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Matsuzaki H, Makiyama K, Hasegawa H, Asai R, Morita M, Oshima T. Human Papillomavirus Vaccination as an Adjuvant Therapy for Recurrent Respiratory Papillomatosis: Additional Case Series. J Voice 2024; 38:204-209. [PMID: 34600799 DOI: 10.1016/j.jvoice.2021.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 07/09/2021] [Accepted: 07/13/2021] [Indexed: 11/30/2022]
Abstract
Prevention of the recurrence of recurrent respiratory papillomatosis (RRP), a neoplasm of the respiratory tract, is a challenge. Human papillomavirus (HPV) vaccine has been expected to suppress the aggressiveness of RRP. However, there has been insufficient data to verify whether HPV vaccination can serve as an adjuvant therapy option for RRP. The aim of this study was to add our data on the efficacy of HPV vaccination for RRP to the academic discipline. Twenty-four RRP patients were treated with a combination therapy of surgery and three sessions of quadrivalent HPV vaccine. The patients' clinical courses, which were HPV infection status changes, intersurgical interval, and disease severity score (Derkay's site score), were statistically analyzed before and after combination therapy. Twelve of the 24 (52.5%) RRP patients who were HPV-DNA positive turned negative after the combination therapy. The mean of intersurgical interval was significantly extended from 6.85 ± 4.49 months to 30.5 ± 27.6 months after the therapy (P <0.01). The median of Derkay's score of the participants also significantly decreased from 7.5 (interquartile range, 5-12) to 1 (interquartile range, 0-4.25) after the therapy (P <0.01). Thus, combination therapy comprising of surgery and HPV vaccination can postpone the recurrence and lessen the severity of RRP.
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Affiliation(s)
- Hiroumi Matsuzaki
- Department of Otorhinolaryngology, Head and Neck Surgery, Nihon University School of Medicine, Tokyo, Japan.
| | - Kiyoshi Makiyama
- Department of Otorhinolaryngology, Head and Neck Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Hisashi Hasegawa
- Department of Otorhinolaryngology, Head and Neck Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Ryohei Asai
- Department of Otorhinolaryngology, Head and Neck Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Masato Morita
- Department of Otorhinolaryngology, Head and Neck Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Takeshi Oshima
- Department of Otorhinolaryngology, Head and Neck Surgery, Nihon University School of Medicine, Tokyo, Japan
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Freeman T, Erickson E, Koch B, Young T, Allen D, Kim B, deSilva B, Matrka L. Smoking and Carcinoma Trends in Recurrent Respiratory Papillomatosis Patients. Ann Otol Rhinol Laryngol 2023; 132:1380-1385. [PMID: 36879422 DOI: 10.1177/00034894231158459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
INTRODUCTION Recurrent respiratory papillomatosis (RRP) is a chronic disease of the upper respiratory tract caused by human papillomavirus types 6 and 11. The disease course is characteristically unpredictable, ranging from spontaneous remission to aggressive, recurrent disease. Thus, management is often challenging and requires unique approaches tailored to each individual patient. While recent literature has described risk factors for more aggressive disease, few sources have investigated the impact of smoking on RRP disease course and risk for malignant transformation. METHODS A retrospective chart review was conducted for adult RRP patients evaluated at an academic tertiary care center between 2005 and 2020. A total of 188 patients were identified. Demographic and clinical data were collected, including smoking and alcohol history, HPV subtype, history of dysplasia and/or carcinoma, voice handicap index scores, Derkay scores, debulkings (in office and operating room), and days to papilloma recurrence. RESULTS Malignant degeneration in RRP occurred in 16.3% of smokers and 3.6% of nonsmokers. Smokers who developed carcinoma had less debulkings per years of evaluation than those not developing carcinoma (0.21 vs 0.92, P = .004). Additionally, patients that either presented with or developed carcinoma during their course had a higher pack-year smoking history (18.0 vs 12.21, P = .0002). No difference in days to recurrence or inter-surgical interval was demonstrated between smokers and nonsmokers. CONCLUSIONS The report demonstrates that smoking can increase the risk of malignant transformation in RRP patients.
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Affiliation(s)
- Taylor Freeman
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Ericka Erickson
- College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Brandon Koch
- Department of Public Health, The Ohio State University, Columbus, OH, USA
| | - Tyler Young
- College of Medicine, The Ohio State University, Columbus, OH, USA
| | - David Allen
- University of Texas Houston Health Science Center, Houston, TX, USA
| | - Brandon Kim
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Brad deSilva
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Laura Matrka
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Ballestas SA, Hidalgo Lopez J, Klein AM, Steuer C, Shin DM, Abousaud M, Schmitt NC, Teng Y, Saba NF, Tkaczuk AT. Long-Term Follow-up of Parenteral Bevacizumab In Patients with Recurrent Respiratory Papillomatosis. Laryngoscope 2023; 133:2725-2733. [PMID: 36815602 DOI: 10.1002/lary.30617] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/30/2023] [Accepted: 02/01/2023] [Indexed: 02/24/2023]
Abstract
OBJECTIVE The clinical course of recurrent respiratory papillomatosis (RRP) varies from spontaneous remission to severe airway obstruction with wide variability in recurrence. Standard treatment involves debulking to improve voice and/or breathing. Non-surgical therapies are emerging in hopes of non-operative disease control. This retrospective review analyzes long-term safety, efficacy, and durability of clinical control in the largest reported series of parenteral bevacizumab in adults with RRP. METHODS Twenty-three patients with known RRP who have been receiving off-label systemic bevacizumab were included. Dosage, infusion interval, number of cycles, debulking requirements, subjective outcomes, adverse events, and reasons for treatment termination were investigated. RESULTS Patients have been followed for an average of 791.43 (21-1468) days. The most common starting dosing regimen was 15 mg/kg at 3 weeks in 11 followed by 10 mg/kg at 6 weeks intervals in 6 individuals. Long-term maintenance dosage varied with the least intensive regimen being 10 mg/kg at 14-week intervals. Subjective improvement of voice and/or breathing was reported in 18/23 subjects. The median time for patients that needed a procedure after treatment was 634 days. Procedures after infusions decreased from 3.08 ± 2.48 procedures in the year prior to 0.52 ± 1.12 during systemic Bevacizumab, and to 0.86 ± 2.05 after stopping bevacizumab. Therapy termination occurred in 8 subjects where only 3 were due to adverse events. CONCLUSION Parenteral bevacizumab remains a well-tolerated treatment for patients with recalcitrant RRP. There appears to be a durable reduction in the frequency of debulking surgery requirements although on a maintenance regimen. Laryngoscope, 133:2725-2733, 2023.
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Affiliation(s)
- Samir A Ballestas
- Department of Otolaryngology - Head and Neck Surgery, Emory University, Atlanta, Georgia, USA
| | - Julio Hidalgo Lopez
- Department of Otolaryngology - Head and Neck Surgery, Emory University, Atlanta, Georgia, USA
| | - Adam M Klein
- Department of Otolaryngology - Head and Neck Surgery, Emory University, Atlanta, Georgia, USA
| | - Conor Steuer
- Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia, USA
| | - Dong M Shin
- Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia, USA
| | - Marin Abousaud
- Department of Pharmaceutical Sciences, Emory University, Atlanta, Georgia, USA
| | - Nicole C Schmitt
- Department of Otolaryngology - Head and Neck Surgery, Emory University, Atlanta, Georgia, USA
| | - Yong Teng
- Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia, USA
| | - Nabil F Saba
- Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia, USA
| | - Andrew T Tkaczuk
- Department of Otolaryngology - Head and Neck Surgery, Emory University, Atlanta, Georgia, USA
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Ponduri A, Azmy MC, Axler E, Lin J, Schwartz R, Chirilă M, Dikkers FG, Yang CJ, Mehta V, Gangar M. The Efficacy of Human Papillomavirus Vaccination as an Adjuvant Therapy in Recurrent Respiratory Papillomatosis. Laryngoscope 2023; 133:2046-2054. [PMID: 36651338 PMCID: PMC10859188 DOI: 10.1002/lary.30560] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 12/05/2022] [Accepted: 12/13/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To characterize the efficacy of human papillomavirus (HPV) vaccination as an adjuvant therapy in recurrent respiratory papillomatosis (RRP). DATA SOURCES PubMed, Embase, Cochrane, Google Scholar, ClinicalTrials.gov, and Web of Science databases were queried for articles published before April 2021. REVIEW METHODS All retrieved studies (n = 870) were independently analyzed by two reviewers according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement using predefined inclusion and exclusion criteria. 13 studies met inclusion criteria. A random-effects meta-analysis was performed to study intersurgical interval (ISI) and number of surgical procedures per year before and after vaccination. RESULTS The systematic review included 13 studies, comprising 243 patients. All studies utilized the Gardasil® quadrivalent vaccine, and one study (Yiu et al. 2019) utilized both the quadrivalent and Gardasil® 9-valent vaccines. Our meta-analysis included 62 patients with ISI data across 4 studies, and 111 patients with data on the number of surgical procedures per month across 7 studies. The mean number of surgical procedures decreased by 4.43 per year after vaccination (95% CI, -7.48 to -1.37). Mean ISI increased after vaccination, with a mean difference of 15.73 months (95% CI, 1.46-29.99). Two studies reported on HPV sero-conversion, with HPV seropositivity of 100% prior to vaccination and 25.93% after vaccination. CONCLUSION The addition of HPV vaccination was associated with an increase in time between surgeries and reduction in the number of surgical procedures required. HPV vaccination may be a beneficial adjuvant treatment for RRP. LEVEL OF EVIDENCE NA Laryngoscope, 133:2046-2054, 2023.
