Stumme Aspiration eines ösophagotrachealen Shuntventils

Einleitung: Die Stimmrehabilitation nach einer totalen Laryngektomie erfolgt bei derMehrheit der Patienten heutzutage mit einem ösophagotrachealen Shuntventil. Über eineShuntventil-Aspiration wird in 1-13% der Patientenberichtet. Die Aspiration wird i.d.R durchakute Dyspnoe, Husten und Speichelaspiration bemerkt. Wir berichten hier über eine 8Monate unbemerkte Stimmprothesenaspiration.Falldarstellung: Ein 52-jähriger vor 1,5 Jahren laryngektomierter Patient stellte sich beschwerdefrei in unserer regulären Tumornachsorgevor. Uns fiel eine Aphonie bei nicht sichtbarem Shuntventil auf. In der durchgeführten Röntgendiagnostik zeigte sich einrundlicher röntgendichter Fremdkörper in Projektion auf den linken Unterlappenbronchus.Wir führten eine starre Tracheobronchoskopie durch. Intraoperativ konnte das inGranulationsgewebe fest eingebettete Sprechventil im linken Hauptbronchus lokalisiert undentfernt werden.Schlussfolgerung: Nicht nur eine symptomatische sondern auch eine stumme Shuntventilaspiration stellt einen HNO-ärztlichen Notfall dar. Eine präinterventionelle radiologische Diagnostik sollte mittels einer Röntgenaufnahme durchgeführt werden. Die Sprechprothesenentfernung im Rahmen einer starren Tracheobronchoskopie ist dieTherapie der Wahl.Der Erstautor gibt keinen Interessenkonflikt an

Life-threatening post-tonsillectomy hemorrhage. Case report including suggestions for a prehospital emergency care algorithm

Ayoung woman suffered an out-of-hospital hemorrhage in her parents' home one week after having undergone tonsillectomy. She was initially awake when the emergency medical service personnel arrived. But because of severe aspiration of blood, she quickly became hypoxemic and required cardiac resuscitation. Endotracheal intubation failed so that airway had to be secured by means of cricothryrotomy. Under resuscitation care, she was taken to the university hospital. Despite surgical exploration of the pharyngeal and collar region as well as advanced life support, return of spontaneous circulation (ROSC) could not be achieved and the patient died. On the basis of this case report, an attempt is made to include all emergency procedures that are necessary in posttonsillectomy hemorrhage such as difficult airway management, bleeding control and hemodynamic support into auseful algorithm

Dermatologist-like explainable AI enhances trust and confidence in diagnosing melanoma

Abstract Artificial intelligence (AI) systems have been shown to help dermatologists diagnose melanoma more accurately, however they lack transparency, hindering user acceptance. Explainable AI (XAI) methods can help to increase transparency, yet often lack precise, domain-specific explanations. Moreover, the impact of XAI methods on dermatologists’ decisions has not yet been evaluated. Building upon previous research, we introduce an XAI system that provides precise and domain-specific explanations alongside its differential diagnoses of melanomas and nevi. Through a three-phase study, we assess its impact on dermatologists’ diagnostic accuracy, diagnostic confidence, and trust in the XAI-support. Our results show strong alignment between XAI and dermatologist explanations. We also show that dermatologists’ confidence in their diagnoses, and their trust in the support system significantly increase with XAI compared to conventional AI. This study highlights dermatologists’ willingness to adopt such XAI systems, promoting future use in the clinic