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1.
Int J Pediatr Otorhinolaryngol ; 150: 110893, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34438187

RESUMO

BACKGROUND: Neck-related chief complaints are common in the pediatric Emergency Department (ED), and although the incidence of pathology such as retropharyngeal abscesses is rare, the ability to rule out abscesses requiring surgical/procedural intervention is essential. However, there are no clear clinical guidelines regarding work-up and diagnosis in this population, possibly contributing to an excess use of potentially harmful and costly computed tomography (CT) imaging. OBJECTIVE: In this study we sought to identify historical, physical exam, and laboratory findings associated with surgically significant neck abscesses to better delineate CT neck imaging criteria. METHODS: We conducted a retrospective chart review of all patients ≤18 years presenting to a pediatric ED between 2013 and 2017 who underwent CT neck imaging. Surgically significant abscesses (SSAs) were defined as abscesses ≥2 cm, retropharyngeal abscesses (RPA), parapharyngeal abscesses (PPA), or peritonsillar abscesses (PTA). Historical factors, physical exam findings, laboratory results, demographics, and CT results were analyzed using univariate statistical analysis and regression models. RESULTS: A total of 718 patients received neck CTs and 153 SSAs were identified. In children younger than 6 years, factors associated with statistically significant increased odds of an SSA were reported throat pain (OR 1.18; 95% CI 1.05, 1.33), fussiness (OR 1.18; 1.01, 1.39), lethargy (OR 1.43; 1.07, 1.91), tonsillar enlargement (OR 1.17; 1.02, 1.34), C-reactive protein (CRP) > 10 (OR 1.22; 1.07, 1.40), and an ED visit within the preceding week (OR 1.18; 1.04, 1.33). In children older than 6 years, the factors associated with statistically significant increased odds of an SSA included current antibiotic use (OR 1.12; 1.02, 1.22) and a CRP >10 (OR 1.14; 1.03, 1.26). CONCLUSION: Some historical, physical exam, and laboratory findings are associated with SSAs, and while not definitive in isolation, may be beneficial additions to routine SSA assessment, as a supplement to clinical judgement regarding CT and observation decisions. This may potentially allow for the identification of patients requiring CT versus those who may not, and thus the opportunity to safely reduce the use of CT imaging in select patients.


Assuntos
Abscesso Peritonsilar , Abscesso Retrofaríngeo , Criança , Humanos , Pescoço/diagnóstico por imagem , Abscesso Retrofaríngeo/diagnóstico por imagem , Abscesso Retrofaríngeo/epidemiologia , Abscesso Retrofaríngeo/cirurgia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
2.
Open Forum Infect Dis ; 8(6): ofab165, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34113683

RESUMO

Background: Mycobacterium species, specifically M. abscessus and M. chelonae (MABs), are known to contaminate water systems and are uncommon causes of health care-associated infection, but morbidity can be significant and treatment complex. Methods: Odontogenic MAB infections occurred in patients following pulpotomy procedures at dental clinic A from 1 January to 6 September 2016. We identified confirmed and probable cases using culture data, imaging, pathology results, and surgical findings. Epidemiologic and clinical data including demographics, symptoms, laboratory findings, treatment regimens, and outcomes were extracted. Results: Of 1082 at-risk patients, 71 case patients (22 confirmed; 49 probable) were identified. Median age was 6 years. Median symptom onset was 85 days postpulpotomy. Pain and/or swelling on admission occurred in 79%. On imaging, 49 of 70 had abnormalities of the mandible or maxilla, 13 of 70 had lymphadenopathy, and 19 of 68 had pulmonary nodules. Seventy were hospitalized (average of 8.5 days). Intravenous antibiotics were administered to 32 cases for a median length of 137 days. Clofazimine was administered to 29 patients as part of their multidrug regimen. Antibiotic treatment was associated with many adverse effects. Treated children showed evidence of jaw healing with resolved/improving pulmonary nodules at 1-year follow-up. Conclusions: This is the largest outbreak of invasive MAB infections associated with a pediatric dental practice. While infections were indolent, patients suffered medical and surgical consequences of treatment, including permanent tooth loss. Identification of this outbreak led to a change in water standards for pediatric dental procedures in California. Enhanced national dental water quality standards are needed to prevent future outbreaks.

