RESUMEN
BACKGROUND: Understanding factors that influence patients' preferences towards oral cancer (OC) screening is imperative to provide high-quality evidence-based OC screening interventions that can be targeted for population-level uptake. This study determined adult patients' knowledge and awareness of OC, and how health behaviours influenced their preferences towards OC screening. METHODS: This cross-sectional study used a 42-point questionnaire, between February and May 2020 using a combination of in-person and telephone interviews. Chi-square test and multiple logistic regression analysis were applied to confounding factors that returned statistical significance against OC knowledge and awareness. Significance of P < 0.05 was accepted. RESULTS: Sixty-eight (38.6%) participants out of a total 176 had good knowledge of OC and 89 (50.6%) had good awareness. A total of 31.8% reported preference for OC screening by a general dental practitioner (GDP) over a general medical practitioner (GMP). Majority (72.7%) reported acceptance of OC screening at their next GDP visit. Ages 56-70 (OR = 0.357, 95% CI) and previous smokers (OR = 0.336, 95% CI) significantly influenced screening preferences. Knowledge of risk factors did not significantly influence OC screening preferences (χ2 = 3.178, P = 0.075). CONCLUSIONS: Significant gaps in OC knowledge, screening and role of GDPs exist with smoking history and age influencing OC screening preferences.
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Odontólogos , Neoplasias de la Boca , Adulto , Anciano , Estudios Transversales , Detección Precoz del Cáncer , Conocimientos, Actitudes y Práctica en Salud , Humanos , Persona de Mediana Edad , Neoplasias de la Boca/diagnóstico , Neoplasias de la Boca/prevención & control , Salud Bucal , Rol Profesional , Encuestas y Cuestionarios , Atención Terciaria de Salud , UniversidadesRESUMEN
The adaptation of the tubercle bacillus to the host environment is likely to involve a complex set of gene regulatory events and physiological switches in response to environmental signals. In order to deconstruct the physiological state of Mycobacterium tuberculosis in vivo, we used a chemostat model to study a single aspect of the organism's in vivo state, slow growth. Mycobacterium bovis BCG was cultivated at high and low growth rates in a carbon-limited chemostat, and transcriptomic analysis was performed to identify the gene regulation events associated with slow growth. The results demonstrated that slow growth was associated with the induction of expression of several genes of the dormancy survival regulon. There was also a striking overlap between the transcriptomic profile of BCG in the chemostat model and the response of M. tuberculosis to growth in the macrophage, implying that a significant component of the response of the pathogen to the macrophage environment is the response to slow growth in carbon-limited conditions. This demonstrated the importance of adaptation to a low growth rate to the virulence strategy of M. tuberculosis and also the value of the chemostat model for deconstructing components of the in vivo state of this important pathogen.
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Perfilación de la Expresión Génica , Macrófagos/microbiología , Mycobacterium/genética , Transcripción Genética , Adaptación Fisiológica/genética , Animales , Quimiotaxis/genética , Análisis por Conglomerados , Regulación Bacteriana de la Expresión Génica , Genes Bacterianos , Humanos , Metabolismo de los Lípidos/genética , Viabilidad Microbiana/genética , Mycobacterium/crecimiento & desarrollo , Mycobacterium bovis/genética , Mycobacterium bovis/crecimiento & desarrollo , Mycobacterium tuberculosis/genética , Mycobacterium tuberculosis/crecimiento & desarrollo , Análisis de Secuencia por Matrices de Oligonucleótidos , Reacción en Cadena de la Polimerasa de Transcriptasa InversaRESUMEN
An experimental system of Mycobacterium tuberculosis growth in a carbon-limited chemostat has been established by the use of Mycobacterium bovis BCG as a model organism. For this model, carbon-limited chemostats with low concentrations of glycerol were used to simulate possible growth rates during different stages of tuberculosis. A doubling time of 23 h (D = 0.03 h(-1)) was adopted to represent cells during the acute phase of infection, whereas a lower dilution rate equivalent to a doubling time of 69 h (D = 0.01 h(-1)) was used to model mycobacterial persistence. This chemostat model allowed the specific response of the mycobacterial cell to carbon limitation at different growth rates to be elucidated. The macromolecular (RNA, DNA, carbohydrate, and lipid) and elemental (C, H, and N) compositions of the biomass were determined for steady-state cultures, revealing that carbohydrates and lipids comprised more than half of the dry mass of the BCG cell, with only a quarter of the dry weight consisting of protein and RNA. Consistent with studies of other bacteria, the specific growth rate impacts on the macromolecular content of BCG and the proportions of lipid, RNA, and protein increased significantly with the growth rate. The correlation of RNA content with the growth rate indicates that ribosome production in carbon-limited M. bovis BCG cells is subject to growth rate-dependent control. The results also clearly show that the proportion of lipids in the mycobacterial cell is very sensitive to changes in the growth rate, probably reflecting changes in the amounts of storage lipids. Finally, this study demonstrates the utility of the chemostat model of mycobacterial growth for functional genomic, physiology, and systems biology studies.
