Vascular injury following accidental intra-arterial injection of clindamycin: adverse drug reaction report.

Clindamycin in a commonly used antibiotic, considered safe for oral, intravenous and intra-arterial use. We present a case of a patient that received an inadvertent injection clindamycin 600 mg in 4 mL through a radial arterial line. The patient presented signs and symptoms of vascular occlusion and despite aggressive pharmacological and medical treatment developed massive and severe tissue injury.

Parameters affecting pharyngeal response to genioglossus stimulation in sleep apnoea.

Chronic stimulation of the hypoglossus nerve may provide a new treatment modality for obstructive sleep apnoea (OSA). In previous studies we observed large differences in response to stimulation of the genioglossus (GG). We hypothesised that both individual patient characteristics and the area of the GG stimulated are responsible for these differences. In the present study, we compared the response to GG electrical stimulation at the anterior area (GGa-ES), which activates the whole GG and the posterior area (GGp-ES), which activates preferentially the longitudinal fibres. Studies were performed in 14 propofol-sedated OSA patients. The parameters evaluated included cephalometry, pressure-flow relationship and pharyngeal shape and compliance assessed by pharyngoscopy. Compared with GGa-ES, GGp-ES resulted in significantly larger decreases in the critical value of end-expiratory pressure (P(crit)) (from 3.8 ± 2.2 to 2.9 ± 3.3 and -2.0 ± 3.9 cmH(2)O, respectively (p<0.001)). Both tongue size and velopharyngeal shape (anteroposterior to lateral ratio) correlated significantly with the decrease in P(crit) during GGp-ES (R = 0.53 and -0.66, respectively; p<0.05). In the patients with the larger tongue size (n = 7), the decrease in P(crit) reached 8.0 ± 2.2 cmH(2)O during GGp-ES. We conclude that directing stimulation to longitudinal fibres of the GG improves the flow-mechanical effect. In addition, patients with large tongues and narrow pharynx tend to respond better to GGp-ES.

Protection of high-riding aberrant innominate artery during open tracheotomy.

PURPOSE: Variations of the normal anatomy of the aortic great vessels can lead to severe complications if not recognised pre- or peri-operatively. One such anomaly is a high-riding aberrant innominate artery. STUDY DESIGN: Retrospective review of case series. MATERIALS AND METHODS: We present our experience with seven patients in whom a high aberrant innominate artery was encountered just before or during open tracheotomy. We describe a procedure designed to protect the artery from erosion due to the tracheotomy tube, using an inferiorly based, U-shaped flap from the anterior tracheal wall averted over the innominate artery. RESULTS: None of the patients had any bleeding from the tracheotomy site, during a follow-up period of nine to 46 months. CONCLUSION: The technique described is simple to perform and prevents any damage to a high aberrant innominate artery, as assessed over a long follow-up period.

Synergistic necrotizing cellulitis as a complication of peritonsillar abscess.

Peritonsillar abscess, a complication of tonsillitis, is not uncommon. The usual treatment consists of needle aspiration or surgical drainage and antibiotic treatment. Tonsillectomy may be used in the management of this condition, either at the time of diagnosis or after an interval period. Severe complications of peritonsillar abscess are rare. Synergistic necrotizing cellulitis is a fulminant infection associated with spread along fascial plains, necrosis of connective tissue and muscle, and high mortality. It is usually otondogenic in origin in the cervicofacial area and occurs in debilitated or immune compromised patients. We discuss cervicofacial-necrotizing soft tissue disease and report an unusual case of extensive synergistic necrotizing cellulitis of the neck, chest, and shoulder as a result of a peritonsillar abscess.

The association between iron-deficiency anemia and recurrent acute otitis media.

