RESUMEN
Exponential-phase yeast cells readily enter stationary phase when transferred to fresh, carbon-deficient medium, and can remain fully viable for up to several months. It is known that stationary-phase prokaryotic cells may still synthesize substantial amounts of DNA. Although the basis of this phenomenon remains unclear, this DNA synthesis may be the result of DNA maintenance and repair, recombination, and stress-induced transposition of mobile elements, which may occur in the absence of DNA replication. To the best of our knowledge, the existence of DNA turnover in stationary-phase unicellular eukaryotes remains largely unstudied. By performing cDNA-spotted (i.e. ORF) microarray analysis of stationary cultures of a haploid Saccharomyces cerevisiae strain, we demonstrated on a genomic scale the localization of a DNA-turnover marker [5-bromo-2'-deoxyuridine (BrdU); an analogue of thymidine], indicative of DNA synthesis in discrete, multiple sites across the genome. Exponential-phase cells on the other hand, exhibited a uniform, total genomic DNA synthesis pattern, possibly the result of DNA replication. Interestingly, BrdU-labelled sites exhibited a significant overlap with highly expressed features. We also found that the distribution among chromosomes of BrdU-labelled and expressed features deviates from random distribution; this was also observed for the overlapping set. Ty1 retrotransposon genes were also found to be labelled with BrdU, evidence for transposition during stationary phase; however, they were not significantly expressed. We discuss the relevance and possible connection of these results to DNA repair, mutation and related phenomena in higher eukaryotes.
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Reparación del ADN , Replicación del ADN , Genoma Fúngico , Estudio de Asociación del Genoma Completo , Saccharomyces cerevisiae/genética , Saccharomyces cerevisiae/metabolismo , Bromodesoxiuridina/metabolismo , Ciclo Celular/genética , ADN/metabolismo , Expresión Génica , Regulación Fúngica de la Expresión Génica , Mutación , Retroelementos , Saccharomyces cerevisiae/crecimiento & desarrollo , Proteínas de Saccharomyces cerevisiae/genética , Proteínas de Saccharomyces cerevisiae/metabolismoRESUMEN
We applied genome-wide gene expression analysis to the evolutionary processes of adaptive speciation of the Israeli blind subterranean mole rats of the Spalax ehrenbergi superspecies. The four Israeli allospecies climatically and adaptively radiated into the cooler, mesic northern domain (N) and warmer, xeric southern domain (S). The kidney and brain mRNAs of two N and two S animals were examined through cross-species hybridizations with two types of Affymetrix arrays (mouse and rat) and muscle mRNA of six N and six S animals with spotted cDNA mouse arrays. The initial microarray analysis was hypothesis-free, i.e., conducted without reference to the origin of animals. Principal component analysis revealed that 20-30% of the expression signal variability could be explained by the differentiation of N-S species. Similar N-S effects were obtained for all tissues and types of arrays: two Affymetrix microarrays using probe oligomer signals and the spotted array. Likewise, ANOVA and t test statistics demonstrated significant N-S ecogeographic divergence and region-tissue specificity in gene expression. Analysis of differential gene expression between species corroborates previous results deduced by allozymes and DNA molecular polymorphisms. Functional categories show significant N-S ecologic putative adaptive divergent up-regulation of genes highlighting a higher metabolism in N, and potential adaptive brain activity and kidney urine cycle pathways in S. The present results confirm ecologic-genomic separation of blind mole rats into N and S. Gene expression regulation appears to be central to the evolution of blind mole rats.
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Evolución Molecular , Perfilación de la Expresión Génica , Genoma , Spalax/genética , Adaptación Fisiológica/genética , Análisis de Varianza , Animales , Análisis por Conglomerados , Ecología , Israel , Masculino , FilogeniaRESUMEN
MOTIVATION: It is common knowledge that the avalanche of data arriving from the sequencing projects cannot be annotated either experimentally or manually by experts. The need for a reliable and convenient tool for automated sequence annotation is broadly recognized. RESULTS: Here, we describe the Adaptive Algorithm of Automated Annotation (A(4)) based on a statistical approach to this problem. The mathematical model relates a set of homologous sequences and descriptions of their functional properties, and calculates the probabilities of transferring a sequence description onto its homologue. The proposed model is adaptive, its parameters (distribution characteristics, transference probabilities, thresholds, etc.) are dynamic, i.e. are generated individually for the sequences and various functional properties (words of the description). The proposed technique significantly outperforms the widely used test for frequency threshold, which is a special case of our model realized for the simplest set of parameters. The prediction technique has been realized as a computer program and tested on a random sequence sampling from SWISS-PROT. AVAILABILITY: The automated annotation program based on the proposed algorithm is available through the Web browser at http://www.genebee.msu.su/services/annot/basic.html.