3.
Int J Pediatr Otorhinolaryngol ; 144: 110685, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33819896

RESUMO

BACKGROUND: Choking injuries are a significant cause of morbidity and mortality in children and represent a significant public health concern. Evaluating trends and the impact of interventions are essential to highlight whether progress has been made and to target public health efforts. OBJECTIVE: To investigate how rates of nonfatal and fatal choking injuries have changed before and after 2010 when policy recommendations were made by the American Academy of Pediatrics. METHODS: A descriptive study investigating unintentional nonfatal and fatal choking injuries in children aged 0-19 years using national data from 2001 to 2016 through the Centers for Disease Control and Prevention's WISQARS™ and WONDER databases, focusing on the 6 years prior and 6 years after release of the AAP's recommendations. The data was categorized by age, gender, year, and race/ethnicity for descriptive and statistical analyses. RESULTS: From 2001 to 2016, there were a total of 305,814 nonfatal injuries and 2347 choking deaths in children from 0 to 19 years. Children under five years of age accounted for 73% of nonfatal injuries and 75% of choking fatalities. There was a statistically significant increase in the nonfatal injuries rate when comparing 2005-2010 and 2011-2016 (19/100,000 versus 26/100,000, respectively). There was a decrease in the choking fatalities rate in all children (0.18/100,000 versus 0.16/100,000, respectively) but no change in fatalities rate for children under five. White and Black children experience nonfatal choking injuries at a higher rate than Hispanics. Black children had highest rates of choking fatalities over Hispanic, White, Asian, and Alaskan or American Indian ethnicities. The lowest rates of death occurred in Asians. CONCLUSIONS: Overall rate of nonfatal choking injuries increased, while rate of choking fatalities in children decreased after 2010. However, the choking fatalities rate in 0-4 years olds, the highest risk group, did not change. Racial gaps exist with highest rates of injury in Black children. We must continue to educate and raise awareness of choking injuries, with targeted efforts to address racial disparities.


Assuntos
Obstrução das Vias Respiratórias , Ferimentos e Lesões , Afro-Americanos , Obstrução das Vias Respiratórias/epidemiologia , Criança , Pré-Escolar , Humanos , Estados Unidos/epidemiologia
4.
Int J Pediatr Otorhinolaryngol ; 143: 110639, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33556848

RESUMO

OBJECTIVES: Previous studies on pediatric thyroid surgical complications suggest that high-volume centers achieve improved outcomes. We hypothesize that initial outcomes from a nascent pediatric surgical practice may be comparable to higher volume centers. Furthermore, we determine whether a low-volume center can safely transition to an intermediate or high-volume center. METHODS: A retrospective chart review was performed for all pediatric patients undergoing thyroid surgery at a single institution from 2014 to 2020. Surgeries were performed by two pediatric otolaryngologists. All patients were managed postoperatively by a multidisciplinary team of physicians that included pediatric otolaryngologists and endocrinologists. Data collection focused on patient demographics and postoperative complications, including rates of recurrent laryngeal nerve injury and permanent hypoparathyroidism. RESULTS: From 2014 to 2020, a total of 31 patients underwent thyroid surgery at our pediatric thyroid surgery center, 9 of whom underwent neck dissection. The mean age of our cohort was 14.4 ± 3.9 years (range 8 months-20 years). Postoperative pathology results revealed that 15 patients (46.9%) were diagnosed with PTC, 6 (18.8%) with follicular adenoma, and 4 (15.6%) with benign thyroid tissue. One (2.0%) patient had permanent unilateral recurrent laryngeal nerve paralysis and one patient experienced permanent hypoparathyroidism (2.7%). CONCLUSIONS: Our initial low complication rate as a nascent pediatric thyroid surgery center suggests that favorable outcomes can be achieved at lower volume surgery centers. In order to increase patient access to high-volume pediatric thyroid surgery centers, new centers must start with lower volumes before ultimately becoming high-volume centers. Our study shows that this can be safely achieved. LEVEL OF EVIDENCE: IV.


