Acute laryngeal obstruction is one of the most common diseases in Department of ENT, and it can cause suffocation without prompt treatment. Methods by using Nasopharyngofiberoscope guided tracheal intubation treatment of a case of acute laryngeal obstruction patients in a timely manner. This method is well tolerated, less trauma, high success rate, in the shortest time to improve the patient's ventilation, for the next step of the treatment to win the time.
Airway Obstruction ; surgery ; Humans ; Intubation, Intratracheal ; Larynx ; physiopathology

Adult ; Airway Obstruction ; physiopathology ; Asthma ; physiopathology ; Electrocardiography ; Female ; Humans ; Male ; Middle Aged

Airway Obstruction ; complications ; etiology ; physiopathology ; Asphyxia ; etiology ; physiopathology ; Fibroma ; complications ; pathology ; Humans ; Infant, Newborn ; Oropharyngeal Neoplasms ; complications ; pathology ; Rare Diseases

OBJECTIVETo investigate the obstructive site and the dynamic change of the upper airway in patients with obstructive sleep apnea hypopnea syndrome (OSAHS) during sleep and wakefulness.

METHODSAfter being deprived of sleeping for 20 hours, sequential midline sagittal images of the upper airway were obtained in 21 patients during sleep and wakefulness with dynamic MRI. The obstructive state was studied according to hypopnea (< 10 s) and apnea (> or = 10 s). The length of obstruction site was measured and the dynamic characteristics of obstruction was observed. Statistical analysis was performed with paired t-test.

RESULTSThe obstruction at the level of the palatopharynx in patients with hypopnea during wakefulness was similar to that in patients with apnea during sleep. The maximal length [(6.61 +/- 1.23) cm], the minimal length [(0.95 +/- 0.22) cm] and maximal length difference [(5.66 +/- 1.27) cm] related to apnea during sleep were longer than those correlated with hypopnea [(2.99 +/- 0.51) cm, (0.72 +/- 0.23) cm, (2.27 +/- 0.67) cm, respectively] in wakefulness. (P < 0.01).

CONCLUSIONSThe obstruction of upper airway during sleep is dynamic and multilevel in patients with OSAHS. To a certain degree, hypopnea during wakefulness can give a clue to the obstructive state during sleep.

Adult ; Airway Obstruction ; diagnosis ; physiopathology ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Sleep Apnea, Obstructive ; diagnosis ; physiopathology

Under hypoxia condition, microRNA （miRNA） can interact with transcription factors for regulating the cell metabolism, angiogenesis, erythropoiesis, cellular proliferation, differentiation and apoptosis. The biological processes above may play an important role in mechanical asphyxia death. This article reviews the regulating function of miRNA under hypoxia condition and the influence of hypoxia to biosynthesis of miRNA, which may provide some new ideas to the research of miRNA on determining the cause of mechanical asphyxia death in the field of forensic medicine.
Accidents ; Airway Obstruction/physiopathology* ; Apoptosis ; Asphyxia/pathology* ; Cause of Death ; Death ; Forensic Medicine ; Humans ; Hypoxia/physiopathology* ; MicroRNAs/metabolism* ; Oxygen

OBJECTIVE: To investigate the relationship between the subjective sensation of nasal obstruction and the corresponding objective parameters of acoustic rhinometry. METHOD: Three hundred and sixty-five patients with nasal diseases were divided into two groups: one group included 220 cases with nasal obstruction, and the second group of 145 cases without nasal obstruction. Seventy healthy adults were selected as control. Each one were assessed for nasal minimal cross-sectional area (NMCA), volume of nasal cavity (NV), nasal airway resistance (NAR) and distance of the minimal cross section area from the nostril (DCAN) by using acoustic rhinometry, and the subjective test were performed using the VAS scores. The results were statistically analyzed. RESULT: NV, DCAN and NAR had a significant difference between nasal obstruct group and control group (P < 0.05). The VAS score had linear correlation with NMCA, NV, DCAN and NAR, and the correlation coefficient were R(NAR) = 0.7385, R(NV) = -0.853 2, R(NMCA) = -0.745 4 and R(DCAN) = 0.369 7, respectively. CONCLUSION Since NAR and NV coincide with the subjective perception of patients with nasal obstruction, they can be used as the sensitive parameters to evaluate subjective symptoms of patients.
Adult ; Aged ; Airway Resistance ; Case-Control Studies ; Humans ; Male ; Middle Aged ; Nasal Obstruction ; physiopathology ; Rhinometry, Acoustic ; Young Adult