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Algoritmos , Biología Computacional , Simulación por Computador , Bases de Datos de Proteínas/estadística & datos numéricos , Programas InformáticosRESUMEN
OBJECTIVE: To correlate direct laryngoscopic and bronchoscopic findings with the presence of positive test results for gastroesophageal reflux disease (GERD) in children. DESIGN: Prospective collection of structured data. SETTING: An academic pediatric otolaryngology department. PATIENTS: Seventy-seven consecutive patients who underwent direct laryngoscopy and bronchoscopy between June and October 1999. INTERVENTIONS: During direct laryngoscopy and bronchoscopy, descriptions of 7 laryngeal and 6 cricotracheal findings were recorded on a 3-point scale (i.e., absent, mild, or severe). Medical records were later reviewed to obtain results of the following tests, if they were part of the record: gastric scintiscan, 24-hour pH probe monitoring, upper gastrointestinal tract series, and esophageal biopsy. MAIN OUTCOME MEASURES: Correlation of mucosal abnormalities with the presence or absence of a positive test result for GERD. RESULTS: Fifty (65%) of 77 patients had GERD diagnosed with at least 1 positive test result, 21 (27%) had no clinical symptoms and no positive GERD test results, and 5 (7%) had clinical symptoms but no positive test results. There were significant differences for total laryngeal and cricotracheal scores (P<.001) between the groups with positive and negative results. Significant differences were as follows: in the larynx-large lingual tonsil (P<.001), postglottic edema (P<.001), arytenoid edema (P<.001), ventricle obliteration (P =.03), and true vocal fold edema (P = .001), and in the cricotracheal region-general edema and erythema (P =.003) and blunting of the carina (P<.001). Severe arytenoid edema, postglottic edema, or enlargement of lingual tonsil were pathognomonic of GERD. CONCLUSION: Many direct laryngoscopic and bronchoscopic findings correlate well with the diagnosis of GERD as determined by using other tests.
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Broncoscopía , Reflujo Gastroesofágico/diagnóstico , Laringoscopía , Adolescente , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Valor Predictivo de las Pruebas , Estudios ProspectivosRESUMEN
OBJECTIVE: To describe the patient, disease and clinical characteristics that optimize the effectiveness of laser tympanic membrane fenestration (LTMF) to treat chronic otitis media with effusion (OME). SETTING: Four pediatric otolaryngology tertiary referral centers. IRB approved; participation by informed consent. METHODS: An observational clinical effectiveness trial was conducted in 164 ears (94 children), who had chronic OME. All patients were candidates for insertion of pressure equalization tubes (PETs) but agreed to undergo LTMF instead. Clinical and audiologic follow-up are reported at 90 days after LTMF. OUTCOME MEASURES: Clinical effectiveness was defined as an effusion free middle ear at otoscopy with A or C1 tympanogram and normal hearing. RESULTS: At 90 days, 66% of the 95 evaluable ears were effusion free, all with normal hearing. Children younger than 4 years (P<0.04), who had shorter durations of effusion (P<0.009), and who experienced longer duration of fenestration patency (FP) (P<0.009) correlated to improved outcomes. CONCLUSIONS: The use of LTMF to create 2--3 weeks of middle ear ventilation in patients with chronic OME (middle ear effusion (MEE) for 3 months or greater) is effective in 66% of 95 (58%) of ears evaluable at 90 days follow-up. This study provides basic information needed to optimize the use of LTMF today and enhance research efforts in the future.
