Role of thuja in the management of laryngeal papilloma.

Juvenile respiratory laryngeal papillomatosis is a subset of a larger clinical entity of recurrent respiratory papillomatosis. It is characterised by the development of recurrent papillomata in the vocal folds. Human papillomavirus types 6 and 11 has been implicated to be the most common strain of virus associated with the formation of laryngeal papilloma. Clinical diagnosis is based on typical appearance of warty lesion on endoscopy. Surgery is the primary line of management along with adjuvant therapy like antiviral drugs and immunomodulators. Thuja occidentalis is a tree native to North America whose leaves and leaf oil have antiviral, antibacterial and antifungal properties. It has been widely used for the treatment of condylomatous skin lesions and warts. Here we discuss the outcome of thuja as an adjuvant therapy in the treatment of laryngeal papillomatosis in an 8-year-old child.

Herpesvirus associated dermal papillomatosis in Williams' mud turtle Pelusios williamsi with effects of autogenous vaccine therapy.

An adult female of Williams' mud turtle, Pelusios williamsi long-term captive, that was allegedly caught wild in Kenya was found to have developed papilloma-like skin lesions. Excised tumors were examined histologically after routine processing with hematoxylin and eosin (H & E) stained slides, examined for the presence of viral particles by electron microscopy employing negative staining, and examined for the presence of viral DNA by PCR. Microscopic features in pre-treatment biopsies were fully diagnostic and consistent with multifocal squamous cell papilloma. Viral-type inclusion bodies were not identified. Turtle was found to be infected by reptilian herpesvirus. Association with herpesvirus and vast multiplicity of tumors thwarted surgical solution. An autogenous vaccine was prepared using 5 g of excised fresh tissue, aseptically ground, treated with diluted formalin, centrifuged to obtain a supernatant, and subsequently exposed to UV light. Autogenous vaccine induced substantial areas of necrosis of the papillomatous lesions noted by the loss of cytological architecture, nuclear loss, and by edema. The outer edges of the healing biopsies appeared to be regenerating. Therefore, our vaccine application could be considered as effective. It is difficult to treat and eliminate herpesvirus infection because of its cryptic presence and sudden onset of disease. Successful application of autogenous vaccine could be a potentially promising strategy, which deserves further testing.

Retrospective analysis of laser vs other therapeutic modalities for laryngeal papillomatosis: European multicenter study.

PURPOSE: Laryngeal papillomatosis can be an aggressive and potentially life-threatening disease, affecting both children and adults. Local excision is the gold standard of treatment, but recurrences are frequently inevitable. The purpose of this study was to present the experience of three institutions with different therapeutic modalities and discuss them in relation with the relevant literature. METHODS: Sixty patients underwent papilloma resection during the last decade in three institutions (Homburg/Saar and Marburg, Germany and Athens,Greece). Patient data were retrospectively analyzed for therapeutic modalities applied, rate of complications and synechia formation, necessary operations and need for tracheostomy. RESULTS: Carbon dioxide laser therapy was the most common modality applied alone or combined with other treatment modalities. No major complication was observed, while glottic synechia was the most common minor complication in 5 (8.3%) patients. Of the patient cohort 55.6% required reoperation, while no patient required tracheostomy. CONCLUSIONS: Surgical debulking with or without adjuvant treatment remains the mainstay of treatment, which mainly aims to reduce the number and frequency of recurrences since no definitive curative therapy is known so far.

[Laryngeal papillomatosis: problem update].

The objective of the present overview was to analyse the available data on etiology, pathogenesis, diagnostics, and treatment of laryngeal papillomatosis. It is shown that the pathogenetic mechanism underlying the development of this pathology is related to cell proliferation mechanisms. The human papilloma virus is most effectively identified by the polymerase chain reaction technique in combination with in situ hybridization. It is expected that new and more informative criteria for diagnostics, treatment,and prognosis of laryngeal papillomatosis will be proposed based on recent progress in molecular biology, morphology,and immunology. Different variants of the therapeutic strategy for the treatment of laryngeal papillomatosis are described.Modern practice of the management of laryngeal papillomatosis takes advantage of the three main approaches and/or their combination. First, further improvement of surgical techniques, such as the application of endoscopic devices and surgical lasers.Second, the search for new pharmaceutical agents (indole-3-carbinol, cidofovir, antiviral medicines, etc.) most frequently used for adjuvant therapy. Third, the development of new vaccination methods. Besides these three approaches, photodynamic therapy and the use of ionizing radiation are currently being studied as the tools for the treatment of extensive and recurrent laryngeal papillomatosis as well as the methods of laser-induced interstitial thermotherapy.

Successful endoscopic procedures for intraductal papillary neoplasm of the bile duct: a case report.

