[Clinical Characteristics of Pediatric Deep Neck Abscesses]

Pediatric deep neck abscesses are a relatively rare and can lead to critical or life-threatening situations. However, the clinical characteristics of pediatric deep neck abscesses are not fully understood in Japan. We conducted a retrospective study of the clinical characteristics of children presenting with pediatric deep neck abscesses at our hospital. All pediatric patients were diagnosed with deep neck abscesses on the basis of the clinical findings and computed tomography (CT) scanning of the neck between April 2009 and March 2014. The incidence, initial examining department, sex, age, presenting signs and symptoms, physical findings, duration between onset and admission, timing of CT scanning, abscess location, causative organism, and method of treatment were determined from the medical records. 　We identified a total of 20 pediatric patients with deep neck abscesses, with a mean incidence of 4.0±1.9 cases per year. Pediatric deep neck abscesses were more common during winter and spring. Most patients initially presented to the pediatric department before consulting an otolaryngologist. Fourteen (70%) patients were male and six (30%) were female, with no obvious peak age of onset. The mean duration between onset and admission was 7.2±3.9 days. The mean timing of CT scanning was 8.1±3.6 days after onset. The most commonly involved area was the retropharyngeal space in nine (45%) and the retro-cervical space in eight (40%) patients. The most frequent causative organism was Staphylococcus aureus (20%), with no cases of antibiotic-resistant bacteria infection observed. Majority of the children were initially managed with conservative treatment. Five patients who failed to improve within 48 h of treatment subsequently underwent surgical drainage. No significant complications such as descending mediastinitis and septic shock were observed in any of the patients.

Why do geriatric patients visit otorhinolaryngology?

The number and proportion of people more than 65 years old in the population are increasing with the rise in life expectancy. This study was designed to investigate the otolarygologic needs and visits of geriatric patients. We conducted a retrospective study that included all patients ≥65 years of age who visited the otolaryngology department between 8 a.m. and 4 p.m. during 1 year. Age, gender, main complaint, and clinical diagnosis were noted on a chart and analyzed. In 2012, a total of 19,875 patients attended the otolaryngology department between 8 a.m. and 4 p.m., of whom 418 (2.1%) were aged ≥65 years. The most common complaints were ear and hearing disorders (24.2%), epistaxis(15.3%), balance disorders (15.1%), pharyngotonsillar pathologies (14.8%), and head and facial trauma (9.6%). This study shows that the changing patient population will change the type and frequencies of pathologies seen in general otolaryngology practices. Geriatric patients need a targeted approach to their diseases because they have special issues unique to their population.

Postlaryngectomy Pharyngocutaneous Fistula: Incidence, Predisposing Factors, and Therapy

OBJECTIVE: The pharyngocutaneous fistula (PCF) is a serious complication after total laryngectomy, and its etiology is not well understood yet. The aim of our study was to evaluate predisposing factors, incidence, and management of this complication.

STUDY DESIGN AND SETTING: This was a retrospective study of 268 patients who underwent total laryngectomy in our clinic (January 1990-December 2001). A number of factors potentially predisposing to PCF formation were evaluated.

RESULTS: A PCF was observed in 16% of patients. Systemic diseases, previous radiotherapy, supraglottic origin of tumor, and concurrent radical neck dissection were significantly associated with PCF. Spontaneous closure was noted in 28 patients, whereas a surgical closure was necessary in 15 patients.

CONCLUSIONS: In presence of a specific risk factor, PCF can be expected; nevertheless, its prevention remains very difficult. Moreover, given the high percentage of spontaneous closure, we suggest the “wait and see” approach for 28 days before proceeding with a surgical approach.

Increased incidence of head and neck abscesses in children

Objective

To describe increasing incidence and changing microbiology of head and neck abscesses in children admitted to the hospital during the first quarters of 2000 through 2003.