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Metabolismo de los Lípidos , Mycobacterium bovis/crecimiento & desarrollo , Mycobacterium bovis/metabolismo , Ribosomas/metabolismo , Medios de Cultivo , Sustancias Macromoleculares/metabolismoRESUMEN
OBJECTIVE: To investigate the possible genetic relationship among erythromycin-resistant Streptococcus pneumoniae strains isolated in Greece and the UK. METHODS: During 1995-97, 140 S. pneumoniae strains were isolated from clinical specimens submitted to the microbiology departments of the two main children's hospital in Athens. All erythromycin-resistant strains were further studied with respect to the presence of genes encoding for the two major mechanisms of macrolide resistance, their serotypes, and pulsed-field gel electrophoresis (PFGE) types, in comparison to a previously characterized UK erythromycin-resistant clone. RESULTS: Eleven of the 140 isolates (7.9%) were resistant to erythromycin; nine of these were susceptible to penicillin. Serotyping allocated seven, three and one isolates to serotypes 14, 19F and serogroup 6, respectively. The mefA gene was detected in seven isolates (five serotype 14 and two serotype 19F), ermB in two (one serotype 19F and the serogroup 6 isolate), whilst in the remaining two isolates no resistance gene could be detected by polymerase chain reaction (PCR). Pulsed-field gel electrophoresis of genomic DNA showed that five Greek serotype 14 isolates belonged to the same chromosomal type as the serotype 14 erythromycin-resistant UK clone. CONCLUSIONS: The present study showed that erythromycin resistance among the S. pneumoniae isolates was mostly owing to the efflux mechanism and suggested a possible clonal spread of serotype 14 erythromycin-resistant S. pneumoniae strains between Greece and the UK.
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Eritromicina/farmacología , Streptococcus pneumoniae/genética , Niño , Células Clonales/microbiología , ADN Bacteriano/química , ADN Bacteriano/genética , Farmacorresistencia Bacteriana/genética , Electroforesis en Gel de Campo Pulsado , Eritromicina/uso terapéutico , Grecia , Humanos , Pruebas de Sensibilidad Microbiana , Infecciones Neumocócicas/microbiología , Reacción en Cadena de la Polimerasa , Serotipificación , Streptococcus pneumoniae/clasificación , Streptococcus pneumoniae/efectos de los fármacos , Streptococcus pneumoniae/aislamiento & purificación , Reino UnidoRESUMEN
OBJECTIVE: Timely and experienced intervention for esophageal foreign bodies generally allows for removal with minimal morbidity. However, esophageal foreign bodies present a risk for esophageal perforation and subsequent mediastinitis, especially if the diagnosis of the foreign body is delayed. Although much has been written about the management of esophageal foreign bodies and their complications, little has been mentioned in recent literature about the specific complication of mediastinitis. This review was performed to examine our experience with this uncommon complication of esophageal foreign bodies. METHODS: A retrospective review of the esophageal foreign body database at Children's Hospital of Wisconsin from 1987 to 1997 was performed to identify patients with esophageal foreign bodies and subsequent mediastinitis. RESULTS: Four patients with esophageal perforation with associated mediastinitis secondary to retained esophageal foreign bodies were identified. Three of the four patients were treated with conservative measures consisting of foreign body removal, intravenous antibiotics and discontinuing of oral nutrition. These patients all achieved resolution of their mediastinitis and esophageal perforation with subsequent return to normal diets and no significant morbidity. One patient, with vascular erosion, required aggressive, invasive therapy. CONCLUSION: From review of this limited number of patients, in the absence of major vascular erosion, conservative methods of treating children with foreign body esophageal perforation and subsequent mediastinitis appears to be effective.
