Supraglottic Area Research Articles

COVID-19–Induced Acute Laryngitis: A Case Series

ObjectivesThe objective of this study is to present a novel clinical manifestation of COVID-19 with characteristic endoscopic laryngeal findings. A group of patients who reported similar symptoms, displayed akin laryngoscopic features and received appropriate treatment is analyzed. Endoscopic images are provided and the pattern of this entity is discussed. Study DesignThis single- center descriptive analysis of a case series was performed in General Hospital of Volos (Greece), during a six-month period (from April 2022 to September 2022). 23 patients who suffered from COVID-19 and were simultaneously diagnosed with acute laryngitis were enrolled. MethodsDemographic data, clinical and endoscopic findings, laboratory results and treatment courses were recorded. Descriptive statistics were performed with the statistical package SPSS (IBM Corp. Released 2017. IBM SPSS Statistics for Windows, Version 25.0. Armonk, NY: IBM Corp.). ResultsThe majority of the patients were male and fully vaccinated, as defined by Greek legislation at the time. None of them was a smoker. All patients were infected with SARS-COV2 for the first time and presented with acute odynophagia. The characteristic endoscopic finding was an erythematous larynx with white undetachable lesions mainly in the supraglottic area. Pooling of saliva in the pyriform fossae was an independent predicting factor for patients’ hospitalization (p<0.001). None of the patients required intubation or tracheostomy and all responded to the systemic treatment with corticosteroids and antibiotics. ConclusionCOVID-19 induced laryngitis should be considered in any patient with positive COVID-19 who complains of acute odynophagia. Fiberoptic laryngoscopy is necessary in order to confirm the diagnosis. In our series, timely initiation of treatment minimized the need of securing the airway and ensured a favorable prognosis.

Aryepiglottic cyst in young adult. A clinical case report

Andrius Račiūnas1 1Royal London Hospital, Barts Health NHS Trust, Ear, Nose & Throat department, London, United Kingdom Abstract Introduction. Laryngeal cysts are benign fluid-filled non-infected sacs that can appear in different anatomical parts of the larynx. They are most commonly found in the supraglottic area. Symptoms include voice changes, foreign body sensation, snoring, obstructive sleep apnea, […]

A study comparing either using intravenous propofol or topical lidocaine over the larynx as adjuncts to inhalational induction of anesthesia for facilitating nasotracheal intubation for pediatric patients undergoing tonsillectomy surgery

Background Nasotracheal intubation in tonsillectomy surgery is used to facilitate surgical exposure. Intubation without muscle relaxant is commonly practiced for pediatric patients in ambulatory surgeries. Using adjuncts to inhalational induction makes more suitable conditions for intubation with hemodynamic stability and less laryngeal morbidities. In this study, lidocaine, 1% was used topically on vocal cords to facilitate nasotracheal intubation in comparison with intravenous propofol after inhalational induction using muscle relaxant only as a rescue medication in case of failure.Patients and methods A randomized controlled study was conducted on 96 patients aged 3–7 years and with American Society of Anesthesiologists physical status I and II scheduled for elective tonsillectomy. Patients were divided randomly into two equal groups, each consisting of 48 patients. Group P patients received inhalational induction using sevoflurane followed by propofol 2 mg/kg. Group L received inhalational induction by sevoflurane followed by topical lidocaine 1% on glottic and supraglottic areas. The intubation conditions, hemodynamic parameters (heart rate, mean blood pressure, and oxygen saturation), respiratory depression, sedation score, and incidence of laryngospasm after recovery were recorded and statistically analyzed.Results The intubation score was statistically significant with a high difference between the two groups. The score mean values were less than 10 with more success of the intubation in the lidocaine group. The success rate of intubation without the use of short-time-acting muscle relaxant was higher in the lidocaine group (88.89%) as compared with the propofol group (79.2%). Hemodynamic stability after intubation in the lidocaine group, was statistically significant. The incidence of postoperative laryngospasm was statistically nonsignificant, but the incidence rate was higher in the propofol group.Conclusion Using lidocaine 1% topically on the larynx can achieve an acceptable condition of the intubation without muscle relaxant in most of the cases, with hemodynamic stability and decreasing incidence of postoperative laryngospasm.