Study Design and Setting

Retrospective data warehouse review identified 89 children less than 19 years of age admitted to a tertiary care pediatric hospital during the first quarters of 2000 through 2003 for suspicion of head and neck abscess involving the neck, face, and peritonsillar, retropharyngeal, and parapharyngeal spaces; and for orbital and intracranial complications of acute sinusitis.

Outcome Measures

Outcome measures included the incidence of infection admissions and description of infection location and microbiology, calculated by χ2 technique.

Results

The incidence of infections increased in 2003. The greatest increase was in neck abscesses and complications of acute sinusitis.

Conclusions

The increase in group A strep infections may be related to its biologic properties.

Significance

Group A strep remains a significant cause of head and neck infections in children.

Branchial cleft and pouch anomalies in childhood: a report of 50 surgical cases

BACKGROUND AND AIMS

Branchial abnormalities occur when there is disturbance in the maturation of the branchial apparatus during fetal development. Branchial anomalies are congenital lesions usually present in childhood, even if they can be diagnosed later for enlargement or infection. A correct diagnosis will lead to proper management: complete surgical excision is the treatment of choice. The purpose of this article is to present clinical features, diagnostic methods and surgical treatment of branchial anomalies in childhood, based on a series of 50 patients.

METHODS

We conducted a retrospective analysis of a total of 50 pediatric patients operated from June 2005 to June 2014 for the presence of branchial cleft anomalies.

RESULTS

27 cases (54 %) presented a second branchial cleft fistula and 11 cases (22 %) a second branchial cleft cyst and one case (2 %) presented both cyst and sinus of the second branchial cleft; four cases (8 %) presented first branchial cleft cyst whereas four cases (8 %) a first branchial cleft sinus and two cases (4 %) a first branchial cleft fistula; one case (2 %) presented a piriform sinus fistula (third branchial cleft). None of our patients presented anomalies of the fourth branchial cleft. All patients underwent surgical treatment and lesions have been removed by excision or fistulectomy. No post-surgical complication occurred. The rate of recurrence was 4 %.

CONCLUSIONS

Pre-operative diagnosis supplies important information to the surgeon for a proper therapy: a complete excision of the lesion without inflammatory signs is essential to avoid re-intervention and to achieve a good outcome.

Recorded gonorrhoea rates in Denmark, 1900-2010: the impact of clinical testing activity and laboratory diagnostic procedures

OBJECTIVES

Assessment of the relations between recorded gonorrhoea rates and clinical testing activity and disposable diagnostic tests.

METHODS

In Denmark, two sources of information on the epidemiology of gonorrhoea are available: (1) a mandatory clinical notification system (since 1867) comprising summary information about geographic distribution, season, age group and gender; in 1994, more detailed anonymous individualised epidemiological information was included; (2) a voluntary countrywide laboratory surveillance system for culture-confirmed cases (since 1957) comprising information about patient's age and gender, infected anatomical sites and medical setting attended.

RESULTS

Both surveillance systems showed marked simultaneous changes in gonorrhoea rates, although periodically considerable under-reporting or under-diagnosing was demonstrated. The annual incidence of notified cases peaked in 1919 (474/100,000), in 1944 (583/100,000) and in 1972 (344/100,000). Since 1995, the incidence has been at a low endemic level (1.5-10/100,000) and the total male/female incidence ratios were from 3 to 7 times higher than previously recorded. Among approximately 2 million persons tested during 1974-1988 78,213 men and 63,143 women with culture-confirmed gonorrhoea were identified. During this period, pharyngeal sampling was performed in 36% of men and 25% of women with gonorrhoea; pharyngeal gonorrhoea was found in 10% and 16%, respectively; 40% and 30% of these patients had no concomitant urogenital gonorrhoea. Among men with gonorrhoea, 34% were sampled from the rectum; 9% had rectal gonorrhoea, among whom the rectum was the only infected site in 67%.

CONCLUSIONS

Crucial factors for case finding are clinical sampling tradition and appropriate laboratory diagnostic facilities. When case finding is insufficient, a reservoir of asymptomatic rectal or pharyngeal gonorrhoea remains unrecognised.

