Laryngeal Trauma Complicating a Suicide Attempt by Hanging

A 40-year-old man was admitted to the emergency room after a suicide attempt. He was found hanged in his garden shelter by a neighbour. The patient complained only of a slight dysphagia and anterior cervical pain. The clinical examination revealed no cutaneous lesion or neurological deficit. Head and neck CT scan with and without injection of contrast agent was performed. CT has shown displaced fractures of the two horns of the thyroïd cartilage (Figs. A, B; white arrow). Fractures were associated with a small tumefaction of the left hypopharyngeal soft tissue (Fig. C; white star) and left side of the larynx. The airways were patent. The ENT specialist achieved a laryngoscopy and confirmed the small buldging of the larynx, with no significant effect on the airways. Larynx mobility was conserved. A control fibroscopy was done 12 hours later with no modification of the lesion

Severe dysphagia caused by vagus nerve herpetic neuropathy: a case report

In this study, we report a rare case of herpetic infection of the larynx with vagus nerve palsy. Herpes simplex virus (HSV) and varicella zoster virus (VZV) are among the most common viral causes of vagus nerve (VN) dysfunction. The clinical presentation of herpetic laryngitis is variable. The diagnosis is clinical and can be confirmed by serological test or better yet by a PCR. When HSV or VZV infection is suspected, it is mandatory to start the antiviral treatment rapidly, within 72 hours. The use of corticosteroids remains a controversial subject. The consequences of vagus nerve damage are not negligible in terms of quality of life and may cause multiple symptoms due to the anatomical distribution of the nerve. Once the diagnosis is confirmed, intensive voice and swallowing rehabilitation must be undertaken to limit the functional impact and quality of life degradation

Depletion of clomiphene residues in eggs and muscle after oral administration to laying hens

The selective oestrogen receptor modulator (SERM) clomiphene is therapeutically used to induce ovulation. While prohibited as a doping agent in sports, it is frequently detected in sports drug testing urine samples. Few reports exist on clomiphene's (illicit) use in the farming industry to increase the egg production rate of laying hens, which creates a risk that eggs as well as edible tissue of these hens contain residues of clomiphene. To investigate the potential transfer of clomiphene into eggs and muscle tissue, laying hens were orally administered with clomiphene citrate at 10 mg/day for 28 days. To determine clomiphene residues in eggs, chicken breast and chicken thigh, the target analyte was extracted from homogenised material with acetonitrile and subjected to ultra-high performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS) analysis. The test method reached a limit of quantification (LOQ) of 1 mu g/kg and was characterised concerning specificity, precision, trueness and linearity. Analyses were performed on whole egg, egg white and yolk separately, and chicken muscle from breast and thigh. Clomiphene was detectable in eggs two days after the beginning of the drug administration period. The drug concentrations increased to 10-20 mu g per egg within one week, and after withdrawal of clomiphene, residues decreased after 4 days, but traces of clomiphene were still detectable until the end of the study (14 days after the last administration). In the chicken's muscle tissue, clomiphene levels up to 150 mu g/kg (thigh) and 36 mu g/kg (breast) were found. Six days after the last dose, tissue clomiphene concentrations fell below the LOQ. Overall, these results underline the concerns that clomiphene may be transferred into animal-derived food and future research will therefore need to focus on assessing and minimising the risk of unintentional adverse analytical findings in doping controls

Transoral robotic surgery hypopharyngectomy (TORSH): feasibility and outcomes.

With the development of minimal invasive procedure, trans-oral robotic surgery (TORS) is expanding in the field of ENT. Most reviews focus on oropharyngeal and laryngeal (supra-glottic) localization. We report here the feasibility and outcomes of TORS hypopharyngectomy (TORSH) for selected patients with hypopharyngeal tumor. Between September 2009 and July 2017, 22 patients, retrospectively included, underwent TORSH with curative intent. From 22 successful hypopharyngectomy, no conversion to open procedure was needed. Three patients (13%) presented a post-operative bleeding and were managed by surgical revision. No fistula was encountered. The 3-year overall survival and disease-specific survival rates were 54 and 92%, respectively. Patients started oral feeding after an average of 7 days. Naso-gastric feeding tubes were removed after a median period of 16 days. Two patients (9%) needed a transient gastrostomy (< 1 year). Three patients (13%) received a transient tracheostomy (< 2 months). Median hospitalization stay was 13 days. TORSH is a safe technique. Patients' outcomes are favorable and the post-operative morbidity is reduced compared to open neck approach. Hospitalization length and safe swallowing time are reduced

Prognostic impact of tumor growth velocity in head and neck squamous cell carcinoma treated by radiotherapy: A pilot study.