Case report of acute epiglottitis in a 44-year-old man: a rare case

Background: Acute epiglottitis, also known as supraglottitis or supraglottic laryngitis, is an acute inflammation of the supraglottic area of the larynx. The diagnosis can be made based on clinical signs and symptoms as well as several investigations.Case Description: We reported a case of a 44-year-old man who presented to our emergency department and whose condition was ultimately diagnosed as epiglottitis. Indirect laryngoscopy and lateral soft tissue neck radiograph had an important role in determining the diagnosis. The patient was treated conservatively by giving a high dosed antibiotic, anti-inflammatory, and analgesic drugs.Conclusion: Acute epiglottitis can be a life-threatening condition because it can cause sudden upper airway obstruction. Therefore, management must be given quickly and precisely so as not to fall into a life-threatening condition.

Invention and Pilot Study of the Efficacy and Safety of the SUPRAtube Device in Continuous Supraglottic Aspiration for Intubated and Mechanically Ventilated Patients.

BackgroundBronchoaspiration of content that accumulates in the supraglottic area (eg, saliva, gastroesophageal reflux) is a risk factor for ventilator-associated pneumonia. A continuous supraglottic suction system may decrease the risk of bronchoaspiration in these patients.Objective(1) Constructing a conceptual model and functional prototype of a continuous supraglottic suction device for use in humans; (2) defining functional characteristics in ex vivo swine head models; and (3) evaluating its efficacy and safety in mechanically ventilated patients.MethodsStudy conducted in three phases. First phase: definition of distances and diameters of the triangle determined by dental arch, posterior oropharynx and vallecula, and diameter of the oropharynx in axial projection; and identification of the declining area of supraglottic suction. Second phase: design engineering and functional prototype evaluated in ex vivo models. Third phase: evaluation of device use in terms of safety and efficacy in ventilated patients.ResultsWe obtained a final functional model of the SUPRAtube device injected into PVC for medical use. Device effectiveness in in vitro simulation showed a high and fast suction capacity of liquid and thick volumes. Study of swine heads allowed to validate the shape, size and functional fenestration of the device. Study in intubated and mechanically ventilated patients showed a high supraglottic suction capacity and the absence of local adverse events during 72 (7–240) hours of continuous operation.ConclusionOur study describes the process of conceptualization, design and production of a practical, safe, low-cost continuous supraglottic suction device without representing antibiotic pressure, which appears to be a new complementary preventive strategy for the standard management of intubated and mechanically ventilated patients.

Facial angioedema in young elderly: Rare complication of rare drug

Angioedema is an intense often disfiguring but temporary swelling of a localized area which usually involves superficially lying structures like skin, mucosa along with subcutaneous tissues. Areas which are often affected by angioedema have a wide range starting from the face, lips, tongue, pharynx, the supraglottic area and rarely, the subglottic area. It might also effect the gastrointestinal mucous membranes, genitalia, hands and feet. There maybe variety of causes for development of angioedema including various drug intake, insect bites or stings and certain types of food products particularly nuts, milk and eggs. Levamisole is known to have anthelminthic and immunomodulatory properties and is a common contaminant in cocaine due to its mood stimulatory action. Here we report a case of a 60-year-old female who presented with angioedema following ingestion of a drug known as levamisole for its anthelminthic activity.

Chondrosarcoma of the Thyroid Cartilage Successfully Treated With Partial Resection of the Thyroid Cartilage.

Chondrosarcoma of the thyroid cartilage is a sporadic disease with nonspecific clinical presentation. Smooth swelling of the supraglottic area should arouse suspicion of possible pathology. In addition to laryngoceles, which usually do not have a significant impact, otolaryngologists should consider chondrosarcoma of the thyroid cartilage and indicate computed tomography (CT). Late diagnosis leads to worse prognosis, particularly worse voice after more extensive surgery, need for tracheostomy, and worse survival from higher degree chondrosarcomas.

Laryngeal Schwannoma: Emphasis on Treatment with Surgical Instrument Excision

Background: Laryngeal schwannomas are rare benign tumors of schwann cell origin and commonly present in the supraglottic area. Patients present with non-specific symptoms such as dysphagia and dysphonia with the occasional patient presenting with more severe symptoms such as stridor. Case Presentation: A 65-year-old female presented to the clinic with symptoms of hoarseness and globus sensation for three months. Fiberoptic flexible nasolaryngoscopy revealed a mass at the right arytenoid, appearing consistent with a mucosally covered cyst-like lesion. Computed Tomography (CT) of the neck showed a lobular hypoenhancing mass at the level of the aryepiglottic fold. A schwannoma was diagnosed via histopathology, positive for S-100. Conclusion: Tailored surgical excision via an intraoral approach successfully removed the laryngeal schwannoma with no recurrence at one-year follow up. This case highlights the clinical presentation, diagnosis, surgical treatment with outcome of this rare laryngeal tumor.