Assuntos
Glândula Tireoide , Adolescente , Criança , Pré-Escolar , Humanos , Lactente , Esvaziamento Cervical , Complicações Pós-Operatórias/epidemiologia , Traumatismos do Nervo Laríngeo Recorrente , Estudos Retrospectivos , Glândula Tireoide/cirurgia , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia/efeitos adversos , Adulto Jovem
5.
Laryngoscope ; 131 Suppl 2: S1-S9, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32969500

RESUMO

OBJECTIVES: 1) To assess the current status of pediatric intracapsular tonsillectomy in the United States, and 2) To apply lessons from the scientific literature and adoption of surgical innovation to predict future trends in pediatric intracapsular tonsillectomy. METHODS: This was a cross-sectional survey study and literature review. An anonymous survey was sent to all members of the American Society of Pediatric Otolaryngology (ASPO) to determine current practices in pediatric tonsillectomy. Statistical analysis was performed to compare differences in individuals who perform intracapsular tonsillectomy as opposed to extracapsular tonsillectomy. A literature analysis of the adoption of new technological advancements and innovative surgical techniques was then performed. RESULTS: The survey was sent to 540 pediatric otolaryngologists with a response rate of 42%. Of all respondents, 20% currently perform intracapsular tonsillectomy. The primary reason cited for not performing the procedure was concern for tonsillar regrowth. Time in practice, practice setting, and fellowship status was not associated with an increased incidence of intracapsular tonsillectomy. CONCLUSIONS: Only 20% of pediatric otolaryngologist respondents in the United States perform intracapsular tonsillectomy. Based on the documented advantages of intracapsular tonsillectomy over extracapsular tonsillectomy and an analysis of adoption of novel surgical techniques, we predict a paradigm shift in the specialty toward intracapsular tonsillectomy. LEVEL OF EVIDENCE: 3 Laryngoscope, 131:S1-S9, 2021.


Assuntos
Complicações Pós-Operatórias/epidemiologia , Síndromes da Apneia do Sono/cirurgia , Tonsilectomia/métodos , Tonsilite/cirurgia , Criança , Estudos Transversais , Humanos , Otorrinolaringologistas/estatística & dados numéricos , Tonsila Palatina/anatomia & histologia , Tonsila Palatina/cirurgia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Inquéritos e Questionários/estatística & dados numéricos , Tonsilectomia/efeitos adversos , Tonsilectomia/estatística & dados numéricos , Tonsilectomia/tendências , Resultado do Tratamento , Estados Unidos/epidemiologia
6.
Ann Otol Rhinol Laryngol ; 127(4): 285-290, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29436237

RESUMO

OBJECTIVES: Aneurysmal bone cysts (ABC) are benign, rapidly growing osteolytic lesions. Solid variant of ABC (SVABC) is a rare subtype of ABC that has not been reported in the temporal bone. METHODS: We report the case of a 6-year-old boy presenting with a slowly enlarging bony protuberance over the right zygomatic/malar eminence region. Computed tomography and magnetic resonance imaging demonstrated a 2.6 × 5.8 × 5.1 cm temporal bone mass involving the right mastoid, petrous, and temporal squamosal calvarium, with extradural intracranial extension to the middle cranial fossa. RESULTS: The patient underwent preoperative embolization of feeder arteries followed by combined neurosurgical and neurotologic resection. Histopathology revealed characteristic ABC features with interspersed areas of intralesional osteoid formation. CONCLUSION: Solid variant of ABCs are rare lesions of the skull base that present a diagnostic challenge given their unique radiographic and histologic features. Thorough cytogenetic evaluation is warranted to rule out potential malignant secondary causes. Early surgical resection is essential due to the risk of intracranial extension. This is the first report of ABC of any type with concurrent involvement of the squamous, mastoid, and petrous portions of the temporal bone and the first report of SVABC of the temporal bone.