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Terapia por Láser/métodos , Ventilación del Oído Medio/métodos , Otitis Media con Derrame/cirugía , Membrana Timpánica/cirugía , Niño , Preescolar , Enfermedad Crónica , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Pruebas Auditivas , Humanos , Lactante , Masculino , Otitis Media con Derrame/diagnóstico , Estudios Prospectivos , Sensibilidad y Especificidad , Resultado del TratamientoRESUMEN
OBJECTIVE: Adenoidectomy alone or with tonsillectomy (A+/-T) is an effective surgical intervention in the management of otitis media in children, especially when it is performed in conjunction with insertion of pressure equalization tubes (PETs). Otorrhea and persistent tympanic membrane (TM) perforation are frequent complications. This study evaluates the effectiveness of intermediate duration middle ear ventilation using laser tympanic membrane fenestration (LTMF) without tube insertion and as an adjunct to adenoidectomy in resolving middle ear disease within the first 90 days after surgery. STUDY DESIGN: This pilot study was a multicenter, prospective clinical cohort trial. Institutional review board approval and informed consent were obtained. The study involved four tertiary care pediatric otolaryngology departments. Fifty children (96 ears) were treated with LTMF in conjunction with A+/-T from June 1, 1998, through March 30, 1999. Ages ranged from 9 months to 12 years. Patients undergoing A+/-T who would have been recommended for PET insertion instead underwent middle ear ventilation with LTMF using the Oto-LAM device (ESC/Sharplan, Yokneam, Israel). Patients were seen at 30, 60, and 90 days postoperatively. Resolution of otitis media with effusion was determined by clinical examination, which included pneumatic otoscopy, audiometry, and tympanometry. RESULTS: Of the treated ears, 88%, 86%, and 83% had clinical resolution of middle ear disease at 30, 60, and 90 days, respectively. Preoperatively, 45% (n = 85) of ears had normal hearing; 92% (n = 49) had normal hearing at 90 days. Eighty-nine percent (n = 92) had type C2 or B tympanograms preoperatively, and 12% (n = 60) had type C2 or B at 90 days. CONCLUSION: Laser tympanic membrane fenestration in conjunction with adenoidectomy was effective in restoring normal middle ear function at 90 days post-treatment in greater than 80% of children who otherwise may have had placement of PETs.
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Tonsila Faríngea/cirugía , Terapia por Láser , Ventilación del Oído Medio , Otitis Media con Derrame/cirugía , Niño , Preescolar , Terapia Combinada , Femenino , Estudios de Seguimiento , Humanos , Lactante , Masculino , Proyectos Piloto , Estudios Prospectivos , Resultado del TratamientoRESUMEN
The palatine tonsils play an important role in immunologic surveillance and resistance to infection in the upper aerodigestive tract. Dendritic cells and macrophages function to capture and process antigen and present it to T lymphocytes, a critical step in the early immune response. Few studies have characterized the distribution and phenotype of those antigen-presenting cells in the normal palatine tonsil, or determined how those parameters change with disease. Immunohistochemical analysis was performed to determine the microanatomical distribution, quantity, morphology, and phenotype of macrophages and dendritic cells in both normal and diseased tonsils. Differences were observed in macrophage and dendritic cell distribution, quantity, and phenotype in the surface and crypt epithelium. The number of macrophages was significantly increased in all compartments in all disease groups (p < .05), although the number of macrophages that expressed phenotypes of maturity and/or activation was not concomitantly increased. In the surface epithelium, Langerhans and interdigitating cells decreased significantly with disease (p < .05). Chronic infection may impose an immunosuppressive effect on responses within tonsil tissue, affecting the immunologic factors responsible for macrophage maturation and activation.