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Affiliation(s)
- Anusha Ponduri
- Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Otorhinolaryngology - Head and Neck Surgery, Montefiore Medical Center, Bronx, New York, United States
| | - Monica C Azmy
- Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Otorhinolaryngology - Head and Neck Surgery, Montefiore Medical Center, Bronx, New York, United States
| | - Eden Axler
- Albert Einstein College of Medicine, Bronx, New York, USA
| | - Juan Lin
- Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Magdalena Chirilă
- Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Frederik G Dikkers
- Department of Otorhinolaryngology/Head and Neck Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
| | - Christina J Yang
- Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Otorhinolaryngology - Head and Neck Surgery, Montefiore Medical Center, Bronx, New York, United States
| | - Vikas Mehta
- Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Otorhinolaryngology - Head and Neck Surgery, Montefiore Medical Center, Bronx, New York, United States
| | - Mona Gangar
- Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Otorhinolaryngology - Head and Neck Surgery, Montefiore Medical Center, Bronx, New York, United States
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Wang MC, Chu CH, Wang YP. Factors influencing surgeon decision-making by measuring waiting time for pediatric ventilation tube insertions. J Chin Med Assoc 2022; 85:699-703. [PMID: 35421868 DOI: 10.1097/jcma.0000000000000731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The surgeon and physician's decision-making may be influenced by many factors. The clinical practice guideline suggested that watchful waiting for 3 months should be the initial management for pediatric otitis media with effusion. The waiting time of ventilation tube insertion for pediatric patients is a proper measurement for physician decision-making. This study investigated factors influencing the waiting time for pediatric ventilation tube insertion and to explore factors influencing physician decision-making. METHODS Information associated with all patients under 18 years of age who received ventilation tube insertions from July 1, 2000 to December 31, 2009 were retrieved and analyzed from a nationwide, population-based administrative database. The waiting time before ventilation tube insertions from the time of diagnosis of otitis media with effusion was recorded. Certain factors that would influence the waiting time were identified. At the same time, how these factors influenced clinical decision-making were also identified. RESULTS The waiting time decreased as patient age increased (p < 0.001), and increased as the recent frequency of upper respiratory tract infection diagnosis increased (p < 0.001). Patients who received simultaneously bilateral ventilation tube insertions had shorter waiting time than those who had unilateral surgery (p < 0.01) and patients who had undergone ventilation tube insertions in a tertiary referral center generally had longer waiting times (p < 0.001). CONCLUSION The waiting time of ventilation tube insertions for pediatric otitis media with effusion can be influenced by many factors. Patients with older age and undergone simultaneously bilateral ventilation tube insertion had shorter waiting time. Patients who had more upper respiratory tract infection episodes and who received ventilation tube insertions in a tertiary referral center setting were subject to longer waiting times.
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Affiliation(s)
- Mao-Che Wang
- Department of Otolaryngology Head Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine and Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Chia-Huei Chu
- Department of Otolaryngology Head Neck Surgery, Mackay Memorial Hospital, Taipei, Taiwan, ROC
- Department of Audiology and Speech Language Pathology and School of Medicine, Mackay Medical College, New Taipei City, Taiwan, ROC
| | - Ying-Piao Wang
- Department of Otolaryngology Head Neck Surgery, Mackay Memorial Hospital, Taipei, Taiwan, ROC
- Department of Audiology and Speech Language Pathology and School of Medicine, Mackay Medical College, New Taipei City, Taiwan, ROC
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Pogoda L, Ziylan F, Smeeing DPJ, Dikkers FG, Rinkel RNPM. Bevacizumab as treatment option for recurrent respiratory papillomatosis: a systematic review. Eur Arch Otorhinolaryngol 2022; 279:4229-4240. [PMID: 35462578 PMCID: PMC9363326 DOI: 10.1007/s00405-022-07388-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 04/02/2022] [Indexed: 11/28/2022]
Abstract
Purpose To this day, there is no cure for recurrent respiratory papillomatosis (RRP). Multiple surgical procedures are performed to achieve symptom relief and prevention of airway obstruction. A promising drug for RRP is the vascular endothelial growth factor (VEGF) binding antibody bevacizumab. This chemotherapeutic agent has an angiogenesis-inhibiting effect which inhibits tumor growth. The objective of this review was to investigate the efficacy of bevacizumab as treatment option for RRP, and to explore the difference of its effects between intralesional and systemic treatment. Methods A systematic search was conducted in Cochrane, PubMed, and Embase. Articles were included if bevacizumab treatment was given intralesionally and/or systemically. The methodological quality of the studies was assessed using the CAse REport (CARE) guidelines. Results Of 585 unique articles screened by title and abstract, 15 studies were included, yielding a total of 64 patients. In 95% of the patients treated with systemic bevacizumab, the post-bevacizumab surgical interval was considerably prolonged. More than half of them did not need any surgical intervention during mean follow-up of 21.6 months. Treatment with intralesional bevacizumab showed a lower efficacy: in 62% of the patients, the post-bevacizumab surgical interval (mean, 1.8 months follow-up) was extended when compared to the interval before the treatment. Conclusion Systemically and intralesionally administered bevacizumab are effective treatment options for severe RRP. A systemic administration might be the treatment of first choice. Further prospective research with long term follow-up is advocated to elucidate this important topic.
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Affiliation(s)
- Louis Pogoda
- Department of Otorhinolaryngology-Head and Neck Surgery, Amsterdam University Medical Center, Location VUmc, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Fuat Ziylan
- Department of Otorhinolaryngology-Head and Neck Surgery, Amsterdam University Medical Center, Location VUmc, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Diederik P J Smeeing
- Department of Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Frederik G Dikkers
- Department of Otorhinolaryngology-Head and Neck Surgery, Amsterdam University Medical Center, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Rico N P M Rinkel
- Department of Otorhinolaryngology-Head and Neck Surgery, Amsterdam University Medical Center, Location VUmc, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
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Heireman L, Abrams S, Bruynseels P, Cartuyvels R, Cuypers L, De Schouwer P, Laffut W, Lagrou K, Hens N, Ho E, Padalko E, Reynders M, Vandamme S, Van der Moeren N, Verstrepen W, Willems P, Naesens R. Evaluation of the SARS-CoV-2 positivity ratio and upper respiratory tract viral load among asymptomatic individuals screened before hospitalization or surgery in Flanders, Belgium. PLoS One 2021; 16:e0259908. [PMID: 34762704 PMCID: PMC8584712 DOI: 10.1371/journal.pone.0259908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 10/28/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION The incidence of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infections in the Belgian community is mainly estimated based on test results of patients with coronavirus disease (COVID-19)-like symptoms. The aim of this study was to investigate the evolution of the SARS-CoV-2 reverse transcriptase polymerase chain reaction (RT-PCR) positivity ratio and distribution of viral loads within a cohort of asymptomatic patients screened prior hospitalization or surgery, stratified by age category. MATERIALS/METHODS We retrospectively studied data on SARS-CoV-2 real-time RT-PCR detection in respiratory tract samples of asymptomatic patients screened pre-hospitalization or pre-surgery in nine Belgian hospitals located in Flanders over a 12-month period (1 April 2020-31 March 2021). RESULTS In total, 255925 SARS-CoV-2 RT-PCR test results and 2421 positive results for which a viral load was reported, were included in this study. An unweighted overall SARS-CoV-2 real-time RT-PCR positivity ratio of 1.27% was observed with strong spatiotemporal differences. SARS-CoV-2 circulated predominantly in 80+ year old individuals across all time periods except between the first and second COVID-19 wave and in 20-30 year old individuals before the second COVID-19 wave. In contrast to the first wave, a significantly higher positivity ratio was observed for the 20-40 age group in addition to the 80+ age group compared to the other age groups during the second wave. The median viral load follows a similar temporal evolution as the positivity rate with an increase ahead of the second wave and highest viral loads observed for 80+ year old individuals. CONCLUSION There was a high SARS-CoV-2 circulation among asymptomatic patients with a predominance and highest viral loads observed in the elderly. Moreover, ahead of the second COVID-19 wave an increase in median viral load was noted with the highest overall positivity ratio observed in 20-30 year old individuals, indicating they could have been the hidden drivers of this wave.
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Affiliation(s)
- Laura Heireman
- Department of Laboratory Medicine, ZiekenhuisNetwerk Antwerpen, Antwerp, Belgium
| | - Steven Abrams
- Data Science Institute, Interuniversity Institute for Biostatistics and statistical Bioinformatics (I-BioStat), UHasselt, Hasselt, Belgium
- Global Health Institute, Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium
| | - Peggy Bruynseels
- Department of Laboratory Medicine, ZiekenhuisNetwerk Antwerpen, Antwerp, Belgium
| | | | - Lize Cuypers
- Department of Laboratory Medicine and National Reference Center for Respiratory Pathogens, University Hospitals Leuven, Leuven, Belgium
| | - Pieter De Schouwer
- Department of Laboratory Medicine, ZiekenhuisNetwerk Antwerpen, Antwerp, Belgium
| | - Wim Laffut
- Department of Laboratory Medicine, Heilig Hart Hospital, Lier, Belgium
| | - Katrien Lagrou
- Department of Laboratory Medicine and National Reference Center for Respiratory Pathogens, University Hospitals Leuven, Leuven, Belgium
| | - Niel Hens
- Data Science Institute, Interuniversity Institute for Biostatistics and statistical Bioinformatics (I-BioStat), UHasselt, Hasselt, Belgium
- Centre for Health Economic Research and Modelling Infectious Diseases, University of Antwerp, Antwerp, Belgium
| | - Erwin Ho
- Department of Laboratory Medicine, Sint-Maarten Hospital, Mechelen, Belgium
| | - Elizaveta Padalko
- Department of Laboratory Medicine, University Hospital Ghent, Ghent, Belgium
| | - Marijke Reynders
- Department of Laboratory Medicine, Sint-Jan Hospital, Bruges, Belgium
| | - Sarah Vandamme
- Department of Laboratory Medicine, Antwerp University Hospital, Antwerp, Belgium
| | | | - Walter Verstrepen
- Department of Laboratory Medicine, ZiekenhuisNetwerk Antwerpen, Antwerp, Belgium
| | - Philippe Willems
- Department of Laboratory Medicine GasthuisZusters Antwerpen, Antwerp, Belgium
| | - Reinout Naesens
- Department of Laboratory Medicine, ZiekenhuisNetwerk Antwerpen, Antwerp, Belgium
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van Munster JJCM, ZamanipoorNajafabadi AH, van den Hout WB, van Benthem PPG. [Reduction in the number of paediatric tonsillectomies and adenoidectomies in the Netherlands between 2005 and 2018]. Ned Tijdschr Geneeskd 2021; 165:D5828. [PMID: 34346636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Tonsillectomy with or without adenoidectomy (ATE) and adenoidectomy have been among the most frequently performed procedures in children for approximately 100 years. Randomized controlled trials were performed in the Netherlands to study the effectiveness of ATEs and adenoidectomies in children with upper respiratory tract infections. Subsequently, evidence-based guidelines were developed and implemented. We described changes in utilization of paediatric ATEs and adenoidectomies in the Netherlands between 2005 and 2018 using administrative databases. A significant decrease in the annual number of ATEs (-39%) and adenoidectomies (-49%) was observed in children between 0 and 15 years of age. The most pivotal change was observed between 2011 and 2012. The decrease in number of procedures led to estimated annual savings of €5.3 million on the healthcare budget and €10.4 million on societal costs. Furthermore, we observed small changes in patients' age, socioeconomic status, and registered diagnosis of surgically treated patients in the period 2012-2018 compared to 2010-2011.
