Mycoplasma pneumoniae and Chlamydophila pneumoniae: a comparative study in patients with nasal polyposis and healthy controls.

INTRODUCTION: The role played by Mycoplasma pneumoniae and Chlamydophila pneumoniae in the pathogenesis of chronic rhinosinusitis with nasal polyps has been the object of ongoing debate. We used real-time polymerase chain reaction to investigate the prevalence of both microorganisms in the nasal tissue samples of patients and controls. METHODS: We extracted DNA from nasal polyp samples obtained during functional endoscopic sinus surgery and the inferior turbinate samples of controls undergoing septoplasty. We used the highly sensitive real-time polymerase chain reaction to detect the presence of M pneumoniae and C pneumoniae DNA. RESULTS: Patients with chronic rhinosinusitis with nasal polyps consisted of 62 individuals (39 men; mean age 51 years); the control group consisted of 24 individuals (13 men; mean age 45 years). All samples from both groups were negative for M pneumoniae and C pneumoniae DNA. CONCLUSION: We have demonstrated that the likelihood of M pneumoniae and C pneumoniae acting as an ongoing inflammatory stimulus in chronic rhinosinusitis with nasal polyps is slim.

Multiparametric comparison of cold knife tonsillectomy, radiofrequency excision and thermal welding tonsillectomy in children.

OBJECTIVE: This is a prospective study evaluating certain intraoperative and postoperative parameters, comparing the relatively new technique of thermal welding tonsillectomy with cold knife tonsillectomy, and radiofrequency excision in pediatric population. METHODS: Ninety children aged from 5 through 13 years were enrolled a randomized prospective trial comparing cold knife tonsillectomy, radiofrequency excision, and thermal welding tonsillectomy. Indications included recurrent acute tonsillitis and/or obstructive sleep apnea syndrome. All techniques were compared by means of length of surgery time, blood loss, postoperative bleeding and postoperative pain. RESULTS: Sixty-eight patients underwent tonsillectomy for obstructive sleep apnea, whereas 22 children underwent tonsillectomy due to recurrent acute tonsillitis. Median values of all variables tested, length of surgery time, blood loss, postoperative bleeding and postoperative pain, were found to differ significantly among the three surgical techniques (P<0.001). Particularly, a statistically significant higher median duration (P<0.001) and intraoperative blood loss (P<0.001), as well as, a statistically significant lower median pain score in each day tested (P<0.001) of the cold knife group, compared to each one of the other two groups, were found. Tissue welding and radiofrequency groups did not differ significantly in any aspect tested. CONCLUSIONS: Both thermal welding and radiofrequency excision techniques have shown comparable results regarding intraoperative blood loss, postoperative hemorrhage, and pain. Compared with cold knife tonsillectomy, welding and radiofrequency excision techniques were associated with less intraoperative blood loss and duration, though cold knife tonsillectomy seems to prevail over the two techniques in terms of the postoperative pain.

Subcutaneous benign fibrous histiocytoma of the cheek. Case report and review of the literature.

Fibrous histiocytoma is a benign tumour composed of a mixture of fibroblastic and histiocytic cells. Based on the location of this tumour, fibrous histiocytoma are usually divided into cutaneous types and those involving deep tissues. These lesions most often arise on the skin, but may rarely occur in soft deep tissues. The diagnosis of fibrous histiocytoma may be clinically difficult when the lesion is located in the deep tissues, and is frequently confirmed after local excision. The most important diagnostic distinction is the separation of this tumour from aggressive forms of fibrohistiocytic neoplasms, including dermatofibrosarcoma protuberans and malignant fibrous histiocytoma. A 19-year-old male presented with a painless swelling on the right cheek. Detailed clinical and laboratory examinations were performed. The lesion had been totally excised under local anaesthesia, and histopathology revealed a benign fibrous histiocytoma. The diagnosis, location, treatment and prognosis of fibrous histiocytoma are also discussed.

Brushing cytology in cutaneous lesions of the head and neck.

BACKGROUND: Brushing cytology is a well established diagnostic procedure used by gynaecologists, physicians and surgeons to obtain representative samples from lesions. Our aim was to evaluate its reliability in ulcerative and tumour-like conditions arising in the skin of the head and neck. METHODS: Over 28 months, 86 patients with suspected cutaneous malignant lesions underwent a cytological examination with a cytobrush within the otolaryngology department. RESULTS: Cytological analysis identified 63 out of 64 histologically documented malignant tumours (60 primary basal cell and squamous cell carcinomas and three metastatic adenocarcinomas), and 21 out of 22 benign lesions. There was one false positive and one false negative result. CONCLUSIONS: Brushing cytology of suspected cutaneous malignant lesions is a rapid and reliable diagnostic method which helps the clinician to decide on appropriate planning and treatment. The technique can be performed as an out-patient procedure, and smear preparation can be done in the laboratory, even at a peripheral hospital.