Characterization of patients' requests and pharmacists' professional practice in oropharyngeal condition in Spain

BACKGROUND

A sore throat is the reason behind 4 million visits to health care services per year in Spain. The management of these ailments is usually associated with an inappropriate use of medicines. Community pharmacists are often the first point of contact for patients under the healthcare system and play a major role in the management of minor ailments.

OBJECTIVE

To characterize the pharmacists' professional practice in oropharyngeal condition in terms of patients' requests and pharmacists' interventions performed.

SETTING

Community pharmacies throughout Spanish territory.

METHOD

Cross-sectional multicenter observational study, undertaken between November 2012 and March 2013. Patients were recruited consecutively in the participant pharmacies. Eligible patients were those making a consultation related to an oropharyngeal condition or requesting treatment for an oropharyngeal condition. A univariate descriptive analysis showing the frequency of occurrence of the different variables was performed. This was completed with a multivariate statistical analysis through a multiple correspondence method, in order to analyze the potential association between the pharmacist profile and the intervention provided.

MAIN OUTCOME MEASURE

Professional Pharmacy Service requested (dispensing/counselling/medication review with follow-up), reason for consultation, source of the recommendation, Pharmacist's intervention and reason for referral.

RESULTS

710 pharmacies and 3,547 patients participated in the study. The most frequently requested service was dispensing (44.7 %), followed by counselling (31.8 %). Regarding dispensing, the majority of patients requested a throat preparation, mostly antiseptics. Symptoms associated with the pharmacy consultation were mainly throat symptoms (70.8 %), voice symptoms (24.9 %), and mouth/tongue/lip symptoms (10.1 %). The most common pharmacist intervention was "selection of pharmacological treatment", followed by "dispensing the requested medicine"; 6.51 % of the patients were referred to a general practitioner, mainly due to fever and other symptoms associated with infection. No relationship between the pharmacist profile and the intervention performed was found.

CONCLUSION

The most frequently requested professional service was the dispensing service, mainly for treating throat symptoms. Community pharmacists play a major role in managing patients with an oropharyngeal condition. They can keep them out of general practice or act as referral agents when a more severe disease is identified.

Pharyngo-cutaneous fistula complicating laryngectomy in the chemo-radiotherapy organ-preservation epoch

Pharyngo-cutaneous fistula is a serious complication of laryngectomy, with a significant associated morbidity and mortality. The oncologic success of organ-preservation protocols with radiotherapy or chemo-radiotherapy for laryngeal carcinoma means laryngectomy is increasingly reserved for surgical salvage in the event of persistent or recurrent disease. A retrospective review of fistula incidence after laryngectomy in 171 patients in a UK tertiary referral centre over the last decade was conducted to identify trends in this complication in the epoch of non-surgical organ preservation. The overall fistula incidence following laryngectomy is 29.2% (50/171). Fistula incidence following salvage total laryngectomy is significantly higher than after primary total laryngectomy [19/51 (37.3%) vs. 8/47 (17.0%), χ2 = 5.02, p = 0.03]. There is no significant effect of prior treatment on fistula incidence following laryngo-pharyngectomy or pharyngo-laryngo-oesophagectomy [14/39 (35.9%) vs. 9/27 (33.3%), χ2 = 0.05, p = 0.83]. Prophylactic vascularised tissue flaps to reinforce the pharyngeal suture line may reduce fistula incidence and fistula severity in salvage total laryngectomy.

Pharyngocutaneous fistulae after total laryngectomy: analysis of the risk factors and treatment approaches

OBJECTIVES

To investigate the incidence and predisposing factors in the development of postoperative pharyngocutaneous fistula (PCF) after total laryngectomy.

METHODOLOGY

A total of 166 patients with complete medical records who underwent total laryngectomy (TL) due to laryngeal cancer were analysed retrospectively. The mean age of the patients was 57.4 (+ 19.6) years. This study looked at a total of 32 different parameters considered to be effective in the development of pharyngocutaneous fistula after total laryngectomy.