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Affiliation(s)
- Juliëtte J C M van Munster
- Leids Universitair Medisch Centrum, afd. Keel-, Neus-, en Oorheelkunde en Hoofd- Hals chirurgie, Leiden
- Contact: Juliëtte J.C.M. van Munster
| | | | | | - Peter Paul G van Benthem
- Leids Universitair Medisch Centrum, afd. Keel-, Neus-, en Oorheelkunde en Hoofd- Hals chirurgie, Leiden
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Rojas-Lechuga MJ, Remacha J, González-Sánchez N, Grau JJ, Castillo P, Haag O, Vilaseca I. Juvenile recurrent respiratory papillomatosis treated with combined erlotinib and celecoxib: Initial report. Int J Pediatr Otorhinolaryngol 2020; 137:110194. [PMID: 32658799 DOI: 10.1016/j.ijporl.2020.110194] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 06/07/2020] [Accepted: 06/10/2020] [Indexed: 11/18/2022]
Abstract
Recurrent respiratory papillomatosis (RRP) is a chronic disease caused by human papillomavirus (HPV). RRP is a clinical challenge because of the high recurrence rate, poor surgery response, extension to tracheobronchial tree and because of the risk of malignancy in some cases. There is no consensus on which adjuvant therapy is better for those patients with highly recurrent course. Because papilloma cells overexpress the epidermal growth factor receptor (EGFR), together with an increased expression of COX-2 and prostaglandin E2, the combination of erlotinib and celecoxib seems plausible, and could be proposed for patients with poor response to previous lines of treatment.
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Affiliation(s)
| | - Joan Remacha
- Otorhinolaryngology Department Hospital Clinic, Barcelona, Spain
| | | | - Juan José Grau
- Medical Oncology Department, Hospital Clinic, Barcelona, Spain; IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Paola Castillo
- Pathology Department, Hospital Clinic, Barcelona, Spain; IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Oliver Haag
- Otorhinolaryngology Department, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Isabel Vilaseca
- Otorhinolaryngology Department Hospital Clinic, Barcelona, Spain; IDIBAPS, University of Barcelona, Barcelona, Spain
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Jayawardena ADL, Liu T, Pereira B, Wang Y, Baker L, Leary R, Mirambeaux M, Zablah E, Sabatos-Peyton CA, Hartnick CJ. Immune Signature Variation in Twins With Clinically Different Recurrent Respiratory Papillomatosis. Laryngoscope 2020; 131:E1335-E1338. [PMID: 32722845 DOI: 10.1002/lary.28930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/04/2020] [Accepted: 06/21/2020] [Indexed: 11/07/2022]
Affiliation(s)
- Asitha D L Jayawardena
- Department of Otolaryngology Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Tingyu Liu
- Novartis Institutes of BioMedical Research, Cambridge, MA, USA
| | - Bernard Pereira
- Novartis Institutes of BioMedical Research, Cambridge, MA, USA
| | - Ye Wang
- Novartis Institutes of BioMedical Research, Cambridge, MA, USA
| | - Lisa Baker
- Novartis Institutes of BioMedical Research, Cambridge, MA, USA
| | - Rebecca Leary
- Novartis Institutes of BioMedical Research, Cambridge, MA, USA
| | - Marcos Mirambeaux
- Department of Otolaryngology, Roberto Reid Cabral, Santa Domingo, Dominican Republic
| | - Evelyn Zablah
- Department of Otolaryngology Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | | | - Christopher J Hartnick
- Department of Otolaryngology Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
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Dailey SH, Schoeff S. "Office versus Operating Room - More to Discover". Ann Otol Rhinol Laryngol 2020; 130:233. [PMID: 32693618 DOI: 10.1177/0003489420942741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Abstract
Scedosporium genus as a significant emerging opportunist causes a broad spectrum of disease in not only immunosuppressed but also immunocompetent patients. The lung is one of the most commonly encountered sites of Scedosporium infection. Due to its very high levels of antifungal resistance, surgery has been recommended as an important part in the treatment of pulmonary Scedosporium spp infection, even in immunocompetent cases. However, whether lung surgery could help to reduce the risk of death in immunocompetent patients is not clear.We retrospectively retrieved the records of pulmonary infections with Scedosporium species in immunocompetent patients through a comprehensive literature search. The association of surgery on all-cause mortality was explored using binary logistic regression (BLR). Receiver operating characteristic (ROC) curve analysis was carried out to evaluate the capability of the model.The comprehensive searching strategy yielded 33 case reports and 3 case series in total, with 40 individual patients being included. The overall mortality was 12.50%. The fatality rate was 9.09% (2/22) in cases with surgery and 16.67% (3/18) in cases without surgery (odds ratio, 0.50; 95% confidence interval, 0.07-3.38; P = .48). Consistently, BLR analysis identified no statistical association between surgery and reduced mortality (odds ratio, 1.19; 95% confidence interval, 0.09-15.64; P = .89), after adjusting for age, gender, and antifungal chemotherapy. The area under the ROC curve was 0.88.For immunocompetent patients with pulmonary Scedosporium spp infection, surgical therapy may not be associated with reduced mortality. Surgical excision could be considered but is not imperative in this group of patients.
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Araki K, Tomifuji M, Uno K, Suzuki H, Tanaka Y, Tanaka S, Kimura E, Shiotani A. Feasibility of transnasal flexible carbon dioxide laser surgery for laryngopharyngeal lesions. Auris Nasus Larynx 2019; 46:772-778. [PMID: 30765273 DOI: 10.1016/j.anl.2019.01.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 01/03/2019] [Accepted: 01/23/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The fiber-guided carbon dioxide (CO2) laser is a useful device for laryngopharyngeal surgery. The flexible CO2 wave-guide laser has been developed and commercially available for several years. However, the transnasal use of CO2 flexible wave-guided laser surgery through the instrument channel of a flexible endoscope (CO2 TNFLS) is not permitted in Japan. This feasibility study aimed to assess the value and the safety of an in-office CO2 TNFLS procedure. METHODS Patients with small laryngopharyngeal diseases were enrolled from June 2015. Eligible patients had indications with lesions generally localized superficial lesions such as the benign tumor, leukoplakia, and premalignant lesion-like carcinoma in situ (CIS). Patients were locally well anesthetized using xylocaine. After removing as much of the lesion(s) as possible with flexible forceps, the remainder of the lesions were evaporated using CO2 TNFLS through the instrument channel of a flexible endoscope under local anesthesia. RESULTS Eighteen surgeries involving 13 patients, including 9 papilloma (7 recurrent respiratory papilloma [RRP]), 2 carcinoma in situ, 1 leukoplakia, and 1 large epiglottic cyst), were performed. Four patients with RRP required multiple surgeries. Except for 3 patients with RRP, all patients achieved disease control without additional intervention. All procedures were completed with no severe adverse events. CONCLUSION Office-based CO2 TNFLS is safe and feasible for patients with laryngopharyngeal pathologies. It is especially valuable for RRP patients with small lesions to avoid surgery under general anesthesia.
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Affiliation(s)
- Koji Araki
- Department of Otolaryngology - Head & Neck Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan.
| | - Masayuki Tomifuji
- Department of Otolaryngology - Head & Neck Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan
| | - Kosuke Uno
- Department of Otolaryngology - Head & Neck Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan
| | - Hiroshi Suzuki
- Department of Otolaryngology - Head & Neck Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan
| | - Yuya Tanaka
- Department of Otolaryngology - Head & Neck Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan
| | - Shingo Tanaka
- Department of Otolaryngology - Head & Neck Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan
| | - Eiko Kimura
- Department of Otolaryngology - Head & Neck Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan
| | - Akihiro Shiotani
- Department of Otolaryngology - Head & Neck Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan
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Scatolini ML, Cocciaglia A, Pérez CG, Rodríguez HA. Laryngeal reconstruction in children with recurrent respiratory papillomatosis. Int J Pediatr Otorhinolaryngol 2018; 115:120-124. [PMID: 30368371 DOI: 10.1016/j.ijporl.2018.09.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 09/25/2018] [Accepted: 09/25/2018] [Indexed: 11/18/2022]
Abstract
OBJETIVES To describe our experience in reconstructive laryngeal surgery in patients with recurrent respiratory papillomatosis (RRP). INTRODUCTION RRP is a rare laryngeal disease requiring multiple surgical endoscopic interventions during its course. These interventions may cause secondary lesions that may compromise airway patency. Open larynx reconstructive surgery, as tracheostomy, is a procedure considered to potentially favor extralaryngeal papilloma dissemination. In patients with RRP, the use of endoscopic posterior cricoid split and rib grafting has not been previously described. METHODS The clinical charts of 230 patients with RRP seen between 1996 and 2017 were reviewed. All patients who underwent airway expansion procedures either by open or endoscopic approach were included in the study. RESULTS Four patients with RRP underwent laryngeal surgery for laryngeal stenosis were included. A double-stage open approach was used in two patients and a single-stage endoscopic approach in the remaining two. The two tracheostomized patients were decannulated while tracheostomy was avoided in the two patients who underwent a single-stage endoscopic procedure. Two patients had active papillomatous lesions limited to the larynx at the time of surgery; no dissemination was observed during follow-up (cases 1 and 3). One patient had extralaryngeal disseminated papilomatosis; surgery did not lead to an increased lesion load compared to presurgical lesions (case 4). The patient who did not have active lesions did not have recurrence (case 2). CONCLUSIONS Reconstructive laryngeal surgery is a safe and effective option in the management of stenotic sequelae resulting from the surgical treatment of RRP, allowing for decannulation or avoiding tracheostomy.
