Mechanical Airway Obstruction Research Articles

Evaluation of clinical factors predicting dysphagia in patients with traumatic and non-traumatic cervical spinal cord injury: a retrospective study.

Dysphagia is a common complication in patients with cervical spinal cord injury (C-SCI) and can cause various pulmonary complications, such as aspiration pneumonia and mechanical airway obstruction increasing mortality and morbidity. This study evaluated the clinical factors that predict dysphagia in patients with traumatic and non-traumatic C-SCI. Ninety-eight patients with C-SCI were retrospectively enrolled in this study and were divided into those with and without dysphagia. Clinical factors such as age, sex, tracheostomy, spinal cord independence measure, pulmonary function test (PFT) including forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1) and FVC/FEV1, American Spinal Cord Injury Association score, Berg Balance Scale, and surgical approach were investigated retrospectively. Multivariate logistic regression analysis revealed that FVC and the presence of tracheostomy were significantly correlated with dysphagia in patients with C-SCI (p < 0.05). FVC and the presence of tracheostomy are useful tools for detecting dysphagia in patients with C-SCI. Considering the results of our study, early PFTs, especially FVC, in patients with C-SCI and early initiation of dysphagia management and treatment in patients with C-SCI and tracheostomy will be advantageous in lowering the mortality and morbidity due to pulmonary aspiration in these patients.

Crushed, uncooked egg in the oropharynx: a café coronary?

BackgroundObstruction of the upper respiratory airway can terminate in fatal asphyxia. Autopsy findings in asphyxial deaths as described in literature are not necessarily pathognomonic. A complete autopsy with ancillary studies is necessary to establish the cause, time, and manner of death.Case presentationThe authors present a 44-year-old male who was found dead in his car. He had been remanded in prison for drug trafficking 1 year prior to his death. No other history or death scene findings were provided by the police. Autopsy revealed a crushed, uncooked egg in his oropharynx. Postmortem radiology and toxicology were not done due to nonavailability of the required facilities. Death was ascribed to asphyxia due to a crushed, uncooked egg in the oropharynx.The manner of death could not be ascertained because pertinent information regarding the deceased’s medical records, locus report, and other ancillary investigations was not available.ConclusionsThis report presents an unusual cause of mechanical upper airway obstruction that has never been documented and discusses some of the deficiencies of autopsy practice in resource-limited countries.

Anatomical relationship between the brachiocephalic trunk and the trachea and the clinical implications

To observe the anatomical features and relative position of the brachiocephalic trunk and the trachea to provide an anatomical basis for diagnosis and treatment of mechanical airway obstruction and for facilitating the performance of tracheotomy. A total of 91 formalin- fixed adult cadavers (70 male and 21 female) were used in this study. The whole length of the larynx and the trachea were separated and exposed from the neck to the chest, followed by separation of the aortic arch and its 3 branches to observe the anatomical position of the brachiocephalic trunk and the trachea. The brachiocephalic trunk and the trachea did not intersect in 3.30%, partially intersected in 71.43%, and completely intersected in 25.27% of the 91 cadaveric specimens. The male specimens all showed greater outer diameter of the aortic arch, the brachiocephalic trunk and the trachea with a greater length of the trachea than the female specimens (P < 0.05), while the distances from the aortic arch to the brachiocephalic trunk or the cricoid cartilage did not differ significantly between them (P > 0.05). The number of the tracheal cartilage rings above the brachiocephalic trunk ranged from 3 to 10, and the mean number did not differ significantly between the male and female specimens (P > 0.05). The brachiocephalic trunk has complex anatomical relationship with the trachea, and caution should be taken to avoid injuries of the brachiocephalic trunk and the aortic arch in the diagnosis and treatment of mechanical respiratory obstruction and during tracheotomy.

An Analysis of Medico-Legal Autopsies Alleged to be Homicide: A Study from the Northern Province of Sri Lanka