Intramuscular haemangioma of the orbicularis oculi muscle of the orbit.

Intramuscular haemangiomas are uncommon, benign tumours frequently arising in the trunk and extremities. When they appear in the head and neck, the most frequent sites are the trapezius and the masseter muscles, rarely other sites. The case is reported of an intramuscular haemangioma with an unusual location in the orbital part of the orbicularis oculi muscle of a 54-year-old female. Clinical, radiological and histological findings as well as the treatment approach are discussed.

The combined endoscopic CO(2) laser posterior cordectomy and total arytenoidectomy for treatment of bilateral vocal cord paralysis.

Upper airway obstruction, because of bilateral vocal cord paralysis, presents a serious challenge to the Otolaryngologist. Various surgical techniques have been advocated for the management of patients with vocal cord paralysis. Among these techniques, the individual use of laser CO(2) arytenoidectomy and posterior cordotomy has gained wide acceptance. In this report, we describe our experience in the management of bilateral vocal cord paralysis by combining posterior partial cordotomy as described by Dennis and Kashima, with total arytenoidectomy as described by Ossoff et al. We report the long-term results in the management of 18 patients treated in our department during the last 8 years.

Frontal lobe abscess secondary to head trauma and nasal polyposis.

Cerebral frontal lobe abscess may be a frequent intracranial complication of paranasal sinusitis. An unusual case of cerebral abscess complicating massive polyposis is described in a patient with history of previous severe head trauma 30 years ago. Imaging evaluation using both computed tomography and magnetic resonance imaging is important to diagnose such rare entities.

The challenge of esophagoscopy in infants with open safety pin in the esophagus: report of two cases.

Among all foreign bodies impacted at the esophagus, the safety pin still seems to be a challenge for the specialist. This is a report of 2 cases presenting infants with open safety pin impacted in the esophagus. The strategy and intraoperative management of this rare finding is discussed in detail.

Bronchoscopy for foreign body removal in children. A review and analysis of 210 cases.

OBJECTIVE: A foreign body aspiration in the tracheobronchial tree is a dangerous and common medical emergency in childhood, with serious and potentially lethal consequences. It must be suspected in children with a suggestive history, even though the clinical symptoms or radiographic findings are not pathognomonic for foreign body aspiration. METHODS: In this study 210 pediatric cases, with a suggestive history of foreign body aspiration undergoing bronchoscopy in the last 8 years in the department, were reviewed. In all cases bronchoscopy was performed under general anesthesia using a Storz ventilation bronchoscope with distal cold light illumination. RESULTS: In 130 patients a foreign body was discovered, in 17 cases pus was aspirated and in 63 cases there were no findings. Seventy-eight (60%) foreign bodies were found in the right main bronchus, 43 (33.1%) in left main bronchus, seven (5.4%) in both bronchi and two (1.5%) were found in the subglottic area. The incidence of bronchoscopy during the last 8 years was 28 procedures per 100000 children population per year in the island of Crete. CONCLUSION: More attention should be given to the need for a careful history and the use of radiographs as supplemental information to make the decision to perform a bronchoscopy. The parents, also, should pay attention not to allow children dry fruits and small toys, as well as, teaching their children to avoid any physical or emotional activity while having a full mouth.

Angiosarcoma of the maxillary sinus.

Angiosarcomas are rapidly growing malignant neoplasms arising from the vascular endothelial cells. Most common sites are the extremities and the retroperitoneal space, with only four per cent of angiosarcomas arising in the head and neck area, whilst the paranasal sinuses are one of the rarest locations. We report the case of a maxillary sinus angiosarcoma in a 72-year-old male patient. The first biopsy was inconclusive, whereas the second revealed an angiosarcoma. Medial maxillectomy was performed with subsequent external irradiation.

Fibrous dysplasia of the temporal bone: report of a case and a review of its characteristics.

Fibrous dysplasia is an uncommon benign disorder of unknown etiology. It represents a disturbance of normal bone development--specifically a defect in osteoblastic differentiation and maturation that originates in the mesenchymal precursor of the bone. Because fibrous dysplasia shows a predilection for the facial and cranial bones, where it causes deformity and dysfunction, the disease is of particular interest to the otolaryngologist. In this paper, we report a case of fibrous dysplasia of the temporal bone, the first symptom of which was a mixed hearing loss. We discuss the characteristic features of this specific location of the disease, the differential diagnosis, and the treatment policy. We also address the issue of secondary sensorineural hearing loss.