RESULTS

Thirty-two patients (19.2%) had a pharyngocutaneous fistula. Aged over 61 years (p = 0.003), Diabetes Mellitus (DM) (p = 0.002), alcohol use (p = 0.006), history of preoperative radiotherapy (p = 0.001), preoperative tracheotomy (p = 0.017), postoperative low levels of haemoglobin (Hb) (p = 0.029), low levels of preoperative albumin (p = 0.001), total protein and a low alb/glb (albumin/globulin) ratio (p = 0.001), serum prealbumin levels on the third and seventh postoperative days (p = 0.001), high postoperative CRP levels (p = 0.002), T4 stage (extralaryngeal) and presence of transglottic lesion (p = 0.003), presence of stage IV (p = 0.012) lesion, primary surgery accompanied by bilateral neck dissection (p = 0.047), T-shaped oesophagus suture, postoperative bleeding (p = 0.07), presence of postoperative fever (p = 0.001), presence of skin defect in the anterior neck (p = 0.001) and presence of postoperative depression (p = 0.001) were found to be statistically significant factors in the development of PCF.

CONCLUSIONS

Our study found many parameters associated with an increased risk of the development of PCF. According to the multivariate regression analysis, aged over 61 years, DM, preoperative RT, preoperative tracheostomy, postoperative Hb under 10 g/dl, prealbumin under 17 mg/dl on the third postoperative day, and a postoperative fever of 38.3 degrees C and above were found be associated with a higher risk of the development of fistulae more than the other risk factors.

Stapler suture of the pharynx after total laryngectomy

The use of a stapler for pharyngeal closure during total laryngectomy was first described in 1971. It provides rapid watertight closure without surgical field contamination. The objective of our study was to compare the incidence of pharyngocutaneous fistula after total laryngectomy with manual and mechanical closures of the pharynx. This was a non-randomised, prospective clinical study conducted at two tertiary medical centres from 1996 to 2011 including consecutive patients with laryngeal tumours who underwent total laryngectomy. We compared the incidence of pharyngocutaneous fistula between two groups of patients: in 20 patients, 75 mm linear stapler closure was applied, whereas in 67 patients a manual suture was used. Clinical data were compared between groups. The groups were statistically similar in terms of gender, age, diabetes mellitus, smoking and alcohol consumption and tumour site. The group of patients who underwent stapler-assisted pharyngeal closure had a higher number of patients with previous tracheotomy (p < 0.001) and previous chemoradiation (p < 0.001). The incidence of pharyngocutaneous fistula was 30% in the mechanical closure group and 20.9% in the manual suture group (p = 0.42). In conclusion the use of the stapler does not increase the rate of fistulae.

How reliable is self-testing for gonorrhea and chlamydia among men who have sex with men?

BACKGROUND

Recent studies have demonstrated a high prevalence of pharyngeal (P) and rectal (R) Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT) infections among men who have sex with men (MSM). Guidelines by the Centers for Disease Control and Prevention recommend testing at least annually. But surveys of medical providers suggest that adherence to these guidelines is minimal as a result of limited time and staff. Because of these concerns, we evaluated the feasibility and accuracy of patient self-testing.

METHODS

Three-hundred seventy-four patients at a Washington, DC clinic who identified themselves as MSM and requested testing for sexually transmitted infections (STIs) participated in the study. Patients performed self-screening using the Gen-Probe APTIMA Combo 2 (AC2) kit after viewing written and pictorial instructions. Trained providers also screened patients. We randomized the order in which patients or providers performed testing.

RESULTS

Among those receiving specific tests, 8% of patients tested positive for R-GC, 9.3% for P-GC, 12.7% for R-CT, and 1.3% for P-CT. We performed McNemar tests, stratified by infection type and anatomic site to evaluate concordance. Self-administered testing was significantly better at identifying P-GC (discordant: 3%) and R-GC (discordant: 2.9%) (P ≤.01), and had results similar to provider- administered testing for P-CT (discordant: 0.5%) and R-CT (discordant: 1.1%) detection.

