1/27. Respiratory diphtheria in three paediatric patients.From August till November 1998, the Paediatric and Anaesthetic Units of Hospital Kuala Terengganu managed three patients from Kuala Terengganu District who were ventilated for respiratory diphtheria. Their ages were 5, 4 and 7 years old and their immunisation for diphtheria were not complete. All three patients presented with respiratory distress and were ventilated for upper airway obstruction. Their treatment included intravenous penicillin and diphtheria antitoxin. One patient died of cardiogenic shock with secondary pneumonia. Pharyngeal and tonsillar swabs of all three patients grew toxigenic corynebacterium diphtheriae biotype mitis. There were 765 throat cultures taken from contacts. The confirmed positive cultures grew 2 toxigenic and 3 non-toxigenic corynebacterium diphtheriae biotype mitis and surprisingly, 10 non-toxigenic biotype gravis. A prevalence study is needed to document the endemicity of diphtheria in Kuala Terengganu and to determine the carrier rate of both biotypes. Steps have been taken to increase the immunisation coverage in children. The giving of regular booster doses of diphtheria toxoid to the adult population should be considered.- - - - - - - - - - ranking = 1keywords = throat (Clic here for more details about this article) |
2/27. Tortuosity of the internal carotid artery--report of three cases and MR-angiography imaging.Three cases of a tortuous internal carotid artery bulging the lateral pharyngeal wall that caused a persistent throat abnormal sensation were presented. Magnetic resonance angiography was non-invasive and useful for establishing its diagnosis. Otolaryngologists should recognize this anomaly, because it may cause a fatal hemorrhage during surgical procedures on the pharynx.- - - - - - - - - - ranking = 1keywords = throat (Clic here for more details about this article) |
3/27. Traumatic aneurysm of the internal carotid artery in an infant: a surprise diagnosis.Isolated aneurysm of the extracranial section of the internal carotid artery has been reported in children but never, to our knowledge, in an infant. It can represent a major anaesthetic challenge with compromise of both airway and cerebral perfusion and the associated risks of rupture. We report on an 11-month-old infant, who had undergone an examination under anaesthesia of her nose and throat for epistaxis and gastrointestinal endoscopy due to apparent gastrointestinal bleeding shortly before presenting to us with signs of rapidly progressive upper airway obstruction. Emergency examination under anaesthesia revealed a large pulsatile mass in the posterior nasopharynx which, on subsequent radiological investigation, was revealed to be a large pseudoaneurysm of the right internal carotid artery, obstructing distal flow. An apparently minor episode of trauma had occurred around the time of the first nosebleed; she had allegedly fallen onto her face with a spoon in her mouth.- - - - - - - - - - ranking = 1keywords = throat (Clic here for more details about this article) |
4/27. Fatal angioedema associated with lisinopril.OBJECTIVE: To report a case of fatal angioedema associated with the use of lisinopril, a long-acting angiotensin-converting enzyme (ACE) inhibitor. DATA SOURCES: case reports, review articles, short reports, and pertinent information from the patient's medical record. DATA EXTRACTION: Data was collected from contemporary medical journals and reviewed by both authors. DATA SYNTHESIS: angioedema associated with ACE inhibitors (captopril and enalapril) is well documented in the literature. With increased prescribing of newer, longer-acting agents, this potentially lethal adverse reaction is of even greater concern. Because angioedema associated with ACE inhibitors is a class-related event, the number of reported cases would be expected to increase with increasing numbers of prescriptions written for these drugs. This report, describing a patient who developed angioedema following therapy with lisinopril, illustrates the severity of this adverse reaction. PATIENT: A 66-year-old man presented to the emergency room complaining of increased swelling of the back of his throat and difficulty breathing. Despite treatment with epinephrine, antihistamines, and corticosteroids, the patient's condition progressed from that of severe laryngeal edema to total laryngospasm and complete airway obstruction. Emergency measures to intubate the patient were complicated by severe swelling of his neck and oropharynx, forcing the physician to perform a grossly traumatic tracheotomy. The difficulty encountered during intubation deprived the patient of oxygen for a significant amount of time, precipitating cardiopulmonary arrest. The anoxic episode resulted in hypoxic, ischemic encephalopathy and, ultimately, death. CONCLUSIONS: angioedema is a serious, potentially life-threatening adverse effect associated with the use of ACE inhibitors. Clinicians need to be aware of this effect when prescribing ACE inhibitors to treat hypertension and congestive heart failure, and when assessing patients presenting to the emergency room with complaints of tongue or pharyngeal swelling. patients should be instructed to report immediately to an emergency room for medical attention if they experience any unexplained shortness of breath or swelling of the throat or tongue.- - - - - - - - - - ranking = 2keywords = throat (Clic here for more details about this article) |
5/27. Extrathoracic obstruction and hypoxemia occurring during exercise in a competitive female cyclist.A 22-year-old competitive female cyclist complained of cough, chest tightness, and wheeze during high-intensity exercise that had previously been diagnosed as exercise-induced bronchospasm (EIB). A loud stridor, a sensation of her "throat closing," and severe dyspnea developed during maximal cycling exercise with concomitant reductions in both inspiratory and expiratory flow rates. A decrease of 25 L/min (26%) in minute ventilation and arterial hypoxemia (PaO(2) decrease, 93 to 76.5 mm Hg) resulted from this obstruction. Spontaneous tidal flow-volume loops (FVLs) during exercise exhibited a sawtooth pattern during inspiration, and substantial drops in flow rates after the stridor developed. However, maximal FVLs were unchanged from baseline following exercise, indicating that the obstruction was not EIB. We suggest that the continuous measurement of spontaneous breath-by-breath tidal FVLs may be a useful diagnostic tool for the identification of exercise-induced extrathoracic obstruction. Additionally, extrathoracic obstruction should be considered as an uncommon but potential cause of inadequate ventilation and arterial hypoxemia during exercise.- - - - - - - - - - ranking = 1keywords = throat (Clic here for more details about this article) |