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Células Dendríticas/inmunología , Células Dendríticas/ultraestructura , Macrófagos/inmunología , Macrófagos/ultraestructura , Tonsila Palatina/anatomía & histología , Tonsila Palatina/inmunología , Tonsilitis/inmunología , Tonsilitis/patología , Enfermedad Aguda , Antígenos CD/inmunología , Antígenos CD/ultraestructura , Antígenos CD1/inmunología , Antígenos CD1/ultraestructura , Antígenos de Diferenciación Mielomonocítica/inmunología , Antígenos de Diferenciación Mielomonocítica/ultraestructura , Biopsia , Estudios de Casos y Controles , Recuento de Células , Niño , Enfermedad Crónica , Antígenos HLA-DR/inmunología , Antígenos HLA-DR/ultraestructura , Humanos , Tolerancia Inmunológica , Inmunohistoquímica , Inmunofenotipificación , Células de Langerhans/inmunología , Células de Langerhans/ultraestructura , Monocitos/inmunología , Monocitos/ultraestructura , Recurrencia , Proteínas S100/inmunología , Proteínas S100/ultraestructura , Linfocitos T/inmunología , Tonsilectomía , Tonsilitis/cirugíaRESUMEN
OBJECTIVE: To compare the incidence of gastroesophageal reflux disease (GERD) in children under 2 years of age who have symptomatic adenoid hypertrophy requiring surgical removal or who have otitis media with effusion requiring ventilation tube insertion without adenoidectomy. STUDY DESIGN: Retrospective chart review. SETTING: An academic pediatric otolaryngology unit. PATIENTS: All children under age 2 undergoing adenoidectomy (Ad group) between January 1998 and May 2000 were compared with children in the same age range having ventilation tube insertion without adenoidectomy (VT group). MAIN OUTCOME MEASURES: Whether a diagnosis of GERD was made, how it was made, GERD treatment, and resolution of symptoms were compared. RESULTS: There were 95 children in the Ad group and 99 in the VT group. GERD incidence was significantly higher in the Ad group where it was 42% versus 7% in the VT group (P < .001). In the Ad group, 88% of children age 1 or less had GERD, and 32% of those older than 1 had GERD diagnosed. In the VT group, 14% of patients age 1 or less and 2% of those older than 1 had a diagnosis of GERD. CONCLUSIONS: Children under age 2 with symptomatic adenoid enlargement requiring adenoidectomy have a significantly higher incidence of GERD than children in the same age group presenting with otitis media requiring ventilation tube insertion.
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Adenoidectomía/normas , Tonsila Faríngea/patología , Reflujo Gastroesofágico/epidemiología , Obstrucción de las Vías Aéreas/epidemiología , Obstrucción de las Vías Aéreas/cirugía , Preescolar , Femenino , Humanos , Hipertrofia , Lactante , Masculino , Factores de RiesgoRESUMEN
OBJECTIVE: To determine if the success of paediatric tympanoplasty is dependent on certain criteria, which are determinable prior to surgery. DESIGN: Retrospective chart review. SETTING: An academic paediatric otolaryngology department. PATIENTS: Seventy-seven patients who had undergone tympanoplasty with or without ossicular reconstruction, but without mastoidectomy, between April 1997 and May 1999. MAIN OUTCOME MEASURES: Status of the repaired tympanic membrane at last follow-up visit measured by otoscopic examination and with tympanometry. RESULTS: Eighty-nine tympanoplasties were performed during this period. The age range was 2.9 to 22 years. The success rate was 75% overall. For patients younger than 11 years (n = 43), the success rate was 82%, and for those 11 to 18 years (n = 44), it was 74%, which was not significantly different. In 18 patients 7.5 years or younger, the success rate was 79%. Perforation location, size, presence of myringosclerosis, status of the other ear or nose, history of the perforation, surgical approach, middle ear findings, canal packing, and gender were not shown to be significantly different between successful and unsuccessful tympanoplasty groups. CONCLUSION: These young patients had a good success rate post-tympanoplasty, which we believe reflects less severe disease. These results mitigate against delaying tympanoplasty in young children.
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Perforación de la Membrana Timpánica/cirugía , Timpanoplastia , Adolescente , Adulto , Factores de Edad , Niño , Preescolar , Factores de Confusión Epidemiológicos , Femenino , Humanos , Masculino , Reemplazo Osicular , Selección de Paciente , Pronóstico , Estudios Retrospectivos , Perforación de la Membrana Timpánica/epidemiologíaRESUMEN
Hemangiomas and VMs are potentially complicated lesions that are often misdiagnosed and treated under the presumption that if left untreated, they will go away on their own. A well thought out multidisciplinary team put together to determine the most appropriate diagnosis of a lesion and to formulate and insititute a treatment plan can prove invaluable to the patient and community as a whole. Team members must be chosen to maximize input and use time to best diagnose and treat these lesions. It is imperative that the presence of such a team be brought to the attention of primary care providers who most often are the first to see these patients and that correct information about diagnosis, potential treatment options, and projected results be conveyed.
