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1.
Rev Med Suisse ; 17(753): 1690-1693, 2021 Oct 06.
Artigo em Francês | MEDLINE | ID: mdl-34614309

RESUMO

Acute tonsillitis is a common disease. The tonsillar infection can be uni- or bilateral with a high rate of spontaneous recovery. In some cases, a peritonsillar cellulitis or abscess can occur, characterized by an inflammatory reaction of the peritonsillar space. The red flags consist of a gradually worsening odynodysphagia, an ipsilateral swelling of the soft palate, a trismus (infrequent in children) and in some cases a change of voice (« hot potato voice ¼). A needle puncture of the swollen soft palate is then required. If pus is found, a surgical drainage by either hot tonsillectomy or incision under local anesthesia with an appropriate antibiotic therapy must be carried out.


Assuntos
Abscesso Peritonsilar , Criança , Humanos , Abscesso Peritonsilar/diagnóstico , Abscesso Peritonsilar/terapia
3.
Emerg Med Clin North Am ; 39(3): 529-554, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34215401

RESUMO

Point-of-care ultrasound can improve efficacy and safety of pediatric procedures performed in the emergency department. This article reviews ultrasound guidance for the following pediatric emergency medicine procedures: soft tissue (abscess incision and drainage, foreign body identification and removal, and peritonsillar abscess drainage), musculoskeletal and neurologic (hip arthrocentesis, peripheral nerve blocks, and lumbar puncture), vascular access (peripheral intravenous access and central line placement), and critical care (endotracheal tube placement, pericardiocentesis, thoracentesis, and paracentesis). By incorporating ultrasound, emergency physicians caring for pediatric patients have the potential to enhance their procedural scope, confidence, safety, and success.


Assuntos
Medicina de Emergência Pediátrica , Sistemas Automatizados de Assistência Junto ao Leito , Ultrassonografia de Intervenção , Abscesso/diagnóstico por imagem , Abscesso/cirurgia , Artrocentese/métodos , Cateterismo Venoso Central/métodos , Cateterismo Periférico/métodos , Criança , Drenagem/métodos , Corpos Estranhos/diagnóstico por imagem , Corpos Estranhos/cirurgia , Articulação do Quadril/diagnóstico por imagem , Humanos , Intubação Intratraqueal/métodos , Bloqueio Nervoso/métodos , Paracentese/métodos , Nervos Periféricos/diagnóstico por imagem , Abscesso Peritonsilar/diagnóstico por imagem , Abscesso Peritonsilar/terapia , Punção Espinal/métodos
4.
Emerg Med Clin North Am ; 39(3): 661-675, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34215408

RESUMO

Ear, nose, and throat (ENT) emergencies presenting with a chief complaint of pharyngitis can be due to infection, trauma, or postprocedure complications. The entities described in this article include retropharyngeal abscess, peritonsillar abscess, epiglottitis, bacterial tracheitis, and post-tonsillectomy bleeding. This article provides the emergency physician with the tools needed to decipher between the mundane and the critical, variations in presentation, and their emergent management. All of them require early recognition for any airway compromise or obstruction in order to avoid serious complications.


Assuntos
Epiglotite , Abscesso Peritonsilar , Abscesso Retrofaríngeo , Tonsilectomia/efeitos adversos , Antibacterianos/uso terapêutico , Infecções Bacterianas/complicações , Infecções Bacterianas/tratamento farmacológico , Criança , Técnicas de Apoio para a Decisão , Diagnóstico Diferencial , Drenagem , Epiglotite/diagnóstico , Epiglotite/terapia , Humanos , Medicina de Emergência Pediátrica , Abscesso Peritonsilar/diagnóstico , Abscesso Peritonsilar/terapia , Hemorragia Pós-Operatória/etiologia , Hemorragia Pós-Operatória/terapia , Abscesso Retrofaríngeo/diagnóstico , Abscesso Retrofaríngeo/terapia , Traqueíte/diagnóstico , Traqueíte/terapia
5.
J Laryngol Otol ; 135(7): 584-588, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33913412