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Perforación del Esófago/etiología , Esófago , Cuerpos Extraños/complicaciones , Mediastinitis/etiología , Antibacterianos/uso terapéutico , Perforación del Esófago/diagnóstico , Perforación del Esófago/terapia , Esofagoscopía/métodos , Femenino , Cuerpos Extraños/diagnóstico , Cuerpos Extraños/terapia , Humanos , Lactante , Inyecciones Intravenosas , Intubación Gastrointestinal/métodos , Masculino , Mediastinitis/diagnóstico , Mediastinitis/tratamiento farmacológico , Estudios Retrospectivos , Tomografía Computarizada por Rayos XRESUMEN
PURPOSE: Computed topography (CT) and magnetic resonance imaging (MRI) are important, both clinically and in a research setting, in assessing bacterial sinusitis (BS). The use of CT scanning to evaluate sinus opacification in a reversible model of rabbit acute sinusitis has been reported. MRI offers the potential for better visualization of soft tissue and fluid changes within the paranasal sinuses. MRI has potential as a research tool in animal models of sinusitis. This article compares the use of CT and MRI in measuring maxillary sinus opacification in rabbits during experimental, reversible BS. MATERIALS AND METHODS: In 2 independent trials, New Zealand White rabbits were imaged for baseline anatomy, and BS was generated by sinus inoculation with Staphylococcus aureus. Serial imaging was performed as a measure of the progression and resolution of BS during the trials. Two experienced, independent reviewers then scored each CT and MRI for percent opacification of the maxillary sinus. These scores were analyzed to assess the degree of agreement between the reviewers. RESULTS: The correlation coefficients for CT and MRI were 0.6816 and 0.3584, respectively. The Z-statistic comparing these correlation coefficients was significant (P < .0001), indicating that CT is a more precise measure of reversible BS in this rabbit model. Differences in mean scan time and cost per scan were also significantly different (P < .0001), with CT being both quicker and less expensive. CONCLUSIONS: Greater interobserver consistency of scan interpretation, with less time and cost, make CT the preferred tool for measuring BS in this rabbit model. Attributes of MRI such as better resolution of fluid-tissue interfaces and custom surface coil design for visualization of specific anatomic structures are discussed as they may increase the effectiveness of MRI as an imaging modality in future sinusitis research.
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Modelos Animales de Enfermedad , Imagen por Resonancia Magnética , Seno Maxilar , Sinusitis , Infecciones Estafilocócicas/microbiología , Staphylococcus aureus , Tomografía Computarizada por Rayos X , Enfermedad Aguda , Animales , Femenino , Masculino , Seno Maxilar/diagnóstico por imagen , Seno Maxilar/microbiología , Seno Maxilar/patología , Conejos , Sinusitis/diagnóstico por imagen , Sinusitis/microbiología , Sinusitis/patologíaRESUMEN
OBJECTIVES: This purpose of this study was to investigate the effect of blockade of the inflammatory cytokine pathway on experimentally induced otitis media in the chinchilla model. STUDY DESIGN: Pilot, randomized placebo-controlled trial. METHODS: Ampicillin-sensitive Haemophilus influenzae otitis media was induced in 45 adult chinchillas. The animals were randomly assigned to the following treatment groups: 1) transbullar injections (TBI) of interleukin-1 receptor antagonist (IL-1ra) and intramuscular ampicillin, 2) TBI of saline and intramuscular ampicillin, 3) TBI of IL-1ra and intramuscular sa-1 line or 4) TBI of saline and intramuscular saline. Blinded investigators measured resolution of otitis media by otomicroscopy, tympanogram, and culture results. RESULTS: Comparisons were made between the treatment groups to assess the ability of IL-1ra to assist with resolution of otitis media using exact two-group binomial tests with the StatXact statistical program. The group with TBI of IL-1ra and intramuscular ampicillin as a treatment demonstrated trends suggesting more rapid resolution of positive cultures and more rapid and complete return to normal results on tympanograms and otomicroscopic findings compared with the group treated with TBI of saline and intramuscular ampicillin. These trends did not achieve statistical significance with the relatively small sample sizes used in this pilot study. CONCLUSIONS: This investigation provides further evidence that the inflammatory cytokine cascade plays a significant role in the pathophysiology of otitis media and that modulation of this inflammatory pathway may provide novel and efficacious treatments for otitis media Further studies with larger groups of animals are warranted to determine whether the trends identified in this pilot study are reproducible and achieve statistical significance.