The Poor Validity of Asymmetric Laryngoscopic Findings in Predicting Laterality in Vocal Fold Paresis

To determine the laryngoscopic findings most predictive of laterality in vocal fold paresis in patients with known RLN and/or SLN paresis by laryngeal electromyography (LEMG). Blinded, prospective video perceptual analysis study. Patients with vocal fold paresis diagnosed by LEMG at a tertiary care hospital from 2017 to 2019 were identified. Two fellowship-trained laryngologists blinded to clinical history and LEMG results reviewed laryngostroboscopic examinations and assessed for evidence of paresis using defined criteria. Inclusion criteria were adults with laryngeal asymmetry and evidence of decreased recruitment on LEMG. Exclusion criteria were children, presence of laryngeal lesions, myasthenia gravis, vocal fold paralysis, and normal laryngeal symmetry. We identified 95 patients who were diagnosed with vocal fold paresis with LEMG who met inclusion and exclusion criteria (mean age 43.8 ± 20.4 years (18-88), 38.9% male). When comparing the laterality of the observed laryngoscopic finding with LEMG, we found that in patients who had severe true vocal fold (TVF) range of motion disturbance, the laterality of the finding matched the LEMG distribution of paresis in 12 out of 13 (92.3%) patients (P=0.002). No other laryngoscopic findings reliably predicted laterality including corniculate and cuneiform cartilage asymmetry, pyriform sinus dilation, abnormal TVF show, petiole deviation, abnormal ventricular show, increased supraglottic area, and FVF hyperfunction of the opposite side. With the exception of severe TVF range of motion disturbance, there seems to be poor validity of laryngoscopic findings in predicting the affected side in vocal fold paresis. We recommend neurophysiologic testing to confirm the clinical diagnosis of vocal fold paresis.

Refractory aphthae in the epiglottis and supraglottic area due to Crohn's disease.

A 27-year-old woman complaining of persistent fever and sore throat was consulted. Examination of the laryngopharynx revealed multiple aphthous ulcers in the uvula, arytenoids, epiglottis, and laryngeal pyriform fossa. Crohn's disease was diagnosed by colonoscopy.

An Unusual Cause of Stridor After Decannulation of a Tracheostomised Patient

Stridor is commonly seen post decannulation in a tracheostomised patient. Usually it occurs due to airway obstruction secondary to tracheal stenosis, granulation tissue, tracheomalacia. We report a rare case of stridor due to dynamic pharyngeal collapse after decannulation. A 68- year - old male who presented with inferior wall MI and Complete Heart Block had to be put on a mechanical ventilator for hemodynamic instability and subsequently tracheostomised. Post decannulation he developed stridor and breathlessness. CT scan of neck revealed a supraglottic narrowing which on bronchoscopy showed a dynamic collapsibility of supraglottic area. This dynamic collapse was treated with non invasive positive pressure ventilation.

Dose Reduction to the Swallowing Apparatus and the Salivary Glands by De-Intensification of Postoperative Radiotherapy in Patients with Head and Neck Cancer: First (Treatment Planning) Results of the Prospective Multicenter DIREKHT Trial.

Aim: Evaluating radiotherapy treatment plans of the prospective DIREKHT trial (ClinicalTrials.gov, NCT02528955) investigating de-intensification of radiotherapy in patients with head and neck cancer. Patients and Methods: The first 30 patients from the DIREKHT trial of the leading study centre were included in this analysis. Standard treatment plans and study treatment plans derived from the protocol were calculated for each patient. Sizes of planning target volumes (PTVs) and mean doses to organs at risk were compared using the Student’s t-test with paired samples. Results: Mean PTV3 including primary tumor region and ipsilateral elective neck up to a dose of 50 Gy in the study treatment plans was 662 mL (+/− 165 mL standard deviation (SD)) and therefore significantly smaller than those of the standard treatment plans (1166 mL (+/− 266 mL SD). In the medial and inferior constrictor muscles, cricopharyngeal muscle, glottic and supraglottic laryngeal areas, arytenoid cartilages, contralateral major salivary glands highly significant dose reductions (p < 0.0001) of more than 10 Gy were achieved in study treatment plan compared to standard treatment plan. Conclusion: De-intensification of radiotherapy led to smaller planning target volumes and clinical relevant dose reductions in the swallowing apparatus and in the contralateral salivary glands.