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Malformaciones Arteriovenosas/terapia , Hemangioma/terapia , Malformaciones Arteriovenosas/cirugía , Hemangioma/cirugía , Humanos , Grupo de Atención al Paciente , Educación del Paciente como Asunto , FotograbarRESUMEN
BACKGROUND: Certain vital dyes are known to cause pulse oximetry (Spo2) desaturation. The authors studied the effect of isosulfan blue (IB) on Spo2. METHODS: Thirty-three women, aged 34-81 yr, who were undergoing surgery for breast cancer were studied. IB, 5 ml (50 mg), was injected intraparenchymally around the tumor area by the surgeon. A pulse oximeter was used to continuously record Spo2 values up to 130 min after IB injection. Friedman repeated-measures analysis of ranks was used to analyze the baseline Spo2 and values at 5, 10, 20, 30, 40, 50, and 60 min. RESULTS: Spo2 values were significantly different from baseline values at 5, 10, 20, 30, 40, 50, and 60 min (P < 0.05). In a typical patient, a maximum Spo2 decrease of 3% can be anticipated 25 min after injection of IB. CONCLUSIONS: After peritumoral administration of IB, 50 mg, a significant interference with Spo2 will occur.
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Oximetría/métodos , Colorantes de Rosanilina/farmacología , Adulto , Anciano , Anciano de 80 o más Años , Biopsia/métodos , Neoplasias de la Mama/sangre , Neoplasias de la Mama/patología , Femenino , Humanos , Ganglios Linfáticos/patología , Persona de Mediana Edad , Oxígeno/sangre , Estudios Prospectivos , Colorantes de Rosanilina/efectos adversos , Colorantes de Rosanilina/farmacocinéticaRESUMEN
OBJECTIVE: To determine the correlation between findings at direct laryngoscopy and bronchoscopy and presence of extraesophageal reflux disease (EERD). STUDY DESIGN: Retrospective chart review METHODS: Operative notes of 155 children undergoing direct laryngoscopy and bronchoscopy between 1996 and 1999 for airway symptoms for whom there was a suspicion of EERD were examined. Gastroesophageal reflux disease (GERD) was considered present if at least one test was positive (including upper GI series, pH probe, gastric scintiscan, or esophageal biopsy). RESULTS: A total of 130 (84%) patients had GERD diagnosed. Ninety percent had at least one laryngotracheal abnormality: 83% had an abnormal larynx and 66% had an abnormal trachea. Laryngeal abnormalities in GERD included postglottic edema, 69%; arytenoid edema, 30%; large lingual tonsil, 16%; vocal fold edema, 12%; vocal fold nodule, 12%; ventricular obliteration, 5%; and hypopharyngeal cobblestoning, 3%. Tracheobronchial abnormalities in GERD included tracheal cobblestoning, 33%; blunting of carina, 12.5%; subglottic stenosis, 11%; increased secretions, 11%; and generalized edema or erythema, 5%. The best sensitivity or specificity was obtained by combining postglottic edema, arytenoid edema, and vocal fold edema, resulting in a sensitivity of 75% and a specificity of 67%. Positive predictive value was 100% for the combination of postglottic edema and any vocal fold or ventricular abnormality. CONCLUSION: Laryngoscopy and bronchoscopy can reveal findings with a high positive predictive value for the presence of GERD. Endoscopy of the upper airway in children with clinical signs and symptoms of EERD is a promising tool for diagnosis.