CONCLUSIONS

The equivalent or better detection rates for rectal and oral gonorrhea and chlamydia among patients suggest that patients are capable of performing their own screening for STIs, which may increase infection detection and treatment.

Human myiasis in Fars Province, Iran

We evaluated the prevalence and consequences of human myiasis among people involved in animal husbandry and butchers among 6 counties in Fars Province, Iran using a descriptive cross sectional survey. A semi-structured questionnaire was used to evaluate knowledge, community perceptions and practices. Three hundred two herders shepherds and butchers were included in the study. Eighty-eight point three percent of subjects had experienced myiasis during their job experiences. Seventy-one point five percent had become infected in barns. Pharyngeal myiasis was reported by 87% of subjects. The most likely cause of myiasis in subjects was the sheep botfly, Oestrus ovis (Diptera: Oestridae). Age and job experiences did not have an effect on the knowledge and practice regarding myiasis of subjects. Academic educational level had no significant effect on knowledge but did have a significant effect on practices. A myiasis education program needs to be created to better control and prevent this problem.

Postlaryngectomy pharyngocutaneous fistula: determining the risk of preoperative tracheostomy and primary tracheoesophageal puncture

BACKGROUND

This article considers whether preoperative tracheostomy and primary tracheoesophageal puncture (TEP) contribute as independent risk factors to the development of pharyngocutaneous fistula (PCF), as well as discusses the significant factors related to the perioperative management of these patients.

METHODS

Retrospective data were collected on 145 patients treated with total laryngectomy/pharyngolaryngectomy between January 2003 and July 2010 at the Victoria Hospital in London, Ontario, including whether preoperative tracheostomy or primary TEP was performed.

RESULTS

One in four (25%) patients developed a postoperative PCF. No increase in PCF rates was observed with either preoperative tracheostomy or primary TEP. Salvage surgery PCFs achieved lower rates of spontaneous closure compared to those undergoing primary surgery (p  =  .002).

CONCLUSIONS

Neither preoperative tracheostomy nor primary TEP was associated with the development of PCF. Surgical closure of PCF is more likely to be required in the setting of salvage surgery.

Three years audit of the emergency patients in the department of ENT of a rural medical college

Surgical audit is a systematic, critical analysis of the quality of surgical care provided, with the aims of improving quality of care, continuing education for surgeons, and guiding appropriate use of health resources. Emergency service is an integral part of any discipline of clinical medicine and it is considered as an indicator of quality of healthcare system. A three years record based, retrospective, cross-sectional study was carried out in the department of ear, nose and throat (ENT) of Midnapore Medical College, Paschim Medinipur,West Bengal to identify the total attendance of various emergency patients, diagnosis made thereafter, the mode of interference and outcome and the potential problems in the quality of care provided to the community. A total of 9051 patients had been admitted/attended in the ENT emergency from January 2008 to December 2010 who were included in this audit. Detailed statistical analysis of the data showed male: female (2.38:1) with the peak in the first decade of life. Majority of the patients were from Medinipur sadar (58.43%). The total otological cases were maximum (42.41%) in comparison to nose (28.98%) and throat (28.60%). The most common ear emergencies were earache due to impacted wax, acute suppurative otitis media, foreign body ear and the trauma/injury. Chronic suppurative otitis media with complications were the least. Amongst the sinonasal emergency, the most common aetiology was the epistaxis and foreign body nose in children. The different types of foreign body impaction in the throat and the inflammatory condition of throat or the inspiratory stridor due to upper airway obstruction were the main emergency situation recorded. Some cases were fatal. The overall mortality was 0.44%.

[Urumqi 11 689 secondary school teachers of throat disease investigation]

OBJECTIVE

To investigate the prevalence of throat disease in secondary school teachers of Urumqi.

METHOD

Use Stage-Two random sampling at 11689 teachers from 109 secondary schools in Urumqi; Draw 3 217 from 11689 teachers in 109 secondary schools to accept voice self-assessment questionnaire survey and routine examination of throat, and the one who were confirmed abnormal in routine inspection would be underway stroboscopic laryngoscopy.