Asunto(s)
Ampicilina/uso terapéutico , Infecciones por Haemophilus/tratamiento farmacológico , Haemophilus influenzae , Otitis Media/tratamiento farmacológico , Otitis Media/microbiología , Penicilinas/uso terapéutico , Receptores de Interleucina-1/antagonistas & inhibidores , Sialoglicoproteínas/uso terapéutico , Ampicilina/administración & dosificación , Animales , Chinchilla , Modelos Animales de Enfermedad , Quimioterapia Combinada , Inyecciones Intramusculares , Proteína Antagonista del Receptor de Interleucina 1 , Penicilinas/administración & dosificación , Proyectos Piloto , Distribución Aleatoria , Sialoglicoproteínas/administración & dosificaciónRESUMEN
New pneumococcal conjugate vaccines covering a limited number of serotypes are likely to come into widespread use over the next few years. It is unknown what effect this will have on the relative importance of different serotypes as causes of pneumococcal infection. Hence, it will be important to monitor serotype prevalence before, during, and after the introduction of new vaccines. We have investigated the ability of a PCR method based on polymorphisms in two genes common to the different capsule loci to predict the serotype of 93 clinical isolates of Streptococcus pneumoniae submitted to the Central Public Health Laboratory in 1997. Of 70 isolates with vaccine serotypes, 65 were predicted to belong to the correct serotype; this number was improved to 69 with the inclusion of two additional patterns to the database. Of 23 isolates with other serotypes, 19 were correctly predicted as non-vaccine serotypes, the discrepancy lying with four isolates of 6A (non-vaccine serotype) that were indistinguishable from isolates of 6B (vaccine serotype). In situations in which culture of the organism is not feasible, this method could potentially be applicable directly to clinical specimens and could be a valuable aid to the surveillance of pneumococcal serotypes.
Asunto(s)
Cápsulas Bacterianas/genética , Polimorfismo Genético , Streptococcus pneumoniae/clasificación , Cartilla de ADN/genética , ADN Bacteriano/análisis , ADN Bacteriano/genética , Estudios de Evaluación como Asunto , Predicción , Genes Bacterianos , Humanos , Infecciones Neumocócicas/microbiología , Reacción en Cadena de la Polimerasa , Mapeo Restrictivo , Serotipificación , Streptococcus pneumoniae/genéticaRESUMEN
OBJECTIVE: There is considerable variation in opinion regarding the optimal management of patients with Pierre Robin sequence (PRS). No single method of airway intervention or feeding strategy is universally appropriate and effective. This study was performed to examine methods used for airway and feeding management and to identify specific problems encountered. STUDY DESIGN: A retrospective study of 252 patient charts between 1989 and 1997 at Children's Hospital of Wisconsin. METHODS: Patient information was collected regarding perinatal history, genetics evaluation, and airway and feeding evaluations and intervention. A group of 47 patients was determined as having PRS. RESULTS: Secondary respiratory difficulties, defined as respiratory abnormalities in addition to the expected PRS obstruction, were identified in 23% of patients. Also, intrinsic feeding abnormalities not associated with airway obstruction were identified in 11% of patients. Analysis by Fisher's Exact Test revealed patients with a syndromic diagnosis to have a significantly higher rate for tracheotomies and gastrostomy tube placement (P = .041, and P = .0004, respectively). Syndromic patients were also found to have significantly lower Apgar scores and longer hospital stays. Positioning techniques, tongue-lip adhesion, and tracheotomy were also employed effectively with specific indications and specific difficulties that need to be considered. CONCLUSION: Patients with PRS require thorough airway and feeding evaluation. Those with additional syndromic diagnoses demonstrate higher rates of more invasive interventions. Patients with PRS must undergo individualized approaches with consideration of multiple factors for successful management.