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Affiliation(s)
- M L Scatolini
- Department of Respiratory Endoscopy, Hospital de Pediatría Juan P. Garrahan, Buenos Aires, Argentina.
| | - A Cocciaglia
- Department of Respiratory Endoscopy, Hospital de Pediatría Juan P. Garrahan, Buenos Aires, Argentina
| | - C G Pérez
- Department of Respiratory Endoscopy, Hospital de Pediatría Juan P. Garrahan, Buenos Aires, Argentina
| | - H A Rodríguez
- Department of Respiratory Endoscopy, Hospital de Pediatría Juan P. Garrahan, Buenos Aires, Argentina
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Rasmussen ER, Schnack DT, Jørkov AS, Raja AA, Olsen CH, Homøe P. Long-term follow-up and outcome in patients with recurrent respiratory laryngeal papillomatosis. Dan Med J 2017; 64:A5424. [PMID: 29206094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Recurrent respiratory papillomatosis is characterized by wart-like lesions of the upper airway and is most frequently caused by human papillomavirus (HPV). The disease has significant impact on quality of life due to potential airway obstruction, dysphonia and the need for serial surgeries. The main objective of this study was to describe patient characteristics and long-term follow-up data in a Danish cohort with the disease. METHODS The study was a longitudinal retrospective cohort-study using data from electronic medical records and a pathology database. RESULTS A total of 61 adult and four juvenile patients were identified. The male-to-female ratio was 2.4. In the adult population, the mean age at onset was 45 years. The median number of surgeries was four (interquartile range: 2.8). The mean follow-up time was 8.7 years (range: 7 days-30 years). Three cases of malignant transformation were observed. In the juvenile population, the mean age of onset was 8.5 years (range: 3-12 years). The mean follow-up time was 11.5 years (range: 2-23 years), and the number of surgeries per year at risk was one/year. CO2-laser and microdebrider were the surgical techniques usually employed. 43% of histopathologic analyses could detect HPV infection (subtype 6 or 11). CONCLUSIONS More males than females suffer from respiratory papillomatosis; age of onset was either in childhood or in mid-life. Use of CO2-laser or microdebrider was the preferred surgical approach in this cohort. FUNDING none. TRIAL REGISTRATION not relevant.
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Issoufou I, Rabiou S, Belliraj L, Ammor FZ, Harmouchi H, Diarra AS, Lakranbi M, Serraj M, Ouadnouni Y, Smahi M. [The place of surgery in bilateral sequelae bronchiectasis]. Rev Pneumol Clin 2017; 73:127-134. [PMID: 28365046 DOI: 10.1016/j.pneumo.2017.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Revised: 02/04/2017] [Accepted: 02/27/2017] [Indexed: 06/07/2023]
Abstract
INTRODUCTION The aim of our study is to report our surgery results in bilateral sequelae bronchiectasis and to assess its impact on the life quality of our patients. METHOD This is a retrospective descriptive study in thoracic surgery department of Teaching Hospital Hassan II of Fez in Morocco. It involved all patients with bilateral bronchiectasis which is predominant on a few lobes or segments (localized) and who underwent surgery during the period 2010-2015. The epidemiological, clinical and paraclinical data, the surgery results, the evolution and the impact on life quality were assessed. RESULTS From a total of 47 patients with bilateral bronchiectasis, 13 were operated, thus a frequency of 27.6%. The average age was 32years, ranging from 15 to 54years. Women were in majority (61.5%) representing a sex ratio of 1.6. The association of chronic bronchorrhea and hemoptysis was the main reason of medical consultation in 46.16%, followed by isolated chronic bronchorrhea in 38.46%. Surgical resection involved the left side in 61.5% of cases. The left lower lobectomy was the most accomplished gesture. An improvement in symptoms was found in 11 patients (84.6%) as a decrease in bronchorrhea, hemoptysis episodes and decreasing use of antibiotics. CONCLUSION Bilateral bronchiectasis surgery can be performed with acceptable morbidity and mortality in well-selected patients with an improvement in symptoms.
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Affiliation(s)
- I Issoufou
- Service de chirurgie thoracique, CHU Hassan II, BP 1893, Km 2.200, route de Sidi Harazem, 3000 Fès, Maroc.
| | - S Rabiou
- Service de chirurgie thoracique, CHU Hassan II, BP 1893, Km 2.200, route de Sidi Harazem, 3000 Fès, Maroc
| | - L Belliraj
- Service de chirurgie thoracique, CHU Hassan II, BP 1893, Km 2.200, route de Sidi Harazem, 3000 Fès, Maroc
| | - F Z Ammor
- Service de chirurgie thoracique, CHU Hassan II, BP 1893, Km 2.200, route de Sidi Harazem, 3000 Fès, Maroc
| | - H Harmouchi
- Service de chirurgie thoracique, CHU Hassan II, BP 1893, Km 2.200, route de Sidi Harazem, 3000 Fès, Maroc
| | - A S Diarra
- Laboratoire d'épidémiologie, recherche clinique et santé communautaire, faculté de médecine et de pharmacie de Fès, 3000 Fès, Maroc
| | - M Lakranbi
- Service de chirurgie thoracique, CHU Hassan II, BP 1893, Km 2.200, route de Sidi Harazem, 3000 Fès, Maroc
| | - M Serraj
- Service de pneumologie, CHU Hassan II, BP 1893, Km 2.200, route de Sidi Harazem, 3000 Fès, Maroc
| | - Y Ouadnouni
- Service de chirurgie thoracique, CHU Hassan II, BP 1893, Km 2.200, route de Sidi Harazem, 3000 Fès, Maroc
| | - M Smahi
- Service de chirurgie thoracique, CHU Hassan II, BP 1893, Km 2.200, route de Sidi Harazem, 3000 Fès, Maroc
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Toyama S. [Anesthetic Management of Children with Upper Respiratory Tract Infections]. Masui 2017; 66:4-10. [PMID: 30380249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Respiratory adverse events, such as cough, hypoxia, laryngospasm, bronchospasm and stridor, are major causes of morbidity and mortality during pediatric anesthesia. Since several studies have shown that upper respiratory tract infection is an independent risk factor for perioperative respiratory adverse events, children presenting for elective surgery with upper respiratory tract infection require a careful evaluation to decide whether or not to proceed with anesthesia. However, there are no standard guidelines to proceed with or postpone anesthesia, and thus the decision pro- cess is often based on unique institutional, patient, surgical, and social factors. Most of perioperative respira- tory adverse events can be anticipated, recognized, and treated easily, while laryngospasm and bronchospasm that can lead to oxygen desaturation and death are serious complications and their prevention and treat- ment are challenging. Anesthesiologists should be fa- miliarized with the prevention and treatment of peri- operative respiratory adverse events.
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Hu H, Zhang Q, Sun G, Yu Z. [Treatment of recurrent laryngeal papilloma by submucosal resection and the effect on prognosis]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2015; 29:1873-1877. [PMID: 26930909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To investigate the efficacy of submucosal resection by CO2 laser in the treatment of recurrent laryngeal papilloma and the effect on prognosis. METHOD A total of 11 patients diagnosed as recurrent laryngeal papilloma were included in this review. Papilloma was marked before operation and checked under fibro-laryngoscope. Papilloma was resected completely including the submucosal tissure with CO2 laser or microequipment. In widespread papilloma, false membrane in raw surface were cleared 7-10 days after operation. Surgical specimens (including membrane) were detected by routine pathology, HPV typing and immunohistochemical pathologic examination. The patients were checked once a month in the first 3 months after operation, and then once for every 3 months. Once the hoarseness and other symptoms aggravated or the disease was recurrent, the patients were treated immediately. RESULT HPV viral DNA was found in 10/11 cases, with HPV11 (7/11 cases) and HPV6 (3/11 cases). Cases with regards to follow-up, from 6 months to 1 year, 3 cases were followed up 1 year after operation, without recurrence. Five patients including 2 children were followed up 6 to 12 months after operation, without recurrence. Two children underwent 2 or 3 operations, were followed-up more than 6 months withouting recurrence. CONCLUSION Papilloma submucosal resection could decrease postoperative recurrence and is worth to be further investigated.
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Enyuma COA, Offiong M, Adekanye A, Akpan U, Ezeanyagu N, Uffiah O. FOREIGN BODY IN THE NASOPHARYNX; MASQUERADING AS PHARYNGOTONSILLITIS. Niger J Med 2015; 24:380-383. [PMID: 27487618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
Foreign body (FB) in the aerodigestive tracts has been commonly reported but findings of impacted foreign bodies in the nasopharynx following inhalation/ingestion are very rare. Most of the FB gets lodged as a result of forceful vomiting, coughing,and digital manoeuvres for removal of FB in the oropharynx. Several objects have been identified lodged in the nasopharynx. No age group is spared although most victims are children under 10 years of age. Foreign bodies in the nasopharynx can be uneventful or potentially dangerous depending on type, size and location as it may cause sudden airway obstruction, or local pressure necrosis of alimentary or respiratory tract or both. Presentation in children is usually with a history of swallowed FB which may not be witnessed in children, choking, cough, bluish discolouration, breathlessness, drooling of saliva, halitosis, rhinorrhoea, snoring, stridor, dysphagia, vomiting and dysphonia. A foreign body in the nasopharynx is a challenge to patient, parents, the physician and the ENT surgeon, as it may be miss-diagnosed, in the index case, as Pharyngotonsilitis. The index patient, a 14 month child,was presented with a two days history of fever, drooling of saliva, mouth breathing, and digital manipulation. Lateral imaging of the post nasal space following initial treatment with antibiotics, aided the diagnosis of a periwinkle shell in the nasopharyngx that was removed during a nasopharyngoscopy under general anaesthesia without complication and subsequently discharged home. This emphasizes a high index of suspicion for FB in the nasopharynx in children with history of missing foreign body, digital manipulation, drooling of saliva and mouth breathing. Lateral X-ray of the postnasal space, neck, chest and abdomen should be the minimum investigation required.