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Broncoscopía , Reflujo Gastroesofágico/diagnóstico , Reflujo Gastroesofágico/etiología , Laringoscopía , Bronquios/anomalías , Niño , Preescolar , Femenino , Humanos , Lactante , Laringe/anomalías , Masculino , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Tráquea/anomalíasRESUMEN
OBJECTIVE: to determine if there is a correlation between common otolaryngologic symptoms and presence of gastroesophageal reflux disease (GERD) in children. METHODS: charts of 295 children presenting with suspicion of GERD were reviewed for presenting symptoms including: (1) airway symptoms: stertor, stridor, frequent cough, recurrent croup, wheezing, nasal congestion, obstructive apnea, blue spells, hoarseness, throat clearing; (2) feeding symptoms: wet burps, globus sensation, frequent emesis, dysphagia, choking/gagging, sore throat, halitosis, food refusal, stomach aches, arching, drooling, chest pain, irritability, and failure to thrive. At least one positive test of barium esophagram, gastric scintiscan, pH probe or esophageal biopsy resulted in inclusion in the GERD positive group. RESULTS: 214 children had GERD diagnosed while 81 had no positive tests for GERD. Between the GERD positive and GERD negative groups, the significantly different symptoms were stertor (P=0.040), cyanotic spells (P=0.043), frequent emesis (P=0.007), failure to thrive (P=0.006), and choking/gagging (P=0.044). Three pooled variables were created: airway flow (stertor, stridor, cyanotic spells), airway irritation (frequent cough, recurrent croup, throat clearing), and feeding (dysphagia, failure to thrive, frequent emesis). GERD patients who were 2 years or less were compared to those older than 2 years and all three of these pooled variables were significantly different between these groups (P<0. 001). CONCLUSION: children who present with a certain constellation of airway or feeding symptoms are more likely to have a positive GERD test. Children 2 years old or less are more likely to present with airway symptoms or feeding difficulties while children older than 2 years are more likely to present with airway irritation.
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Reflujo Gastroesofágico/diagnóstico , Obstrucción de las Vías Aéreas/etiología , Estudios de Casos y Controles , Preescolar , Femenino , Reflujo Gastroesofágico/complicaciones , Humanos , Masculino , Trastornos Respiratorios/etiologíaRESUMEN
OBJECTIVES: To determine the role of intermediate duration ( approximately 3 weeks) middle ear ventilation using office-based laser assisted tympanic membrane fenestration in resolving an episode of otitis media with effusion in adults and children who otherwise would have been treated with insertion of pressure equalization tubes. METHODS: A retrospective chart review of 92 patients (162 ears) was conducted to identify the utility and technical challenges associated with laser assisted tympanic membrane fenestration in an office setting. Clinical characteristics reviewed included: age, gender, duration of effusion, season performed, and hearing and health status of middle ear upon healing of the fenestration. RESULTS: 69% of all patients were effusion free upon closure of the fenestration; 68% of those <3 years; 70% of those 3-7 years; and 70% of those 25-80 years. Some episodes recurred and at final follow-up 64% had normal middle ear structure and function (range of follow-up =1-18 months, mean 2.5 months, median 2.0). Shorter duration of effusion pre-fenestration was more often associated with return to normal middle ear structure and function (P<0.01). Season performed, number of previous episodes of otitis media and pre-treatment tympanometry were not predictive of result. No significant complications were observed. CONCLUSIONS: The use of office-based laser assisted tympanic membrane fenestration is a reasonably safe and effective procedure for the treatment of otitis media in most adults and children. As a minimally invasive otologic procedure, laser assisted tympanic membrane fenestration has great potential to decrease the rates of both antibiotic usage and insertion of ear tubes.
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Procedimientos Quirúrgicos Ambulatorios , Terapia por Láser/métodos , Ventilación del Oído Medio/métodos , Otitis Media/cirugía , Pruebas de Impedancia Acústica/métodos , Adulto , Anciano , Anciano de 80 o más Años , Niño , Femenino , Estudios de Seguimiento , Trastornos de la Audición/diagnóstico , Trastornos de la Audición/etiología , Humanos , Masculino , Persona de Mediana Edad , Otitis Media/complicaciones , Otitis Media/diagnóstico , Proyectos Piloto , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Índice de Severidad de la EnfermedadRESUMEN
BACKGROUND: Morbidity following tonsillectomy continues to be a major concern to parents, children, and physicians alike. Reduction in post-operative complications, optimal control of pain, and satisfactory return to a normal lifestyle are all important to both family and society. This study compares both the complication and recovery rates after microbipolar dissection (MBPD) technique of tonsillectomy to two well established tonsillectomy techniques: hot knife (HK) and cold knife/cautery (CK/C). METHODS: A total of 200 consecutive patients presenting for tonsillectomy by the first author (MP) were randomized to either undergo MBPD or HK tonsillectomy. Concurrently, an additional two hundred patients were randomized to undergo MBPD or CK/C tonsillectomy by the second author (LB). Patients were prospectively followed for complications including bleeding and dehydration and multiple indicators of recovery rate. RESULTS: Postoperative bleeding of any kind was significantly less in the MBPD group than in the CK/C and HK groups (5 vs 12.4 vs 12.5% (P<0.001). The need for post-operative intervention for bleeding, i.e. local control or return to the operating room, was also significantly less in the MBPD group. Return to normal activity occurred 2 days earlier in the MBPD group versus either CK/C or HK (P<0.001). Additionally, earlier recovery was reflected in fewer total doses of pain medication in the MBPD group. Operative time was 3-5 min longer for MBPD (24.2 min) than for CK/C or HK (21.1 and 16.5 min, respectively); blood loss was similar (within 15 cc) among all treatment groups. CONCLUSION: MBPD tonsillectomy compared most favorably to conventional techniques (CK/C and to HK tonsillectomy). Important clinical outcome differences included a lower bleed rate, earlier recovery and fewer days lost from work and school. The financial impact is estimated to be quite favorable. MBPD tonsillectomy is now our preferred method in children.