PURPOSE: This study was designed to examine the association between iron-deficiency anemia and the frequency of recurrent acute otitis media in children, and to evaluate the effect of restoring normal hemoglobin levels on the frequency of acute otitis media attacks. MATERIALS AND METHODS: A total of 680 children with frequent episodes of acute otitis media were enrolled in the study. The levels of the hemoglobin were measured in both these children and in 200 healthy children with no history of infections. The correlation between hemoglobin level and the frequency of middle ear infections was studied and analyzed. All children with hemoglobin levels lower than 9.5 g/dL received iron supplementation until they reached a level of at least 11 g/dL, and the subsequent frequency of middle ear infections was recorded. RESULTS: The 680 children had an average of 8.3 +/- 2.7 episodes of acute otitis media per year per child, and an average hemoglobin level of 11.4 +/- 2.7 g/dL, whereas the controls had an average hemoglobin level of 13.1 +/- 2.5 g/dL. Twenty percent had hemoglobin levels below 9.5 g/dL. These children had more episodes of acute otitis media when compared with children with average levels. By increasing the hemoglobin level in these children, the frequency of the episodes of acute otitis media decreased significantly. CONCLUSIONS: This study confirms that anemic children have higher prevalence of episodes of acute otitis media in comparison to healthy, nonanemic children, and shows that there is a direct relationship between the degree of the anemia and the number of the episodes.

Malignant tumors of the nose and paranasal sinuses: a retrospective review of 291 cases.

Malignant neoplasms of the nose and paranasal sinuses are not common among the general population. We present a retrospective study of 291 cases of malignant tumors of the nose and paranasal sinuses that were diagnosed in a northern Romanian population over a period of 35 years. We review the etiology, diagnosis, prognosis, and treatment of these tumors.

The effects of noise on the vestibular system.

PURPOSE: Subjects with noise-induced hearing loss sometimes also complain about balance disorders, but reports of clinical series that give contradictory results are highly controversial. This study was designed to evaluate the effects of intense noise on the vestibular labyrinth, both in subjects with symmetrical hearing loss and in subjects with asymmetrical loss, and to examine the correlation between the subjects' complaints and the results of the vestibular function tests. METHODS: A total of 258 male military personnel, heavily exposed to various intense noises, were included in the study. They were divided into 2 groups according to their hearing; 134 had a symmetrical high-tone hearing loss, and 124 had asymmetrical losses. Each group was divided into 2 subgroups according to the presence or absence of vestibular complaints. All of the subjects underwent a complete audiological and electronystagmographic evaluation. RESULTS: We found that vestibular damage caused by intense noise exposure might be expressed clinically in subjects with asymmetrical hearing loss. There was a strong correlation between the subjects' complaints and the results of the vestibular function tests. There was no correlation between the severity of the hearing loss and the vestibular symptomatology and pathology. CONCLUSIONS: Subjects exposed to intense noise may have evidence of vestibular pathology only when there is an asymmetrical hearing loss. Whenever hearing loss is symmetrical, an equal damage to the vestibular system of both ears is most probably responsible for the absence of abnormal findings on the vestibular function tests. The results of this study have important medicolegal implications for individuals exposed to intense noises.

Epstein-Barr virus and cancers of the head and neck.

Denis Burkitt pioneered the association of viruses and cancer in humans with his observations of lymphomatous tumors in children in equatorial Africa. The Epstein-Barr virus (EBV), a human B lymphotrophic herpes virus, is strongly associated with undifferentiated carcinoma of the nasopharynx and African-type Burkitt's lymphoma. More recently, an association of this virus with other epithelial neoplasms, lymphomas, and immunodeficiency-related malignant and nonmalignant conditions has been reported. Since many of these tumors are rare, much of the information is based on sporadic reports and relatively small series of patients. The purpose of this report is to review the literature and examine the growing association of EBV with various head and neck malignancies.

Laser partial epiglottidectomy as a treatment for obstructive sleep apnea and laryngomalacia.