Assessment of HPV 16, HPV 18, p16 expression in advanced stage laryngeal cancer patients and prognostic significance

IntroductionHuman papilloma virus is an etiological risk factor for a subset of head and neck squamous cell carcinomas. HPV has been proven to be a powerful prognostic biomarker for oropharyngeal cancer, but its role in the larynx has not been explored in depth. The developmental mechanisms of laryngeal carcinomas are quite complex and controlled by various factors. Smoking and alcohol are most important risk factors. Recent studies indicate that HPV infection also plays an important role in larynx carcinomas. HPV related laryngeal carcinomas especially occur at the supraglottic region of larynx. ObjectiveWe aimed to determine the frequency of HPV/protein16 positivity in patients with laryngeal carcinoma and association of HPV and/or p16 positivity with variables such as age, sex, smoking habits, tumor localization, lymph node metastasis, recurrence and survival in advanced stage laryngeal carcinoma in our study. MethodsThis retrospective study included 90 patients with advanced laryngeal carcinoma. The Control group was 10 normal larynx mucosa specimens. The presence of HPV was investigated polyclonally by polymerase chain reaction, and protein16 with immunohistochemical method. In HPV positive cases, the presence of HPV types 16, 18 were evaluated by polymerase chain reaction. Demographic features of patients were noted. Patient survival and association with HPV/protein16 was determined. ResultsPolyclonal HPV positivity was detected in 11 (12.2%) of 90 cases. Out of these 11 cases, HPV 16 was positive in 6, HPV 18 in 4, and both HPV 16 and 18 were positive in 1. In 18 (20%) of the cases, p16 was positive. Six of the cases (6.6%) had both HPV and protein16 positivity. In cases where protein16 alone or HPV and protein16 were co-positive, alcohol use was less and the tumor was found more likely to be localized in the supraglottic area. These ratios were statistically significant. Supraglottic localization of tumor was determined to be increased in protein16 positive cases. The correlation between protein16 positivity and supraglottic area location was determined to be statistically significant (p = 0.011). 55.6% of protein16 positive cases was located in the supraglottic region, 33.3% was glottic and 11.1% was transglottic. Although life expectancy over 5 years were numerically higher in HPV and protein16 positive cases, this was not found to be statistically significant. There was no statistically significant relationship between HPV positivity and mean age, differentiation, smoking and alcohol use, tumor progression, lymph node metastasis, localization, recurrence, cause of mortality and treatment methods in our study. The mean follow-up period of our patients was 6.7 years. ConclusionThe close relationship between HPV and oropharyngeal squamous cell carcinoma could not be shown in larynx malignancy in many studies, including our study. Our findings support a limited role of HPV in laryngeal carcinogenesis. Protein16 is not a reliable surrogate for HPV status in laryngeal cancers and is not a predictor of laryngeal cancer survival. Supraglottic localization of tumor was determined to be increased in protein16 positive cases. The correlation between protein16 positivity and supraglottic area location was determined to be statistically significant. There is a need for more populated clinical trials, where neoplastic proliferation is better demonstrated and the accuracy of the results obtained is supported by different techniques.

Differences in laryngeal movements during exercise in healthy and dyspnoeic adolescents

ObjectivesTo compare glottic and supraglottic movements in healthy adolescents and adolescents experiencing dyspnoea during strenuous exercise. MethodsUsing the continuous laryngoscopy exercise (CLE)-test laryngeal movements during exercise were analysed in healthy controls (n = 28) and compared to subjects with exercise induced bronchoconstriction (EIB) (n = 10), exercise induced laryngeal obstruction (EILO) (n = 10) and subjects experiencing exercise-induced dyspnoea without having any of these diagnoses (n = 31). Images from the video recordings were assessed regarding glottic angle, glottic area and supraglottic area using the software measuring tool EILOMEA. ResultsNo significant differences were detected between controls, the dyspnoea group without a diagnosis of EIB or EILO and the EIB group regarding glottis angle, glottis area or supraglottic area at maximum effort. All three parameters differed significantly in the EILO group compared to the other groups (p=<0.001). In the group with EILO all but one had supraglottic obstruction (corresponding to a CLE-test score ≥2). Movement of the laryngeal structures, corresponding to a CLE-test score of 1, at glottic and/or supraglottic level was seen in 26 of 35 (74%) of controls, 34 out of 41 (83%) of patients in the dyspnoea group, and in 25 of 38 (66%) of EIB-subjects. ConclusionMinor movements at both glottic and supraglottic level are equally common in healthy controls as among adolescents with exercise induced dyspnoea without EIB or EILO and adolescents with EIB. Adolescents with EILO had a statistically significant more pronounced supraglottic obstruction than the other groups.

