RESUMEN
UNLABELLED: Recurrent respiratory papillomatosis causes significant morbidity among affected children and usually requires frequent surgeries. We present a prospective case series including nine children at a Mexican tertiary referral center. All enrolled patients had severe disease that had required at least four surgical procedures, with a median of 6. Two children had tracheobronchial involvement, one had lung parenchymal disease, and one had a tracheostomy performed during his first surgery. OBJECTIVE: To assess the efficacy of intralesional cidofovir in lowering the surgery rate. STUDY DESIGN: Prospective case series. SETTING: Tertiary referral center in Mexico City. METHODS: Nine Mexican children with severe disease were enrolled. Intralesional cidofovir was applied after surgical debulking at a concentration of 5 mg/mL with a four to six week interval. RESULTS: Six of the nine patients had a notable decrease in the rate of surgeries, with three patients remaining disease-free with follow up ranging from 1.8 to 3.3 years. No patient demonstrated laboratory abnormalities. Two patients showed moderate and mild dysplasia on papilloma biopsy distinguished by a lack of epithelial maturation with no mitoses or cellular atypia. Two patients died several months after the last injection. CONCLUSIONS: Intralesional cidofovir appears to be effective in the treatment of recurrent respiratory papillomatosis, although further studies are required to determine its safety.
Asunto(s)
Citosina/análogos & derivados , Neoplasias Laríngeas/tratamiento farmacológico , Organofosfonatos/administración & dosificación , Papiloma/tratamiento farmacológico , Antineoplásicos/administración & dosificación , Niño , Preescolar , Cidofovir , Citosina/administración & dosificación , Relación Dosis-Respuesta a Droga , Femenino , Estudios de Seguimiento , Humanos , Lactante , Inyecciones Intralesiones , Neoplasias Laríngeas/diagnóstico , Masculino , Estadificación de Neoplasias , Papiloma/diagnóstico , Estudios Prospectivos , Índice de Severidad de la Enfermedad , Factores de Tiempo , Resultado del TratamientoRESUMEN
Malignant external otitis is a life-threatening infection occurring in aging diabetic and immunocompromised patients. The development of new antimicrobial and diagnostic aids has modified the therapy and prognosis of the disease. We describe our experience in 12 cases seen between 1982 and 1991, and review the diagnostic and therapeutic criteria during this lapse. Ten cases were males and 11 were diabetics. The most common symptoms were unilateral otalgia and otorrhea. All had edema of the external auditory channel and nine, proliferation of granulation tissue. Four had cranial nerve palsy. In ten patients Pseudomonas aeruginosa was recovered. All had axial computed tomographic scans and six sequential radionuclide scanning performed at diagnosis and follow-up. Eleven patients received combined therapy with an aminoglucoside and an anti-pseudonomas beta-lactam antibiotic; in four ambulatory treatment was continued with a quinolone. Only one patient received a quinolone as only treatment due to unavailability of other drugs in the mexican market. Presentation of granulation tissue or bone sequestrum was performed in nine patients. Only three required extensive surgical debridement procedures. We conclude that a combined antimicrobial therapy and the use of quinolones has favorably modified the prognosis and avoids extensive surgery and disminishes hospital stay.
Asunto(s)
Complicaciones de la Diabetes , Otitis Externa/complicaciones , Anciano , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Otitis Externa/diagnóstico , Otitis Externa/terapia , Estudios RetrospectivosRESUMEN
This is a report about the outcome following a study of watchfullness on hospital acquired infections of the E.N.T.-area, during a 7 months term. In the study are included those internees admitted for more than 48 hours in the unit. In each case the clinical record comprises the infective risk factors, the follow-up and treatment, as well as a naso-pharyngo-laryngoscopy with cold light. If necessary cultures and imaging studies were done and even invasive procedures employed with diagnostical and/or therapeutical purposes (punction or surgery). In the whole, a collective of 24 patients, with an average attendance of 17.5 days (margin 3-60 days), average age 54.4 years (margin 22-85 years), 5 nosocomial E.N.T.-infections were detected: 2 pansinusitis, 2 bacterial otitis media and 1 case of infected tracheostome. This figures should be related with an incidence rate of 20.8 percent discharges. Cranio-encephalic traumata, the taken of antimycotics and either the simultaneous use of feeding tubes (naso-gastric, naso-jejunal) have had a statistical value as risk factors linked with ENT-area. Discussion on the need for establishing a permanent program of surveillance of ENT-infections in the ICU without missing a routine naso-pharyngolaryngoscopy.