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Doganer YC, Rohrer JE, Aydogan U, Thurston MJ, Saglam K. Tonsillectomy, adenoidectomy and adenotonsillectomy rates in school-aged children: Relative contributions of socio-demographic and clinical features. Int J Pediatr Otorhinolaryngol 2015; 79:969-74. [PMID: 25979652 DOI: 10.1016/j.ijporl.2015.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 03/04/2015] [Accepted: 03/07/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The present study sought to investigate the frequencies of tonsillectomy, adenoidectomy and both adenotonsillectomy (T&A) among 6-12 years old children. In addition, we tried to find out the predictors associated with these previous upper respiratory tract (URT) surgeries. METHODS This cross-sectional study consisted of 1900 children educated in 3 different elementary schools in Ankara, Turkey. Data about demographics and health conditions were obtained from survey questionnaires completed by parents. RESULTS Of the 1900 children, 15 children (0.8%) previously underwent tonsillectomy, 43 children (2.3%) had adenoidectomy and 80 children (4.2%) had T&A surgical histories. Multiple logistic regression analysis revealed that older students compared to younger ones [odds ratio (OR) = 1.15, p = 0.011], and those who had parent-reported apnea compared to subjects without apnea were more likely to have URT surgery histories [OR = 2.34, p = 0.001]. Those children with surgery histories were more likely to have fathers with a higher educational level [medium level: OR = 2.07, p = 0.012; high level: OR = 2.79, p = 0.001 vs. low level) and the subjects had greater BMI percentiles [overweight: OR = 1.71, p = 0.036; obesity: OR = 2.32, p = 0.003 vs. healthy weight]. Children who had 1-2 URT infections per year [OR = 0.47, p = 0.019] had less probability of URT surgery histories, whereas those children with AOM ≥ 3 times per year [OR = 2.52, p = 0.003] had more probability of URT surgery history. CONCLUSIONS We conclude that a reasonable explanation for higher rates of URT surgery among children with a high level of paternal education may originate from their awareness about URT associated diseases and possibly due to the ease of access to health care services.
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Affiliation(s)
- Yusuf C Doganer
- Department of Family Medicine, Turkish Military Academy, Primary Care Examination Center, Ankara, Turkey; Department of Family Medicine, Mayo Clinic, Rochester, MN, USA.
| | - James E Rohrer
- Department of Family Medicine, Mayo Clinic, Rochester, MN, USA
| | - Umit Aydogan
- Department of Family Medicine, Gulhane Military Medical Faculty, Ankara, Turkey
| | | | - Kenan Saglam
- Department of Internal Medicine, Gulhane Military Medical Faculty, Ankara, Turkey
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Zhang C, Chen B, Nan B, Chen Y, Gao J, Huang S, Xiang H, Yu X, Liu X, Luo B. [Juvenile onset respiratory papillomatosis: risk factors for severity]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2014; 28:1848-1851. [PMID: 25980154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE This study was designed to explore the risk factors associated with severity of juvenile onset recurrent respiratory papillomatosis. METHOD A retrospective study was conducted to study determinants of severe forms of juvenile recurrent onset respiratory papillomatosis. The patients were separated into different groups based on the onset age, the first recurrence of age, the first recurrence of period, gender and incision of tracheal respectively. The relationship among the lesion severity score,the involvement of the subregion, operation period and the next operation period were also explored. RESULT It was observed that some children who recurred before 4 years old required more surgery, shorter operation period(the average, longest or shortest operation period) than those elder children, the differences were statistically (P=0. 029, 0. 003, 0. 010, 0. 039, respectively). The severity score of lesion was correlated positively with the involvement of the subregion and negatively with operation period (r=0. 914, -0. 451, respectively). Some children who diagnosed before 4 years old had to endure more severity score and shorter operation period than those older children, the differences were statistically (P= 0. 036, 0. 000, respectively). 8 cases accepted incision of tracheal, they accepted more surgery too. But the differences in the onset age, the first recurrence of age, and the operation period were not statistically. CONCLUSION The results showed that the clinical course of juvenile onset recurrent respiratory papillomatosis was closely related to the first recurrence age and period, while the severity of disease was associated to the onset age and the involvement of the subregion.
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Herath S, Lewis C, Nisbet M. Increasing awareness of Rhodococcus equi pulmonary infection in the immunocompetent adult: a rare infection with poor prognosis. N Z Med J 2013; 126:165-174. [PMID: 24362741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The aim of this case report and review is to increase awareness of this uncommon infection with Rhodococcus equi (R. equi), in immunocompetent adults. R. equi is a soil-dwelling Gram-positive bacillus that frequently causes infection in grazing livestock. Human infection is rare and mostly limited to the immunocompromised hosts. We present a case of pneumonia caused by R. equi infection in a 55-year-old male builder who presented with cough, dyspnoea and night sweats, initially suspected to have pulmonary tuberculosis. Following biopsy of the mediastinal lymph nodes, R. equi was cultured, which is usually not a contaminant. Despite extensive investigations a host immune defect was not identified. The patient recovered after three months of combination antibiotic treatment, initially with intravenous vancomycin and meropenem followed by oral clarithromycin and rifampicin. To further clarify this rare disease we did a literature review that identified 26 adult patients with R. equi infection, without an identified host immunosuppressive condition. In this cohort, the median age at presentation was 53 years and infection holds a strong male predominance 19 (73%). An environmental exposure (e.g. farming, horse breeder) was found in 13 (50%). Ten (38%) of these patients had pulmonary infection. All deaths 3 (12%) occurred in the patients had pulmonary infection. R.equi is an infection that is difficult to diagnose and carries a high mortality if prompt treatment is not established. It is important to realise the potential for this disease to be misdiagnosed as pulmonary tuberculosis or community acquired pneumonia. Clinical suspicion is important especially if an environmental exposure is suspected.
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Affiliation(s)
- Samantha Herath
- Respiratory and Interventional Pulmonology, The Montreal Chest Institute, McGill University, 3650, Rue St-Urbain, Montreal, H2X2P4, Canada.
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Huang HJ, Fang XM. [Effect of endotracheal intubation and laryngeal mask airway on perioperative respiratory adverse events in children with upper airway infections]. Zhonghua Yi Xue Za Zhi 2013; 93:3626-3628. [PMID: 24534318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To investigate the effect of endotracheal intubation (TT) or the laryngeal mask airway (LMA) on the incidence of perioperative respiratory adverse events in children with upper respiratory tract infection undergo general anesthesia. METHODS From November, 2006 to October, 2012 in the Zhuji People's Hospital, 76 children with upper respiratory tract infection approved by hospital ethic committee were randomly divided into 2 groups:group I (n = 36), children were applied with endotracheal intubation during general anesthesia (TT group), while groupII (n = 40), laryngeal mask airway were used (LMA group).Intraoperative mean arterial pressure (MAP), hear rate (HR), pulse oximetry (SPO2), and end-tidal carbon dioxide partial pressure (P ETCO2) were recorded during the surgery. The incidence of adverse events such as hypoxemia, fidgety, sore throat, and laryngospasm were evaluated in resuscitation room.We also assessed the pre- and postoperative symptoms of respiratory tract infection. RESULTS There was no significant difference in upper respiratory tract infection symptoms between two groups, and the children in both groups have good tolerance to TT or LMA.However, the hemodynamics status in LMA group were more stable than those in TT group after the LMA insertion or removing (P < 0.05). The incidence of hypoxemia, fidgety, sore throat, and laryngospasm were significant lower in LMA group compared with those in TT group (P < 0.05). CONCLUSION LMA could decrease the incidence of perioperative respiratory adverse events and can be safely used in children with upper respiratory tract infection undergo general anesthesia.
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Affiliation(s)
- Hua-jun Huang
- Department of Anesthesia, Zhuji people's Hospital, Zhejiang 311800, China
| | - Xiang-ming Fang
- Department of Anesthesiology, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310009, China.
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Avelino MAG, Zaiden TCDT, Gomes RO. Surgical treatment and adjuvant therapies of recurrent respiratory papillomatosis. Braz J Otorhinolaryngol 2013; 79:636-42. [PMID: 24141682 PMCID: PMC9442437 DOI: 10.5935/1808-8694.20130114] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 06/29/2013] [Indexed: 11/20/2022] Open
Abstract
Objective Method Results Conclusion
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Obregón-Guerrero G, Martínez-Ordaz JL, Moreno-Aguilera E, Ramírez-Martinez M, Peña-García JF, Pérez-Álvarez C. [Deep neck abscess. Factors related to reoperation and mortality]. CIR CIR 2013; 81:299-306. [PMID: 25063894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Deep neck abscesses are major complications that arise of odontogenic, pharyngeal, or cervicofacial foci, mainly in patients with morbidities that facilitate the spread to other spaces. Many of them require surgical treatment, and an appropriate evaluation and surgical drainage is required to obtain the best results. AIM To identify factors which relate to reoperation and mortality in patient submitted to surgical treatment due to deep neck abscess. METHODS Review of all patients with deep neck abscess who underwent surgical treatment in a Head and Neck Surgery Department in a third-level hospital during a two year period. RESULTS There were 87 patients, 44 of which were female. The median age was 49 years old. Thirty-five patients (40%) had comorbidities, diabetes mellitus being the most common, found in 30 (34%) patients. Twenty-one patients (24%) required reoperation (primarily due to inadequate surgical drainage). The risk factors identified with it were presence of comorbidities (mainly diabetes mellitus) (p< 0.05), multiple deep neck spaces involvement (p< 0.001) and an ASA score of three or above (p< 0.01). Eight patients died, for a mortality of 9%. The factors related to mortality were multiple deep neck spaces involvement (p< 0.01), bilateral involvement (p< 0.05) and reoperation (p< 0.001). CONCLUSION Deep neck abscesses appropriate evaluation and a complete surgical drainage of all deep space neck abscesses are primordial to avoid reoperation and improve survival.
