spondylotic myelopathy, with a low incidence of postoperative complications and fast improvement speed, which can effectively enhance the impact of surgery on cervical spondylotic myelopathy patients, thus it is worthy of application and promotion.

Utilizing ultrasonography to determine the minimal transverse diameter of the subglottic airway for informed selection of reinforced cuffed endotracheal tube models in children.

We explored the use of ultrasonography in determining the minimal transverse diameter of the subglottic airway (MTDSA) for the purpose of choosing an appropriate model of reinforced cuffed endotracheal tube. A total of 110 pediatric patients who received general anesthesia and tracheal intubation for selective surgeries at the hospital from February 2019 to February 2022 were chosen. They were then randomly assigned to three groups: 39 in the MTDSA group, 35 in the age formula group, and 36 in the height formula group. We assessed how accurately the appropriate endotracheal tube model was predicted in each group and compared their predictive performance. The age range of the enrolled pediatric patients was 3-6 years old. The ultrasonic measurement method demonstrated a prediction accuracy of 87.18%, while the age formula method and height formula method exhibited lower accuracy rates of 54.29% and 47.22%, respectively. Notably, the ultrasonic measurement method outperformed the other two methods significantly (P < 0.05). In the MTDSA group, 2 patients had their catheters changed during anesthesia, and the proportion of patients who changed their catheters was 5.13%. In the MTDSA group, 6 catheters were replaced, and the frequency of catheter replacement was 15.38%. In contrast, these percentages were much higher in the age formula group, at 31.43% and 45.71%, and in the height formula group, at 36.11% and 52.78%. The latter two groups had significantly higher values than the MTDSA group (P < 0.05). Regarding complications such as hoarseness, laryngeal edema, aspiration, and laryngospasm, the MTDSA group experienced a notably lower total incidence of 7.69% compared to the 37.14% in the age formula group and 41.67% in the height formula group, demonstrating statistical significance (P < 0.05). The ultrasonic measurement technique employed in MTDSA exhibits impressive precision when it comes to forecasting the specific model of a reinforced cuffed endotracheal tube for pediatric patients. This enhanced accuracy contributes significantly to minimizing the need for tube replacements during anesthesia and the associated complications. It holds immense importance in assisting clinicians in selecting the most appropriate pediatric endotracheal tube model for anesthesia induction.

Airway Issues in Management of Severe Cut-Throat Injuries

&amp;lt;i&amp;gt;Introduction:&amp;lt;/i&amp;gt; Open or incised anterior neck injuries inflicted by sharp implements may be described as Cut-throat injuries (CTIs). The managing team is immediately confronted with airway management options, therefore, a close collaboration between the surgeon and the anesthetist is required to adopt a strategy that will guarantee a safe airway and ensure a successful outcome. In this article, we discuss the factors that led us to perform tracheostomy before repair while avoiding a rule of tracheostomy for all. &amp;lt;i&amp;gt;Method:&amp;lt;/i&amp;gt; A prospective study was conducted at Federal Medical Centre, Gusau, between January 2019 -August 2023. Nine (9) patients presented with zone II cut-throat injuries and the choice of airway management was discussed between the surgeon and the anesthetist focused on symptoms of air obstruction and findings within the larynx that could lead to airway obstruction once repair was done. &amp;lt;i&amp;gt;Result:&amp;lt;/i&amp;gt; There were nine patients (9) with the age range of 18-60 years. Tracheostomy rate was 55.6% (n=5). There is a positive correlation (+1) between tracheostomy and laryngeal edema. A subset of patients, 22.2% (n=2) was selected for repair without a tracheostomy. &amp;lt;i&amp;gt;Conclusion:&amp;lt;/i&amp;gt; The choice of perfect airway management should result from constructive collaboration between the surgeon and the anesthetist. Tracheostomy should be considered in patients with asymptomatic laryngeal edema.