Introduction: Homicide, killing one person by another, is considered the most devastating violence. Legally homicide can be either murder or culpable homicide, where the difference lies in the degree of knowledge and intention. Objective: To describe the demographic features and medico-legal significance of the injury and to evaluate the social background of the victims of homicide. Methodology: A retrospective descriptive study based on a postmortem report was carried out on all the cases examined at the JMO office, Jaffna, from June 2014 to June 2022. The data were analyzed using SPSS statistical package. Results: Among 105 postmortem examinations alleged to be homicides, 77.1% of deaths were recorded in the Jaffna district, while 22.9% were recorded outside the Jaffna district. There was a male predominance (62.9%) with a male-to-female ratio of 7:4. The commonest weapon or force used in homicide was blunt (51.4%), while sharp was the second highest (32.4%). Cut and laceration were the nature of injury for 25.7% and 21.9% of homicides, respectively. Consequences of craniocerebral injury (32.4%) were the major cause of death, while head and neck regions were commonly involved in 38.2% and 24.5%, respectively. Regarding the nature of the injury, burn injuries (90%), mechanical airway obstruction (77.8%), and lack of breathable air (100%) showed female preponderance (p value<0.05). In contrast, cut injury (61.5%), laceration (78.3%), stab injury (100%), and firearm injury (100%) were predominantly seen in the male population. Considering the cause of death, consequences of cranial-cerebral injury (79.4%) were commonly seen in the male gender (p<0.05), and asphyxia-related deaths (85.7%) were more in the female gender(p<0.05). Conclusion: The nature of the injury and the cause of death in homicides had a significant relationship with the gender of victims.

RF11 | PSAT274 A Dramatic Response of a Thyroid Lymphoma to R-CHOP Chemotherapy Reversing Mechanical Airway Obstruction and Respiratory failure, A Case Report

Abstract Introduction Primary thyroid lymphoma is extremely rare and accounts for &amp;lt;5% of all thyroid malignancies, with an estimated incidence of 2 per 1 million each year. It usually occurs in patients with preexisting Hashimoto thyroiditis and commonly presents between 60 to 70 years. Almost all thyroid lymphomas are non-Hodgkin's lymphoma of B-cell origin, with diffuse large B-cell lymphoma being the most common subtype. Chemotherapy and radiotherapy are the primary treatment of thyroid lymphomas. This case report shows a dramatic response to chemotherapy in a patient with mechanical airway obstruction due to large thyroid lymphoma, which facilitated her extubation. Case Presentation An 83-year-old woman with a past medical history significant for type 2 diabetes, coronary heart disease, and hypothyroidism controlled on L-thyroxine replacement therapy was presented with 3 months history of gradually progressive dysphagia. It was associated with left-sided neck pain with swallowing, choking on food, and shortness of breath. She denied fever, chills, or excessive sweats. Local examination of her neck revealed a large firm thyroid mass associated with left cervical lymphadenopathy. Her CT neck scan with intravenous contrast showed an enlarged, probably malignant thyroid gland with marked amount of adjacent pathologic lymph nodes and marked transverse narrowing of the trachea to approximately 8.6 mm with no retrosternal extension. Also, Her CT abdominal scan with intravenous contrast showed a 3.6 cm lesion of the medial right hepatic lobe (segment 8) concerning for metastases. The patient underwent an ultrasound-guided thyroid biopsy, and the results confirmed the diagnosis of diffuse large B cell lymphoma of the neck and thyroid. A few days later, the patient experienced respiratory distress and failure secondary to mechanical airway obstruction that required urgent intubation and mechanical ventilation. The discussion among different specialties, including general surgery, concluded that the patient was not a candidate for surgical intervention or tracheostomy, and recommendations were to proceed to palliative chemotherapy. She started R-CHOP chemotherapy (Rituximab, Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone), followed by a marked reduction in the thyroid size and relieving of the tracheal compression on the following CT neck scan. Her condition dramatically improved, and she was extubated after 5 days of receiving the first cycle of R-CHOP chemotherapy. Conclusion Our case report demonstrates dramatic reversal of mechanical airway obstruction caused by a thyroid lymphoma within a few days of initiation of R-CHOP chemotherapy. These cases are usually considered terminal and do not undergo aggressive surgical interventions. R-CHOP chemotherapy needs to be considered in these cases before considering hospice care. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m., Saturday, June 11, 2022 1:12 p.m. - 1:17 p.m.