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Affiliation(s)
- Gabriela Obregón-Guerrero
- Servicio de Cirugía de Cabeza y Cuello, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México DF., Mexico
| | - José Luis Martínez-Ordaz
- Servicio de Gastrocirugía, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México DF., Mexico.
| | - Eduardo Moreno-Aguilera
- Servicio de Gastrocirugía, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México DF., Mexico
| | - Martha Ramírez-Martinez
- Servicio de Cirugía de Cabeza y Cuello, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México DF., Mexico
| | - Juan Francisco Peña-García
- Servicio de Cirugía de Cabeza y Cuello, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México DF., Mexico
| | - Claudia Pérez-Álvarez
- Servicio de Cirugía de Cabeza y Cuello. Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México DF., Mexico
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Tsou YA, Lin CC, Lai CH, Wang CY, Lin CD, Chen PC, Tsai IJ, Chen CM, Sung FC, Tsai MH. Does Adenotonsillectomy really reduced clinic visits for pediatric upper respiratory tract infections? A national database study in Taiwan. Int J Pediatr Otorhinolaryngol 2013; 77:677-81. [PMID: 23394793 DOI: 10.1016/j.ijporl.2013.01.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Revised: 01/07/2013] [Accepted: 01/12/2013] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To investigate whether adenotonsillectomy reduces upper respiratory tract infections (URIs) in the pediatric population. METHODS AND SUBJECTS We identified 415 children, aged ≤18 years who had undergone adenoidectomy and/or tonsillectomy during the period from 1999 to 2006, from the Taiwan National Health Insurance Research Database. The comparison group consisted of 1630 children without the surgery randomly selected from the same database frequency matched with sex, age and the surgery date (index date). Changes in physician visits for URIs 2-year period before and 2-year period after the index date were compared between the two groups of children. RESULTS The number of outpatient visits for URIs decreased with time, children with tonsillectomy and/or adenoidectomy had a greater reduction than comparison children (mean changes, -14 times and -6 times, respectively) in the 2-year period after the index date. Multivariate analyses using generalized estimated equation revealed a significant effect in reducing URIs visits from the surgery (relative ratio=0.85, p<0.0001), strongest for children undergoing both tonsillectomy and adenoidectomy (relative ratio=0.76, p<0.0001). The association between surgery and the decrease in URIs was more pronounced for children aged 12 years and less. CONCLUSION This population-based study suggests that tonsillectomy and/or adenoidectomy is associated with fewer physician visits for URIs. The association is weakened in old children.
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Affiliation(s)
- Yung-An Tsou
- Department of Otolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan
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Guo YL, Zhang TS. [Long-term therapeutic effects of tracheotomy on children with recurrent laryngeal papillomatosis]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2012; 47:969-973. [PMID: 23328033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To explore the long-term therapeutic effects of tracheotomy on juvenile onset recurrent respiratory papillomatosis in children. METHODS Between 1993 and 2007, 86 cases of juvenile onset recurrent respiratory papillomatosis (JRRP) in children were encounted and divided into tracheotomy group and conventional surgery group, the clinical data of these children were retrospectively analyzed. RESULTS There were 29 cases in tracheotomy group, the time of carrying tracheal casing pipe was 13 - 66.5 months, the operative times of every case was 4 - 9 times (median 7), there were 27 cases with more than 2 years release after extubation. There were 2 cases with tumor dissemination into incision of trachea and endotracheal, one case lost to follow up and the other one dead. No case developed laryngotracheal stenosis and severe complication. There were 57 cases in conventional surgery group, the operation times of every case was 9 - 32 times (median 18). Fifty-three cases with no recurrence after follow up for more than one year; 2 cases with trachea tumor dissemination, and after operation, no recurrence after 2 years follow up. Two cases with endotracheal dissemination, one case lost to follow up and the other one dead. No case developed laryngotracheal stenosis and severe complication. The voice assessment result of tracheotomy group was obviously better than that in the conventional surgery group, the difference had statistical significance (χ(2) = 33.16, P < 0.005), the tumor dissemination rate of the two groups had no statistical significance (χ(2) = 0.0026, P > 0.05). CONCLUSIONS Tracheotomy significantly reduce the operative times, give the greatest degree of preservation of laryngeal function, and it do not increase the tumor dissemination into trachea. Tracheotomy is an effective method of treatment in children with a high rate of recurrence, and with poor economic conditions, and difficult to follow-up. It can improve the long-term life quality of the children.
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Affiliation(s)
- Ya-li Guo
- Department of Otorhinolaryngology Head and Neck Surgery, Kunming Children's Hospital, Kunming 650034, China
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Abstract
This article describes the clinical presentation of pneumonia, acute respiratory distress syndrome, lung abscess, and empyema: life-threatening infections of the pulmonary system. The etiology and risk factors for each of these conditions are described, diagnostic approaches are discussed, and evidence-based management options are reviewed.
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Affiliation(s)
- Himanshu Desai
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Eastern Virginia Medical School, Norfolk, VA-23507, USA.
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Yuan H, Myers S, Wang J, Zhou D, Woo JA, Kallakury B, Ju A, Bazylewicz M, Carter YM, Albanese C, Grant N, Shad A, Dritschilo A, Liu X, Schlegel R. Use of reprogrammed cells to identify therapy for respiratory papillomatosis. N Engl J Med 2012; 367:1220-7. [PMID: 23013073 PMCID: PMC4030597 DOI: 10.1056/nejmoa1203055] [Citation(s) in RCA: 130] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
A patient with a 20-year history of recurrent respiratory papillomatosis had progressive, bilateral tumor invasion of the lung parenchyma. We used conditional reprogramming to generate cell cultures from the patient's normal and tumorous lung tissue. Analysis revealed that the laryngeal tumor cells contained a wild-type 7.9-kb human papillomavirus virus type 11 (HPV-11) genome, whereas the pulmonary tumor cells contained a 10.4-kb genome. The increased size of the latter viral genome was due to duplication of the promoter and oncogene regions. Chemosensitivity testing identified vorinostat as a potential therapeutic agent. At 3 months after treatment initiation, tumor sizes had stabilized, with durable effects at 15 months.
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Affiliation(s)
- Hang Yuan
- Department of Pathology, Georgetown University Medical Center, Washington, DC 20057, USA
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Ongkasuwan J, Friedman EM. Juvenile recurrent respiratory papilloma: Variable intersurgical intervals. Laryngoscope 2012; 122:2844-9. [PMID: 22847877 DOI: 10.1002/lary.23534] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Revised: 05/02/2012] [Accepted: 05/30/2012] [Indexed: 11/08/2022]
Affiliation(s)
- Julina Ongkasuwan
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA.
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Nan BY, Chen BB, Zhang CQ. [Peri-operative management on juvenile recurrent respiratory papillomatosis]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2012; 47:454-457. [PMID: 22932135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To investigate the safety of peri-operative management on children with juvenile recurrent respiratory papilloma (JORRP). METHODS A retrospective analysis was conducted on preoperative assessment, anesthesia methods and options, operative procedure, and postoperative airway maintenance in 28 JORRP children aged from ten months to seven years old. A total of 148 times of surgery was performed on these 28 children. RESULTS One hundred and nine JORRP children graded one and two-degree dyspnea underwent surgery within 24 hours and were intubated successfully in the first attempt after intravenous induction. Thirty-nine emergency operations were performed in the children graded three and four-degree dyspnea, 35 of them were intubated successfully in the first attempt after inhalation induction and 4 succeeded in the second attempt. No complications occurred in 129 JORRP children postoperatively, 17 children suffered from mild dyspnea and relieved after oxygen inhalation, 2 children were intubated and sent to intensive care unit because of postoperative hypoxemia. All JORRP children got through the peri-operative period safely. The quality of pronunciation in 101 children improved markedly and 35 suffered from slight hoarseness on the 1st postoperative day. Three children had the tracheal tube of tracheostomy removed after receiving five, four and three operations respectively. Nineteen children were followed up for 2 - 5 years. Among them, one child did not relapse 3 years after surgical management.One child suffered from laryngostenosis postoperatively. No death occurred. CONCLUSION Complete preoperative preparation, rational anesthesia methods, careful operative procedure and airway maintenance after surgery could increase the safety for children with recurrent respiratory papilloma.
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Affiliation(s)
- Ben-yu Nan
- Department of Otorhinolaryngology, Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical College, China
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Abstract
Juvenile-onset recurrent respiratory papillomatosis, caused by the human papilloma virus, is the most common benign neoplasm of the larynx in children. Recurrent respiratory papillomatosis is relatively rare, but it can have a significant impact on afflicted children and their family's quality of life as dysphonia and multiple surgical procedures are hallmarks of this disease. The current standard of care is surgical therapy with a goal of complete papilloma removal and preservation of normal structures. The technique in this atlas combines both the microdebrider and the pulse KTP laser. The microdebrider allows for rapid removal of bulky lesions without the risk of thermal injury, yet it cannot provide precise removal in areas such as the anterior commissure and ventricle. The pulse KTP laser allows for removal of sessile lesions and in sensitive areas such as the vocal folds. The authors describe this technique as well as discuss adjuvant therapies and pearls for success.
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Affiliation(s)
- Stephen C Maturo
- Department of Otolaryngology, San Antonio Military Medical Center, Fort Sam Houston, TX, USA
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Baidoo KK, Kitcher E. Recurrent respiratory papillomatosis: the Korle-Bu experience. Ghana Med J 2012; 46:43-45. [PMID: 22605888 PMCID: PMC3353504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
BACKGROUND Recurrent respiratory papillomatosis is a benign disease of the aero digestive tract which is caused by the human papilloma virus type 6 and 11 and mainly affects children. OBJECTIVE The aim of this study is to describe the pattern of recurrent respiratory papillomatosis at the E.N.T Unit Korle Bu Teaching Hospital, Accra. METHOD This is a retrospective study of theatre records of patients managed for respiratory papillomata from January 1995 to December 2004 at the E.N.T Unit of Korle Bu Teaching Hospital, Accra which is a tertiary facility. These records were studied and we obtained information on gender, age, number of surgeries and the presence of tracheotomy. RESULTS Sixty-nine patients were identified over the period. Thirty-three males and 36 females with a M:F ratio 1:1.1, and ages ranging from 2 to 54 years. The mean age was 12.3 years and a median age of 8.5 years.Children less than 10 years accounted for 69% and 46.4% had repeated surgery with overall tracheotomy rate of 14.5%. CONCLUSIONS Recurrent Respiratory Papillomatosis is primarily a paediatric disease. Locally, its distribution is comparable to others in the sub region and worldwide and surgery is the mainstay of treatment.
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Affiliation(s)
- K K Baidoo
- E.N.T Unit, Korle-Bu Teaching Hospital, P.O. Box 77, Korle Bu, Accra.