Asunto(s)
Trastornos de Ingestión y Alimentación en la Niñez/etiología , Síndrome de Pierre Robin/complicaciones , Insuficiencia Respiratoria/etiología , Puntaje de Apgar , Femenino , Gastrostomía , Humanos , Tiempo de Internación , Masculino , Estudios Retrospectivos , TraqueotomíaRESUMEN
Twelve children with fibromyalgia and complaints of chronic dizziness were evaluated with both clinical office maneuvers of vestibular function and laboratory tests composed of electronystagmography and sinusoidal harmonic acceleration rotary chair testing. All test results were normal for spontaneous nystagmus with or without visual fixation, oculocephalic reflex, dynamic visual acuity, head-shaking nystagmus, Quix test, and Dix-Hallpike maneuver. Electronystagmography test results were essentially normal for saccades, gaze, Dix-Hallpike, pendular tracking, and caloric evaluation. Rotary chair testing was normal in all 12 patients. These findings suggest that central (brainstem) and peripheral vestibular (inner ear) mechanisms do not account for the complaints of dizziness in the pediatric patient with fibromyalgia. The common musculoskeletal abnormalities of fibromyalgia may affect their proprioceptive orientation, therefore giving them a sense of imbalance.
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Mareo/etiología , Fibromialgia/fisiopatología , Vestíbulo del Laberinto/fisiopatología , Adolescente , Tronco Encefálico/fisiología , Niño , Electronistagmografía , Femenino , Humanos , Masculino , Propiocepción/fisiologíaRESUMEN
The prevalence of chronic otitis media with effusion (COME) was investigated in a 4-year retrospective study of a pediatric tracheotomy population followed in the outpatient Tracheotomy-Ventilation Clinic of Children's Hospital of Wisconsin. After exclusions, 83 patients comprised the study population. In a given patient, COME was defined by the presence of middle ear effusion in more than 50% of ear evaluations during the 4-year study period, or tympanostomy tube placement. The prevalence of COME was 60% in the study population as a whole. Special population groups had prevalence as follows: 90% in craniofacial anomaly patients, 79% in chronically ventilated patients, and 48% in nonventilated patients. Chronically ventilated patients had a statistically significant higher prevalence of COME than the nonventilated group (P < 0.025). These data indicate that COME is a prevalent condition in the pediatric tracheotomy population.
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Otitis Media con Derrame/etiología , Traqueotomía/efectos adversos , Adolescente , Niño , Preescolar , Anomalías Craneofaciales/complicaciones , Femenino , Humanos , Lactante , Masculino , Otitis Media con Derrame/epidemiología , Prevalencia , Respiración Artificial/efectos adversos , Estudios Retrospectivos , Factores de RiesgoRESUMEN
OBJECTIVE: To determine the frequency of serious bacterial infection in well appearing infants aged 0-8 weeks with isolated otitis media (OM). METHODS: Infants with confirmed OM underwent tympanocentesis with middle ear fluid (MEF) culture and complete sepsis evaluation. Enrolled infants were admitted to the hospital for parenteral antibiotics until blood, urine, and CSF cultures were negative for 48 hours. RESULTS: Forty non-toxic appearing infants were enrolled between January 1994 and April 1995, of whom 15 (38%) had a documented rectal temperature > or =38 degrees C. Bacterial pathogens were isolated from MEF cultures in 25 (62.5%) infants. All afebrile infants had negative blood, urine, and cerebrospinal fluid cultures (upper limit (UL) 95% CI 0.11). Only two febrile infants had positive cultures from sites other than the MEF (UL 95% CI 0.36). CONCLUSION: In our study population, previously healthy, non-toxic appearing afebrile infants aged 2-8 weeks and having isolated OM infrequently have an associated serious bacterial infection, suggesting that outpatient treatment with oral antibiotics and close follow-up may be an option. Further studies with large numbers of infants are necessary to confirm this conclusion.
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Infecciones Bacterianas/epidemiología , Otitis Media/complicaciones , Sepsis/epidemiología , Administración Oral , Antibacterianos/administración & dosificación , Infecciones Bacterianas/complicaciones , Líquidos Corporales/microbiología , Oído Medio/microbiología , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Otitis Media/tratamiento farmacológico , Otitis Media/microbiología , Prevalencia , Estudios Prospectivos , Sepsis/complicacionesRESUMEN
An 11 year old Chinese boy developed a unilateral cervical mass associated with pronounced eosinophilia and a marked increase in IgE concentrations. A biopsy sample showed massive eosinophilic tissue infiltration consistent with Kimura's disease. This disorder should be suspected when the clinical triad of painless unilateral cervical adenopathy, hypereosinophilia, and hyper-IgE is present, particularly in male Asian patients.
