Acta otorhinolaryngologica Italica : organo ufficiale della Società italiana di otorinolaringologia e chirurgia cervico-facciale
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Acta Otorhinolaryngol Ital · Dec 2018
Aspiration: diagnostic contributions from bedside swallowing evaluation and endoscopy.
The aim of this study was to identify which characteristics, collected by bedside swallowing evaluation (BSE) and fiberoptic endoscopic evaluation of swallowing (FEES), are a risk or a protective factor for aspiration. This retrospective study included data on 1577 consecutive patients, collected by BSE and FEES. Bivariate analysis was performed to verify the association of each variable with aspiration (Chi-Square test). ⋯ Patients able to perform dry swallows were 77% less likely to aspirate (protective factor). Several variables are involved in protection of airways during swallowing. Their interaction, in patients with swallowing disorders, offers the clinician the best means of interpreting BSE and FEES.
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Acta Otorhinolaryngol Ital · Oct 2018
Case ReportsTreatment-emergent central sleep apnoea after surgery for obstructive sleep apnoea.
Central sleep apnoea (CSA) is a lack of drive to breathe during sleep, which can occur in physiologic as well as in pathologic conditions. A particular type of CSA, defined treatment-emergent CSA (TECSA), may occur after the treatment of obstructive sleep apnoea syndrome (OSAS), either with CPAP or surgery. TECSA is transitory and seems to be related to the severity of OSAS. ⋯ We believe that CSA was triggered by the sudden variation in nocturnal arterial PCO2, which decreased from 52.3 mmHg before surgery to 42.0 mmHg after surgery. It is conceivable that, due to long-lasting severe OSAS, our patient lowered his chemosensitivity to PCO2. Consequently, the resolution of obstructive apnoeas and the restoration of normal nocturnal values of PCO2 may have reduced the nocturnal PCO2 to the point of being inadequate to stimulate ventilation.
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Acta Otorhinolaryngol Ital · Oct 2015
Clinicopathologic characteristics of familial versus sporadic papillary thyroid carcinoma.
It is unclear whether familial non-medullary thyroid carcinoma (FNMTC) is more aggressive than sporadic carcinoma, and its prevalence is still under debate. In this study, we investigated the clinicopathologic features of familial papillary thyroid carcinoma (PTC) compared with its sporadic counterpart. We used data from our hospital between 2008 and 2014 to compare the features of 24 familial PTC with 80 sporadic PTC. ⋯ Based on our results, we conclude that familial PTC is a clinically distinct entity with an aggressive nature. Because of the frequent presence of benign nodules, multifocality, bilaterality and high rate of recurrence, total or near-total thyroidectomy with neck dissection in these patients might be recommended. To date, the optimal clinical treatment is yet to be established, but improved awareness and screening will permit earlier detection, more timely intervention and improved outcomes for patients and their families.
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Acta Otorhinolaryngol Ital · Feb 2015
Case ReportsUtility of Glidescope(®) videolaryngoscopy in surgical procedures involving the larynx.
GlideScope(®) is a recently developed videolaryngoscope that helps to achieve a good view of the laryngeal inlet and the vocal cords. Videolaryngoscopy has been proven effective in patients with unusual anatomical or pathological features, suggesting the possibility of a difficult endotracheal intubation. This device may also be useful for otorhinolaryngologists by facilitating access to the larynx and tongue base, especially in selected cases, where good visualisation of disease-altered structures is vital. ⋯ In our experience, we performed five procedures involving the larynx with the GlideScope(®) in patients presenting unusual clinical characteristics that potentially compromised surgical outcome. No complications related to videolaryngoscopy were found. We recommend the use of GlideScope(®) for small surgical procedures involving the larynx in selected patients.
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Acta Otorhinolaryngol Ital · Dec 2014
ReviewSTANDING, a four-step bedside algorithm for differential diagnosis of acute vertigo in the Emergency Department.
Vertigo is generally due to a benign disorder, but it is the most common symptom associated with misdiagnosis of stroke. In this pilot study, we preliminarily assessed the diagnostic performance of a structured bedside algorithm to differentiate central from non-central acute vertigo (AV). Adult patients presenting to a single Emergency Department with vertigo were evaluated with STANDING (SponTAneous Nystagmus, Direction, head Impulse test, standiNG) by one of five trained emergency physicians or evaluated ordinarily by the rest of the medical staff (control group). ⋯ The test had good interobserver agreement (k = 0.76), with very high sensitivity (100%, 95%CI 72.3-100%) and specificity (94.3%, 95%CI 90.7-94.3%). Furthermore, hospitalisation and neuroimaging test rates were lower in the STANDING than in the control group (27.6% vs. 50.5% and 31.6% vs. 71.1%, respectively). In conclusion, STANDING seems to be a promising simple structured bedside algorithm that in this preliminary study identified central AV with a very high sensitivity, and was associated with significant reduction of neuroimaging and hospitalisation rates.