Assessing and Quantifying Air Added to the Voice by Means of Laryngostroboscopic Imaging, EGG, and Acoustics in Vocally Trained Subjects

To assess and quantify singers' strategies for adding air to phonation to sound "breathy" in a healthy manner STUDY DESIGN: Case-control study with 20 professional singers. Twenty singers were recorded performing sustained vowels in the Complete Vocal Technique Neutral vocal mode with and without audible air added to the voice by means of laryngostroboscopic imaging using a videonasoendoscopic camera system, electroglottography, long-term average spectrum, as well as acoustic signals and audio perception. Singers completed Voice Handicap Index and Reflux Symptom Index questionnaires prior to examination. Air added to the voice resulted in an expected glottal gap along the length of the vocal folds, with little to no further difference in the supraglottic area, as compared with the Neutral phonation. Air added resulted in lowered Qx, mean Sound Pressure Level, and Cepstral Peak Prominence, but higher Harmonics-to-Noise Ratio, Jitter, and Shimmer, with decreased energy at the fundamental frequency. Adding audible air to the phonation did not exhibit similar effects on acoustics for males and females. Also, for females, H1-H2 difference decreased with air added, while it increased for males. Singers produce an audible airy phonation similar yet significantly different to the breathy phonation reported for both healthy and pathological speakers.

USE OF ALL-IN-ONE AIRWAY STABILIZING DEVICE TO SECURE OXYGEN SUPPLEMENT DURING BRONCHOSCOPY

SESSION TITLE: Tuesday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM PURPOSE: To guarantee the application of supplemental oxygen to supraglottic area and bypass any nasal or oral cavities hindrance. Oxygen supplement during moderate sedation prevents occurrence of clinically significant desaturation during endoscopic procedures. Providing oxygen via nasal cannula or face mask during bronchoscopy may not necessarily secure delivery of same amount of liter flow to the supraglottic area. The availability of higher amounts of oxygen in this anatomical site will secure oxygen supplement to lower levels of the airway with less work of breathing. Patients who require sedation may have less effort for breathing. Therefore, providing higher amounts of oxygen right above the vocal cords or to the supraglottic area will facilitate easier oxygen supplement to the lower levels of bronchial tree. Unforeseen nasal passages or oral cavity anatomical or pathological abnormalities, may hinder the adequate supplying of oxygen to lower levels of the bronchial tree. This unforeseen dilemma may cause intermittent or prolonged desaturations that require increasing oxygen flow to overcome those anatomical or pathological barriers. Deviated nasal septum, nasal polyps, large size tongue or redundant mucosal lining of upper airway passages constitute some of the examples for those anatomical or pathological dilemmas. The use of this All-In-One airway device is seeking stabilization of upper airway patency to allow supplying oxygen to the supraglottic area and, hence, the lower bronchial tree without having to refer to trans laryngeal intubation. The device is orally inserted. It consists of a tubular structure with a curvature to help depressing the tongue and create a passage for the fiber optic bronchoscope via the working channel. The device has a multi-functioning revolving valve that allows connection with different tubing systems to provide oxygen. The whole amount of oxygen provided through the oxygen side port will continue to flow through the tubular structure up to the level of vocal cords in the supraglottic area. The All-In-One airway stabilizing device has another side port that can connect to capnography equipments as desired while patients are sedated. METHODS: A comparison study between the All-In-One airway stabilizing device and mouth piece during bronchoscopy. Oxygen source was attached to the oxygen side port in the All-In-One airway stabilizing device in one arm of the study and a nasal cannula was provided to the other patient on the other arm of the study where the mouth piece was provided. RESULTS: Oxygen supplement source was more secured to provide higher flow of oxygen at the targeted anatomical location. CONCLUSIONS: The use of All-In-One airway stabilizing device will enable more guaranteed oxygen supplement to flow at the targeted anatomical locations. CLINICAL IMPLICATIONS: Use of All-In-One airway stabilizing device will secure oxygen supplement for sedated patients. DISCLOSURES: Owner/Founder relationship with AGobi, Inc Please note: $1-$1000 Added 03/14/2019 by Victor Ghobrial, source=Web Response, value=Ownership interest