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Electrocoagulación/métodos , Tonsilectomía/métodos , Adolescente , Niño , Preescolar , Electrocoagulación/efectos adversos , Electrocoagulación/instrumentación , Femenino , Humanos , Masculino , Complicaciones Posoperatorias , Tonsilectomía/efectos adversosRESUMEN
OBJECTIVE: To describe the role of the hand-held otoscope combined with a flashscanner CO2 laser, OtoLAM (ESC/Sharplan, Yokneam, Israel), for pressure equalization tube (PET) insertion in an office setting. STUDY DESIGN: Prospective, multisite, clinical cohort trial (Institutional Review Board approved; informed consent) in the setting of pediatric otolaryngology outpatient departments at four tertiary care children's hospitals. METHODS: Selected for the study were 54 patients (96 ears), ages 6 months to 23 years, who met standard indications for PET insertion using cold-knife myringotomy and tube insertion under general anesthesia. PETs were indicated for recurrent otitis media, chronic otitis media with effusion, and eustachian tube dysfunction-all unresponsive to medical therapy. Topical anesthesia was achieved with iontophoresis (n = 1) or topical anesthesia: 8% tetracaine on an Otowick (Xomed Surgical Products, Jacksonville, FL, catalogue No. 400141) against the tympanic membrane for 45 to 180 minutes (n = 53). Laser-assisted tympanic membrane fenestration was performed with the OtoLAM set at single pulse, 2.0- to 2.6-mm spot size, and between 3 and 18 W. Insertion of grommets was accomplished using the otomicroscope and an "alligator" microforceps. Restraints with papoose were used in 79% of children with a mean age of 34.4 months (SD = 60.9 mo). Clinical, parent/patient, and physician satisfaction and comparative cost impact outcomes are described. RESULTS: All ears but three (3%) underwent successful placement of a PET. Pain was described as "absent" in 39%, "present but tolerable" in 30%, and "severe" in 30% of children at the time of procedure; 5 minutes after the procedure pain was described as "absent" in 75%, "present but tolerable" in 22%, and "severe" in 3%. Tube plugging (3 of 74 available ears; 4%) or persistent otorrhea (1 of 74 ears; 1.4%) occurred infrequently at the 1-month follow-up. Before PET insertion, hearing loss was noted in 66% of cases (mild, 38%; moderate, 22%; and severe, 6%). Mild hearing loss was noted in only 8% and moderate hearing loss in 2% of 47 (50%) of the ears at the 3-month follow-up. Ninety-two percent of parents were highly satisfied with the procedure in preference to PETs in the operating room under general anesthesia, and 97% preferred OtoLAM with PET insertion, rather than further courses of antibiotics; only one parent would rather have had the PET insertion under general anesthesia. Cost savings to health care organizations, particularly payers, and to parents are substantial (32%-48%) and warrant attention. Cost to the physician is manageable only if an appropriate approach to the third party payers results in a substantial increase in reimbursements. CONCLUSIONS: The data indicate excellent clinical effectiveness, reduced risk, and high parent and physician satisfaction. Strong incentives for physicians to use this technique are in all stakeholders' best interests. These incentives need to evolve as soon as possible for the more widespread acceptance of OtoLAM with PET insertion in an office setting for appropriately selected patients.