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Hiperplasia Angiolinfoide con Eosinofilia/complicaciones , Inmunoglobulina E/sangre , Enfermedades Linfáticas/etiología , Hiperplasia Angiolinfoide con Eosinofilia/inmunología , Asia/etnología , Niño , Humanos , Enfermedades Linfáticas/inmunología , Masculino , CuelloRESUMEN
Tonsillectomy and adenoidectomy have become frequently performed outpatient procedures and are generally considered to have a low morbidity profile. Postoperative haemorrhage remains a rare but important complication, while intraoperative uncontrollable bleeding is extremely uncommon. A child with congenital vascular malformation of the lip and oropharynx undergoing tonsillectomy experienced massive blood loss, subsequent resuscitation and significant perioperative morbidity including a prolonged intensive care unit stay. Preoperative/preanaesthetic nasopharyngoscopic exam and magnetic resonance imaging did not reveal vascular prominence of the tonsils. Preoperative consideration of angiography or magnetic resonance angiography may be prudent to avoid this potentially fatal complication.
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Pérdida de Sangre Quirúrgica , Labio/irrigación sanguínea , Orofaringe/irrigación sanguínea , Tonsilectomía , Venas/anomalías , Adenoidectomía , Volumen Sanguíneo , Preescolar , Hemostasis Quirúrgica , Humanos , Masculino , Morbilidad , Complicaciones Posoperatorias/epidemiologíaRESUMEN
Foreign body (FB) injury from aspiration or ingestion is a common pediatric health problem. Diagnosis relies on clinical judgment plus medical history, physical examination, and radiographic evaluation. A multi-institutional review of 1269 FB events revealed that 85% were correctly diagnosed following a single physician encounter. However, 15% of the children had an elusive diagnosis (>1 week), despite previous evaluation. Delays in diagnosis were seven times more likely to occur in aspirations than in ingestions. Secondary injuries (e.g., pneumonia and atelectasis) occurred in 13% of airway FBs but in only 1.7% of esophageal FBs. Plain radiographs were used in 82% of children, and special studies (e.g., fluoroscopy) in only 7%. We conclude that diagnosis of FB injury in children is frequently achieved at the initial evaluation but that continued surveillance by follow-up visits to health care facilities from parents and other caretakers is important, to reduce pulmonary injuries.
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Esófago , Cuerpos Extraños/complicaciones , Sistema Respiratorio , Adolescente , Niño , Preescolar , Deglución , Femenino , Humanos , Lactante , Recién Nacido , Inhalación , Masculino , Estudios RetrospectivosRESUMEN
A key precipitating factor in the pathogenesis of acute bacterial sinusitis (ABS) is ostiomeatal obstruction. It has been postulated that ABS cannot resolve until the sinus ostium is patent. The primary purpose of this study is to quantify sinusitis resolution after temporary ostial occlusion in a rabbit model. A secondary aim is to quantify bacterial clearance with and without antimicrobial therapy in Staphylococcus aureus infected sinuses. A blinded, placebo controlled study in 10 New Zealand white rabbits was performed using Merocel as a temporary maxillary sinus ostial obstruction. Computerized tomography (CT) of the maxillary sinuses was obtained before and after bilateral ostial occlusion; sinuses were cultured and then the left sinus was injected with approximately 10(8) cfu/mL S. aureus. CT imaging and sinus cultures were obtained and then the ostial plugs were removed. Serial CT and cultures were done until sinusitis resolved and cultures were negative for S. aureus. Mean CT sinusitis scores increased with ostial obstruction and decreased with ostial plug removal (P < 0.0001 and P < 0.001). Injection of S. aureus did not significantly change mean CT sinusitis scores despite being cultured from 45% of sinuses. Antimicrobial therapy was not significant in reducing mean CT scan sinusitis scores or positive cultures. Resolution of mucosal swelling is more dependent on relief of ostial obstruction rather than antimicrobial therapy in this rabbit model.
