Myeloid sarcoma: An unusual and rare laryngeal presentation

IntroductionMyeloid Sarcoma (MS) or Granulocytic Sarcoma is an uncommon laryngeal malignancy. It may arise from myelodysplastic syndromes, malignancy or de novo. Presentation in the larynx is rare and some may present with Acute Myeloid Leukaemia (AML) whereby the later may be asymptomatic.Case PresentationA 44-year-old South East Asian lady presented with a six months history of hoarseness, shortness of breath, reduced exercise tolerance, weight loss and laryngeal irritation. Symptoms progressed to coughing with liquids two months prior. On examination, she had a resting biphasic stridor and laryngoscopy revealed right immobile vocal cord with a firm right ventricle mass extending into the right paraglottic space. She was pale and haematology investigations revealed microcytic hypochromic anaemia. Magnetic Resonance Imaging (MRI) of the neck and thorax showed thickening of the right false cord, true cord and aryepiglottic fold. A biopsy taken during endolaryngeal microsurgery (ELMS) confirmed myeloid sarcoma of the right ventricle and para glottic mass. Further investigation revealed a background of AML and she then underwent chemotherapy.DiscussionMS is a rarity with only nine reported cases between the years of 1954 until 2015. Immunohistochemistry and immunophenotyping are definite for diagnosis confirmation as MS cells often exhibit myeloperoxidase (MPO), lymphocyte common antigen (LCA) and CD117 markers. MS is treated with are chemotherapy (either systemic or intrathecal), radiotherapy, surgical excision or in combination. Systemic chemotherapy has better efficacy and prognosis as compared to localised treatment of radiotherapy or surgical excision. However, there has yet to be a definitive chemotherapy protocol. Prognosis is poor with a 5-year survival rate of 48%.ConclusionAlthough laryngeal MS is a rare phenomenon, early recognition is key and patients should always be investigated for an underlying myeloproliferative or dysplastic disease.     

阻塞性睡眠呼吸暂停综合征与咽喉反流性疾病相关研究进展

阻塞性睡眠呼吸暂停综合征(OSAS)与咽喉反流性疾病(LPRD)是耳鼻喉科两种常见的疾病,近年来由于发病率逐渐增高,影响着越来越多人的健康。随着对这两种疾病研究的深入,两者之间的相关性引起了广大学者的重视。回顾近几年研究二者的相关文献,得出两者之间存在相关性的结论,阐述两者之间相互影响的因素、机制,并分析OSAS与LPRD的治疗方法,为进一步探寻两者的诊治提供新思路。     

规范喉神经损伤的功能评估与治疗

规范喉神经损伤的功能评估与治疗基金项目：第一作者简介：通信作者：肖水芳（目的随着嗓音医学的发展，喉神经损伤近些年逐渐得到重视，尽管如此，国内当前其诊治欠规范且多依赖个人经验。喉神经损伤原因较多，不同类型损伤的症状、体征以及转归亦不完全一致，针对已知特定类型的喉神经损伤，尤其是喉返神经损伤，当前亦无公认的一线治疗方案，现存的治疗手段均存在相对的优势及不足。本文对喉神经损伤的病因、分类、诊断以及现行的治疗方案进行了归纳与评价，以期能为其诊断及治疗选择提供临床参考。     

MicroRNA-107抑制喉癌细胞的迁移及侵袭能力的临床分析

目的通过观察microRNA 107（miR 107）在喉癌及癌旁组织中的表达，并且在喉癌细胞系选择性上调及敲减miR 107，检测其对喉癌细胞迁移及侵袭能力的影响。方法收集40例喉癌及其邻近癌旁组织标本，运用RT qPCR检测miR 107的表达，并分析其在喉癌中的临床意义。在人喉癌细胞TU212及TU686中过表达或敲减miR 107，通过Transwell法检测其对喉癌细胞迁移及侵袭能力的影响。结果MiR 107在喉癌组织中的表达显著低于癌旁组织，差异具有统计学意义（P<0.05），miR 107的表达水平与肿瘤细胞分化程度、淋巴结转移及原发部位相关（P<0.05）。细胞实验显示，过表达miR 107后喉癌细胞迁移及侵袭能力明显下降（P<0.05），而敲减miR 107后细胞迁移及侵袭能力明显增强（P<0.05）。结论MiR 107在喉癌中表达显著下调，它能够抑制喉癌细胞的迁移和侵袭能力。     