RESUMO

BACKGROUND: The impact of coronavirus disease 2019 on healthcare has led to rapid changes in otolaryngology service provisions. As such, new standard operating procedures for the management of suspected tonsillitis or quinsy were implemented in our centre. METHODS: A retrospective audit was performed of acute referrals to ENT of patients with suspected tonsillitis, peritonsillar cellulitis or quinsy, during the 10 weeks before (group 1) and 10 weeks after (group 2) implementation of the new standard operating procedures. RESULTS: Group 2 received fewer referrals. Fewer nasendoscopies were performed and corticosteroid use was reduced. The frequency of quinsy drainage performed under local anaesthetic increased, although the difference was not statistically significant. Hospital admission rates decreased from 56.1 to 20.4 per cent, and mean length of stay increased from 1.13 to 1.5 days. Face-to-face follow up decreased from 15.0 to 8.2 per cent, whilst virtual follow up increased from 4.7 to 16.3 per cent. There were no significant differences in re-presentation or re-admission rates. CONCLUSION: Management of suspected tonsillitis or quinsy using the new standard operating procedures appears to be safe and effective. This management should now be applied to an out-patient setting in otherwise systemically well patients.


Assuntos
COVID-19/epidemiologia , Abscesso Peritonsilar/terapia , Melhoria de Qualidade , Tonsilite/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia por Agulha Fina , Drenagem , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Tempo de Internação/estatística & dados numéricos , Londres , Masculino , Pessoa de Meia-Idade , Otolaringologia/métodos , Otolaringologia/normas , Otolaringologia/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Encaminhamento e Consulta , Estudos Retrospectivos , Adulto Jovem
6.
J Laryngol Otol ; 135(7): 579-583, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33653421

RESUMO

OBJECTIVES: This study examined the uptake of ENT UK coronavirus disease 2019 adult tonsillitis and quinsy guidelines at our tertiary centre, and assessed perceived barriers to uptake. METHODS: A retrospective case series of tonsillitis and quinsy patients was analysed in two arms: before and after the introduction of new ENT UK management guidelines. A survey assessed perceptions and practice differences between ENT and emergency department doctors. RESULTS: Each study arm examined 82 patients. Following the introduction of new ENT UK guidelines, ENT clinicians demonstrated significant changes in practice, unlike their emergency department counterparts. Survey results from emergency department doctors highlighted a lack of appreciation of guideline change and identified barriers to guideline uptake. CONCLUSION: The introduction of new management guidelines for tonsillitis and quinsy patients during the pandemic resulted in disparate uptake within ENT and emergency department departments at the tertiary centre. Clearer dissemination to all affected clinicians is paramount for future rapidly introduced changes to practice, to ensure clinician safety.


Assuntos
COVID-19/epidemiologia , Fidelidade a Diretrizes/estatística & dados numéricos , Abscesso Peritonsilar/terapia , Tonsilite/terapia , Adulto , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Masculino , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/estatística & dados numéricos , Estudos Retrospectivos , Inquéritos e Questionários , Reino Unido/epidemiologia , Adulto Jovem
7.
J Laryngol Otol ; 135(2): 117-124, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33612142

RESUMO

BACKGROUND: Coronavirus disease 2019 imposed dramatic changes on ENT service delivery. Pre-pandemic, such changes would have been considered potentially unsafe. This study outlines the impact of lockdown on the incidence and management of ENT emergencies at a large UK centre. METHODS: After modification of pre-pandemic guidelines, ENT emergency referrals data during the UK lockdown were prospectively captured. A comparative analysis was performed with retrospective data from a corresponding period in 2019. RESULTS: An overall reduction (p < 0.001) in emergency referrals (n = 119) and admissions (n = 18) occurred during the lockdown period compared to the 2019 period (432 referrals and 290 admissions). Specifically, there were reduced admission rates for epistaxis (p < 0.0001) and tonsillar infection (p < 0.005) in the lockdown period. During lockdown, 90 per cent of patients requiring non-dissolvable nasal packing were managed as out-patients. CONCLUSIONS: Coronavirus disease 2019 compelled modifications to pre-pandemic ENT guidelines. The enforced changes to emergency care appear to be safe and successfully adopted. Arguably, the measures have both economic and patient-related implications post-coronavirus disease 2019 and during future similar pandemics and lockdowns.