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Hermann JS, Pontes P, Weckx LLM, Fujita R, Avelino M, Pignatari SSN. Laryngeal sequelae of recurrent respiratory papillomatosis surgery in children. Rev Assoc Med Bras (1992) 2012; 58:204-208. [PMID: 22569615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Accepted: 08/12/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To evaluate laryngeal sequelae from surgical treatment of recurrent respiratory papillomatosis in children, as well as associated risk factors. METHODS Case-control study. Medical record data analysis of 50 children with recurrent respiratory papillomatosis, divided into two groups: with and without laryngeal sequelae. The group of patients with laryngeal sequelae was compared to those without sequelae in regard to the onset of disease, age at first surgery, number and frequency of surgeries, disease stage, and type of surgery (CO2 laser, cold forceps). RESULTS 23 patients (46%) sustained laryngeal sequelae. The most frequent sequela was anterior commissure synechia (17 patients [34%]), followed by glottic stenosis (six patients [12%]). There was no statistically significant difference between groups with and without laryngeal sequelae regarding the disease onset (p = 0.93), age at first surgery (p = 0.68), number of surgeries (p = 0.22), annual frequency of surgery (p = 0.93), presence of papilloma in anterior (p = 0.430) or posterior commissure (p = 0.39), and type of surgery (p = 0.27). The Derkay anatomical score (a staging system that assesses the extent of the disease in the aerodigestive tract) was significantly higher in the laryngeal sequelae group (p = 0.04). CONCLUSION Laryngeal sequelae are a frequent complication of recurrent respiratory papillomatosis surgical treatment in children, particularly anterior commissure synechiae and glottic stenosis. Advanced stages are associated with increased risk of laryngeal sequelae after surgery.
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Affiliation(s)
- Juliana Sato Hermann
- Department of Otorhinolaryngology and Head and Neck Surgery, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.
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van den Aardweg MTA, Boonacker CWB, Rovers MM, Hoes AW, Schilder AGM. Effectiveness of adenoidectomy in children with recurrent upper respiratory tract infections: open randomised controlled trial. BMJ 2011; 343:d5154. [PMID: 21896611 PMCID: PMC3167877 DOI: 10.1136/bmj.d5154] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To assess the effectiveness of adenoidectomy in children with recurrent upper respiratory tract infections. DESIGN Open randomised controlled trial. SETTING 11 general hospitals and two academic centres. PARTICIPANTS 111 children aged 1-6 with recurrent upper respiratory tract infections selected for adenoidectomy. INTERVENTION A strategy of immediate adenoidectomy with or without myringotomy or a strategy of initial watchful waiting. Main outcome measure Primary outcome measure: number of upper respiratory tract infections per person year calculated from data obtained during the total follow-up (maximum 24 months). SECONDARY OUTCOME MEASURES days with upper respiratory tract infection per person year, middle ear complaints with fever in episodes and days, days with fever, prevalence of upper respiratory tract infections, and health related quality of life. RESULTS During the median follow-up of 24 months, there were 7.91 episodes of upper respiratory tract infections per person year in the adenoidectomy group and 7.84 in the watchful waiting group (difference in incidence rate 0.07, 95% confidence interval -0.70 to 0.85). No relevant differences were found for days of upper respiratory tract infections and middle ear complaints with fever in episodes and days, nor for health related quality of life. The prevalence of upper respiratory tract infections decreased over time in both groups. Children in the adenoidectomy group had significantly more days with fever than the children in the watchful waiting group. Two children had complications related to surgery. CONCLUSION In children selected for adenoidectomy for recurrent upper respiratory tract infections, a strategy of immediate surgery confers no clinical benefits over a strategy of initial watchful waiting. Trial registration Dutch Trial Register NTR968: ISRCTN03720485.
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Affiliation(s)
| | - C W B Boonacker
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht
| | - M M Rovers
- Department of Otorhinolaryngology, University Medical Centre Utrecht, Netherlands
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht
| | - A W Hoes
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht
| | - A G M Schilder
- Department of Otorhinolaryngology, University Medical Centre Utrecht, Netherlands
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht
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Wang J, Qu X, Yang Q, Ma L. [The hypoxia tolerance of children with recurrent respiratory papillomatosis in surgical procedures]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2011; 25:250-254. [PMID: 21650056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To investigate hypoxia tolerance of children with recurrent respiratory papillomatosis with the spread of trachea in surgical procedures without ventilation via endotracheal tube intermittently under general anesthesia. METHOD Forty children with recurrent respiratory papillomatosis were enrolled in the observation. The duration of SpO2 from 100% to the points of 99%, 95%, 90%, 85%, the heart rate in each time point above. PaO2, PaCO2, pH valve when SpO2 was 85%, the duration of SpO2 back to 100% were recorded respectively. RESULT Duration of SpO2 from 100% down to 99%, 95%, 90%, 85% was (168.4 +/- 58.3)s, (204.6 +/- 56.4)s, (224.8 +/- 58.9)s, (239.9 +/- 60.6)s, respectively. Heart rate was (121.6 +/- 14. 6)bpm, (123.3 +/- 15.1) bpm, (124.1 +/- 14.8)bpm, (125.0 +/- 15.1)bpm, respectively. When SpO2 was 85%, pH value was 7.22 +/- 0.05, PCO2 was (69 +/- 8.7)mmHg, PO2 was (52 +/- 7.9)mmHg. Duration of SpO2 up to 100% was (28.6 +/- 2.5)s; When SpO2 back to 100%, pH value was 7.40 +/- 0.02, PCO2 was (40.5 +/- 2.0)mmHg, PO2 was (358 +/- 104.3)mmHg. CONCLUSION Intermittent apnea during the surgical procedures in RRP children with distal spread of papillomas was safe, hypercapnia and hypoxia caused by the apnea can be corrected soon after the re-ventilation. Duration of apnea should be controlled within 3--5 minutes in each apnea-reoxygenation cycle.
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Affiliation(s)
- Jun Wang
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, Beijing, 100730, China
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[Prevention of respiratory infection in patients following surgical intervention]. Vestn Otorinolaringol 2011;:88-90. [PMID: 22433703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The objective of the present study was to estimate the efficacy of therapy with hexetedine for the prevention of the respiratory infection in the patients undergoing surgical intervention. The study included 64 patients (28 adults and 36 children) ranging in the age from 3 to 55 years who were examined before and after surgery (radiosurgical tonsillectomy and radiosurgical uvulopalatoplasty). Complete clinical examination was supplemented by a microbiological study of cultivated mucosal swab samples obtained from the pharynx before and after the treatment. 41 patients of the study group received hexetedine (hexoral) for the 4 days preceding the operation and during 3 days of the postoperative period. It was shown that the patients treated with hexetedine both in the pre- and postoperative periods experienced a substantial decrease in microbial infestation of pharyngeal mucosa and accelerated elimination of the inflammatory process. Moreover, the general therapeutic effect on day 5 after surgery was more pronounced in the hexetedine-treated patients compared with controls.
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Abstract
Recurrent respiratory papillomatosis (RRP) is an infrequent benign neoplasm commonly involving the upper respiratory tract with laryngeal predilection. The diagnosis and treatment of this disease are challenging due to its nonspecific clinical presentations and recurrent nature. We report here a rare juvenile case of RRP arising in the trachea without laryngeal lesions. Our experiences indicate that a high awareness of RRP and proper consideration in the right clinical context are prerequisites for early diagnosis, and a combination of multiple treatment modalities should be considered as a feasible treatment regimen.
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Affiliation(s)
- Qingliang Xue
- Respiratory Diseases Department of the Chinese PLA General Hospital
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Moraitaki P, Vasilikos K, Archontovasilis F, Marosis K, Tsekouras D, Spiliadi C, Lagoudianakis E, Manouras A, Dahambre J. Recurrent respiratory infection and epithelial-myoepithelial carcinoma of the lung. A common presentation with a rare etiology. J BUON 2009; 14:147-148. [PMID: 19365889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Mukhopadhyay B, Tripathy BB, Saha S, Shukla RM, Saha SR. Acquired tracheo-oesophageal fistula: a case report. J Indian Med Assoc 2008; 106:806-808. [PMID: 19370955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
This is a case report of a girl aged 4 years who presented with repeated attacks of chocking and dysphagia. She was diagnosed to be having an acquired tracheo- oesophageal fistula caused by fish bone impaction. She was treated successfully. In this report, the literature was reviewed of this rare condition.
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Affiliation(s)
- B Mukhopadhyay
- Department of Paediatric Surgery, NRS Medical College, Kolkata
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Greinwald J, Cohen AP, Hemanackah S, Azizkhan RG. Massive lymphatic malformations of the head, neck, and chest. J Otolaryngol Head Neck Surg 2008; 37:169-173. [PMID: 19128607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
OBJECTIVE To provide clinicians with an overview of the complications and functional and clinical outcomes of children affected by massive lymphatic malformations affecting multiple sites in the head, neck, and/or chest. METHODS We reviewed the medical records of all patients who received treatment for massive cervicofacial lymphatic malformations at our tertiary care pediatric institution during a 17-year period. Massive lesions were defined as (1) unilateral lesions that infiltrated at least 50% of two anatomic regions, including the head, neck, or chest; (2) unilateral lesions in which there was involvement of the midline structures of the head or neck; or (3) bilateral lesions in which 50% of each side was affected. Data consisted of critical clinical parameters, including extent of anatomic involvement, treatment interventions, pre- and post-treatment complications, lesion resolution, and functional outcomes. RESULTS Sixteen patients were treated for massive head, neck, and chest lymphatic malformations. Ten of 16 had massive unilateral lesions, whereas 6 had bilateral lesions. Eleven patients experienced airway compromise resulting from airway involvement; eight of these patients required placement of a tracheostomy tube. Six patients, all of whom had airway compromise, suffered with orodigestive complications; four of these six required gastrostomy tube placement. Eleven of 16 patients were managed exclusively with surgery, and 3 of 11 showed marked (60-80%) disease resolution; however, all 3 of these patients required preoperative placement of a tracheostomy tube, and only 1 was decannulated following resection. The severity of the airway symptoms resulted in the death of three patients, all of whom had tracheostomies. CONCLUSIONS Children with massive head, neck, and chest lymphatic malformations suffer from high morbidity and significant mortality. Airway involvement is an important prognostic factor in these patients.