Attention has recently been focused on biliary papillary tumors as the novel disease entity intraductal papillary neoplasm of the bile duct (IPNB), which consists of papillary proliferation of dysplastic biliary epithelium. As even benign papillary tumors are considered as premalignant, some investigators recommend aggressive surgical therapy for IPNB, although no guidelines are available to manage this disease. Few reports have described long-term follow-up of patients with benign IPNB without radical resection. If patients with IPNB who are treated only with endoscopic procedures are noted, clinical profiles and alternative therapies other than resection may be recommended. We report the case of a patient who experienced repetitive cholangitis for 10 years and was finally diagnosed with IPNB. Radical resection could not be recommended because of the age of the patient, therefore, endoscopic sphincterotomy was performed. Although an endoscopic retrograde biliary drainage catheter was placed several times for repetitive cholangitis, the patient has done well during follow-up. Our case may offer insights into the natural course and management decisions for the novel disease entity of IPNB.

[Laryngeal papillomatosis treated with CO2 laser]. / Larynxpapillomer behandlet med CO2-laser.

INTRODUCTION: Review of "respiratory papillomatosis" (RRP) treatment with CO2 laser at Rigshospitalet. MATERIAL AND METHODS: Retrospective study covering the period from 2000 to 2007. RESULTS: A total of 138 surgical procedures was performed in 44 patients, 11 with "juvenile onset of RRP" (JORRP), 33 with "adult onset of RRP" (AORRP). The male/female ratio was 35/19. Mean age at onset was 5.5 years for JORRP and 41.6 years for AORRP. Annually, 3.4 new patients were seen. The average annual number of procedures was 0.6 for JORRP and 0.3 for AORRP, all performed in general anaesthesia, and using jet ventilation in 42%. CO2 laser was used in 94% of cases. No adjuvant treatment was used. Clinical remission was achieved after 1-2 procedures in 19/44 patients while the remaining patients recurred repeatedly and required surgery. Pulmonary papillomatosis was not observed. Voice quality was good or acceptable in patients in remission. HPV screening of 11 patients showed eight with HPV-6, two with HPV-11 and one with HPV6-11 and 62. CONCLUSION: JORRP patients required surgery twice as often as AORRP patients partly due to the small dimensions of the juvenile larynx. Jet ventilation with a metal tube opening below the vocal cords and CO2-laser is recommended for routine use. National guidelines in RRP concerning diagnosis, treatment and follow-up are needed. RRP is a rare disease and centralisation is required to achieve experience with diagnostics and treatment.

Microlaryngoscopic and office-based injection of bevacizumab (Avastin) to enhance 532-nm pulsed KTP laser treatment of glottal papillomatosis.

OBJECTIVES: Photoangiolytic lasers effectively treat glottal papillomatosis, but do not reliably prevent recurrence. Therefore, sublesional injections of the antiangiogenic agent bevacizumab (Avastin) were given to assess the effect on disease recurrence and phonatory function. METHODS: A retrospective investigation was done in a pilot group of 10 adult patients with bilateral glottal papillomatosis who had prior angiolytic laser treatment with established patterns of recurrence. The patients underwent 5 bevacizumab injections (5 to 10 mg) into the diseased vocal folds along with 532-nm pulsed KTP laser photoangiolysis treatments 4 to 6 weeks apart. Their disease resolution was compared to findings from prior laser treatment alone, and objective measures of vocal function (acoustic, aerodynamic, Voice-Related Quality of Life survey) were obtained. RESULTS: All 10 patients had a greater than 90% reduction in recurrence. Four of the 10 had resolution. Four of the 10 have limited recurrent or persistent disease, receive injections of bevacizumab at 8- to 12-week intervals, and have not required laser treatment. Two of the 10 have ongoing periodic office-based KTP laser treatment along with bevacizumab injections. No patient has required microlaryngeal surgery with general anesthesia, and all 10 have had substantial improvement in vocal function. CONCLUSIONS: This pilot investigation provides preliminary evidence that bevacizumab injections enhance photoangiolytic laser treatment of glottal papillomatosis while enhancing phonatory function. Coupling an antiangiogenesis agent with pulsed KTP laser photoangiolysis is conceptually promising, since the mechanisms of action are complementary.

Recurrent respiratory papillomatosis: a review.