Assuntos
Assistência Ambulatorial/estatística & dados numéricos , COVID-19 , Epistaxe/terapia , Hospitalização/estatística & dados numéricos , Abscesso Peritonsilar/terapia , Tonsilite/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Orelha , Otopatias/epidemiologia , Otopatias/terapia , Emergências , Serviço Hospitalar de Emergência , Epistaxe/epidemiologia , Feminino , Corpos Estranhos/epidemiologia , Corpos Estranhos/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Otorrinolaringopatias/epidemiologia , Otorrinolaringopatias/terapia , Abscesso Peritonsilar/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/terapia , Guias de Prática Clínica como Assunto , Encaminhamento e Consulta/tendências , SARS-CoV-2 , Tonsilite/epidemiologia , Reino Unido/epidemiologia , Adulto Jovem
8.
J Laryngol Otol ; 135(3): 191-195, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33593465

RESUMO

OBJECTIVES: The global pandemic of coronavirus disease 2019 has necessitated changes to 'usual' ways of practice in otolaryngology, with a view towards out-patient or ambulatory management of appropriate conditions. This paper reviews the available evidence for out-patient management of three of the most common causes for emergency referral to the otolaryngology team: tonsillitis, peri-tonsillar abscess and epistaxis. METHODS: A literature review was performed, searching all available online databases and resources. The Medical Subject Headings 'tonsillitis', 'pharyngotonsillitis', 'quinsy', 'peritonsillar abscess' and 'epistaxis' were used. Papers discussing out-patient management were reviewed by the authors. RESULTS: Out-patient and ambulatory pathways for tonsillitis and peritonsillar abscess are well described for patients meeting appropriate criteria. Safe discharge of select patients is safe and should be encouraged in the current clinical climate. Safe discharge of patients with epistaxis who have bleeding controlled is also well described. CONCLUSION: In select cases, tonsillitis, quinsy and epistaxis patients can be safely managed out of hospital, with low re-admission rates.


Assuntos
Assistência Ambulatorial/organização & administração , COVID-19/epidemiologia , Epistaxe/terapia , Otolaringologia/organização & administração , Abscesso Peritonsilar/terapia , Tonsilite/terapia , COVID-19/prevenção & controle , COVID-19/transmissão , Emergências , Serviço Hospitalar de Emergência/organização & administração , Humanos , Encaminhamento e Consulta/organização & administração
9.
Orv Hetil ; 161(44): 1877-1883, 2020 11 01.
Artigo em Húngaro | MEDLINE | ID: mdl-33130604

