Does laryngopharyngeal reflux affect healing and recovery after tonsillectomy?

INTRODUCTION: Laryngopharyngeal reflux is increasingly being implicated in several otolaryngological disorders. AIMS: To study a potential correlation between pre-operative laryngopharyngeal reflux and wound healing and recovery after tonsillectomy, based on subjective and objective findings. MATERIALS AND METHODS: A prospective, blinded study was undertaken, including 60 patients scheduled for tonsillectomy, divided into two equal groups: a study group (group A) with pre-operative laryngopharyngeal reflux documented using ambulatory 24-hour pH monitoring; and a control group (group B) without laryngopharyngeal reflux. RESULTS: Group A had significantly higher pain scores on the seventh and 14th post-operative days (p = 0.022 and p = 0.000, respectively) and took a significantly longer time to return to normal eating (p = 0.013), compared with group B. Group A also showed significantly slower healing on the seventh and 14th post-operative days, as estimated by assessing the grade of post-operative slough formation (p = 0.016 and p = 0.029, respectively). A significant correlation between the number of pharyngeal reflux episodes and the degree of post-operative slough was also found. CONCLUSIONS: Laryngopharyngeal reflux can significantly decrease wound healing following tonsillectomy. Therefore, pre-operative recognition and management of this condition is desirable in order to eliminate its negative post-operative effect.

Coblation tonsillectomy: a prospective, double-blind, randomised, clinical and histopathological comparison with dissection-ligation, monopolar electrocautery and laser tonsillectomies.

INTRODUCTION: Coblation tonsillectomy is a relatively recently introduced surgical technique which attempts to bridge the gap between 'hot' and 'cold' tonsillectomy methods. AIM: To compare coblation tonsillectomy with three commonly used surgical techniques: cold dissection-ligation, monopolar electrocautery and CO2 laser. MATERIALS AND METHODS: A prospective, randomised, double-blinded clinical trial was undertaken of 60 adult patients divided into three equal study groups. Patients in each group were randomly assigned to have one tonsil removed with coblation and the second with one of the other three tonsillectomy techniques. Ten randomly selected tonsils resected by each method were sent for histopathological evaluation. RESULTS: Coblation was significantly faster to perform than laser and produced significantly less intra-operative blood loss than both the dissection-ligation and laser techniques. Subjective visual analogue scale comparisons showed a non-significant pain score difference between coblation and dissection-ligation on most post-operative days. Coblation produced consistently highly significantly (p < 0.001) less pain, compared with electrocautery up to the 12th post-operative day and laser up to the 10th post-operative day. There was no significant difference in tonsillar fossa healing, comparing coblation to both dissection-ligation and laser techniques. Monopolar electrocautery produced significantly slower healing than coblation after 7 post-operative days, with no significant difference after 15 post-operative days. Histopathological evaluation showed that coblation inflicted significantly less thermal tissue injury than either electrocautery (p = 0.001) or laser (p = 0.003). CONCLUSIONS: In adult patients, coblation tonsillectomy offers some significant advantages in terms of post-operative pain and healing, compared with other tonsillectomy techniques.

Helicobacter pylori infection and chronic, persistent cough: is there an association?

INTRODUCTION: Chronic, persistent cough is a common clinical problem, the cause of which sometimes remains unidentifiable. AIMS: To study a potential association between Helicobacter pylori infection and chronic, persistent cough. MATERIALS AND METHODS: A clinical observational study with symptom analysis, including 162 patients whose main presenting complaint was chronic, persistent cough of unidentifiable cause (study group) and 42 patients with chronic, non-specific laryngopharyngeal manifestations not including chronic cough (control group). RESULTS: Active H pylori infection was present in 86.4 per cent (140/162) of patients in the chronic cough group, as opposed to 45.2 per cent (19/42) of the control group, as confirmed by detection of H pylori antigen in stool specimens. This difference was statistically significant (p<0.001). There was a significant improvement of the chronic cough of 75.4 per cent (98/130) of patients after successful H pylori eradication using appropriate medical therapy (p<0.001). CONCLUSIONS: Helicobacter pylori infection may lead to laryngopharyngeal irritation, with several clinical manifestations including chronic, persistent cough. However, the exact mechanism of this requires further research.

Synthesis and biological evaluation of some pyrrolo[2,3-d]pyrimidines.

Pyrrolo[2,3-d]pyrimidine and tetrazolopyrimidine derivatives 2a, b-5a, b were prepared. Also, acyclic and cyclic C-nucleosides 7a, b-12a, b were prepared by treating compound 6 with some aldoses. All prepared products were tested for antiviral activity against hepatitis-A virus (HAV, MBB-cell culture adapted strain) and herpes simplex virus type-1 (HSV-1). Plaque reduction infectivity assay was used to determine virus count reduction as a result of treatment with tested compounds. Compound 2a showed the highest effect on HAV, while compound 11b showed the highest effect on the HSV-1 virus.

Pyrazolopyranopyrimidines as a class of anti-inflammatory agents.

Pyrazolopyranopyrimidines 6a-c and 8a-c were prepared from the reaction of compounds 4a-c or 7a-c with methylamine or ammonium hydroxide solutions. Treatment of compounds 6a-c or 8a-c with 2-chloroethyl methyl ether afforded their corresponding acyclonucleosides 9a-c or 10a-c, respectively, as a new class of acyclonucleosides. All prepared compounds were tested as anti-inflammatory agents and some of them revealed moderate to potent anti-inflammatory activity.

Synthesis and antimicrobial screening of some fused heterocyclic pyrroles.

Pyrrole derivatives 1a,b were used as precursors for the preparation of pyrrolo[2,3-d]pyrimidine derivatives 2a,b-7a,b. Also, the formation and structure of different pyrrolotriazolopyrimidine derivatives 8a,b-11a,b were discussed. Some of the prepared products showed potent antimicrobial activity.