The effect of Leptospermum petersonii essential oil on Candida albicans and Aspergillus fumigatus.

A variety of assays were utilized to determine the effects of Leptospermum petersonii essential oil on both Candida albicans and Aspergillus fumigatus. Hyphal morphology, susceptibility of spheroplasts and uptake of propidium iodide following exposure to the oil suggest that the mode of action of L. petersonii essential oil is through direct disturbance of the fungal cell membrane. Data also confirms that the volatile component of the oil is highly antifungal, independent of direct contact between the liquid oil and the fungal membrane. The degree of inhibition was greater when fungi were directly exposed to oil volatiles compared to pre-inoculation exposure of oil volatiles into the agar. It is likely that the essential oil volatiles are acting both directly and indirectly on the fungi to produce growth inhibition.

Safe pediatric outpatient sedation: the chloral hydrate debate revisited.

Diagnostic imaging in the pediatric patient frequently requires sedation. The use of chloral hydrate, the standard agent for many years, has recently come under severe scrutiny. The American Academy of Pediatrics (AAP) published guidelines for the elective sedation of pediatric patients; however, compliance with the AAP guidelines is not compulsory. A review of the medical literature shows a wide range of medications used for pediatric sedation, along with a diversity in the protocols available for monitoring the cardiopulmonary status of the patient. When ordering computed tomography and magnetic resonance imaging scans, pediatric otolaryngologists indirectly are exposing their patients to the sedation practices and monitoring protocols of their referral imaging center. A questionnaire regarding the sedation protocol for routine, outpatient, computed tomography or magnetic resonance imaging scans in children aged 5 years or younger was sent to staff radiologists at 36 pediatric medical centers throughout the United States. A variety of sedation practices were elicited. The complete survey results are presented, including monitoring practices, complication, and success rates. Despite concerns about its safety, chloral hydrate remains a frequently used and safe method of pediatric outpatient sedation.

Laryngocele associated with squamous carcinoma in a 20-year-old nonsmoker.

A laryngocele associated with squamous cell carcinoma of the larynx is reported in a 20-year-old man without a history of smoking. This is the youngest reported case of carcinoma associated with laryngocele in the literature. This association is supported by the patient's young age and his nonsmoking status. However, this case does not appear to support the conclusion that laryngoceles predispose to the development of squamous cell carcinoma. The clinical history supports the tumor obstruction theory, whereby a laryngocele developed from an obstructing carcinoma of the ventricle.

Neonatal otitis media. An update.

Neonatal otitis media may be an isolated infection or part of a more complex sepsis syndrome. Because early studies suggested that the microbiologic characteristics of neonatal otitis media included a high risk of gram-negative coliforms and Staphylococcus aureus, tympanocentesis was recommended routinely. Subsequent studies have supported empiric medical therapy in selected patients, reserving tympanocentesis for patients in whom medical treatment fails. Because of these conflicting recommendations, records from 37 neonates with otitis media who underwent tympanocentesis from 1986 through 1991 were studied retrospectively. Cultures in one outpatient (11%) and four inpatients (13%) yielded Escherichia coli, all of which were sensitive to amoxicillin. No cultures of S aureus were identified. Sterile cultures and pneumococcus isolates were found most frequently. No septic or intracranial complications were noted. All patients were discharged on regimens of routine antibiotics for otitis media.

Epithelioid hemangioendothelioma with osteoclastlike giant cells.

This article describes histopathologic and immunohistologic features of an epithelioid hemangioendothelioma that presented in the neck of a 40-year-old man. This tumor was unusual because of the presence of osteoclastlike giant cells scattered throughout the entire lesion. The tumor cells reacted positively for factor VIII-related antigen, and the osteoclastlike giant cells were reactive for KP1 antibody, a macrophage-associated antigen. We are aware of only one other previously reported example of soft-tissue epithelioid hemangioendothelioma with an abundance of osteoclast-like giant cells.

Practical aspects of managing non-malignant lumps of the neck.

The etiologies of pediatric neck masses are legion. Optimal management depends upon making the correct diagnosis. A detailed history to ascertain the duration of the illness, presence of systemic symptoms, animal exposures, tuberculous contacts, medications ingested, recent trauma, dental work or upper respiratory infection (URI), as well as a travel history, may yield important clues to establishing the diagnosis. The work-up for neck masses must be individualized based upon history and physical examination. Common diagnostic studies often obtained are listed in Table 1, and will be further clarified as individual diagnoses are discussed.