RESUMO

Összefoglaló. Bevezetés és célkituzés: A peritonsillaris tályog a leggyakoribb mély nyaki infekció. Olyan fül-orr-gégészeti kórkép, amely megfelelo kezelés nélkül életveszélyes szövodményekkel járhat. Dönto jelentoségu az empirikus antibiotikumválasztás, melyhez ismerni kell a leggyakoribb kórokozókat és a várható rezisztenciát. Módszerek: A 2012 és 2017 között peritonsillaris tályog miatt kezelt esetek retrospektív feldolgozását végeztük. Összesítettük a sebészi beavatkozás során vett minták aerob és anaerob irányú tenyésztési eredményeit, valamint az empirikusan választott antibiotikumokat. A rutinszeru mikrobiológiai tenyésztés alapján meghatároztuk a leggyakoribb kórokozókat. Az adatokat nemzetközi felmérések eredményeivel hasonlítottuk össze. Eredmények: A vizsgált 6 év során 217 esetben kezeltünk peritonsillaris tályogos beteget. A tenyésztési eredményeket csak 146 esetben tudtuk elemezni. Ebbol 47 esetben került sor Fusobacterium species (ebbol 25 esetben Fusobacterium necrophorum), 31 esetben Actinomyces species és 29 esetben Streptococcus pyogenes izolálására. Az esetek kétharmadában vegyes aerob/anaerob baktériumflórát izolált a laboratórium. Következtetés: A tályogok kezelésében önmagában a sebészi beavatkozás - az anaerob környezet megszüntetésével - jelentos klinikai javulást eredményez. A jól választott antibiotikum meggyorsíthatja a lefolyást, és csökkentheti az esetleges szövodményeket. Nagy jelentosége van a megfelelo mikrobiológiai mintavételnek, nem vagy nehezen gyógyuló esetekben ez teremtheti meg a célzott antibiotikumterápiára történo váltás lehetoségét. Felmérésünk alapján a peritonsillaris tályogok jelentos részét vegyes baktériumflóra okozza, így a szájüregi anaerob baktériumokra is ható amoxicillin-klavulánsav vagy antibiotikum kombinációjának (2. vagy 3. generációs cefalosporinok kombinálva klindamicinnel vagy metronidazollal) alkalmazása javasolt mint empirikus antibiotikumterápia. Orv Hetil. 2020; 161(44): 1877-1883. INTRODUCTION AND OBJECTIVE: Peritonsillar abscess is the most common deep neck infection. Without adequate treatment, this otolaryngological disease pattern can cause life-threatening complications. The empirical choice of antibiotics is crucial which requires knowledge of the most common pathogens and the potential resistance. METHODS: A retrospective analysis of cases treated for peritonsillar abscess was performed between 2012 and 2017. We summarized the aerobic and anaerobic culture results of the surgical samples and the empirically selected antibiotics. The most common pathogens were determined via routine microbiological culture tests. We compared our data with the results of international studies. RESULTS: During the 6-year study at our Clinic, 217 patients with peritonsillar abscess were treated. The microbiological tests were available for analysis in only 146 cases. In 47 cases, Fusobacterium species (including 25 cases with Fusobacterium necrophorum), in 31 cases Actinomyces species and in 29 cases Streptococcus pyogenes were isolated. In 2/3 of the patients, polymicrobial infection was detected. CONCLUSION: In the treatment of peritonsillar abscesses, surgical intervention can result in clinical improvement because of the elimination of the anaerobic milieu. A well-chosen antibiotic can accelerate the healing process and reduce the complication rate. Proper microbiological sampling is of great importance, and in cases of non-recovery or poor recovery, this may create the opportunity to switch for targeted antibiotic therapy. The results of this study show that polymicrobial flora is very important for the development of the peritonsillar abscess, thus the recommended antibiotic therapy is amoxicillin-clavulanic acid or 2nd/3rd generation cefalosporin combined with metronidazol or clindamycin. Orv Hetil. 2020; 161(44): 1877-1883.


Assuntos
Abscesso Peritonsilar/microbiologia , Abscesso Peritonsilar/terapia , Antibacterianos/uso terapêutico , Humanos , Técnicas Microbiológicas , Estudos Retrospectivos
10.
Pediatr Emerg Med Pract ; 17(11): 1-24, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33105074

RESUMO

Head and neck infections can spread to nearby structures, compromising the airway and progressing to life-threatening events. Pediatric head and neck infections can be difficult to recognize; emergency clinicians must know the signs and symptoms of head and neck infections for early diagnosis and urgent management in order to prevent complications and decrease hospitalization rates. This issue reviews presenting signs and symptoms of pediatric head and neck infections, discusses when diagnostic studies are indicated, and offers evidence-based recommendations for management. Conditions reviewed include mastoiditis, sinusitis, Ludwig angina, peritonsillar abscess, retropharyngeal abscess, Lemierre syndrome, and acute suppurative thyroiditis.