Combined irinotecan, docetaxel and conventionally fractionated radiotherapy in locally advanced head and neck cancer. A phase I dose escalation study.

Both docetaxel and irinotecan have shown strong radiosensitizing properties in vitro. Encouraging results have been reported by phase I/II studies on combined docetaxel or irinotecan with radiotherapy. In the present study we investigated the feasibility of double radiosensitization with weekly docetaxel and irinotecan in head and neck cancer. Twelve patients with locally advanced squamous cell head and neck cancer were recruited in a phase I/II dose escalation protocol. Radiotherapy was given as a standard fractionation regimen (2 Gy/day, 5 fractions/week) to a total dose of 66-70 Gy. Three Docetaxel/Irinotecan dose levels were examined thus, 20/25 mg/m2 (level 1), 20/40 mg/m2 (level 2) and, 25/55 mg/m2 (level 3). Severe asthenia was observed in 1/4 patients treated in the 2nd dose level and in all 4 patients treated in the 3rd. The onset of severe asthenia was associated with the onset of severe grade 3/4 mucositis during the 4th week of treatment. Radiation induced mucositis was accompanied by fungal infection in all 5 patients. The symptomatology persisted for 10-14 days. Mild grade 2 mucositis was observed in 7/8 patients treated at the 1st and 2nd dose level, which enforced treatment delay for 3-5 days. Neutrophil toxicity was minimal. There was only one patient treated at the 3rd dose level that presented with grade 2 neutropenia. Hemoglobin toxicity was also minimal, showing a median drop of 1.2 gr/dL. There was no platelet toxicity observed. Complete response was observed in 9/12 (75%) patients and partial response was observed in 3/12 patients. Of interest, the lowest CR rate was observed in the 3rd dose level (2/4; 50%), which may be a consequence of overall treatment time prolongation. It is concluded that docetaxel and irinotecan combination with radiotherapy is feasible and, a high CR rate can be expected. Combination of the regimen with cytoprotective agents warrant further investigation.

Negative pressure suction in nasal septum surgery.

Operations for the correction of septal deviations are among the most common in otorhinolaryngology. Several approaches and techniques have been proposed, for securing the mucoperichondrial flap back in place. A new method of stabilizing the septum by applying a negative pressure suction tube, without the insertion of any kind of packing, is described. The advantages of the negative pressure suction are that the patient can breathe through the nose immediately after the operation, there is no pressure sensation and the pain, if any, is reduced, there is no epiphora, no skin edema and the patient feels very comfortable. Risks for complications are minimal.

Mucocele of the maxillary antrum in an eight-year-old boy.

Mucocele is a rare clinical entity in children. It is considered to be associated with fibrocystic disease. The capacity of mucocele to erode through the bone walls along with the increased density of its content, make the diagnosis difficult when mucocele has to be differentiated from benign or malignant tumors. In this paper, we present the case of an 8-year-old boy with mucocele of the left maxillary antrum. Both the differential diagnosis and the surgical treatment are described.

Swiftlase inferior turbinoplasty.

The hypertrophied inferior turbinates are responsible for nasal obstruction in patients with chronic rhinitis. Several methods have been applied to solve this problem. Recently, laser methods have produced good results. We present the management of 387 patients with hypertrophy of the inferior turbinates mucosa, using CO2 laser in combination with the Swiftlase apparatus. CO2 laser energy delivered through the Swiftlase apparatus provides a char-free ablation of a superficial tissue layer. Swiftlase is easily installed onto the existing CO2 laser units and provides a high-power density. The 1-year postoperative follow-up revealed good results in 261 (81%) of 321 patients, thus establishing CO2 laser in combination with the Swiftlase apparatus as a promising new approach for the management of inferior turbinate hypertrophy. CO2 laser energy delivered through the Swiftlase apparatus offers a treatment modality capable of achieving excellent results in hypertrophy of the inferior turbinates with minimal morbidity.

Meningitis as a complication of tonsillectomy.

Adenotonsillar surgery remains among the most commonly-performed pediatric surgical procedures. The complication rate of tonsillectomy is generally considered to be in a range of 1-5%. Bacterial meningitis following adenotonsillectomy is a rarely reported complication. Bacterial meningitis is a potentially fatal acute infectious disease caused by a variety of micro-organisms. Current case fatality rates associated with this entity can be as low as 2% in infants and children and as high as 30% in neonates. The successful management of meningitis depends on early clinical suspicion and diagnosis, with prompt medical treatment using high-dose, broad-spectrum antibiotics that adequately cross the blood-brain barrier. We present a case of meningitis complicating a tonsillectomy procedure, in a 7-year-old girl. The diagnosis and treatment of this rare complication is illustrated, and the possible etiology is discussed.