Assuntos
Cistos Ósseos Aneurismáticos , Embolização Terapêutica/métodos , Procedimentos Neurocirúrgicos/métodos , Osso Temporal , Cistos Ósseos Aneurismáticos/diagnóstico , Cistos Ósseos Aneurismáticos/fisiopatologia , Cistos Ósseos Aneurismáticos/cirurgia , Criança , Dissecação/métodos , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Cuidados Pré-Operatórios/métodos , Osso Temporal/diagnóstico por imagem , Osso Temporal/cirurgia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
7.
Laryngoscope ; 126(6): 1481-1483, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26297931

RESUMO

Measles is an acute viral respiratory illness caused by a virus of the Paramyxoviridae family. Despite being eliminated from the United States, small outbreaks across the country continue to occur. The United States experienced a record number of cases in 2014, with 668 cases seen across the country, a record since its elimination in 2000. Here, we present a case of an acute presentation of measles illness and discuss the otolaryngologic manifestation of the disease. Laryngoscope, 126:1481-1483, 2016.

8.
Am J Respir Crit Care Med ; 192(12): 1504-13, 2015 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-26214043

RESUMO

RATIONALE: Subglottic edema and acquired subglottic stenosis are potentially airway-compromising sequelae in neonates following endotracheal intubation. At present, no imaging modality is capable of in vivo diagnosis of subepithelial airway wall pathology as signs of intubation-related injury. OBJECTIVES: To use Fourier domain long-range optical coherence tomography (LR-OCT) to acquire micrometer-resolution images of the airway wall of intubated neonates in a neonatal intensive care unit setting and to analyze images for histopathology and airway wall thickness. METHODS: LR-OCT of the neonatal laryngotracheal airway was performed a total of 94 times on 72 subjects (age, 1-175 d; total intubation, 1-104 d). LR-OCT images of the airway wall were analyzed in MATLAB. Medical records were reviewed retrospectively for extubation outcome. MEASUREMENTS AND MAIN RESULTS: Backward stepwise regression analysis demonstrated a statistically significant association between log(duration of intubation) and both laryngeal (P < 0.001; multiple r(2) = 0.44) and subglottic (P < 0.001; multiple r(2) = 0.55) airway wall thickness. Subjects with positive histopathology on LR-OCT images had a higher likelihood of extubation failure (odds ratio, 5.9; P = 0.007). Longer intubation time was found to be significantly associated with extubation failure. CONCLUSIONS: LR-OCT allows for high-resolution evaluation and measurement of the airway wall in intubated neonates. Our data demonstrate a positive correlation between laryngeal and subglottic wall thickness and duration of intubation, suggestive of progressive soft tissue injury. LR-OCT may ultimately aid in the early diagnosis of postintubation subglottic injury and help reduce the incidences of failed extubation caused by subglottic edema or acquired subglottic stenosis in neonates. Clinical trial registered with www.clinicaltrials.gov (NCT 00544427).


Assuntos
Intubação Intratraqueal/efeitos adversos , Laringoestenose/diagnóstico , Tomografia de Coerência Óptica/métodos , Diagnóstico Precoce , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos
9.
Curr Opin Otolaryngol Head Neck Surg ; 21(6): 576-80, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24240134