颈臂丛联合神经阻滞麻醉应用于锁骨骨折手术中的临床体会

目的探讨颈臂丛联合神经阻滞麻醉应用锁骨骨折手术中的临床效果。方法选取锁骨骨折手术患者115例,随机分为观察组和对照组。观察组采用颈臂丛联合阻滞麻醉,对照组采用颈浅丛神经阻滞麻醉。观察2组麻醉效果的优良率、心率、平均动脉压、氧饱和度以及不良反应。结果 2组患者心率与平均动脉压比较差异具有统计学意义P<0.01,氧饱和度比较差异无统计学意义P>0.05。观察组麻醉优良率明显高于对照组,x2=7.9367,P<0.05。2组患者麻醉后不良反应发生率比较,x2=0.2413,P>0.05。结论颈臂丛联合阻滞是一种较好的麻醉方法,、效果理想、并发症少,适合锁骨骨折手术推广使用。     

双管喉管的临床应用进展

背景 双管喉管(laryngeal tube-suction airway,LTSA)是第二代喉管,其操作简便、对呼吸道损伤小、刺激小、患者容易耐受、并发症少,既可维持自主呼吸又能正压通气,已逐渐应用于临床.目的 根据LTSA临床应用情况研究比较其与其他人工气道的利弊,探寻LTSA的合理应用及管理.内容 综述LTSA的结构特点、置入方法、置入后管理、拔除方法、适应证、禁忌症和并发症.趋向 根据LTSA临床应用情况合理选择LTSA,进一步探讨其结构特点、置入方法、置入后管理、拔除方法、适应证、禁忌症和并发症,使其在今后的临床应用中更加安全、有效.     

欢迎订阅2017年《护理与康复》杂志

《护理与康复》杂志是浙江省卫生和计划生育委员会主管、浙江省护理学会主办、国内外公开发行的护理专业学术期刊。中国标准连续出版物号:ISSN 1671-9875,CN 33-1298/R。本刊宗旨:传递护理学术信息,提高护理理论与技术水平,促进护理学科发展。本刊栏目:论著,调查与分析,专科护理,基础护理,康复护理,心理护理,中医护理,护理管理,社区护理,护理教育,药物与护理,健康教育,护理革新,个案护理,综述,专题讲座,国际交流等。     

喉罩的临床适用证及注意事项

喉罩是一种麻醉手术管理的时候,保持血流动力学稳定,比较良好的通气用具,它对于全身麻醉手术的安全性,已经得到很充分的证明。喉罩应用于全身麻醉的呼吸管理,操作简便,容易学会,不用喉镜来暴露声门,刺激不大,对喉头气管产生机械性损伤的可能性小,对血流动力学影响小。能够安全有效微创舒适地维持通气,是声门外气道管理的里程碑。     

探讨喉癌患者气管导管的阶段性护理

目的 探究喉癌患者气管导管的阶段性护理,为医院的临床护理工作提供参考依据。方法 抽取2010年1月~2013年1月收治的42例喉癌患者作为研究对象,给予气管导管的阶段性护理,并结合其临床护理资料进行回顾性分析。结果 42例患者中,有2例出现并发症（内套管脱管、气管黏膜损伤）,发生率为4.7%（2/42）。结论 给予喉癌患者气管导管方面的阶段性护理,能够保证患者的临床治疗效果,提高治愈率,并将并发症的发生率控制在最低,具有重要的临床应用价值,值得推广。     

Anatomical study of minor alterations in neonate vocal folds

IntroductionMinor structural alterations of the vocal fold cover are frequent causes of voice abnormalities. They may be difficult to diagnose, and are expressed in different manners. Cases of intracordal cysts, sulcus vocalis, mucosal bridge, and laryngeal micro-diaphragm form the group of minor structural alterations of the vocal fold cover investigated in the present study. The etiopathogenesis and epidemiology of these alterations are poorly known.ObjectiveTo evaluate the existence and anatomical characterization of minor structural alterations in the vocal folds of newborns.Methods56 larynxes excised from neonates of both genders were studied. They were examined fresh, or defrosted after conservation via freezing, under a microscope at magnifications of 25× and 40×. The vocal folds were inspected and palpated by two examiners, with the aim of finding minor structural alterations similar to those described classically, and other undetermined minor structural alterations. Larynges presenting abnormalities were submitted to histological examination.ResultsSix cases of abnormalities were found in different larynges: one (1.79%) compatible with a sulcus vocalis and five (8.93%) compatible with a laryngeal micro-diaphragm. No cases of cysts or mucosal bridges were found. The observed abnormalities had characteristics similar to those described in other age groups.ConclusionAbnormalities similar to sulcus vocalis or micro-diaphragm may be present at birth.