Access to medications in pediatric patient with hereditary angioedema: the role of the pharmacist

A request for icatibant 30 mg/3ml, a high-cost drug, was made to the pharmacy at the Hospital in San Francisco (Córdoba, Argentina). This medication was not available at the institution (off-formulary), and its active ingredient is only marketed by two laboratories in the country. The cost ranges between 3,500 and 4,500 USD per ampoule, depending on the brand. The medication was requested for a 9-year-old female pediatric patient diagnosed with hereditary angioedema, confirmed by laboratory tests, and prescribed a dose of 15 mg via the subcutaneous route. It was indicated for treating acute episodes, such as facial and/or laryngeal edema, and for administration prior to surgery, such as a dental extraction. The cost of the medication was unaffordable for a family without private health insurance. Additionally, the family lived far from the health center, so it was requested that at least two doses be made available for her. This case highlights the significant challenges in accessing high-cost, life-saving medications for a young patient with hereditary angioedema in a low-resource setting. The situation emphasizes the critical role of pharmacists in navigating these challenges to ensure that patients receive the necessary treatment despite financial and logistical barriers. The pharmacist plays a pivotal role in overcoming these difficulties by addressing the five dimensions of access to medication: availability, affordability, accessibility, acceptability, and quality. In this case, the pharmacist's role extends far beyond dispensing medications. It involves active participation in the management of rare and complex conditions, advocating for patient access to necessary treatments, and ensuring that the care provided is both effective and sustainable.

Prevalence and risk factors of postoperative laryngeal edema in patients undergoing neck dissection.

Postoperative laryngeal edema (PLE) is a common complication in patients undergoing head and neck surgery, leading to symptoms such as odynophagia, dysphagia, or potential airway obstruction. However, the prevalence and risk factors of PLE in patients undergoing neck dissection (ND) have not been well investigated. A retrospective analysis was conducted in three steps. Initially, a pilot study of 50 consecutive ND patients revealed a preliminary PLE prevalence of 0.34. Then, the medical records of an additional 295 ND patients were reviewed to estimate the prevalence of PLE with a total width of 95% confidence interval (CI) of ± 5%. Finally, multivariable logistic regression analyses were performed to identify risk factors for PLE (n = 343). PLE occurred in 29.4% [95%CI 24.4-34.4%] of patients undergoing any type of ND, with the most common symptoms of odynophagia (75.0%) and dyspnea (11.1%). Hospital stay was just one day longer in PLE patients, responding well with short-term steroid treatment (p=0.0057). In multivariable analyses, no significant association was found between PLE occurrence and airway management. However, body mass index and the American Society of Anesthesiologists classification correlated with PLE. More importantly, surgery for oro-hypopharynx or supraglottis tumors (odds ratio, OR = 3.019, [95%CI 1.166-7.815]) and lymph node level 2(3) ND (OR = 4.214 to 5.279, [95%CI 1.160-20.529]) were significant risk factors for PLE. PLE developed in approximately 30% of ND patients, causing uncomfortable symptoms. Early diagnosis and intervention of PLE in high-risk patients can improve patient care and outcomes.

Dislodgement and aspiration of a tooth during endotracheal intubation in a cat

AbstractA 25‐week‐old Oriental shorthair cat was anaesthetised to perform computed tomography and bronchoscopy. During endotracheal intubation, a deciduous premolar was contacted with the laryngoscope blade, dislodged, and subsequently aspirated into the trachea. The tooth was removed via bronchoscopy, and the cat was recovered in the intensive care unit due to the development of laryngeal oedema. The risk factors for tooth dislodgement in the cat and proposed improvements in the immediate period after dislodgement are discussed in this report.

Necrotizing Laryngitis in Patients with Hematologic Disease: The First Case-Report Due to PDR Acinetobacter baumannii and Literature Review.

Immunocompromised patients with hematologic diseases may experience life-threatening infections with rather uncommon manifestations. Laryngitis has been described as a potential infection in such vulnerable patients and may result in major complications, ranging from impending airway obstruction to total laryngeal necrosis. Immediate laryngoscopy is of paramount importance, as it provides quantification of laryngeal edema and evidence of necrosis. Documentation of the causative pathogen is usually feasible through tissue culture. In the literature, 14 cases of necrotizing laryngitis have already been published. Here, we present the case of a 38-year-old male with a recent diagnosis of multiple myeloma, who received the first cycle of therapy a few days before admission. The patient presented with neutropenic fever, diarrhea, and multiple organ dysfunction. His course was complicated with hemophagocytic lymphohistiocytosis and stridor. A diagnosis of necrotizing laryngitis attributed to Acinetobacter baumannii invasion of the larynx was established. This manuscript highlights that the management of patients with hematologic disease and necrotizing laryngitis should be coordinated in highly specialized centers and clinicians should have a high level of clinical suspicion and act promptly.