Assuntos
Cabeça/patologia , Infecções/terapia , Pescoço/patologia , Medicina de Emergência Pediátrica , Guias de Prática Clínica como Assunto , Adolescente , Antibacterianos/uso terapêutico , Criança , Pré-Escolar , Serviço Hospitalar de Emergência , Feminino , Humanos , Infecções/diagnóstico , Síndrome de Lemierre/diagnóstico , Síndrome de Lemierre/terapia , Angina de Ludwig/diagnóstico , Angina de Ludwig/terapia , Masculino , Mastoidite/diagnóstico , Mastoidite/terapia , Abscesso Peritonsilar/diagnóstico , Abscesso Peritonsilar/terapia , Exame Físico/métodos , Abscesso Retrofaríngeo/diagnóstico , Abscesso Retrofaríngeo/terapia , Sinusite/diagnóstico , Sinusite/terapia , Tireoidite Supurativa/diagnóstico , Tireoidite Supurativa/terapia
11.
J Emerg Med ; 59(5): 693-698, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32826122

RESUMO

BACKGROUND: Physical examination for peritonsillar abscess (PTA) has limited sensitivity. Traditional management involves blind needle aspiration, which has a false negative rate of 10-24%. A randomized controlled trial by Costantino et al. demonstrated that point-of-care ultrasound (POCUS) improves PTA management. OBJECTIVES: Compare the use and impact of POCUS between patient cohorts prior to and after the trial by Costantino et al. METHODS: Retrospective cohort study of adult patients diagnosed with PTA. Cohort 1 presented to the emergency department (ED) January 2007-December 2008. Cohort 2 presented between January 2013 and December 2014. Data were separated into those with POCUS vs. without ultrasound (NUS). Primary endpoint was POCUS utilization. Secondary endpoints were successful aspiration, otolaryngology (ear, nose, and throat [ENT]) consultation, computed tomography (CT) imaging, unscheduled return visits, and length of stay (LOS). The Fisher's exact and t-tests analyzed data. RESULTS: Cohort 1 enrolled 48 patients, vs. 114 patients for cohort 2. Twelve patients in cohort 1 had a POCUS (25%) vs 89 in cohort 2 (78%) (p < 0.0001; odds ratio [OR] 0.09 (95% confidence interval [CI] 0.04-0.20). Emergency physician (EP) successful aspiration: 89.1% POCUS vs. 24.5% NUS (p < 0.0001; OR 25 [95% CI 10-59]). Combined EP/ENT successful aspiration: 99.0% POCUS vs. 80.3% NUS (p < 0.0001; OR 24 [95% CI 3-193]). ENT consultation:12.9% POCUS vs. 65.6% NUS (p < 0.0001; OR 0.07 [95% CI 0.03-0.17]). CT usage: 23.8% POCUS vs. 37.7% NUS (p = 0.07; OR 0.51 [95% CI 0.25-1.02]). Return visits: 3.96% POCUS vs. 18.0% NUS (p = 0.004; OR 0.18 [95% CI 0.05-0.61]). CONCLUSION: POCUS use has increased for PTA treatment, improves aspiration, and decreases consultations, CTs, return visits, and LOS.


Assuntos
Abscesso Peritonsilar , Adulto , Serviço Hospitalar de Emergência , Medicina Baseada em Evidências , Humanos , Abscesso Peritonsilar/diagnóstico por imagem , Abscesso Peritonsilar/terapia , Sistemas Automatizados de Assistência Junto ao Leito , Estudos Retrospectivos , Ultrassonografia
12.
Ann Clin Microbiol Antimicrob ; 19(1): 32, 2020 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-32731900