Recurrent respiratory papillomatosis (RRP), which is caused by human papillomavirus types 6 and 11, is the most common benign neoplasm of the larynx among children and the second most frequent cause of childhood hoarseness. After changes in voice, stridor is the second most common symptom, first inspiratory and then biphasic. Less common presenting symptoms include chronic cough, recurrent pneumonia, failure to thrive, dyspnea, dysphagia, or acute respiratory distress, especially in infants with an upper respiratory tract infection. Differential diagnoses include asthma, croup, allergies, vocal nodules, or bronchitis. Reports estimate the incidence of RRP in the United States at 4.3 per 100,000 children and 1.8 per 100,000 adults. Infection in children has been associated with vertical transmission during vaginal delivery from an infected mother. Younger age at diagnosis is associated with more aggressive disease and the need for more frequent surgical procedures to decrease the airway burden. When surgical therapy is needed more frequently than four times in 12 months or there is evidence of RRP outside the larynx, adjuvant medical therapy should be considered. Adjuvant therapies that have been investigated include dietary supplements, control of extra-esophageal reflux disease, potent antiviral and chemotherapeutic agents, and photodynamic therapies; although several have shown promise, none to date has "cured" RRP, and some may have serious side effects. Because RRP, although histologically benign, is so difficult to control and can cause severe morbidity and death, better therapies are needed. The potential for a quadrivalent human papilloma vaccine is being explored to reduce the incidence of this disease.

Papiloma bucal: relato de um caso clínico / Oral papilloma: a clinical case report

Os autores apresentam um caso clínico de papiloma bucal na mucosa labial inferior, de um paciente infantil, ressaltando suas características clínicas, histopatológicas e importância do correto diagnóstico para uma adequada abordagem cirúrgica.

Papilomatosis reticulada y confluente (Gougerot-Carteaud): respuesta terapéutica a sulfuro de selenio y revisión / Reticulated and confluent papillomatosis (Gougerot-Carteaud): response to selenium sulfide

La papilomatosis reticulada y confluente (Gougerot-Carteaud) es una entidad poco frecuente que se carateriza por la presencia de papulas pardas queratósicas que coalescen formando placas de aspecto reticulado en la periferia, cuyas localizaciones mas frecuentes son nuca, axilas, tronco anterior y zona intermamaria. Presentamos un caso que respondió favorablemente al tratamiento con sulfuro de selenio. Se realiza una revisión del tema (AU)

[Diagnosis and treatment of juvenile recurrent laryngeal papillomatosis].

OBJECTIVE: To evaluate some perplexing problems in the diagnosis and treatment of juvenil recurrent laryngeal papillomatosis (JRLP) and the relationship between juvenile onset recurrent respiratory papillomatosis(JORRP) and infantile laryngeal condyloma accuminatum (ILCA). METHODS: A group of 44 cases with JRLP were analyzed retrospectively from March, 1994 to March, 2002 in the light of literature review. RESULTS: The average age of first visit was 1.6 years. Average 5.3 operations had been performed per patient. There was an interval of average 2.4 months between two surgical excisions. Of 233 operations, the total incidence rate of all the complications was 3.9%. At present, the laryngeal lesion of 18 cases have withered away for over 1 year. 11 cases have being followed up. 10 cases have lost follow-up and 5 cases have died (11.4%). Combined laryngeal lesion excision with tracheotomy aiming at prolonging operative interval or Chinese traditional medicine has received more satisfactory effect than other therapies. There is an extensive similarity between JORRP and ILCA. CONCLUSIONS: To demondrate further whether JORRP and ILCA are the same identical disease has important significance in both theoretical study and clinic practice. The treatment for JRLP is still difficult. The tracheotomy for laryngeal obstruction resulted from the laryngeal lesion of JRLP should be avoided as far as possible. Combined laryngeal lesion excision with tracheotomy aiming at prolonging opertive interval or Chinese traditional medicine shows optimistic prospect.

NEVIL del adulto con hiperplasia papilomatosa multifocal / Adult onset ILVEN with multifocal papillomatous hyperplasia

Los nervios epidérmicos verrugosos son lesiones hamartomatosas que se diferencian esencialmente hacia queratinocitos epidérmicos. Ciertas características clínicas e histopatológicas han permitido la individualización del llamado nevo epidérmico verrugoso inflamatorio lineal (NEVIL). Un varón de 42 años presentaba en la extremidad inferior derecha una dermatosis eritematosa y queratósica que se extendía longitudinalmente siguiendo el trayecto de las líneas de Blaschko. En el seno de la previa dermatosis desarrolló en los últimos años varias lesiones tumorales exofíticas cuyo estudio histológico reveló únicamente una intensa papilomatosis de naturaleza benigna. Describimos el ejemplo de un nevo epidérmico verrugoso inflamatorio lineal que en la edad adulta desarrolló múltiples proliferaciones vegetantes de carácter puramente hiperplásico (AU)

Pseudopapiloma irritativo o por succión / Irritation or suction papilloma

El propósito de este trabajo es presentar un caso clínico de pseudopapiloma por irritación o de succión en un niño de siete años de edad, diagnosticado y tratado en la Asignatura de Odontología Integral Niños de la F.O.L.P. El pseudopapiloma irritativo es una lesión gingival exofítica común en la cavidad bucal, desarrollándose como respuesta a la estimulación constante a la que está sometida la mucosa bucal. En nuestro caso clínico, el niño presentaba un espacio producido por la falta de erupción del incisivo lateral inferior permanente, convirtiéndose en el motivo desencadenante del tumor, ya que el paciente realizaba una succión constante a través del espacio interdental. Luego de la motivación se realizó la exéresis de la masa tumoral sin margen de seguridad, obteniendo buenos resultados a corto y a largo plazo