A Dramatic Response of a Thyroid Lymphoma to R-CHOP Chemotherapy Reversing Mechanical Airway Obstruction and Respiratory Failure

Primary thyroid lymphoma is an extremely rare thyroid malignancy that usually occurs in patients with preexisting Hashimoto thyroiditis and commonly presents in older women. The most common type is non-Hodgkin's lymphoma of B-cell origin, particularly diffuse large B-cell lymphoma (DLBCL), which is primarily treated with chemotherapy and radiotherapy. We reported an 83-year-old woman with a past medical history of hypothyroidism who suffered dysphagia and dyspnea secondary to a large thyroid mass. Her CT neck scan showed an enlarged thyroid mass with pathological cervical lymphadenopathy and marked tracheal narrowing. The ultrasound-guided biopsy confirmed the diagnosis of DLBCL of the thyroid. A few days later, she experienced respiratory distress and failure that required endotracheal intubation and mechanical ventilation. She was not considered for tracheostomy or surgical interventions, and after discussion with her family, the decision was made to start R-CHOP therapy (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) which resulted in a marked reduction of the thyroid size and reversal of the mechanical airway obstruction, enabling her extubation. This case report demonstrated the dramatic response of a large thyroid lymphoma to R-CHOP therapy, reducing the thyroid size and its fatal obstructive complications, including mechanical airway obstruction, within a few days of the initiation of R-CHOP therapy.

Prevention And First Aid of Mechanical Airway Obstruction Among Children: Supportive Stratiges For Mothers

Children considered as one third of today’s population and the whole future for us. For raising societybeing healthy, it is vital of having children being healthy. Mechanical airway obstruction is a communaland fatal fortune in group of pediatric age. It needs prompt treatment and recognition for avoiding outcomesas fatal. Despite aspiration of foreign body (FBA) could be event as threatening of life, it can be stillpreventable. The mostly significant risk factor for FBA is caregivers knowledge lacking. A pre/post quasidesign of experimental was implemented in the outgoing study. Three hundred mothers as purposive wereincluded in the current study. The study aim was to assess the supportive strategies influence for mothersin respect to prevention and first aid of mechanical airway obstruction among children. The work wasperformed in the outpatient pediatric department of El Sayed Galal University hospital. Tool I: data sheetas socio-demographic for children and their mothers, Tool II and Tool III: sheet of questionnaire in respectto knowledge of mothers besides reported practices of mothers. Results showed that the mean age of thestudied mothers was (34.13± 8. 97), and more than three quarters of them (%76.7) were didn’t receiveprevious training program. Differences of significant were detected between post and pre supportive strategyin knowledge of mothers and reporting practices in prevention and first aid of chocking that wasn’t affectedby their socio-demographic characteristics (P value ?0. 05).

Unpredicted respiratory arrest following hypoglossal nerve palsy during subarachnoid hemorrhage: Experimental study

Aim: Although acute respiratory arrest is the most dangerous complication of subarachnoid hemorrhage; if there is any association between hypoglossal nerve-tongue palsy induced acute mechanical upper airway obstruction has not been extensively described so far. Our aim is to evaluate if there is a relationship between hypoglossal ischemia-tongue paralysis and upper airway obstruction during subarachnoid hemorrhage. Materials and Methods: Formerly studied 23 rabbits’s documents chosen from our SAH experiments. A control group (Group A) include 5 normal animals, Sham group (Group B) include 5 animals which saline was administered, and a study group (Group C) include 13 animals (7 survive-C1 / 6 dead-C2) which were injected with homologous blood into the cisterna magna. Blood pressure values and and electrocardiograhic changes were recorded per days of all animals before, during and after surgery during two weeks and all animals decapitated under general anesthesia. Hypoglossal nerves, tongue muscles and upper arways were evaluated. Numbers of degenerated axons/neurons density of hypoglossal nerves-atrophic tongue muscles and airway obstruction scores (AOS) of all animals were determined and analysed statistically with ANOVA. AOS was classified according to tongual sliding down distances to larynx numbered between 1-7 mm to scored with 1-7.Results: Important neurodegeneration was noticed in axons of the hypoglosssal nerves and tongue muscle denervation injury was in more severe in AOS observed animals. The hypoglossal nerves, degenerated axon density (n/mm2), numbers of atrophic muscles (n/mm3) and AOS was: 4±2, 1±1, 1±1 in A; 7±3, 2±1, 2±1 in B and 98±11, 23±5, 5±2 in C1 groups. P values between the axonal degeneration of hypoglossal nerves/muscles and AOS was p0.005 for C2/C1; p0.0005 for C2/A and p0.0001 C2/B.Conclusion: Hypoglossal ischemia induced tongual muscle palsy related respiratory arrest should be remembered in neurocritical cases. Maintaining normal respiratory functions is only possible with airway tone, which is possible with an intact hypoglossal nerve.

