RESUMEN
With the introduction of vaccination for haemophilus influenza, the epidemiology of epiglottitis in children has changed. Classic childhood epiglottitis is now rare, and unusual forms of the disease may be seen. Nectrotizing epiglottitis is an extremely rare form of epiglottitis. Only four cases of nectrotizing epiglottitis have been previously reported, and all cases were in immunocompromised adult patients. Hemophagocytic lymphohistiocytosis is a rare condition characterized by high fevers, hepatosplenomegaly, and cytopenias caused by an abnormal proliferation and activation of macrophages. We report the first case of a previously healthy 5-year-old male presenting with acute onset of airway distress and pancytopenia. Subsequent airway evaluation led to the diagnosis of nectrotizing epiglottitis, and he was simultaneously diagnosed with infection-induced hemophagocytic lymphohistiocytosis. The patient recovered with intubation and antibiotics. Follow-up direct laryngoscopy revealed an epiglottis remnant with approximately 50% loss of epiglottic tissue. The presentation and pathophysiology of this unusual manifestation of epiglottitis and hemophagocytic lymphohistiocytosis will be reviewed. In the post-haemophilus influenze vaccination era, the pediatric otolaryngologist must be familiar with unusual forms of epiglottitis and its associated manifestations.
Asunto(s)
Epiglotitis/etiología , Epiglotitis/patología , Linfohistiocitosis Hemofagocítica/complicaciones , Linfohistiocitosis Hemofagocítica/diagnóstico , Infecciones Bacterianas/complicaciones , Preescolar , Epiglotitis/terapia , Humanos , Linfohistiocitosis Hemofagocítica/microbiología , Masculino , Necrosis/diagnóstico , Necrosis/etiología , Necrosis/terapiaRESUMEN
OBJECTIVE: To determine the effect of vocal nodule size on voice in pediatric patients. STUDY DESIGN: Vocal nodules were graded according to a validated grading scale by three pediatric otolaryngologists. SUBJECTS AND METHODS: Patients evaluated from 2003 to 2007 with a diagnosis of vocal nodules were included. RESULTS: Forty patients (21 female) with a mean age of 7.5 years were identified. Vocal nodules were rated as grade 1 (17 patients), grade 2 (15 patients), and grade 3 (8 patients). Pitch range was reduced in patients with larger nodules (P = 0.001). There was no statistical association between nodule grade and fundamental frequency abnormality, perturbation, shimmer, decreased respiratory support, air loss, or significant muscle tension. CONCLUSIONS: Voice characteristics in patients with vocal nodules were evaluated. Other than pitch reduction, objective and subjective voice measurements are not statistically different in varying vocal nodule sizes; however, many of the measures did show a trend towards significance. Vocal rehabilitation is complex in children with nodules and may not directly correlate with vocal nodule size.
Asunto(s)
Pliegues Vocales/patología , Trastornos de la Voz/etiología , Calidad de la Voz/fisiología , Niño , Estudios de Cohortes , Estudios de Factibilidad , Femenino , Humanos , Masculino , Reproducibilidad de los Resultados , Estudios Retrospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Estroboscopía , Grabación en Video , Pliegues Vocales/fisiopatología , Trastornos de la Voz/patología , Trastornos de la Voz/fisiopatologíaRESUMEN
Tumor necrosis factor (TNF)-alpha inhibitors have been used effectively to treat rheumatoid arthritis and inflammatory bowel disease. Although the role of TNF-alpha in tumor development is not well understood, an increased risk of malignancies with anti-TNF-alpha therapy has been suggested. We report an instructive case of a patient, treated for Crohn's disease with infliximab, who presented with a neck abscess diagnosed to be head and neck squamous cell carcinoma. The patient's clinical course illustrates a temporal relationship between reappearance of his cancer after a complete response to therapy and the resumption of infliximab for worsening Crohn's disease.
Asunto(s)
Anticuerpos Monoclonales/efectos adversos , Carcinoma de Células Escamosas/inducido químicamente , Fármacos Gastrointestinales/efectos adversos , Neoplasias de Cabeza y Cuello/inducido químicamente , Recurrencia Local de Neoplasia/inducido químicamente , Factor de Necrosis Tumoral alfa/inmunología , Adulto , Humanos , Infliximab , Masculino , Factores de TiempoAsunto(s)
Educación Médica Continua/métodos , Aprendizaje , Lectura , Guías como Asunto , Factores de TiempoRESUMEN
BACKGROUND AND PURPOSE: To determine the recognition of sleep disorders in a community-based outpatient health setting following an educational intervention for health care professionals. Previously we have reported very low rates of recognition of sleep disorders in minority and medically indigent populations in a community-based setting. This omission is significant, since there is evidence of an increased number of sleep disorders among minority populations. PATIENTS AND METHODS: In-service training on sleep and sleep disorders was conducted over a 4-year period. Patients screened at the health center with suspected sleep disorders were referred to a hospital-based sleep laboratory. Rates of recognition and referral for sleep-related disorders were compared over the 4-year period using the sleep lab and health center databases and patient chart review at the health center. RESULTS: The intervention program was highly rated and well attended by staff. Rates of referral for sleep testing significantly increased from pre-intervention (0.06%) to the last year post-intervention (0.21%). Overall prevalence rate for sleep diagnoses increased similarly (0.11 vs. 0.26%). CONCLUSIONS: The educational intervention was effective in increasing rates of recognition and diagnosis, although the rate remains low compared to the estimated prevalence of sleep disorders in the general population. Despite broad coverage of sleep disorders during the training program, OSA was the primary diagnosis. Further examination of factors leading to the lack of recognition of other primary sleep disorders needs to be addressed in this patient group.