Obstructive sleep apnea (OSA) and laryngomalacia are two different entities. Occasionally, they may have a common etiology: an elongated, flaccid, and lax epiglottis that is displaced posteriorly during inspiration causing airway obstruction. Twenty-seven adults with a diagnosis of airway obstruction or OSA of various degrees, and 12 infants with severe stridor associated with frequent apneas due to laryngomalacia, who on fiberoptic examination were found to have a posteriorly displaced epiglottis, underwent partial epiglottidectomy with a CO2 laser. Their postoperative recovery was uneventful. Polysomnographic studies performed after operation in the adult patients demonstrated statistically significant improvement in 85% of the patients. In all the cases of laryngomalacia, stridor ceased permanently after surgery, together with complete cessation of the apneic episodes. This study demonstrates that similar pathophysiological mechanisms may be involved in both laryngomalacia and in OSA. Effective and relatively safe treatment can be achieved by partial resection of the epiglottis with a microlaryngoscopic CO2 laser.

Tracheotomy complications: a retrospective study of 1130 cases.

BACKGROUND: Tracheotomy is one of the most frequently performed surgical procedures in the critically ill patient. It is frequently performed as an elective therapeutic procedure and only rarely as an emergency procedure. Complications occur in 5% to 40% of tracheotomies depending on study design, patient follow-up, and the definition of the different complications. The mortality rate of tracheotomy is less than 2%. Numerous studies demonstrate a greater complication and mortality rate in emergency situations, in severely ill patients, and in small children. METHODS: A retrospective study of 1130 consecutive tracheotomies performed during 1 decade (January 1987 through December 1996) is presented. We studied the indications for surgery, the major complications of tracheotomy, and their treatment and outcome. We also noted the overall mortality rate and the specific complications that led to these deaths. RESULTS: In total, 1130 tracheotomies were performed. Major complications occurred in 49 of the cases, and 8 deaths were directly attributed to the tracheotomy. The most common complication was tracheal stenosis, which occurred in 21 cases. Hemorrhage was the second most common complication, which occurred in 9 cases. CONCLUSION: This is one of the largest series of consecutive tracheotomies compiled. We found a relatively low overall complication and mortality rate compared with other large series. Tracheal stenosis was the most common complication in contrast to other series. Our opinion is that this may reflect tracheal damage originally caused by prolonged intubation before the tracheotomy. We believe that all other complications of tracheotomy may be prevented or minimized by careful surgical technique and postoperative tracheotomy care.

Plastipore implants in the surgical treatment of atrophic rhinitis: technique and results.

BACKGROUND: Atrophic rhinitis is a distressing and socially crippling disease. Surgical treatment has been used for patients with severe disease that is unresponsive to medical therapy. METHODS: Eight patients with primary atrophic rhinitis were treated surgically by narrowing of the nasal fossae with implantation of 2 Plastipore plates per affected side into submucosal pockets into the floor of the nose and septum, thus reducing the volume of the nasal fossae. RESULTS: Excellent results were obtained in 6 patients, with complete resolution of symptoms and good results and only minor crusting in 2 patients. One implant was extruded spontaneously 18 months after implantation and was reimplanted. Results in this patient before and after reimplantation were excellent. There were no cases of infection and no other complications. CONCLUSION: We implanted Plastipore, a high-density polyethylene sponge with micropores, which enables tissue ingrowth, anchoring the implants to the surrounding tissue. The surgical technique is performed with the patient under local anesthesia and is relatively easy and avoids complicated flap procedures, allogeneic bone harvesting, and the discomfort of nostril closure for prolonged periods.

Cholesteatomas associated with ventilation tube insertion.

OBJECTIVES: To determine the incidence of cholesteatoma formation associated with ventilation tube (VT) placement and to identify and analyze the variables and risk factors that may predict or predispose to this complication. DESIGN: We reviewed the medical records of 2829 children following VT insertion between the years 1978 and 1997 to obtain 1- to 20-year follow-up data. SETTING: Departments of Otolaryngology-Head and Neck Surgery and outpatient clinics of 2 tertiary referral academic medical centers. PATIENTS: A study population of 2829 children, ranging in age from 1.2 to 14 years (5575 ears), underwent a total of 6701 VT placements. MAIN OUTCOME MEASURE: Cholesteatomas were considered a complication of VT placement whenever they developed at or near the site of the tube insertion. RESULTS: Cholesteatomas directly attributed to VT placement occurred in 1.1% of the ears that were operated on. A higher incidence occurred (1) in children younger than 5 years, (2) when Goode T-tubes were used, (3) in cases with repeated insertions of tubes, (4) with intubation exceeding 12 months, and (5) in cases with frequent post-operative otorrhea. CONCLUSIONS: Cholesteatoma formation associated with VT placement occurs in 1.1% of the ears that are operated on, and therefore it should be discussed with patients or parents prior to surgery. Periodic and long-term follow-up microscopic examinations of the eardrum should be performed in all patients following tubal extrusion or removal, especially in those at high risk for developing a secondary cholesteatoma, to detect this complication as early as possible.