RESULT

The total illness prevalence rate of throat disease in secondary school teachers of Urumqi is 28.23%; there is no statistic difference of illness prevalence rate between male and female teachers (P > 0.05). However, results showed statistical significance of illness prevalence rate in teachers of different racial-groups with different years of teaching experience (P < 0.05). Teachers who have 5 to 15 years of teaching experience suffer a high incidence of throat diseases. Among eight racial groups involved in investigation, Kazak teachers are in the highest illness prevalence rate. The results of assessment for voice disorder index between teachers with and without throat diseases showed statistical difference in total score TVH (P < 0.05), which is shown significant in the physical and emotional areas (P < 0.05), while there is no statistical difference in function. Diseases of pharyngeal portion are mainly chronic pharyngitis and hyperplastic tonsil in tongue root; Diseases of laryngeal portion are mainly chronic laryngitis and vocal nodule for female, while mainly chronic laryngitis and vocal polypus for male.

CONCLUSION

There is no significant difference in illness prevalence rate of throat disease for secondary school teachers in Urumqi between genders; the highest prevalence rate is in teachers who have 5 to 15 years teaching experience; among different racial groups, Kazak teachers are of the highest illness prevalence rate; the illness prevalence of throat diseases is related with voice disorder index.

Nose and throat complications associated with passive smoking among Congolese school children

OBJECTIVE

To assess associations between nose-throat (NT) diseases and passive smoking prevalence among school children.

METHODS

A cross-sectional survey was carried out on a randomized multistage sample of 381 school children (50.9% males, aged 9.8 ± 3.5 years) from Kinshasa town. Parents and children were asked to fill in a questionnaire detailing their smoking habits. The NT symptoms and diseases were assessed by the survey NT specialist.

RESULTS

The prevalence of passive smoking was 38.6% (n = 147). Residence in peripheral areas, catholic school system, elementary level, exposure of family to passive smoking, history of NT surgery, medicines and menthol inhaling, headache, nasal pain, dysphagia, odynophagia, dysosmia, dysphonia, pharyngeal irritation, dry throat, snooze, and chronic pharyngitis were more reported by passive smokers. After adjusting for confounding factors, passive smoking (OR = 16.7 95%CI 3.3-83.3), catholic system(OR = 2 95%CI 1.2-3.2), and elementary degree(OR = 1.4 95%, CI 1.1-2.1) were identified as independent determinants of chronic pharyngitis.

CONCLUSION

Parents should not smoke in the same room used by their children.

Contemporary profile of oral manifestations of HIV/AIDS and associated risk factors in a Southeastern US clinic

BACKGROUND

Introduction of highly active antiretroviral therapy (HAART) has resulted in a significant decrease of oral manifestations (OMs). The profile and risk factors for OM in those individuals initiating HAART remain understudied in the Southeast of the United States, region of increasing HIV prevalence.

OBJECTIVE

To determine clinical, socio-demographic, and laboratory characteristics associated with the presence of OM among patients initiating HAART.

METHODS

Retrospective review of electronically captured data from patients initiating HAART at a Southeastern US clinic. Prevalence was determined, and risk factors for overall OM, oropharyngeal candidiasis (OPC), and all other OM were evaluated using logistic regression.

RESULTS

In our sample (n = 744), majority of individuals were males (75 percent), African-American (50 percent), mean age of 39 years, 42 percent of which reported sex with men (MSM). Two hundred sixty-six had some type of OM. Compared with those without any OM, patients with OM had a lower mean baseline CD4+ T cells count (CD4 count) (331 ± 260 versus 179 ± 244 CD4 cells/mm(3) ) and higher mean baseline HIV-1 RNA viral load (4.0 ± 1.34 log(10) versus 4.6 ± 1.30 log(10) ) (P < 0.01). In the logistic regression models seeking to determine factors associated with an increased risk of OM and OPC, the only characteristic associated with the outcome was baseline CD4 value. Being male, African-American, and heterosexual showed a protective role for OM other than OPC.