Pseudopapiloma irritativo o por succión / Irritation or suction papilloma

El propósito de este trabajo es presentar un caso clínico de pseudopapiloma por irritación o de succión en un niño de siete años de edad, diagnosticado y tratado en la Asignatura de Odontología Integral Niños de la F.O.L.P. El pseudopapiloma irritativo es una lesión gingival exofítica común en la cavidad bucal, desarrollándose como respuesta a la estimulación constante a la que está sometida la mucosa bucal. En nuestro caso clínico, el niño presentaba un espacio producido por la falta de erupción del incisivo lateral inferior permanente, convirtiéndose en el motivo desencadenante del tumor, ya que el paciente realizaba una succión constante a través del espacio interdental. Luego de la motivación se realizó la exéresis de la masa tumoral sin margen de seguridad, obteniendo buenos resultados a corto y a largo plazo (AU)

Tratamiento de la infección genital por virus del papiloma humano durante la gestación / Treatmentof genital infections by human papiloma virus during pregnancy

La infección genital por Virus del Papiloma Humano (VPH) puede afectar mujeres, varones e incluso estos. En algunos sitios es incluso la enfermedad de transmisión sexual más frecuente. En las últimas dos décadas ha tomado crecimiento importancia por la posibilidad de afectar al bebé a su paso por el canal del parto infectado provocándole Papilomatosis Laríngea Juvenil así como lesiones virales en conjuntiva e incluso en genitales. Se ha propuesto que la realización de operación cesárea evita dicho riesgo. Información reciente muestra que este abordaje no solo es insuficiente, sino que es exagerado en la mayoría de los casos. Se propone como alternativa efectuar un abordaje integral que incluya realización de colposcopía y biopsia de las lesiones sospechosas, seguido de tratamiento de las zonas infectadas y seguimiento estrecho. Los recursos terápeuticos más valiosos con la crioterapia, laser, electrocauterio y ácido tricoloroacético. La realización de operación cesárea se limitaría entonces a los casos refractarios a tratamiento, aquellos diagnosticados tardíamente o en los que las lesiones voluminosas provoquen distocia. El manejo debe inclir valoración diagnóstica de la(s) pareja(s) sexual(es) de la mujer así como del neonato, con tratamiento subsecuente -de ser necesario- según el caso

Detección de infección por HPV en el hombre a través de la genitoscopia / Detection of HPV infection in men with genitoscopy

Se comunica los resultados del examen mediante genitoscopia de 64 varones sin lesiones clínicas, cuyas parejas sexuales tenían condilomas o CIN I, II o III. En 29 de ellos se observaron lesiones acetopositivas, que fueron confirmadas por histopatologías, como producidas por HPV. La citología, efectuada en 15 pacientes, no permitió confirmar lesiones por HPV. Se destaca la utilidad de la genitoscopia, técnica sencilla y de muy bajo costo, para el control y seguimiento de las parejas infectadas por HPV

Detección de infección por HPV en el hombre a través de la genitoscopia / Detection of HPV infection in men with genitoscopy

Se comunica los resultados del examen mediante genitoscopia de 64 varones sin lesiones clínicas, cuyas parejas sexuales tenían condilomas o CIN I, II o III. En 29 de ellos se observaron lesiones acetopositivas, que fueron confirmadas por histopatologías, como producidas por HPV. La citología, efectuada en 15 pacientes, no permitió confirmar lesiones por HPV. Se destaca la utilidad de la genitoscopia, técnica sencilla y de muy bajo costo, para el control y seguimiento de las parejas infectadas por HPV

Laryngeal papilloma: results of treatment with the CO2 laser and podophyllum.

From 1976 to 1982, 109 patients with recurrent laryngeal papillomas were treated with a total of 548 CO2 laser excisions followed by podophyllum painting. There was high incidence of multiple sites of involvement, especially the tracheobronchial tree (18.3%) and palate (8.3%). Four patients had pulmonary parenchymal involvement. Patients were treated at 2-month intervals until they entered remission. Thereafter, microdirect laryngoscopies were advised at longer intervals. Remission was achieved in 41%; it occurred at all ages although it was most common during adolescence and rarest in the very young and very old. Many patients obtained remission with the CO2 laser after multiple prior cup forceps removals had not achieved remission. Only two tracheotomies (1.8%) were required and no deaths occurred. When compared with mechanical methods of papilloma removal, CO2 laser excision with podophyllum painting represents a clear advance in terms of preservation of laryngeal physiology and avoidance of life-threatening complications.