Primary Laryngeal Neuroendocrine Carcinoma: Two Cases of an Unusual Tumor in a Rare Location

Introduction: Neuroendocrine neoplasm is an infrequent tumor in the larynx which can be sub-classified into five different types: typical carcinoid, atypical carcinoid, large cell carcinoma, small cell carcinoma, and paraganglioma. This tumor mostly occurs in smoker men. The common location of neuroendocrine tumor of the larynx is in the supraglottic area. Because of the complex nature of neuroendocrine neoplasms of the larynx, we found it so interesting to present. We emphasized the clinical importance and aggressive nature of this tumor despite its rarity. Case Presentation: In the present study, we presented 2 cases of atypical carcinoid in non-smoker females. Case 1 was a 74-year-old non-smoker woman who was referred with a history of chronic dysphagia and left otalgia since one year ago. Laryngoscopy revealed a nonulcerated supraglottic epitheliomatous lesion. Biopsy showed atypical carcinoid. The patient had no lymphadenopathy or metastasis in the further workup. The second case was a 60-year-old non-smoker woman with a 4-month history of hoarseness, odynophagia accompanied by cervical lymphadenopathy. Laryngoscopy showed a smooth surface non-ulcerated transglottic tumor. Right vocal cord mobility was restricted. Conclusions: Atypical carcinoid tumor is an underdiagnosed laryngeal malignancy. Although neuroendocrine tumor of the larynx is rare, physicians should be familiar with its unspecified presentations, pathology, clinical course, and prognosis.

Supraglottic jet oxygenation and ventilation for obese patients under intravenous anesthesia during hysteroscopy: a randomized controlled clinical trial

BackgroundSupraglottic jet oxygenation and ventilation (SJOV) can effectively maintain adequate oxygenation in patients with respiratory depression, even in apnea patients. However, there have been no randomized controlled clinical trials of SJOV in obese patients. This study investigated the efficacy and safety of SJOV using WEI Nasal Jet tube (WNJ) for obese patients who underwent hysteroscopy under intravenous anesthesia without endotracheal intubation.MethodsA single-center, prospective, randomized controlled study was conducted. The obese patients receiving hysteroscopy under intravenous anesthesia were randomly divided into three groups: Control group maintaining oxygen supply via face masks (100% oxygen, flow at 6 L/min), the WNJ Oxygen Group with WNJ (100% oxygen, flow: 6 L/min) and the WNJ SJOV Group with SJOV via WNJ [Jet ventilator working parameters:100% oxygen supply, driving pressure (DP) 0.1 MPa, respiratory rate; (RR): 15 bpm, I/E; ratio 1:1.5]. SpO2, PETCO2, BP, HR, ECG and BIS were continuously monitored during anesthesia. Two-Diameter Method was deployed to measure cross sectional area of the gastric antrum (CSA-GA) by ultrasound before and after SJOV in the WNJ SJOV Group. Episodes of SpO2 less than 95%, PETCO2 less than 10 mmHg, depth of WNJ placement and measured CSA-GA before and after jet ventilation in the WNJ SJOV Group during the operation were recorded. The other adverse events were collected as well.ResultsA total of 102 patients were enrolled, with two patients excluded. Demographic characteristics were similar among the three groups. Compared with the Control Group, the incidence of PETCO2 < 10 mmHg, SpO2 < 95% in the WNJ SJOV group dropped from 36 to 9% (P = 0.009),from 33 to 6% (P = 0.006) respectively,and the application rate of jaw-lift decreased from 33 to 3% (P = 0.001), and the total percentage of adverse events decreased from 36 to 12% (P = 0.004). Compared with the WNJ Oxygen Group, the use of SJOV via WNJ significantly decreased episodes of SpO2 < 95% from 27 to 6% (P = 0.023), PETCO2 < 10 mmHg from 33 to 9% (P = 0.017), respectively. Depth of WNJ placement was about 12.34 cm in WNJ SJOV Group. There was no significantly difference of CSA-GA before and after SJOV in the WNJ SJOV Group (P = 0.234). There were no obvious cases of nasal bleeding in all the three groups.ConclusionsSJOV can effectively and safely maintain adequate oxygenation in obese patients under intravenous anesthesia without intubation during hysteroscopy. This efficient oxygenation may be mainly attributed to supplies of high concentration oxygenation to the supraglottic area, and the high pressure jet pulse providing effective ventilation. Although the nasal airway tube supporting collapsed airway by WNJ also plays a role. SJOV doesn’t seem to increase gastric distension and the risk of aspiration. SJOV can improve the safety of surgery by reducing the incidence of the intraoperative involuntary limbs swing, hip twist and cough.Trial registrationChinese Clinical Trial Registry. Registration number, ChiCTR1800017028, registered on July 9, 2018.