OBJECTIVE: To determine whether there was agreement between the short daytime ApneaGraph (dAG) and nocturnal ApneaGraph (nAG) in diagnosing sleep respiratory events initially and identifying the site of obstruction in airway. METHOD: Twenty four patients diagnosed OSAHS by PSG were enrolled. The apnea-hypopnea index (AHI), apnea index (AI), obstructive apnea-hypopnea index (OAHI), central apnea hypopnea index (CAHI), mixed apnea index (MAHI), lowest oxygen saturation (LSaO2) and the proportion of upper/lower obstruction (UPPER, LOWER) of patients were measured using both dAG and nAG. RESULT: There were no significant differences between nAG and dAG for the following parameters: AHI, AI, CAHI, MAHI, OAHI, the proportion of upper/lower obstruction, or LSaO2 (P>0.05). There were significant positive correlations between nAG and dAG with regard to AHI, AI, MAHI, OAHI, the proportion of upper/lower obstruction , LSaO2 except CAHI. CONCLUSION The dAG has similar results with nAG in early diagnosis of sleep respiratory events and identifying the level of airway obstruction. The time-saving dAG is of considerable referential importance in diagnosis of sleep respiratory events and analysing the level of airway obstruction.
Adult ; Airway Obstruction ; Exercise Test ; methods ; Female ; Humans ; Male ; Middle Aged ; Polysomnography ; methods ; Sleep ; Sleep Apnea, Obstructive ; diagnosis ; physiopathology

OBJECTIVE: To study dynamic change and pathophysiology of airway obstruction of the soft palate in patients with obstructive sleep apnea hypopnea syndrome (OSAHS) during wakefulness and natural sleep. METHOD: Sixteen patients who were diagnosed as OSAHS by sleep questionnaires, medical examination and polysomnography were enrolled in this study in Shanghai Tenth People' Hospital from May to December during 2007. All patients were requested to keep awake prior to examination. Sequential midline sagittal images of the upper airway were obtained during awake and asleep state with Cine-MRI and been transmitted to portable computer. Morphologic change of the soft palate, the anterior-posterior pendulum angle of the soft palate, the anteroposterior diameter and the length of soft palate were measured. Statistical analysis was performed with paired t-test. RESULT: During wakefulness: soft palate caused obstruction by floating backwards and widening anteroposterior diameter(distance between hard palate and uvula P > 0.05, included angle of hard palate and segmental vente of uvula P < 0.05, included angle of hard palate and segmental dorsum of uvula P < 0.01, difference of included angle P < 0.01). Main obstruction site was on retropalatal region. During natural sleep: soft palate caused obstruction by lengthening down and widening anteroposterior diameter (distance between hard palate and uvula P < 0.01), included angle of hard palate and segmental vente of uvula P > 0.05, included angle of hard palate and segmental dorsum of uvula P > 0.05, difference of included angle P < 0.01). Main obstruction site was on retroglottal region. CONCLUSION Morphologic change of soft palate in patients with OSAHS is multiple, and level of obstruction is deeper during natural sleep than during wakefulness. Main reason of airway obstruction is distinct during different state. The obstruction of upper airway of patients with OSAHS during wakefulness can't replace that during natural sleep.
Adult ; Airway Obstruction ; Humans ; Magnetic Resonance Imaging, Cine ; Male ; Middle Aged ; Palate, Soft ; pathology ; physiopathology ; Polysomnography ; Sleep Apnea, Obstructive ; pathology ; physiopathology

BACKGROUNDThe assessment of regional pulmonary ventilation and perfusion is essential for the evaluation of a variety of lung disorders. Pulmonary ventilation MRI using inhaled oxygen as a contrast medium can be obtained with a clinical MR scanner, without additional equipment, and has been demonstrated to be a feasible means of assessing ventilation in animal models and some clinical patients. However, few studies have reported on MR ventilation-perfusion imaging. In this study, we evaluated the usefulness of oxygen-enhanced ventilation in combination with first-pass Gd-DTPA-enhanced perfusion MRI in a canine model of pulmonary embolism and airway obstruction.