BACKGROUND: When a patient is seen with a newly diagnosed oropharyngeal squamous cell carcinoma, it remains unclear to the treating physicians how fast the tumor growth rate is. METHODS: From patients with oropharynx squamous cell carcinoma treated by radiotherapy, the investigators selected comparable diagnostic CT-scan (DiCT) and radiotherapy planning CT-scan (RtCT). Tumor and pathological lymph node volumes were measured in order to calculate tumor progression. RESULTS: From the selection of 19 patients, the mean absolute tumor progression rate was 0.23 ± 0.2 cm3 /d and mean relative progression rate was 1.84 ± 1.64%/d. Mean tumor doubling time is 286 days (range 7-1282 days), demonstrating a wide range of tumor growth pattern. Significant tumor progression (>20%) between DiCT and RtCT was shown in 73% of patients, and 53% of the patients were seen a tumor progression of >50% within a mean waiting time of 42.1 days. Kaplan-Meier curves showed a non-significative link between fast progression tumors (>1%/d) and higher risk of recurrence (HR: 2.2; P = .23). CONCLUSIONS: Tumor progression can be assessed based on DiCT and RtCT. Treatment delay should be avoided at all cost. Different growth patterns were evidenced. For the fast-growing tumors subgroup, pejorative clinical outcomes were suggested. Prospective studies are needed to confirm a link between fast-growing tumors and higher risk for recurrence

Use of the montgomery implant system in medialization thyroplasty: postoperative vocal outcomes

Objective: Medialization thyroplasty using the Montgomery® Implant System (MTIS) is a surgical procedure for the treatment of persistent glottal gaps. In this study, we aimed to analyze postoperative vocal outcomes in patients suffering from unilateral vocal fold paralysis. Methods: A retrospective study was conducted on 30 patients undergoing MTIS medialization thyroplasty for unilateral vocal fold immobility. This series was selected from 68 patients operated on by the same technique between 2009 and 2018. Patients with missing data were excluded. The surgical procedure was performed under local anesthesia and sedation with peroperative fiberoptic examination. A complete vocal assessment was undertaken pre- and postoperatively, including perceptual, aerodynamic, and acoustic parameters and a questionnaire. Shortterm outcomes were analyzed. Results: Postoperative assessment was performed at a median of 33 days (range eight to 216). Absolute median maximum phonation time showed an increase of 4.10 seconds (p < 0.05), whereas the voice handicap index decreased by 36 points (p < 0.05). No significant differences were found between sexes. Conclusion: This retrospective study confirms the excellent immediate vocal results after medialization thyroplasty using MTIS. Further studies with prospective data are needed to evaluate the results according to sex of the patient

Transfer of flubendazole and tylosin at cross contamination levels in the feed to egg matrices and distribution between egg yolk and egg white

Chemical residues may be present in eggs from laying hens' exposure to drugs or contaminants. These residues may pose risks to human health. In this study, laying hens received experimental feed containing flubendazole or tylosin at cross contamination levels of 2.5, 5, and 10% of the therapeutic dose. Eggs were collected daily and analysis of the whole egg, egg white, and egg yolk was performed using liquid chromatography tandem mass spectrometry. Highest concentrations of the parent molecule flubendazole, as well as the hydrolyzed and the reduced metabolite, were detected in egg yolk. Residue concentrations of the parent molecule were higher compared with those of the metabolites in all egg matrices. No tylosin residue concentrations were detected above the limit of quantification for all concentration groups and in all egg matrices. Neither molecule exceeded the set maximum residue limits

Perioperative Considerations in Transoral Robotic Surgery (TORS): Experience of CHU UCL Namur

Transoral Robotic Surgery (TORS) is an emerging technique for the treatment of head and neck tumors. The aim of this paper is to describe our experience of perioperative considerations. Indeed, TORS is feasible, safe, and both oncologically and functionally effective. However, this technology has certain perioperative implications. We present the experience of anesthesiologists and surgeons over the past ten years with the Da Vinci Surgical System, and strongly recommend assigning a specific medical and paramedical team to shorten the learning curve and manage this innovative surgical technique with confidence and expertise

Transoral Robotic Surgery Total Laryngectomy.

The aim of our study is to demonstrate our technique for performing transoral robotic surgical total laryngectomy (TORS-TL) with the use of the da Vinci robotic system. We provide a comprehensive description of the TORS-TL operative techniques. Two fresh-frozen human cadavers were selected after ethics approval to describe the appropriate step-by-step surgical resection. We adopted a 5-step procedure that was later applied to 2 of our patients. The first patient presented initially with a squamous cell carcinoma (SCC) in the laryngeal glottis area. A lack of clinical response to initial treatment by chemoradiotherapy led to the decision of performing salvage TL surgery. The second patient had a previous history of head and neck SCC (HNSCC); he had no recurrence of his primary tumor but suffered significantly from postoperative breathing and swallowing difficulties due to severe laryngeal incompetence. TORS-TL was successfully performed in all cases. The operative time for the cadavers was approximately 65 and 55 min, respectively. It was significantly longer for the patients, 210 and 235 min, respectively, despite the fact that exactly the same steps were followed throughout all procedures. There were no intra- or postoperative complications or surgical morbidity related to the use of the da Vinci system. TORS-SL for SCC was performed in a safe, reliable, and smooth manner and was shown to be successful in treating our patients. We thus believe that our step-by-step surgical technique for TORS-SL is efficient and reproducible