Boron neutron capture therapy as a larynx-preserving treatment for locally recurrent laryngeal carcinoma after conventional radiation therapy: A preliminary report

ObjectiveLaryngeal preservation and a radical cure are the treatment goals for laryngeal carcinoma, and larynx-preserving therapy is generally preferred for early-stage laryngeal carcinoma. When laryngeal carcinoma recurs locally, patients are often forced to undergo total laryngectomy, resulting in loss of vocal function. However, many patients with laryngeal carcinoma who have residual or recurrent disease after radiotherapy wish to preserve their voice. The purpose of this study was to investigate the possibility of using BNCT as a larynx-preserving treatment for residual or recurrent laryngeal carcinomas following radical irradiation. Patients and MethodsThis study included 15 patients who underwent BNCT for residual or recurrent laryngeal carcinoma after radical laryngeal carcinoma irradiation. The number of treatment sessions for all patients was one irradiation. Before BNCT, the recurrent laryngeal carcinoma stage was rT1aN0, rT2N0, rT2N1, rT3N0, rT3N1, and rT4aN0 in one, six, one, three, one, and three patients, respectively. The median maximum tumor diameter before BNCT was 15 mm (8–22 mm). All patients underwent a tracheostomy before BNCT to mitigate the risk of upper airway stenosis due to laryngeal edema after BNCT. Treatment efficacy was evaluated retrospectively using monthly laryngoscopy after BNCT and contrast-enhanced CT scans at 3 months. The safety of treatment was evaluated based on examination findings and interviews with patients. ResultsThe median hospital stay after BNCT was 2 days (1–6). The response rate at three months after BNCT in 15 patients with locally recurrent laryngeal carcinoma was 93.3 %, and the CR rate was 73.3 %. The most frequent adverse event associated with BNCT was laryngeal edema, which occurred in nine patients the day after BNCT. The average course of laryngeal edema peaked on the second day after BNCT and almost recovered after 1 week in all patients. One patient had bilateral vocal fold movement disorders. None had dyspnea because of prophylactic tracheostomy. No grade four or higher adverse events occurred. Other grade 2 adverse events included pharyngeal mucositis, diarrhea, and sore throat. Three months after BNCT, tracheostomy tubes were removed in nine patients, retinal cannulas were placed in three patients, and voice cannulas were placed in three patients. ConclusionsBNCT for locally recurrent laryngeal carcinoma can safely deliver radical irradiation to tumor tissues, even in patients undergoing radical irradiation. BNCT has shown antitumor effects against recurrent laryngeal carcinoma. However, further long-term observations of the treatment outcomes are required.

Mediastinal hematoma after trans-radial cerebral angiography: a case report

BackgroundTrans-radial (TRA) access has become increasingly prevalent in neurointervention. Nonetheless, mediastinal hematoma after TRA is an infrequent yet grave complication associated with a notably elevated mortality rate. While our review found no reported mediastinal hematoma cases managed conservatively within neuro-interventional literature, similar complications are documented in cardiac and vascular interventional radiology, indicating its potential occurrence across disciplines.Case PresentationCarotid computed tomography angiography (CTA) showed calcified plaques with stenosis (Left: Severe, Right: Moderate) in the bilateral internal carotid arteries (ICAs) of an 81-year-old male presented with paroxysmal weakness in the right upper limb. Dual antiplatelet therapy with aspirin and clopidogrel was administered. On day 7, DSA of the bilateral ICAs was performed via TRA. Post-DSA, the patient experienced transient loss of consciousness, chest tightness, and other symptoms without ECG or MRI abnormalities. Hemoglobin level decreased from 110 g/L to 92 g/L. Iodinated contrast-induced laryngeal edema was suspected, and the patient was treated with intravenous methylprednisolone. Neck CT indicated a possible mediastinal hemorrhage, which chest CTA confirmed. The patient’s treatment plan involved discontinuing antiplatelet medication as a precautionary measure against the potential occurrence of an ischemic stroke instead of the utilization of a covered stent graft and surgical intervention. Serial CTs revealed hematoma absorption. Discharge CT showed a reduced hematoma volume of 35 × 45 mm.ConclusionsThis case underscores the need for timely identification and precise manipulation of guidewires and guide-catheters through trans-radial access. The critical components of successful neuro-interventional techniques include timely examination, rapid identification, proper therapy, and diligent monitoring.