METHODSPeripheral pulmonary embolisms were produced in eight dogs by intravenous injection of gelfoam strips at the pulmonary segmental arterial level, and airway obstructions were created in five of the dogs by inserting a self-designed balloon catheter into a secondary bronchus. Oxygen-enhanced MR ventilation images were produced by subtracting images from before and after inhalation of pure oxygen. Pulmonary perfusion MR images were acquired with a dynamic three-dimensional fast gradient-echo sequence. MR ventilation and perfusion images were read and contrasted with results from general examinations of pathological anatomy, ventilation-perfusion scintigraphy, and pulmonary angiography.

RESULTSRegions identified as having airway obstructions matched using both MR ventilation and perfusion imaging, but regions of pulmonary embolisms were mismatched. The area of airway obstruction defects was smaller using MR ventilation imagery than that using ventilation scintigraphy. Abnormal perfusion regions due to pulmonary embolisms were divided into defective regions and reduced regions based on the time course of signal intensity changes. In the diagnosis of pulmonary embolisms with the technique of ventilation and perfusion MRI, sensitivity and specificity were 75.0% and 98.1%, respectively, and the diagnostic results of this MRI technique were in agreement with the results of ventilation-perfusion scintigraphy and pulmonary angiography (K: 0.899, 0.743).

CONCLUSIONSOxygen-enhanced ventilation in combination with pulmonary perfusion MRI can be used to diagnose abnormalities of airways and blood vessels in the lungs, and can provide regional functional information with high spatial and temporal resolution. This method possesses great potential value for clinical applications.

Airway Obstruction ; diagnosis ; physiopathology ; Animals ; Disease Models, Animal ; Dogs ; Gadolinium DTPA ; Magnetic Resonance Imaging ; Oxygen ; pharmacology ; Pulmonary Circulation ; Pulmonary Embolism ; diagnosis ; physiopathology ; Respiration

OBJECTIVETo evaluate the feasibility of multi-slice spiral CT scan to localize upper airway stricture in patients with obstructive sleep apnea syndrome (OSAS) during drug-induced sleeping.

METHODSOne hundred and fourteen patients diagnosed as OSAS by polysomnography were included in the study. Multi-slice spiral CT scan covering upper airway was performed at the end of inspiration and clear upper airway images were obtained in waking. After injecting 5 mg of midazolam intravenously slowly in 109 patients, CT scan was performed at apnea and clear upper airway images were obtained in sleeping. Cross-section area and minimal diameter of airway were measured and the parameters were compared under those two states. Upper airway was displayed intuitionisticly by using post-processing techniques.

RESULTSOne hundred and nine patients with OSAS finished the examination with a success rate of 100 %. Airway obstruction at retropalatal level was observed in 62 patients, among whom 26 were associated with airway obstruction at retroglossal level, 27 with narrower airway at retroglossal level in sleeping compared with that in waking, and 9 with no significant change of the airway at retroglossal level after sleeping. Narrower airway at retropalatal level in sleeping compared with that in waking was observed in 40 patients, among whom 20 were associated with narrower airway at retroglossal level in sleeping compared with that in waking, 10 with complete airway obstruction at retroglossal level in sleeping, and 7 with no significant change of the airway at both retropalatal and retroglossal levels before and after sleeping. Minimal mean cross-section area of airway at retropalatal level was (72.60 +/-45.15)mm(2) in waking and (8.26 +/-18.16)mm(2) in sleeping; and minimal mean cross-section area of airway at retroglossal level was (133.21 +/-120.36)mm(2)in waking and (16.73 +/-30.21)mm(2) in sleeping (P <0.01). Minimal mean diameter of airway at retropalatal level was (6.91 +/-2.23) mm in waking and (1.18 +/-2.14) mm in sleeping; and minimal mean diameter of airway at retroglossal level was (8.68 +/-4.32) mm in waking and (1.68 +/-2.22) mm in sleeping (P <0.01).

CONCLUSIONMulti-slice spiral CT with post-processing techniques can display the shape of the upper airway in patients with OSAS in sleeping, and can localize the upper airway stricture and assess its range accurately.

Adult ; Aged ; Airway Obstruction ; diagnostic imaging ; Female ; Humans ; Hypnotics and Sedatives ; administration & dosage ; Male ; Middle Aged ; Oropharynx ; physiopathology ; Palate, Soft ; physiopathology ; Sleep Apnea, Obstructive ; diagnostic imaging ; Tomography, Spiral Computed ; Young Adult