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Affiliation(s)
- John Greinwald
- Division of Pediatric Otolaryngology & Head/Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
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Ohno H, Matsuo N, Suyama N, Nagayoshi Y, Kohara N, Kazumi Y, Miyazaki Y, Kohno S. The first surgical treatment case of pulmonary Mycobacterium malmoense infection in Japan. Intern Med 2008; 47:2187-90. [PMID: 19075549 DOI: 10.2169/internalmedicine.47.1520] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Mycobacterium malmoense is a very rare pathogen of pulmonary infectious disease in Japan. We encountered a case of M. malmoense infectious lung disease which could be cured by surgical operation without chemotherapy. M. malmoense strains were isolated in both the bronchial washing lavage and the removed lung specimen, and it were identified using 16S rRNA gene and rpoB gene sequencing. This case might indicate that pulmonary infectious disease caused by a rare non-tuberculous mycobacteria pathogen should be positively considered to be treated surgically as an initial therapy when the patient's condition is admissive, and also indicated the importance of identification of the causative pathogen from surgical specimens. In addition, this was the second report of M. malmoense infectious disease, and the first case of surgical treatment case of M. malmoense lung disease in Japan, as far as we could determine.
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Affiliation(s)
- Hideaki Ohno
- The Second Department of Internal Medicine, Nagasaki University School of Medicine and Dentistry.
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Date H, Yamane M, Toyooka S, Okazaki M, Oto T, Sano Y, Goto K. [Living-donor lobar lung transplantation for infectious lung diseases]. Kyobu Geka 2007; 60:1005-1009. [PMID: 17926905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The rate of infection among lung transplant recipients is several times higher than that among recipients of other organs and is most likely related to the exposure of the allograft to the external environment. Meticulous peri-operative management is mandatory in performing living-donor lobar lung transplantation for patients with infectious lung diseases. All 5 patients with end-stage infectious lung diseases are currently alive for 17-104 months after receiving living-donor lobar lung transplantation at Okayama University Hospital.
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Affiliation(s)
- Hiroshi Date
- Department of Cancer and Thoracic Surgery, Okayama University Graduate School of Medicine, Okayama, Japan
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Koturoglu G, Onay H, Midilli R, Pehlivan S, Eren E, Itirli G, Kurugol Z, Apaydin F, Ozkinay C, Ozkinay F. Evidence of an association between mannose binding lectin codon 54 polymorphism and adenoidectomy and/or tonsillectomy in children. Int J Pediatr Otorhinolaryngol 2007; 71:1157-61. [PMID: 17559949 DOI: 10.1016/j.ijporl.2007.05.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2007] [Revised: 04/30/2007] [Accepted: 05/02/2007] [Indexed: 11/26/2022]
Abstract
Mannose binding lectin (MBL) is a calcium-dependent lectin that plays an important role innate immunity by activating the complement pathway. There have been a number of studies describing an association between the MBL genotype and disease susceptibility. MBL deficiency has been described as one of the factors leading to a number of infections in children with recurrent upper respiratory tractus infections (URTI). We hypothesized that MBL deficiency may be associated with recurrent URTI, which requires adenoidectomy and/or adenotonsillectomy. In this study to clarify this hypothesis we investigated whether there may be an association between two low producing MBL variants and adenoidectomy and/or tonsillectomy due to recurrent URTI in children. Blood samples were collected, adenoidectomy and/or tonsillectomy due to recurrent URTI and 50 controls (mean age 80.53 +/- 32.62 months). In all patients and controls codon 54 and codon 57 polymorphisms of the MBL gene were analyzed. None of the subjects from the patient group and control group carried codon 57 polymorphism of the MBL gene. The frequency of low-level MBL genotypes (AB and BB) for codon 54 polymorphism in the patient group was found to be significantly higher compared to the control subjects (55.7% versus 14%) (p<0.001). This study shows that the presence of low-level MBL alleles is associated with adenoidectomy and/or tonsillectomy caused by recurrent URTI in children.
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Tait AR, Burke C, Voepel-Lewis T, Chiravuri D, Wagner D, Malviya S. Glycopyrrolate does not reduce the incidence of perioperative adverse events in children with upper respiratory tract infections. Anesth Analg 2007; 104:265-70. [PMID: 17242078 DOI: 10.1213/01.ane.0000243333.96141.40] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Two recent studies have identified copious secretions as an independent risk factor for perioperative adverse events in children who present for elective surgery in the presence of an upper respiratory tract infection (URI). We designed this study, therefore, to determine whether the administration of the anticholinergic drug, glycopyrrolate, to children with URIs would reduce the incidence of adverse perioperative respiratory events. One hundred thirty children (1 mo to 18 yr of age) who presented for elective surgery with a URI were randomized to receive either 0.01 mg/kg glycopyrrolate or placebo and were followed for the appearance and severity of any perioperative respiratory adverse events. The two groups were similar with respect to demographics, presenting URI symptoms, anesthetic management, and surgical procedure. In the intention-to-treat analysis, there were no statistical differences in the incidence or severity of perioperative respiratory adverse events between the glycopyrrolate and placebo groups (45.2% vs 37.5% respectively, P = NS). Furthermore, there were no differences in outcome between the two groups when children with congestion and secretions were analyzed separately (45.0% vs 37.0%, respectively). However, compared with the placebo group, children in the glycopyrrolate group had significantly shorter discharge times (83.9 min vs 111.4 min, P = 0.024), and significantly less postoperative nausea and vomiting (10.7% vs 33.3%, P = 0.005). These results suggest that glycopyrrolate, administered after induction of anesthesia to children with URIs, does not reduce the incidence of perioperative respiratory adverse events, and thus may not be clinically indicated for routine use in this population.
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Affiliation(s)
- Alan R Tait
- Department of Anesthesiology, University of Michigan Health System, Ann Arbor, Michigan 48109, USA.
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Chen Y, Tang Z, Wang Q, Yu Y, Zeng C, Chen H, Liu ZH, Li LS. Long-term efficacy of tonsillectomy in Chinese patients with IgA nephropathy. Am J Nephrol 2007; 27:170-5. [PMID: 17337885 DOI: 10.1159/000100431] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2006] [Accepted: 01/25/2007] [Indexed: 12/16/2022]
Abstract
BACKGROUND To investigate the clinical efficacy of tonsillectomy on long-term clinical remission and renal survival of immunoglobulin A nephropathy (IgAN) patients in China. METHODS We performed a 130-month retrospective case-control study of 112 patients with idiopathic biopsy-diagnosed IgAN from 1983 to 1999. Fifty-four patients underwent tonsillectomy and 58 patients did not. The clinical remission rate during follow-up and variables to predict clinical remission were estimated by chi2 test and multivariate Cox regression analysis; renal survival was evaluated by Kaplan-Meier analysis. RESULTS Up to 2006, the follow-up period lasted 130 +/- 50.3 months (60-276 months). The clinical remission rate was 46.3% in patients with tonsillectomy and 27.6% in those without tonsillectomy during follow-up. Multivariate analysis demonstrated that tonsillectomy was not an independent impact factor for renal clinical remission (p = 0.386). By Kaplan-Meier analysis, there was no significant difference in renal survival rate between patients with tonsillectomy and those without tonsillectomy (p = 0.059). CONCLUSION The clinical remission rate in IgAN patients with tonsillectomy was higher than that in patients without tonsillectomy during follow-up. But within 130 months, it was difficult to find statistical difference in renal survival between IgAN patients with and without tonsillectomy.
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Affiliation(s)
- Yu Chen
- Research Institute of Nephrology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
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van den Akker EH, Sanders EAM, van Staaij BK, Rijkers GT, Rovers MM, Hoes AW, Schilder AGM. Long-term effects of pediatric adenotonsillectomy on serum immunoglobulin levels: results of a randomized controlled trial. Ann Allergy Asthma Immunol 2006; 97:251-6. [PMID: 16937760 DOI: 10.1016/s1081-1206(10)60022-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND It remains controversial whether pediatric adenotonsillectomy ultimately results in decreased serum immunoglobulin levels and if so whether such a decrease is associated with increased susceptibility to upper respiratory tract infections (URIs). OBJECTIVE To evaluate changes in serum immunoglobulin levels in relation to occurrence of URIs in children participating in a randomized controlled trial on the effectiveness of adenotonsillectomy. METHODS A total of 300 children aged 2 to 8 years, with symptoms of recurrent throat infections or tonsillar hypertrophy, were randomly assigned to either adenotonsillectomy or watchful waiting (WW). Serum samples were collected at baseline and at 1-year follow-up. Occurrence of throat infections and other URIs during first-year follow-up was recorded in a diary by the child's parents. RESULTS Paired serum samples were available for 123 children (63 in the adenotonsillectomy group and 60 in the WW group). IgG1 and IgG2 levels decreased but remained within the reference range for age in both study arms. IgM and IgA levels decreased as well but remained elevated. The IgA level in the adenotonsillectomy group decreased in significantly greater degree compared with the WW group, but this difference disappeared in cases where children experienced frequent URIs. In general, no relation between immunoglobulin levels and the number of throat infections or URIs at 1-year follow-up was found. CONCLUSIONS Immunoglobulin levels of children undergoing adenotonsillectomy decreased from elevated to slightly elevated or reference values for age during 1-year follow-up irrespective of treatment (adenotonsillectomy or WW). IgA showed a greater decrease in the adenotonsillectomy group but rose to levels comparable with the WW group in cases of frequent URIs. This finding indicates that the remaining mucosa-associated lymphoid tissue can compensate for the loss of tonsil and adenoid tissue.
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Affiliation(s)
- Emma H van den Akker
- Department of Otorhinolaryngology, Wilhelmina Children's Hospital/University Medical Center Utrecht, The Netherlands
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Pichler M, Albrecht J, Padberg W. Chest wall defect and chronic pleural infection: surgical treatment with thoracomyoplasty and open window thoracostomy. ACTA ACUST UNITED AC 2006; 54:402-4. [PMID: 17037397 DOI: 10.1007/s11748-006-0016-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We report a rare case of a 75-year-old hemiplegic man with a chronic pleural infection, a bronchopleural fistula, and a full-thickness defect of the chest. In one operation we performed open-window thoracostomy and pleural decortication as well as reconstruction of the chest defect and reclosure of the bronchopleural fistula with a latissimus dorsi muscle flap. The patient made a good recovery and was sent for rehabilitation in good condition. Surgical treatment was essential to control and ultimately halt the septic process. Use of a muscle transplant in a hemiplegic patient did not reduce mobility.
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Affiliation(s)
- Maximilian Pichler
- Department of General, Visceral, Thoracic, Transplantation, and Pediatric Surgery, Justus Liebig University Giessen, Germany.
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