Effects of interferon alpha-2b on barrier function and junctional complexes of renal proximal tubular LLC-PK1 cells.

BACKGROUND: Interferon alpha-2b (IFNalpha) treatment of diseases can be accompanied by impaired renal function and capillary leak syndrome. To explore potential mechanisms of IFNalpha-induced renal dysfunction, an in vitro cell culture model system was established to investigate the effects of IFNalpha on barrier function and junctional complexes. METHODS: LLC-PK1 cells were cultured on microporous membranes. Transepithelial resistance (TER) was measured, and the dose- and time-dependent effects of IFNalpha were assessed. The expression patterns of junctional proteins were examined by Western blot analysis and by confocal immunofluorescence microscopy. RESULTS: IFNalpha produced a dose- and time-dependent decrease in TER. The effect was reversible on removal of IFNalpha at doses up to 5 x 103 U/ml. Tyrphostin, an inhibitor of phosphotyrosine kinases, ameliorated the IFNalpha-induced decrease in TER. Increased expression of occludin and E-cadherin was detected by Western blot analysis after IFNalpha treatment. Immunofluorescence confocal microscopy revealed a broader staining of occludin and E-cadherin following IFNalpha treatment, with prominent staining at the basal cell pole in addition to localization at the junctional region. A marked increase in phosphotyrosine staining along the apico-lateral cell border was detected after IFNalpha treatment. CONCLUSIONS: These findings provide evidence that IFNalpha can directly affect barrier function in renal epithelial cells. The mechanisms involve enhanced tyrosine phosphorylation and overexpression and possibly displacement or missorting of the junctional proteins occludin and E-cadherin.

Effects of middle ear effusion on the vestibular system in children.

Vertigo and dizziness are not common in childhood, but are probably present more often than was formerly thought. These symptoms caused mainly by otitis media and middle ear effusion, two of the most common diseases in children, have been neglected for a long time, both in the literature and in practice, until recently. The purpose of this study was to determine objectively the incidence of balance-related symptoms in children with long-lasting middle ear effusion and to discover whether these symptoms resolve after the insertion of ventilation tubes. One hundred thirty-six children, ages 4 to 9 years, were given electronystagmographic tests and the Bruininks-Oseretsky tests for motor proficiency before and after tube ventilation of the middle ear. The results were compared with those in 74 healthy children with no history of middle ear diseases. Pathologic findings were found in 58% of the children with chronic middle ear effusion, as compared with only 4% of the control group. The symptoms and signs of balance disturbances resolved in 96% of the children after ventilation tube insertion. The results of this study indicate that balance-related symptoms often encountered in young children may result from chronic middle ear effusion and that these symptoms will resolve after evacuation of the effusion and ventilation of the middle ear.

Prophylactic treatment after ventilation tube insertion: comparison of various methods.

Otitis media is recognized as one of the most common diseases of childhood. Insertion of tympanostomy tubes for the treatment of otitis media is the most frequently performed otologic operation, and postoperative otorrhea is its most common complication. Many authors have suggested various reasons for posttympanostomy otorrhea, and many different prophylactic treatments were proposed in recent years to prevent this bothersome and frustrating complication. This retrospective study was designed to investigate and compare the efficacy of various prophylactic treatments and to define the most effective method of reducing the rate of postoperative otorrhea.