RESUMO

BACKGROUND: The vast majority of patients with peritonsillar abscess (PTA) recover uneventfully on abscess drainage and antibiotic therapy. However, occasionally patient´s condition deteriorates as the infection spread in the upper airway mucosa, through cervical tissues, or hematogenously. The bacterial etiology of PTA is unclarified and the preferred antimicrobial regimen remains controversial. The current narrative review was carried out with an aim to (1) describe the spectrum of complications previously recognized in patients with peritonsillar abscess (PTA), (2) describe the bacterial findings in PTA-associated complications, and (3) describe the time relation between PTA and complications. METHODS: Systematic searches in the Medline and EMBASE databases were conducted and data on cases with PTA and one or more complications were elicited. RESULTS: Seventeen different complications of PTA were reported. The most frequently described complications were descending mediastinitis (n = 113), para- and retropharyngeal abscess (n = 96), necrotizing fasciitis (n = 38), and Lemierre´s syndrome (n = 35). Males constituted 70% of cases and 49% of patients were > 40 years of age. The overall mortality rate was 10%. The most prevalent bacteria were viridans group streptococci (n = 41, 25%), beta-hemolytic streptococci (n = 32, 20%), F. necrophorum (n = 21, 13%), S. aureus (n = 18, 11%), Prevotella species (n = 17, 10%), and Bacteroides species (n = 14, 9%). Simultaneous diagnosis of PTA and complication was more common (59%) than development of complication after PTA treatment (36%) or recognition of complication prior to PTA (6%). CONCLUSION: Clinicians involved in the management of PTA patients should be aware of the wide range of complications, which may arise in association with PTA development. Especially males and patients > 40 years of age seem to be at an increased risk of complicated disease. In addition to Group A streptococci and F. necrophorum, the current findings suggest that viridans group streptococci, S. aureus, Prevotella, and Bacteroides may also play occasional roles in the development of PTA as well as spread of infection. Complications occasionally develop in PTA patients, who are treated with antibiotics and surgical drainage.


Assuntos
Infecções Bacterianas/microbiologia , Abscesso Peritonsilar/complicações , Abscesso Peritonsilar/microbiologia , Obstrução das Vias Respiratórias/etiologia , Antibacterianos/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Drenagem , Humanos , Abscesso Peritonsilar/terapia
13.
Int J Pediatr Otorhinolaryngol ; 135: 110115, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32447171

RESUMO

INTRODUCTION: Peritonsillar (PT), parapharyngeal (PP), and retropharyngeal (RP) abscesses are common pediatric deep neck space infections (DNSI). Despite established literature on DNSI microbiology, obtaining intraoperative cultures remains commonplace. The objective was to evaluate the resource utilization of intraoperative cultures when draining PT, PP, and RP abscesses. METHODS: Pediatric patients (age <18.0 years) who underwent surgical drainage of a PT, PP, or RP abscess between January 2013 and June 2018 were retrospectively reviewed. Changes in antimicrobials based on intraoperative culture results were assessed by use of Fisher's exact tests or Wilcoxon rank-sum tests, as appropriate. Multivariable linear regression was used to model the association between factors of interest and number of cultures obtained. RESULTS: Eighty-eight patients underwent surgical drainage, of which 80 patients (median age 6.96 years) had intraoperative bacterial cultures (32 PT, 21 PP, and 27 RP). There were no positive fungal or acid-fast bacilli cultures. Seven patients had culture-directed changes in treatment; none of these patients had a PT abscess. Age was inversely associated with culture-directed changes (p = 0.006) while the use of blood cultures (p = 0.012) was positively associated with culture-directed treatment changes. Hospital length of stay (p < 0.001) and history of prior DNSI (p = 0.001) were associated with number of cultures obtained. CONCLUSIONS: Younger children with PP and RP abscesses are most likely to benefit from intraoperative bacterial cultures. Cultures of PT abscesses are unlikely to change clinical management. Fungal and acid-fast bacilli cultures are unlikely to yield clinically useful information. Prudent use of intraoperative cultures may decrease the use of hospital resources and admission-related costs.


