No abstract

Crohn's disease is a granulomatous inflammatory bowel disease. Its pathologic findings include noncontiguous chronic inflammation and noncaseating granulomas. Any segment ofthe gastrointestinal tract can be involved, but it is uncommon to find that Crohn's disease has spread beyond the intestine. We describe the case ofa man with extraintestinal Crohn's disease that was marked by quiescent involvement ofthe lower gastrointestinal tract and florid involvement ofthe nasal cavity, supraglottic structures, glottis, and skin.

Within the first 72 hours after surgery, no complications were observed in our study groups. Patients with BMIs greater than 35 were at increased risk for postoperative desaturations. The uncomplicated OSAS patient, one without significant comorbid factors, can be treated in a safe and prudent fashion outside of an intensive care unit.

To translate and adapt the American Academy outcome measure for rhinosinusitis in Quebec. To establish reliability and validity (concomitant, discriminant, and longitudinal) of the Quebec-French Rhinosinusitis Outcome measure (QF-ROM). Methods: The forward translation was performed by 2 independent certified translators. The 2 versions obtained were tested on 24 patients for clarity and wording. The final version was a mixture of the 2 translated versions. At the initial visit, 120 patients with a diagnosis of recurrent acute rhinosinusitis, chronic rhinosinusitis, or nasal polyposis were administered the QF-ROM and the SF-36. A subgroup was administered the same questionnaires 10 to 14 days after the initial visit. The same questionnaires along with a global rating assessment were performed 3 months postoperatively in a subgroup of patients who had undergone endoscopic sinus surgery. Results: Data collection is ongoing, and analysis has not yet been performed. Conclusions: Outcome assessment of rhinosinusitis is crucial and expected to gain further importance in the Canadian and the Quebec Health System. Validated quality-of-life instruments are needed in French for Quebec.

The formation of a Teflon granuloma may lead to progressive deterioration of voice and eventual airway obstruction. Excision of granuloma by means of lateral laryngotomy allows preservation of any uninvolved mucosal cover of the thyroarytenoid. Further, use of strap muscle or a Silastic implant to rebulk the paraglottic space provides the best opportunity to medialize the vocal fold and restore optimal voice. The ptLrpose of this study was to evaluate acoustic and aerodynamic parameters of voice before and after excision of Teflon granuloma. Methods: Twelve patients underwent lateral laryngotomy for removal of Teflon granuloma. The paralyzed vocal fold was medialized with a strap muscle transfer or Silastic implant. Perceptual judgments of vocal pitch, loudness, and quality were made by 2 trained listeners. Prior to surgery and 3 months afterward, digital audiotape recordings of voice were obtained. Reading and sustained vowel productions were captured with a consistent mouth-to-microphone distance of 6 cm and in a room with confirmed low-level ambient voice. Soundscope software was used to analyze recordings and generate acoustic measures. The phonatory function analyzer provided acoustic and aerodynamic data such as glottal flow rates, maximum phonation time, and extent of pitch and loudness ranges. Stroboscopy allowed preoperative and postoperative evaluation of the vibratory characteristics of the operated fold. Results: Analysis of preoperative and postoperative voice data revealed improved acoustic and aerodynamic parameters of voice following removal of the granuloma. Indices of perturbation in the acoustic signal were reduced, and vocal pitch in females normalized after surgery. While pitch range was unchanged, the capacity to vary loudness was enhanced. Flow rates in conversational speech, abnormally elevated prior to surgery, were normalized after the procedure, and phonation times were significantly longer. Stroboscopy confirmed that evidence of any preoperative mucosal wave was intact following surgery. Conclusion: The integrity of the mucosal cover has previously been shown to be a critical factor in a positive voice outcome. These findings suggest that patients with Teflon granuloma may reasonably expect improved voice following excision by lateral excision by lateral approach and vocal fold medialization.