CONCLUSION

OM continues to be common despite HAART. General OM and OPC were closely associated with a low baseline CD4 count. Knowledge of risk factors for OM can potentially help clinicians target oral evaluation of HIV-positive individuals.

Serum albumin concentration and surgical site identify surgical risk for major post-operative complications in advanced head and neck patients

INTRODUCTION

To determine the relationship between peri-operative predictors of morbidity and mortality in advanced head and neck cancer patients.

METHODS

The records of 37 consecutive patients who underwent major surgery for advanced head and neck cancer were reviewed. We evaluated factors potentially predisposing to major complications after major surgery for treating advanced head and neck cancer.

RESULTS

Twenty-seven men and ten women with a median age of 59 years were included. Eighteen of the thirty-seven had an albumin level < 3.5 g/dl. All the post-operative complications occurred in hypoalbuminemic patients (p = 0.001). The fatal complication appeared in the patient with a albumin level < 0.5 g/dl. The definitive model with logistic regression analysis showed that peri-operative albumin level and the site of origin of the tumour involved a five- and twofold increase respectively in the risk of major complications after major surgery in advanced head and neck patients.

CONCLUSION

The results suggest that hypoalbuminemia is common among head and neck patients. Hypoalbuminemia, as the site of origin of the tumour, is associated with an increased risk of morbidity and mortality in head and neck patients who receive surgical treatment.

[The influence of application of the assisted reproductive technologies on the state of ENT organs in children]

The objective of the present study was to estimate the state of ENT organs in the children born after assisted reproductive technologies (ART). A group of 208 children at the age from 1 to 3 years enrolled in the study included 97 ones born following application of the assisted reproductive technologies. It is concluded that the use of the assisted reproductive technologies has no appreciable effect on the extent and the structure of ENT organ morbidity in the children.

Retropharyngeal and parapharyngeal abscess in children--epidemiology, clinical features and treatment

OBJECTIVE

To describe the clinical presentation, diagnosis, management and complications of children with retropharyngeal abscesses (RPAs) and parapharyngeal abscesses (PPAs).

METHODS

A retrospective chart review was conducted at two tertiary care, pediatric hospitals in Israel. The medical records of all children <18 years who had been admitted with a diagnosis of RPA or PPA during an 11-year period (January 1997 to February 2008) were reviewed. Data on demographics, presenting symptoms, physical examination findings, imaging studies and interpretation, laboratory results, hospital course, medical treatment and surgical interventions were retrieved.

RESULTS

A total of 39 children were diagnosed as having RPA (n=26, 67%) or PPA (n=13, 33%). There was a predominance of boys (61.5%). The mean age of all the children at diagnosis was 4 years. The annual incidence increased over the 11-year period. The most common symptoms at presentation included fever (n=27, 70%) and neck pain (n=24, 62%). The physical examination revealed cervical lymphadenopathy in 30 children (77%), limitation of neck movements in 25 (64%), torticollis in 21 (54%), drooling in three (8%), and stridor in two (5%). Computerized tomographic (CT) scanning with contrast was performed in 37 patients (95%), of whom 17 underwent surgical drainage. Thirteen children were positively diagnosed as having an abscess by the finding of pus at surgery, of whom 12 had been found to have an abscess on their CT scan. All the patients received intravenous antibiotics. There was no significant difference in the duration of hospital stay between those who underwent surgery and those who were treated with antibiotics alone. There were no treatment failures and no complications in either of the two groups.

CONCLUSION

Children with RPA most commonly present with restricted neck movements, fever and cervical lymphadenopathy, and rarely with respiratory distress or stridor. Many patients with RPA and PPA can be treated successfully without surgery. CT scans are helpful in diagnosing and assessing the extent of the infection, but they are not always accurate.