Evaluation of Intraoperative Near-Infrared Fluorescence Visualization of the Lung Tumor Margin With Indocyanine Green Inhalation

Identification of the tumor margin during surgery is important for precise minimal resection of lung tumors. Intravenous injection of indocyanine green (ICG) has several limitations when used for intraoperative visualization of lung cancer. To describe a technique for intraoperative visualization of lung tumor margin using ICG inhalation and evaluate the clinical applicability of the technique in mouse and rabbit lung tumor models as well as lung specimens of patients with lung tumors. In lung tumor models of both mice and rabbits, the distribution of inhaled ICG in the lung tumor margin was investigated in vivo and ex vivo using a near-infrared imaging system. Lung tumor margin detection via inhalation of ICG was evaluated by comparing the results obtained with those of the intravenous injection method (n = 32, each time point for 4 mice). Based on preclinical data, use of ICG inhalation to help detect the tumor margin in patients with lung cancer was also evaluated (n = 6). This diagnostic study was conducted from May 31, 2017, to March 30, 2019. The use of tumor margin detection by inhaled ICG was evaluated by comparing the inhaled formulation with intravenous administration of ICG. From 10 minutes after inhalation of ICG to 24 hours, the distribution of ICG in the lungs was significantly higher than that in other organs (signal to noise ratio in the lungs: 39 486.4; interquartile range [IQR], 36 983.74-43 592.5). Ex vivo and histologic analysis showed that, in both lung tumor models, inhaled ICG was observed throughout the healthy lung tissue but was rarely found in tumor tissue. The difference in the fluorescent signal between healthy and tumor lung tissues was associated with the mechanical airway obstruction caused by the tumor and with alveolar macrophage uptake of the inhaled ICG in healthy tissues. Inhalation at a 20-fold lower dose of ICG had a 2-fold higher efficiency for tumor margin detection than did the intravenous injection (2.9; IQR, 2.7-3.2; P < .001). The results of this study suggest that lung-specific inhalation delivery of ICG is feasible and may be useful for the intraoperative visualization of lung tumor margin in clinical practice.

Endotracheal Intubation in the Pharmaceutical-Poisoned Patient: a Narrative Review of the Literature.

Endotracheal intubation (ETI) is an essential component of the supportive care provided to the critically ill patient with pharmaceutical poisoning; however, specific nuances surrounding intubation including techniques and complications in the context of pharmaceutical poisoning have not been well elucidated. A search of the available literature on ETI in pharmaceutical-poisoned patients was undertaken using Medline, ERIC, Cochrane database, and PsycINFO using the following MeSH and keyword terms: ("toxicology" OR "poisons" OR "drug overdose" OR "poisoning") AND ("intubation, intratracheal" OR "intubation, endotracheal" OR "airway management" OR "respiration, artificial"). A hand-search was also performed when the literature in the above search required additional conceptual clarification, including using the "Similar Articles" feature of PubMed, along with reviewing articles' reference lists that discussed intubation in the context of a poisoning scenario. Articles with any discussion around the ETI process in the context of a pharmaceutical poisoning were then included. Intubation may be performed in patients poisoned with pharmaceuticals in the context of both single and multiple organ dysfunction including central and peripheral nervous system, pulmonary, or cardiovascular toxicity with hemodynamic instability, or localized effects resulting in mechanical airway obstruction. Certain classes of poisonings may require modifications to the standard rapid sequence induction airway management algorithm. ETI is a key component of the supportive care provided to the patient poisoned by a pharmaceutical agent. Clinicians should be aware of the spectrum of toxicities that can necessitate intubation, as well as airway management nuances that are specific to various poisoning presentations.

Validation of a method to assess emphysema severity by spirometry in the COPDGene study

BackgroundStandard spirometry cannot identify the predominant mechanism underlying airflow obstruction in COPD, namely emphysema or airway disease. We aimed at validating a previously developed methodology to detect emphysema by mathematical analysis of the maximal expiratory flow-volume (MEFV) curve in standard spirometry.MethodsFrom the COPDGene population we selected those 5930 subjects with MEFV curve and inspiratory-expiratory CT obtained on the same day. The MEFV curve descending limb was fit real-time using forced vital capacity (FVC), peak expiratory flow, and forced expiratory flows at 25, 50 and 75% of FVC to derive an emphysema severity index (ESI), expressed as a continuous positive numeric parameter ranging from 0 to 10. According to inspiratory CT percent lung attenuation area below − 950 HU we defined three emphysema severity subgroups (%LAA-950insp < 6, 6–14, ≥14). By co-registration of inspiratory-expiratory CT we quantified persistent (%pLDA) and functional (%fLDA) low-density areas as CT metrics of emphysema and airway disease, respectively.ResultsESI differentiated CT emphysema severity subgroups increasing in parallel with GOLD stages (p < .001), but with high variability within each stage. ESI had significantly higher correlations (p < .001) with emphysema than with airway disease CT metrics, explaining 67% of %pLDA variability. Conversely, standard spirometric variables (FEV1, FEV1/FVC) had significantly lower correlations than ESI with emphysema CT metrics and did not differentiate between emphysema and airways CT metrics.ConclusionsESI adds to standard spirometry the power to discriminate whether emphysema is the predominant mechanism of airway obstruction. ESI methodology has been validated in the large multiethnic population of smokers of the COPDGene study and therefore it could be applied for clinical and research purposes in the general population of smokers, using a readily available online website.