6/27. Case of sublingual hematoma threatening airway obstruction.BACKGROUND: The complications of warfarin therapy have classically been described as bleeding in the genitourinary and gastrointestinal tracts, skin, central nervous system, nose, penis, or retroperitoneum. However, rarely warfarin may cause bleeding that compromises a patient's airway. A sublingual haematoma is an example of such a complication. Only 10 previous cases of sublingual haematomas have been reported. CASE REPORT: We describe the case of a 56 year-old woman receiving oral anticoagulation who presented with a sore throat and hoarseness. Examination of her oral cavity revealed a soft, red, submucosal swelling involving the floor of mouth and ventral lingual surface bilaterally. No signs of airway compromise were observed. The patient's PT-INR was 10. Given the potential for rapid airway obstruction, the patient was admitted to a unit with closely monitored beds. Her coagulation disturbance was corrected medically and her haematoma resolved. The patient was discharged to the care of her family physician. CONCLUSIONS: This case makes several important points. First, the case describes a rare, but life-threatening complication of warfarin therapy. Second, the initial signs of a sublingual haematoma are reviewed. Given the vagueness of these signs, diagnosis requires a high index of suspicion on the part of the physician. Finally, the case describes successfully management of this disorder without the use of a surgical airway. For this patient, reversal of her anticoagulation and vigilant monitoring saved her from having a surgical airway placed.- - - - - - - - - - ranking = 10.913704870656keywords = sore throat, throat (Clic here for more details about this article) |
7/27. Tortuous internal carotid artery indenting the piriform sinus: a case report.A case of tortuous internal carotid artery bulging and partially obliterating the piriform sinus, causing a sensation of fullness and abnormal throat, accompanied by choking spells in a 57-year-old patient is presented. Endoscopic examination and computerized tomographic angiography were useful in establishing the diagnosis. This rare anomaly should be recognized in order to prevent possible fatal hemorrhages during further surgical interventions of the piriform sinus.- - - - - - - - - - ranking = 1keywords = throat (Clic here for more details about this article) |
8/27. Successful laser ablation of diffuse laryngeal swelling in posttransplant lymphoproliferative disorder: the Japanese first case.Posttransplant lymphoproliferative disorder (PTLD) is a well-known complication of pediatric organ transplantation. The first symptoms are often in the ear, nose, or throat (ENT) area. We report the first Japanese case of an airway obstruction in PTLD. A 7-year-old boy who had a liver transplant at the age of 2 years presented with progressive stridor. Fiberoptic examination revealed enlarged epiglottis and swelling arytenoids. Highly suspicious of early-PTLD, he was treated with reduction of immunosuppression, but no improvement on his larynx was observed. Laser ablation of swelling arytenoids worked. Surgical debulking is effective to ease an airway obstruction in cases of PTLD.- - - - - - - - - - ranking = 1keywords = throat (Clic here for more details about this article) |
9/27. Choking, sore throat with referred otalgia and dysphagia in a patient with diffuse idiopathic skeletal hyperostosis (DISH).A patient with a progressively increasing immobilisation of the cervical spine, severe impaired swallowing (choking), sore throat with referred right-sided otalgia, mild voice disorder and dysphagia due to extrinsic bone compression of the posterior hypopharyngeal wall and oesophagus is presented. Radiographic investigation demonstrated the underlying condition to be a diffuse idiopathic skeletal hyperostosis with prominent and bumpy alteration of the anterior longitudinal ligament impinging the hypopharynx. Via an anterolateral approach towards the cervical spine the anterior irregular part of the ossification was removed and the surface of the spine flattened. The postoperative evolution was uneventful.- - - - - - - - - - ranking = 54.568524353282keywords = sore throat, throat (Clic here for more details about this article) |
10/27. Brief upper airway (laryngeal) dysfunction.We describe in six men, recurrent episodes recurring over months or years, of sudden, brief complete obstruction to respiration followed by dyspnoea with loud inspiratory stridor lasting two to five minutes. Attacks occurred during wakefulness and/or sleep. In one patient an episode was witnessed endoscopically: the initial obstruction was seen to be caused by complete laryngeal closure. The false vocal cords then opened, but the vocal cords remained adducted and caused inspiratory stridor. The similarity of the attacks described by the other patients suggests that they were all caused by laryngeal closure. Furthermore, they could simulate the episodes by voluntarily adducting their vocal cords. The symptoms were usually preceded by a sensation of throat irritation and in four cases symptoms of upper respiratory infection were present. Associated features present in some of the patients included post-nasal discharge, snoring, sleep apnoea and gastro-oesophageal reflux. None was hypocalcaemic. Although stimulation of laryngeal receptors is known to produce reflex laryngeal closure, cough is the usual response during wakefulness. Treatment aimed at reducing upper airway irritation and voluntary inhibition of coughing appeared successful in reducing the incidence and severity of the episodes. Recognition of the condition is important as it may be confused with other causes of acute dyspnoea and it appears to respond to specific management.- - - - - - - - - - ranking = 1keywords = throat (Clic here for more details about this article) |
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