RESUMO

PURPOSE OF REVIEW: Cricopharyngeal achalasia (CPA) is an infrequently encountered but important diagnosis in pediatric dysphagia. This disorder is characterized by difficulty in feeding, regurgitation of feeds, and recurrent aspiration episodes. In this review, we discuss the current understanding of the pathophysiology of the disease and the recent developments in the diagnosis and therapeutic management of CPA. RECENT FINDINGS: Because of the rarity of the disease, the literature reporting the treatment of CPA is limited to small case series. Although open surgical treatments including cricopharyngeal myotomy have been reported in the past, recent studies advocate less-invasive endoscopic approaches, including balloon dilation, endoscopic cricopharyngeal myotomy, and botulinum toxin injections. SUMMARY: When CPA is suspected as a cause of dysphagia in a child, the diagnosis can be confirmed with videofluoroscopic swallow studies that demonstrate narrowing at the region of the cricopharyngeus muscle. Treatment should be initiated for children who are unable to feed orally. Current options for treatment include botulinum toxin injections, endoscopic balloon dilation, and open or endoscopic cricopharyngeal myotomy. All techniques have shown success in the treatment of the disease. Further studies comparing treatment modalities are needed before a clear recommendation can be made.


Assuntos
Transtornos de Deglutição/etiologia , Transtornos de Deglutição/terapia , Doenças Faríngeas/complicações , Músculos Faríngeos/fisiopatologia , Fatores Etários , Toxinas Botulínicas Tipo A/uso terapêutico , Criança , Transtornos de Deglutição/diagnóstico , Dilatação , Endoscopia , Humanos , Fármacos Neuromusculares/uso terapêutico , Seleção de Pacientes , Doenças Faríngeas/diagnóstico , Doenças Faríngeas/terapia , Músculos Faríngeos/cirurgia
10.
Pediatr Clin North Am ; 60(4): 937-49, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-23905829

RESUMO

Infantile hemangiomas (IHs) are benign vascular tumors. Clinical history and physical examination are the most important factors for diagnosis, with most IHs having a typical presentation. Treatment is required for some IHs that cause significant cosmetic deformity or functional compromise. Propranolol is the first-line treatment of most IHs. Ongoing research is increasing our understanding of the pathophysiology of these tumors and should help to identify future potential therapeutic targets.


Assuntos
Neoplasias de Cabeça e Pescoço/diagnóstico , Neoplasias de Cabeça e Pescoço/terapia , Hemangioma/diagnóstico , Hemangioma/terapia , Diagnóstico por Imagem , Neoplasias de Cabeça e Pescoço/fisiopatologia , Hemangioma/fisiopatologia , Humanos , Lactente , Propranolol/uso terapêutico , Vasodilatadores/uso terapêutico
11.
JAMA Dermatol ; 149(8): 960-1, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-23760516

RESUMO

IMPORTANCE: Isotretinoin is frequently prescribed for the treatment of acne vulgaris. Among the numerous documented adverse effects, most common are xerostomia and cheilitis. Lip abscesses as a consequence of cheilitis present dramatically and may pose a diagnostic challenge. OBSERVATIONS: We present a case of a 15-year-old boy with a severe lip abscess requiring incision and drainage and hospital admission for intravenous antibiotic treatment of methicillin-resistant Staphylococcus aureus. We discuss the pathophysiologic characteristics of isotretinoin therapy and the likely causative role that the medication played in the development of the lip abscess. CONCLUSIONS AND RELEVANCE: Although rare, lip abscesses related to isotretinoin therapy present with substantial morbidity and should be promptly recognized. Misdiagnosis of mucositis and angioedema may delay appropriate therapy.


Assuntos
Abscesso/induzido quimicamente , Fármacos Dermatológicos/efeitos adversos , Isotretinoína/efeitos adversos , Doenças Labiais/induzido quimicamente , Abscesso/microbiologia , Abscesso/patologia , Acne Vulgar/tratamento farmacológico , Adolescente , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Fármacos Dermatológicos/uso terapêutico , Drenagem/métodos , Hospitalização , Humanos , Isotretinoína/uso terapêutico , Doenças Labiais/microbiologia , Doenças Labiais/patologia , Masculino , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Infecções Estafilocócicas/induzido quimicamente , Infecções Estafilocócicas/microbiologia , Infecções Estafilocócicas/patologia
12.
Laryngoscope ; 122(10): 2323-9, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-22865344