Tularaemia outbreaks in Sakarya, Turkey: case-control and environmental studies

INTRODUCTION

Tularaemia is an important zoonotic disease that leads to outbreaks. This study aimed to compare the epidemiological characteristics of two tularaemia outbreaks that occurred in the Sakarya region of Turkey, analyse the risk factors for the development of outbreaks and identify Francisella (F.) tularensis in the water samples.

METHODS

Two tularaemia outbreaks occurred in the Kocadongel village in 2005 and 2006. A field investigation and a case-control study with 47 cases and 47 healthy households were performed during the second outbreak. Clinical samples from the patients and filtrated water samples were analysed for F. tularensis via real-time polymerase chain reaction.

RESULTS

From the two outbreaks, a total of 58 patients were diagnosed with oropharyngeal tularaemia based on their clinical and serological results. Both outbreaks occurred between the months of January and April, and the number of patients peaked in February. Logistic regression analysis revealed that the consumption of natural spring water was the only significant risk factor for tularaemia infection (odds ratio 3.5, confidence interval 1.23-10.07). F. tularensis was detected in eight clinical samples and in the filtrated natural spring water.

CONCLUSION

This study is the first report of tularaemia from this region. The results show that both tularaemia outbreaks were related to the consumption of untreated natural spring water. To prevent waterborne tularaemia, community water supplies should be treated and checked periodically.

Retrospective analysis of cellulitis of the floor of the mouth

OBJECTIVES

To analyze clinical data of patients treated for mouth floor cellulitis during 2003-2006 years at the Department of Maxillofacial Surgery, Vilnius University Hospital Zalgiris Clinic and to compare the results with existing data.

MATERIAL AND METHODS

Patient's gender, age, social insurance, demographic profile, preference of first visit, previous treatment, origin of inflammation, symptoms of disease, treatment protocol and outcomes were evaluated from 240 clinical records.

RESULTS

The male-female ratio was 1.3:1. The mean age of patients was 43.18+/-7.56 years. 65% of patients were from urban. 47% of patients were employed, 15% retirees, 22% unemployed, 10% children, 2% students and 4% handicapped people. In 65% of cases primary diagnosis was incorrect. Majority of patients appealed to doctor on the first five days from the beginning of the disease. 93.7% of mouth floor cellulites were odontogenic origin. In 32.9% of the patients at the time of first examination the extension of inflammation into parapharyngeal, pterygomandibular spaces or neck together with mouth floor cellulitis was diagnosed. In 1.7% (in 4 out of 240) of cases infection extended into the neck and parapharyngeal spaces despite treatment. In 2% (in 5 out of 240) of cases infection extended to mediastinum.

CONCLUSIONS

Despite the aggressive treatment serious complications still are possible. Delayed treatment procedures might determine poor prognosis.

[Fistula following total laryngectomy. Retrospective study and bibliographical review]

BACKGROUND

The pharyngocutaneous fistulae is troublesome and the most common complication following total laryngectomy. Our objective was to determine the incidence of pharingocutaneous fistulae after the total laryngectomy in our serie and to make review of the medical literature.

METHODS

We made a retrospective study of a serie of 81 consecutive cases of laryngeal carcinoma treated between 1995 and 2008 in our section. Total laryngectomy was performed in 29 cases and 52 patients treated with organ preservation approach, were excluded. In 14 cases, the procedure was combined with radical neck dissection, pharyngeal resection or myocutanenous flaps. Nasogastric tube for feeding in the postoperative period was used in all patients and surgical gastrostomy was performed in 5 cases.

RESULTS

Our incidence of fistulas when total laryngectomy was the alone procedure is 20 % and 34.5 % when simultaneous surgical proceedings were associated. Spontaneous closure was noted in 80 % of the cases and the mean hospitalization time was 23 days.

CONCLUSIONS

Most of the fistulas can be managed with conservative treatment. Pectoralis major myocutanenous flap is appropriate when conservative treatment has failed. In small fistulas, nasogastric or gastrostomy tube for feeding can be successfully managed in the ambulatory follow up. The cost-benefit relation must be better analyzed.