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Cefazolina/uso terapéutico , Cefalosporinas/uso terapéutico , Sinusitis Maxilar/microbiología , Infecciones Estafilocócicas/tratamiento farmacológico , Animales , Técnicas Bacteriológicas , Infecciones por Bordetella/diagnóstico por imagen , Infecciones por Bordetella/tratamiento farmacológico , Bordetella bronchiseptica , Cefazolina/administración & dosificación , Cefalosporinas/administración & dosificación , Modelos Animales de Enfermedad , Edema/microbiología , Edema/patología , Formaldehído , Seno Maxilar/diagnóstico por imagen , Seno Maxilar/microbiología , Seno Maxilar/patología , Sinusitis Maxilar/diagnóstico por imagen , Sinusitis Maxilar/tratamiento farmacológico , Sinusitis Maxilar/patología , Membrana Mucosa/microbiología , Membrana Mucosa/patología , Placebos , Alcohol Polivinílico , Conejos , Remisión Espontánea , Método Simple Ciego , Infecciones Estafilocócicas/diagnóstico por imagen , Staphylococcus aureus , Tomografía Computarizada por Rayos XRESUMEN
In adults, sensorineural hearing loss (SNHL) resulting from megavoltage temporal bone radiation therapy (RT) is dose dependent. A review of the literature reveals only two cases of pediatric SNHL after RT without chemotherapy. This report presents four cases of late onset, asymmetric SNHL after RT in children treated for posterior fossa tumors. The children were treated with surgical resection of the tumor, followed by RT of 50 to 54 gray and no chemotherapy. These children, without evidence of tumor recurrence, developed severe SNHL 18 to 36 months after the completion of RT. Although no definite audiometric pattern was seen, most of the patients had a predominately high frequency SNHL in the poorer hearing ear, and fluctuant hearing in the better ear, without evidence of osteoradionecrosis or otitic infection. A review of the literature suggests that injury to the outer hair cells and cochlear neurons of the basal turn of the cochlea are possible sources for the hearing loss. Pretreatment audiologic evaluation as well as a minimum of 3 years of evaluations following RT would be prudent.
Asunto(s)
Pérdida Auditiva Sensorineural/etiología , Hueso Temporal/efectos de la radiación , Neoplasias Encefálicas/radioterapia , Niño , Femenino , Humanos , Radioterapia/efectos adversos , Estudios RetrospectivosRESUMEN
Otolaryngologic complications of gastroesophageal reflux (GER) are well described in adults, but this relationship has not been as carefully studied in children. We reviewed 26 dual pH-probe studies performed on 22 children with upper airway symptoms. The proximal probe was placed in the nasopharynx or hypopharynx. The distal probe was placed in the mid-proximal oesophagus. The proximal recording was considered normal if no episodes of pH < 4 were recorded. Indications for the studies were upper airway obstruction (UAO) and congenital choanal atresia (CCA). The age range was from 2 weeks to 47 months. The distal pH probe study was normal in 13 of 22 patients overall. Seventeen UAO patients had abnormal proximal pH probe studies. After treatment, 16 of 17 had improved airways. Twelve with UAO (67%) were premature and/or had developmental delay. Three CCA patients had abnormal proximal pH-probe studies and all improved after treatment. Four follow-up pH studies were normal or improved. GER-induced UAO is more frequent in infants or children with a history of prematurity or developmental delay. Proximal pH-metry is a useful technique to document the relationship between upper airway symptoms and GER. Patients with GER-induced UAO should undergo endoscopy to rule out simultaneous airway lesions.
Asunto(s)
Obstrucción de las Vías Aéreas/diagnóstico , Obstrucción de las Vías Aéreas/etiología , Reflujo Gastroesofágico/complicaciones , Obstrucción de las Vías Aéreas/prevención & control , Antieméticos/uso terapéutico , Betanecol/uso terapéutico , Preescolar , Atresia de las Coanas/complicaciones , Cimetidina/uso terapéutico , Endoscopía , Esófago/fisiopatología , Estudios de Seguimiento , Fundoplicación , Reflujo Gastroesofágico/tratamiento farmacológico , Reflujo Gastroesofágico/cirugía , Gastrostomía , Trastornos del Crecimiento/complicaciones , Antagonistas de los Receptores H2 de la Histamina/uso terapéutico , Humanos , Concentración de Iones de Hidrógeno , Hipofaringe/fisiopatología , Lactante , Recién Nacido , Recien Nacido Prematuro , Metoclopramida/uso terapéutico , Nasofaringe/fisiopatología , Parasimpaticomiméticos/uso terapéutico , Ranitidina/uso terapéutico , Estudios RetrospectivosRESUMEN
Pediatric laryngeal stenosis presents diagnostic and management challenges. A team approach involving multiple pediatric subspecialties is desirable. Management includes conservative endoscopic and aggressive open surgical intervention. Deciding which approach is appropriate presents a diagnostic dilemma. The long-term prognosis for most children is very good, and the successes are emotionally rewarding.