RESUMO

OBJECTIVES/HYPOTHESIS: To describe the clinical presentation and airway characteristics of infants with airway hemangiomas and concomitant PHACE syndrome and to determine the prevalence of airway hemangiomas in PHACE subjects at our institution. STUDY DESIGN: Case series. METHODS: Retrospective review including clinical presentation, airway findings, treatment measures, and outcomes. RESULTS: A total of 23 subjects were diagnosed with definite PHACE at our institution between September 1, 2005 and September 1, 2011. Twelve (52%) of these subjects had documented airway hemangiomas, six of whom were diagnosed and treated at our institution. All six subjects underwent direct laryngoscopy and bronchoscopy by a pediatric otolaryngologist. Five (83%) subjects had subglottic hemangioma. Three subjects (50%) had additional hemangioma within the airway located on the epiglottis, vocal folds, posterior pharyngeal wall, and tracheal wall. Five subjects (83%) were treated with propranolol, five (83%) were treated with systemic steroids, and one subject received vincristine. One subject required laser ablation of subglottic hemangioma and tracheotomy. All subjects were airway symptom free at last follow-up (average, 35 months; range, 13-76 months). CONCLUSIONS: Airway hemangiomas can be a life-threatening complication of PHACE syndrome. At our institution, 52% of all PHACE subjects were diagnosed with airway hemangiomas. Early detection of airway involvement is paramount. Given the high rates of airway hemangiomas, we recommend performing direct laryngoscopy and bronchoscopy in all PHACE patients with respiratory symptoms. We recommend having a low threshold for airway evaluation in asymptomatic PHACE patients, especially those who will not be otherwise started on propranolol.


Assuntos
Coartação Aórtica/diagnóstico , Coartação Aórtica/terapia , Anormalidades do Olho/diagnóstico , Anormalidades do Olho/terapia , Hemangioma/diagnóstico , Hemangioma/terapia , Neoplasias Laríngeas/diagnóstico , Neoplasias Laríngeas/terapia , Síndromes Neurocutâneas/diagnóstico , Síndromes Neurocutâneas/terapia , Broncoscopia , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Laringoscopia , Terapia a Laser , Masculino , Propranolol/uso terapêutico , Estudos Retrospectivos , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/terapia , Esteroides/uso terapêutico , Traqueotomia , Resultado do Tratamento , Vincristina/uso terapêutico
13.
Laryngoscope ; 122(6): 1405-8, 2012 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-22460362

RESUMO

OBJECTIVES/HYPOTHESIS: To determine and compare the accuracy of different imaging modalities including ultrasound (US), magnetic resonance imaging (MRI), and computed tomography (CT) in the diagnosis of thyroglossal duct cysts (TGDC) in children. STUDY DESIGN: Retrospective chart review. METHODS: A retrospective chart review was performed on patients under the age of 18 years who had undergone surgical excision of midline neck masses between January 2002 and June 2011. All patients had preoperative imaging. Data including age at surgery, preoperative imaging results, and postoperative pathology results were recorded. Preoperative imaging diagnoses were then compared to postoperative pathologic diagnoses. Diagnostic test statistics were performed. RESULTS: A total of 44 patients met the study criteria. There were 15 patients who underwent more than one modality of imaging study. US had a sensitivity of 75% in diagnosis of TGDC. MRI sensitivity was 60% and CT was 82%. None of the tests had high specificity for TGDC; US was the highest at 80%. All three modalities had positive predictive values higher than 90%. US had the highest positive likelihood ratio (3.8), although the 95% confidence interval was not statistically significant. CONCLUSIONS: In a comparison of the three most commonly used imaging modalities for pediatric TGDC, US was the preferred exam given its comparable accuracy, ease of administration, and lower cost. In addition, the added risks of general anesthesia with MRI and ionizing radiation with CT are not justified in this setting given their equivalent or inferior performance when compared to US in this cohort.