Congenital Oral Masses: An Anatomic Approach to Diagnosis.

Although congenital oral masses are rare, they are readily detectable during fetal US screening. Most congenital oral masses are benign, but some may cause mechanical airway obstruction, resulting in poor outcomes at delivery. The radiologist's ability to describe these abnormalities and their physiologic sequelae accurately can have a substantial effect on perinatal treatment. Furthermore, despite being rare, congenital oral lesions encountered at screening and at follow up fetal MRI provide the opportunity to make a specific diagnosis by following a simple anatomic approach. This article describes an anatomic algorithm as the framework for accurate diagnosis of congenital oral lesions. The imaging appearance of the most common congenital oral cavity neoplasms is outlined, including vascular anomalies, epulides, choristomas, congenital lingual thyroid anomalies, lingual hamartomas, and epignathi, and other conditions that mimic these at US. Also reviewed are perinatal management of masses that affect the fetal airway and the imaging features key to optimizing delivery outcomes. Online supplemental material is available for this article. ©RSNA, 2019.

Comparing REM- and NREM-Related Obstructive Sleep Apnea in Jordan: A Cross-Sectional Study.

Obstructive sleep apnea (OSA) is a common disorder that includes an intermittent mechanical obstruction of the upper airway during sleep, which can occur either during rapid eye movement (REM) phase or non-REM (NREM) phase. In this study, we aim to evaluate the differences in demographic and polysomnographic features between REM- and NREM-related OSA in a Jordanian sample, using both the broad and the restricted definitions of REM-related OSA. All patients who were referred due to clinical suspicion of OSA and underwent sleep study were screened. We included patients with a diagnosis of OSA who had Apnea-Hypopnea Index (AHI) greater than or equal to five. We classified patients into REM-related OSA according to either the broad definition (AHIREM/AHINREM ≥ 2) or the strict definition (AHIREM > 5 and AHINREM < 5 with a total REM sleep duration of at least 30 minutes), and patients with AHIREM/AHINREM less than two were classified as NREM-related OSA. A total of 478 patients were included in this study with a mean age of 55.3 years (±12.6). According to the broad definition of REM-related OSA, 86 (18%) of OSA patients were classified as having REM-related OSA compared to only 13 (2.7%) patients according to the strict definition. Significant differences were found between both NREM-related OSA and REM-related OSA according to the broad and to the strict definitions for arousal index (p < 0.001 and p < 0.032), respectively, duration of saturation below 90% (p < 0.001 for both), and saturation nadir (p < 0.036 and p < 0.013), respectively. No significant differences were found between this group and other OSA patients regarding age, BMI, ESS, and snoring. Our study showed that the stricter the definition for REM-related OSA, the milder the associated clinical changes.

The neurology of acutely failing respiratory mechanics

Forces involved in breathing-which effectively pull in air-are the diaphragmatic, intercostal, spine, and neck muscles. Equally important is the bulbar musculature maintaining the architecture of a patent airway conduit and abdominal wall and internal intercostal muscles providing cough. Acute injury along a neural trajectory from brainstem to muscle will impair the coordinated interaction between these muscle groups. Acutely failing respiratory mechanics can be caused by central and peripheral lesions. In central lesions, the key lesion is in the nucleus ambiguus innervating the dilator muscles of the soft palate, pharynx, and larynx, but abnormal respiratory mechanics rarely coincide with abnormalities of the respiratory pattern generator. In peripheral lesions, diaphragmatic weakness is a main element, but in many neuromuscular disorders mechanical upper airway obstruction from oropharyngeal weakness contributes equally to an increased respiratory load. The neurology of breathing involves changes in respiratory drive, rhythm, mechanics, and dynamics. This review focuses on the fundamentals of abnormal respiratory mechanics in acute neurologic conditions, bedside judgment, interpretation of additional laboratory tests, and initial stabilization, with practical solutions provided. Many of these respiratory signs are relevant to neurologists, who in acute situations may see these patients first. Ann Neurol 2017;81:485-494.

