A rare Giant Killian-Jamieson diverticulum in a 97-year-old female. Considerations and multidisciplinary treatments in a symptomatic patient

The purpose of this publication is to describe the clinical and imaging findings of rare symptomatic giant Killian-Jamieson diverticulum (KJD) detected in a 97-year-old female patient and discuss diagnostic and therapeutic protocols to be implemented. The clinical history began implementing anamnesis and physical examination, followed by laryngoscopy, esophagogastroduodenoscopy, sonographic examination and subsequently a double-contrast pharyngoesophagram evaluations, to our symptomatic old patient with results of typically KJD, with maximal dimension of 5 cm. The KJD was successfully treated with a surgical approach, esophagomyotomy in addition to a diverticulopexy; these techniques were used for adequate visualization of the tissue bridge of the diverticulum and protection of the surrounding tissue during dissection of the tissue bridge. Our patient has benefit from the operation immediately, with resolution of the disease. The follow-up (on-going), up to now, showed no recurrence of the pathological and no complications, making sure the authors of the efficacy of the surgical treatment. According to the authors the surgical treatment was the only procedure to cure the patients and, to date, our successful experience suggests that only surgical approach can be a safe and effective method for the treatment of symptomatic giant KJD, due to its close proximity to the recurrent laryngeal nerve and the concern of possible nerve injury

Computerised tomography and magnetic resonance imaging of laryngeal squamous cell carcinoma: A practical approach

Squamous cell carcinoma is the most common head and neck cancer. This review describes the state-of-the-art computerised tomography and magnetic resonance imaging protocols of the neck and the normal larynx anatomy, and provides a practical approach for the diagnosis and staging of laryngeal squamous cell carcinoma

Swallowing disorders after thyroidectomy: What we know and where we are. A systematic review

Introduction Dysphagia and hoarseness are possible complications that can be observed in patients undergoing thyroidectomy or other neck surgery procedures. These complaints are usually related to superior and inferior laryngeal nerves dysfunction, but these can appear even after uncomplicated surgical procedure. Methods We reviewed the current literature available on MEDLINE database, concerning the swallowing disorders appearing after the thyroidectomy. The articles included in the review reported pathophysiology and diagnostic concerns. Results Twenty articles were selected for inclusion in the review. Depends on the possible causes of the difficulty swallowing (related to nerve damage or appearing after uncomplicated thyroidectomy), different types of diagnostic procedures could be used to study patient discomfort, as well as intraoperative nerve monitoring, fiber optic laryngoscopy, endoscopy, pH monitoring, esophageal manometry and videofluorography. Among all these procedures, videofluorography is considered the gold standard to evaluate the entire swallowing process, since that allows a real-time study of all the three phases of swallowing: oral phase, pharyngeal phase and esophageal phase. Conclusion The diagnostic procedures described can help to identify the mechanisms involved in swallowing disorders, with the aim to choose the best therapeutic option. More studies are needed for understanding the causes of the dysphagia appearing after thyroidectomy

The Videofluorographic Swallowing Study in Rheumatologic Diseases: A Comprehensive Review

Autoimmune connective tissue diseases are a heterogeneous group of pathologies that affect about 10% of world population with chronic evolution in 20%-80%. Inflammation in autoimmune diseases may lead to serious damage to other organs including the gastrointestinal tract. Gastrointestinal tract involvement in these patients may also due to both a direct action of antibodies against organs and pharmacological therapies. Dysphagia is one of the most important symptom, and it is caused by failure of the swallowing function and may lead to aspiration pneumonia, malnutrition, dehydration, weight loss, and airway obstruction. The videofluorographic swallowing study is a key diagnostic tool in the detection of swallowing disorders, allowing to make an early diagnosis and to reduce the risk of gastrointestinal and pulmonary complications. This technique helps to identify both functional and structural anomalies of the anatomic chain involved in swallowing function. The aim of this review is to systematically analyze the basis of the pathological involvement of the swallowing function for each rheumatological disease and to show the main features of the videofluorographic study that may be encountered in these patients

Solar wind interaction with comet 67P: impacts of corotating interaction regions

International audienceWe present observations from the Rosetta Plasma Consortium of the effects of stormy solar wind on comet 67P/Churyumov-Gerasimenko. Four corotating interaction regions (CIRs), where the first event has possibly merged with a coronal mass ejection, are traced from Earth via Mars (using Mars Express and Mars Atmosphere and Volatile EvolutioN mission) to comet 67P from October to December 2014. When the comet is 3.1–2.7 AU from the Sun and the neutral outgassing rate ∼1025–1026 s−1, the CIRs significantly influence the cometary plasma environment at altitudes down to 10–30 km. The ionospheric low-energy (∼5 eV) plasma density increases significantly in all events, by a factor of >2 in events 1 and 2 but less in events 3 and 4. The spacecraft potential drops below −20 V upon impact when the flux of electrons increases. The increased density is likely caused by compression of the plasma environment, increased particle impact ionization, and possibly charge exchange processes and acceleration of mass-loaded plasma back to the comet ionosphere. During all events, the fluxes of suprathermal (∼10–100 eV) electrons increase significantly, suggesting that the heating mechanism of these electrons is coupled to the solar wind energy input. At impact the magnetic field strength in the coma increases by a factor of 2–5 as more interplanetary magnetic field piles up around the comet. During two CIR impact events, we observe possible plasma boundaries forming, or moving past Rosetta, as the strong solar wind compresses the cometary plasma environment. We also discuss the possibility of seeing some signatures of the ionospheric response to tail disconnection events

Simple and fast orotracheal intubation procedure in rat

Introduction: Endotracheal intubation in the rat is difficult because of extremely small size of anatomical structures (oral cavity, epiglottis and vocal cords), small inlet for an endotracheal tube and the lack of proper techniacal instruments. Matherial and Methods: In this study we used seventy rats weighthing 400-500 g. The equipment needed for intubation was an operating table, a longish of cotton, a cotton tip, orotracheal tube, neonatal laryngoscope KTR4, small animal ventilator, and isoflurane for inhalation anaesthesia. Premedication was carried out by medetomidine hydrochloride 1 mg/mL; then, thanks to a closed glass chamber, a mixture of oxygen and isoflurane was administered. By means of neonatal laryngoscope the orotracheal tube was advanced into the oral cavity untile the wire guide was visualized trough the vocal cords; then it was passed through them. The tube was introduced directly into into the larynx over the wire guide; successively, the guide was removed and the tube placed into the trachea. Breathing was confirmed using a glove, cut at the end of a finger, simulating a small ballon. Conclusions: We believe that our procedure is easier and faster than those previously reported in scientific literature. (www.actabiomedica.it

Spatial distribution of low-energy plasma around 2 comet 67P/CG from Rosetta measurements

International audienceWe use measurements from the Rosetta plasma consortium (RPC) Langmuir probe (LAP) and mutual impedance probe (MIP) to study the spatial distribution of low-energy plasma in the near-nucleus coma of comet 67P/Churyumov-Gerasimenko. The spatial distribution is highly structured with the highest density in the summer hemisphere and above the region connecting the two main lobes of the comet, i.e. the neck region. There is a clear correlation with the neutral density and the plasma to neutral density ratio is found to be ∼1-2·10 −6 , at a cometocentric distance of 10 km and at 3.1 AU from the sun. A clear 6.2 h modulation of the plasma is seen as the neck is exposed twice per rotation. The electron density of the collisonless plasma within 260 km from the nucleus falls of with radial distance as ∼1/r. The spatial structure indicates that local ionization of neutral gas is the dominant source of low-energy plasma around the comet