Assuntos
Imageamento por Ressonância Magnética/métodos , Cisto Tireoglosso/diagnóstico , Cisto Tireoglosso/cirurgia , Ultrassonografia Doppler/métodos , Adolescente , Criança , Pré-Escolar , Estudos de Coortes , Intervalos de Confiança , Diagnóstico por Imagem/métodos , Feminino , Humanos , Lactente , Funções Verossimilhança , Masculino , Cuidados Pré-Operatórios/métodos , Estudos Retrospectivos , Sensibilidade e Especificidade
14.
Otolaryngol Head Neck Surg ; 145(6): 935-9, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-21753035

RESUMO

OBJECTIVES: The purpose of this study was to investigate etiologic factors for sialolithiasis in a population of patients from the United States. STUDY DESIGN: Retrospective, cohort study. SETTING: Tertiary university. MATERIALS AND METHODS: Charts for all patients diagnosed with sialolithiasis between January 2001 and February 2010 were retrospectively reviewed. Demographic factors, smoking history, comorbid medical conditions, and medication history were recorded. Statistical analyses were then performed on the collected data. Population prevalences of smoking, diuretic usage, cholelithiasis, and nephrolithiasis were obtained through literature review. RESULTS: A total of 153 patients with sialolithiasis were identified. Of these patients, 125 (82%) had submandibular sialolithiasis, and 28 (18%) had parotid sialolithiasis. Positive smoking histories were present in 67 individuals (44%). Both the current rate of smoking and the rate of a history of smoking were higher in our cohort when compared with the general population, although the differences did not reach statistical significance. Smoking history did not correlate with the size of the primary sialolith. Diuretic usage in the cohort was observed at a rate of 20%, higher than reported population rates of diuretic use of 8.7%. The prevalences of cholelithiasis and nephrolithiasis were not different from observed population rates. CONCLUSIONS: Sialolithiasis is an uncommon condition of unclear etiology. This study represents an initial attempt to quantify the prevalence of smoking and diuretic therapy in a population of patients with sialolithiasis.


Assuntos
Diuréticos/efeitos adversos , Cálculos das Glândulas Salivares/epidemiologia , Cálculos das Glândulas Salivares/etiologia , Fumar/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Diuréticos/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Prognóstico , Doenças Raras , Estudos Retrospectivos , Fatores de Risco , Cálculos das Glândulas Salivares/fisiopatologia , Índice de Gravidade de Doença , Distribuição por Sexo , Fumar/efeitos adversos , Estados Unidos/epidemiologia , Adulto Jovem
15.
Case Rep Otolaryngol ; 2011: 430809, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-22937367

RESUMO

Plasma cell tumors are a diverse group of neoplasms characterized by monoclonal proliferation of plasma cells. Extramedullary plasmacytoma (EMP) is a rare form of localized plasma cell tumor that arises most often in the head and neck region. We present an unusual case of EMP of the palatine tonsil from a tertiary care university hospital. We discuss the histopathologic and radiologic evaluation as well as treatment of EMP.

16.
Neuroimaging Clin N Am ; 20(4): 581-96, 2010 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-20974377

RESUMO

Recognizing typical midface fracture injuries and describing the imaging findings that are relevant to the maxillofacial surgeon are important. Particular attention should be paid to findings that potentially result in significant cosmetic or functional complications. Radiologists should evaluate facial fractures in multiple planes with coronal and sagittal reformats, which are especially helpful for horizontally oriented facial fractures, such as injuries to the orbital floor and the hard palate. 3-D images can also facilitate a broader understanding of the fracture impact on facial width, height, and projection and are useful for an overview of more complex fracture patterns that involve multiple facial bones.


Assuntos
Ossos Faciais/diagnóstico por imagem , Imageamento Tridimensional , Fraturas Cranianas/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Ossos Faciais/lesões , Humanos , Fraturas Maxilares/diagnóstico por imagem , Fraturas Orbitárias/diagnóstico por imagem , Fratura da Base do Crânio/diagnóstico por imagem
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