Pneumonia and Lung Involvement in Parasitic Diseases

the healthcare providers in recent travelers or immigrants with respiratory manifestations from endemic areas. For clinicians or pulmonologists, detailed interrogations of travel history to endemic areas are critical to manage this entity. The larvae can cause airway inflammation, while migrating adult worms can cause mechanical airway obstruction. This article provides a comprehensive review of both helminthic and protozoal infestations that affect the respiratory system, particularly the lungs, including roentgenographic and clinical presentations, diagnostic tests, and therapeutic methods. Abstract

SIMPLE, TIMELY, SAFELY? LARYNGEAL MASK AND PEDIATRIC AIRWAY

Laryngeal mask airway (LMA) was a useful, powerful airway management device for routine pediatric airway management, pediatric difficult airway, and in pediatric emergency situations. Over years, various designs, induction and insertion techniques have been described. LMA provides ease of placement and removal as compared with endotracheal intubation, less traumatism for the respiratory tract, better tolerability by patients, improved hemodynamic stability during emergency, less coughing, less sore throat, avoidance of laryngoscopy, and hands free airway. On the other hand, LMA is not suitable to overcome functional airway problems and mechanical airway obstruction in children. Simple airway management in pediatric patients is normally easy in experienced hands, for anesthesiologists working in specialized hospitals with appropriate personnel and equipment that guarantee optimal safety in these patients. On the other hand, pediatric airway management is a great challenge for anesthesiologists working in departments with a small number of pediatric surgical procedures. Careful preoperative evaluation, preparation and training in the recognition of challenges in pediatric airway are essential for the management of the airway in children. LMA plays a special role in the management of difficult pediatric airway; as a supraglottic airway device, it is incorporated into difficult pediatric airway algorithms.

Pathophysiology of airway obstruction caused by wound hematoma after thyroidectomy: an ex vivo study

Background Airway obstruction by postoperative hemorrhage after thyroid resection is a serious adverse and potentially life-threatening event. The aim of this study is to investigate if the possible pressure caused by a postoperative hematoma in the neck would be sufficient to compress the trachea and therefore leads to a mechanical airway obstruction.

A Giant Pleomorphic Adenoma of the Palatine Arch in a 75-Year-Old Man: A Case Report with Review of Literature

ABSTRACT Pleomorphic adenoma (PA) is the most common benign tumor of the salivary glands and has both epithelial and mesenchymal tissues. It most commonly arises from the parotid or submandibular glands. Rarely, it arises from the minor salivary glands. We report here a case of pleomorphic adenoma arising from the soft palate and both sides of anterior tonsillar pillars in a 75-year-old man. This patient was presenting painless slow growing large swelling in the soft palate over 20 years causing mechanical obstruction of airway and food. The entire tumor mass was excised along with overlying mucosa. How to cite this article Swain SK, Sahu MC, Tripathy R. A Giant Pleomorphic Adenoma of the Palatine Arch in a 75-Year-Old Man: A Case Report with Review of Literature. Int J Head Neck Surg 2015;6(1):23-25.

Rare Case of Choking Death by Dispersible Tablet: A Case Report

Choking is a form of asphyxia caused by an obstruction within the air passage. Aspiration of a foreign body is common in children and cause upper airway obstruction leading to significant morbidity and mortality. In most of the cases, death is due to mechanical obstruction of airway, in some cases, death may be due to reflex spasm of respiratory tract or by neurogenic cardiac arrest. Deaths due to choking are relatively rare occurrence.

Traumatische Schilddrüsenruptur: Fallbericht und Literaturübersicht

Traumatic rupture of the thyroid gland is rare. A common approach does not exist. Surgical and nonsurgical management have been advocated. This work summarizes the publications in PubMed including an own case. This study will analyse the accident mechanism, the underlying thyroid pathologies, possible pathogenetic mechanisms of airway obstruction and the therapeutic options. A present classification is revised in order to develop it into a treatment proposal. A total of 34 case reports were analysed. The first half had to be performed a surgery on, the other half was observed without surgical treatment. None of the patients died of his injury. 59% of the patients, that had to be performed a surgery on had thyroid pathology before rupture. 50% of all patients had a road accident as a cause for the rupture. The revised classification and treatment proposal developed here presents a clinically-viable approach.