Asunto(s)
Procedimientos Quirúrgicos Ambulatorios , Terapia por Láser , Ventilación del Oído Medio , Otoscopios , Adolescente , Procedimientos Quirúrgicos Ambulatorios/economía , Niño , Preescolar , Análisis Costo-Beneficio , Femenino , Humanos , Lactante , Terapia por Láser/economía , Masculino , Programas Controlados de Atención en Salud/economía , Ventilación del Oído Medio/economíaRESUMEN
Cellular immune responses to the P6 outer membrane protein of non-typeable Haemophilus influenzae (NTHi) were determined in vitro by measuring immunoglobulin (Ig) secreting cells and lymphocyte proliferation in adenoidal and tonsillar lymphocytes from 19 children. Preliminary tests showed that P6 did not stimulate naive cells such as cord blood lymphocytes, but did stimulate sensitized cells in adenoids and tonsils. Cellular proliferation was significantly higher in adenoidal lymphocytes than in tonsillar lymphocytes (median: quadratile of stimulation index = 3.7:2.3-5.5 vs. 1.2:1.0-2.1, p < 0.02). A comparison between children with or without otitis media revealed that proliferative responses to P6 of adenoidal lymphocytes from children with otitis media were significantly decreased (2.0:1.8-3.6 vs. 3.7:2.3-5.5, p < 0.04). P6-specific antibody secreting cells were identified in a total of 14 adenoids and the number of cells secreting IgA was decreased in the otitis media group compared to controls (median: quadratile/10(6) cells = 435:359-499 vs. 755:593-1870, p < 0.05). Cultivation with P6 stimulated IgA secretion in children without otitis media, while no response was seen in children with otitis media (median: quadratile/10(6) cells = 1323:915-2410 vs. 2240:1900-2830, p < 0.02). These preliminary data demonstrate that lymphocytes from adenoids and tonsils recognize P6 as a specific antigen and that the adenoid is the more reactive of the two organs. Impaired P6-specific cellular immune responses of adenoids in children with otitis media may explain the recurrent nature of otitis media due to NTHi in the otitis prone population.
Asunto(s)
Tonsila Faríngea/inmunología , Proteínas de la Membrana Bacteriana Externa/inmunología , Vacunas contra Haemophilus/inmunología , Otitis Media con Derrame/inmunología , Tonsila Palatina/inmunología , Linfocitos T/inmunología , Enfermedad Aguda , Tonsila Faríngea/cirugía , Anticuerpos Antibacterianos/inmunología , Especificidad de Anticuerpos/inmunología , Movimiento Celular/fisiología , Niño , Preescolar , Femenino , Infecciones por Haemophilus/complicaciones , Infecciones por Haemophilus/inmunología , Humanos , Masculino , Nasofaringe/microbiología , Otitis Media con Derrame/etiología , Tonsila Palatina/cirugíaRESUMEN
The aim of this study was to measure the germinal center area of secondary follicles in a consistent and unbiased manner using image analysis. Tonsil specimens were obtained from children with clinical evidence of recurrent tonsillitis and/or idiopathic tonsillar hypertrophy. Normal control biopsy specimens were obtained from children with no history of ear, nose, or throat infections. The results show a significant increase in the germinal center area in tonsils exhibiting hypertrophy when compared to normal controls (p < .002). Image analysis is an important tool for making quantitative size comparisons in lymphoid tissues.
Asunto(s)
Centro Germinal/patología , Tonsila Palatina/patología , Tonsilectomía/métodos , Enfermedad Aguda , Adolescente , Niño , Preescolar , Femenino , Infecciones por Haemophilus/microbiología , Humanos , Hipertrofia/patología , Tejido Linfoide/patología , Masculino , Distribución Aleatoria , Recurrencia , Tonsilitis/microbiología , Tonsilitis/patología , Tonsilitis/cirugíaRESUMEN
A 2.5-year-old child presented with a sleep disturbance initially diagnosed as a behavioral problem. The child had several atypical symptoms of gastroesophageal reflux disease (GERD). The sleep disturbance resolved quickly after treatment of GERD. GERD is a disease with protean manifestations which is becoming of greater interest to the pediatric otolaryngologist. We discuss diagnosis of this entity.