Clinicopathologic features of rheumatoid nodules: a retrospective analysis.

The clinical and histopathologic features of patients that have been diagnosed with rheumatoid nodules were investigated. This study included patients with rheumatoid nodules, confirmed by histologic assessment, between 2005 and 2018 at the Hanyang University Hospital. Each patient had a total score of 6 or more according to the American College of Rheumatology criteria. A total of 57 cases were included in this study. The median age of the patients at the time of diagnosis was 57years (range, 39-70years). The average duration between the onset of treatment and occurrence of rheumatoid nodule was 11.6years. Bone erosion was observed in 44 patients (77.2%). Among 57 patients, 56 (98.2%) were treated with disease-modifying anti-rheumatic drugs; most of the patients (87.7%) showed high-positive rheumatoid factor or high-positive anti-citrullinated protein antibodies. The foot, hand, and wrist, in order of decreasing frequencies, were the anatomical sites with the highest occurrence of rheumatoid nodules, whereas, the soft tissue adjacent to the joint, subcutis, dermis, lung parenchyma, and submucosal layer of the supraglottic area, also in an order of highest frequency, were the histological sites with the highest occurrence. Microscopically, central necrobiosis was present in all cases. Stromal fibrosis (96.5%), palisading of histiocytes (82.5%), perivascular lymphocytic infiltration (68.4%), and cleft or cystic degeneration (63.2%) were also observed. A clinicopathological review of cases diagnosed with rheumatoid nodules histologically was performed to confirm characteristics that can help clinicians understand the pathophysiology of the condition and make accurate diagnoses of rheumatoid nodules. Key Points • We reviewed the clinical, imaging, and histologic features of rheumatoid nodule. • The average duration between the onset of treatment and occurrence of rheumatoid nodule was 11.6years. • Among 57 rheumatoid nodule patients, 98.2% were treated with disease-modifying anti-rheumatic drugs.

Gender-related incidence, risk factors exposure and survival rates of laryngeal cancers - the 10-years analysis of trends from one institution.

The aim of the study was the analysis of the epidemiology of laryngeal cancer over 10 years in relation to known risk factors and to assess the current survival rates in this group of patients. The data were retrospectively collected from patients' medical records, then entered in the database using dedicated software and a statistical analysis was performed. 512 subjects - 443 men (86.5%) and 69 women (13.5%) were enrolled into the study. The male-to-female ratio was 6.4:1. There were 97.1% smoking women and 98% smoking men, however the history of more than 20 cigarettes per day smoking admitted 81.1 % of women and 94.6% of men. Heavy alcohol consumption was the case in 14 (20.3%) women and in 307 (69.3%) men. For both the size of heavy alcohol consumption and the size of excessive tobacco use, there was found statistically significant difference between women and men with laryngeal cancer (p&lt;0.05). In the majority of male and female subjects, the tumour was located in the supraglottis/glottis area. Apparently this tumour location was much more common among women, accounting for 60.9% of cases , while in men was confirmed in 39.3% of cases. The stages of the laryngeal cancer were similarly of high advancement for both the men and women - stages III and IV were confirmed in 82.6% of women and in 77.6% of men. The over 5-year survival rate was 39.1% among women and 37.2% among men. Conclusions Contradictory to decreased exposure to risk factors and the shorter period for diagnosis, the higher stages of cancer were observed in women. Although in women the advancement was higher and the majority of cases were located in unfavourable supraglottic area, the survival rates were higher. Key words: laryngeal cancer, epidemiology, men and women, risk factors.