Pediatric airway manifestations of gastroesophageal reflux.

Gastroesophageal reflux (GER) in children may be classified as physiologic or pathologic, depending on its degree and consequences. There are many head and neck complications of GER in pediatric patients, but most numerous are the airway manifestations, including stridor, recurrent croup, exacerbation of subglottic stenosis, laryngeal irritation with or without laryngospasm, chronic cough, and obstructive apnea. Diagnosis may be difficult unless there is a high index of suspicion for GER and awareness of the concept of "silent" GER. We present the common pediatric airway manifestations of GER, illustrated by case reports, and provide a paradigm to assist in the diagnosis and management of children with airway compromise associated with GER.

Granular cell tumors of the trachea.

In contrast to the relative frequency of granular cell tumors (GCT) in the larynx and bronchi, the occurrence of these tumors in the trachea is rare. A 50-year review of the English-language literature disclosed only 24 described cases of tracheal GCT. This report reviews the clinicopathologic data from those 24 cases, along with the data from 2 cases obtained via a personal communication and the data from 4 previously unpublished cases obtained from a 30-year review of the Armed Forces Institute of Pathology archives. Tracheal resection was the predominant mode of therapy and often was performed as a salvage procedure for failed endoscopic excisions. Recommendations for a more uniform approach to surgical management are provided.

Tongue gastric choristoma: failure to localize by technetium-99m pertechnetate scan.

Congenital rests of gastric epithelium have been reported in a variety of head and neck locations. Presenting symptoms of these lesions range from an asymptomatic cyst to one which is compromising the airway. The true diagnosis is rarely suspected prior to excision. A case of a gastric choristoma of the tongue is presented which was noted at birth as an intermittently bleeding ulcer. Complete excision of the mass was difficult to ascertain due to poor delineation of the tumor margins from the tongue musculature. A postoperative technetium-99m pertechnetate scan failed to demonstrate residual gastric mucosa. Conservative management resulted in only transient healing of the ulcer. Repeat excision demonstrated abundant residual gastric mucosa. Technetium-99m pertechnetate scanning may not be a reliable indicator of ectopic gastric mucosa in the head and neck region.

Candida laryngotracheitis: a complication of combined steroid and antibiotic usage in croup.

The use of corticosteroids to reduce the morbidity associated with laryngotracheobronchitis (croup) has been a controversial issue for many years. Recent literature, however, does support a decreased morbidity and increased clinical response when short-term steroids are used. As a prophylactic measure against bacterial superinfection, antibiotics are commonly utilized in the treatment of croup. We present the case of an otherwise healthy infant with severe croup who was hospitalized and treated with both steroids and antibiotics. A relapse in her symptoms led to the diagnosis of candida laryngotracheitis. We recommend close monitoring of patients with croup treated aggressively with steroids and antibiotics. Steroid use should be limited to 24 h with antibiotics reserved for patients with signs of bacterial infection.

Extraluminal esophageal coin erosion in children. Case report and review.

Coins are often reported as the most commonly ingested foreign body (FB) in children. They are felt to be benign FBs since they usually pass through the gastrointestinal tract without incident. However, when these objects become impacted within the esophageal lumen, they can perforate the esophagus and migrate extraluminally. Symptoms of the perforation itself are frequently absent, but the potential vascular and suppurative complications may be devastating. We present the 10th reported case of complete extraluminal migration of an esophageal coin, and the only case which was treated without an open surgical procedure. Because of the potential complications, we recommend aggressive surgical intervention as soon as the diagnosis is made.

Closure of the soft palate for persistent otorrhea after placement of pressure equalization tubes in cleft palate infants.

Four case reports of infants with cleft palate and intractable otorrhea following the placement of pressure equalization tubes are presented. In one patient, liquids taken orally were noted to reflux through her ears. Otorrhea was refractory to medical management in all cases and was controlled only after closure of the soft palate. Persistent otorrhea may be an indication for early closure of the soft palate in these infants.

Nocardiosis of the upper aerodigestive tract.

Nocardia asteroides is the major cause of nocardiosis in the respiratory tract. The primary site of infection is the lung, with the upper aerodigestive tract being a rare region for localized disease to occur. We describe a case of a nocardial vallecular cyst and discuss the diagnosis and management of this unusual infection.