Assuntos
Antibacterianos/uso terapêutico , Substituição de Medicamentos , Recursos em Saúde/estatística & dados numéricos , Abscesso Peritonsilar/terapia , Abscesso Retrofaríngeo/terapia , Fatores Etários , Hemocultura , Criança , Pré-Escolar , Contagem de Colônia Microbiana , Drenagem , Feminino , Humanos , Período Intraoperatório , Tempo de Internação , Masculino , Pescoço , Estudos Retrospectivos
14.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi ; 54(12): 919-923, 2019 Dec 07.
Artigo em Chinês | MEDLINE | ID: mdl-31887818

RESUMO

Objective: To explore the clinical manifestation and treatment strategy for descending necrotizing mediastinitis (DNM). Methods: A total of 27 cases diagnosed as DNM from January 2010 to August 2018 in the First People's Hospital of Foshan were reviewed. There were 16 males and 11 females, age ranged from 16 to 84 years. The clinical data were collected. SPSS 16.0 software and chi square test were used for statistical analysis. Results: ALL 27 cases were diagnosed as DNM by contrast-enhanced CT scan of the neck and chest. Among the 27 cases, 13 cases resulted from peritonsillar abscess, 8 cases from esophageal foreign body perforation, 5 cases from parapharyngeal and retropharyngeal space abscess, and one case from infection of oral cavity. These 27 cases were divided into three subtypes according to the sites of mediastinitis, including 11 cases for typeⅠ, 5 cases for type ⅡA and 11 cases for type ⅡB. Of 27 cases, 20 cases underwent transcervical drainage for DNM, of which 5 cases with tracheotomy and 6 cases with thoracic drainage, and finally 19 of the 20 patients were cured, and one patient died of bacteremia; 7 cases refused to received surgery and were routinely treated with antibiotics, of which, one case was cured and 6 cases died. The curative rate in patients underwent surgery was significantly higher than that in patients treated with medication (χ(2)=13.638, P<0.001). Among the 20 cured cases, 4 cases were combined with diabetes mellitus and 6 cases with necrotizing fasciitis, while in the 7 died cases, 5 cases were combined with diabetes mellitus and 6 cases with necrotizing fasciitis. The comorbidity rates of diabetes mellitus (χ(2)=4.074, P=0.044) and necrotizing fasciitis (χ(2)=4.457, P=0.035) in died cases were significantly higher than those in cured cases. Conclusion: DNM is a serious infection, with high mortality especially in patients with diabetes and necrotizing fasciitis. Timely cervical and chest enhanced CT scan play vital role in its diagnosis. DNM can be treated effectively with transcervical drainage.


Assuntos
Fasciite Necrosante , Mediastinite , Abscesso Peritonsilar , Abscesso Retrofaríngeo , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Drenagem , Fasciite Necrosante/diagnóstico , Fasciite Necrosante/terapia , Feminino , Humanos , Masculino , Mediastinite/diagnóstico , Mediastinite/terapia , Pessoa de Meia-Idade , Necrose , Abscesso Peritonsilar/diagnóstico , Abscesso Peritonsilar/terapia , Abscesso Retrofaríngeo/diagnóstico , Abscesso Retrofaríngeo/terapia , Adulto Jovem
15.
Dan Med J ; 66(11)2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31686648

RESUMO

INTRODUCTION: Peritonsillar infection is a common complication to acute tonsillitis in younger adults. If peritonsillar cellulitis progresses to a peritonsillar abscess (PTA), the primary treatment is surgical drainage. But distinguishing cellulitis from PTA on a standard clinical examination is difficult. This trial aims to explore whether point-of-care transoral ultrasound can improve diagnostic accuracy and guide successful needle aspiration in patients referred with PTA. METHODS: A randomised, controlled multicentre trial will be conducted at the departments of otorhinolaryngology, head and neck surgery at Rigshospitalet and Odense University Hospital. Patients referred with PTA will be randomised to either standard clinical examination (control) or standard clinical examination with supplemental transoral ultrasound (intervention). The diagnostic accuracy, the total number of performed needle aspirations and the proportion of successful needle aspirations will be compared between the two groups. The difference will be evaluated using binary logistic regression and a generalised estimating equation to adjust for clustering of data within each physician and each hospital. A total of 88 patients are necessary to measure the clinical effect of adding transoral ultrasound. CONCLUSIONS: This study will explore the clinical benefits of adding transoral ultrasound to the diagnostic work-up of patients with peritonsillar infections. FUNDING: The Rigshospitalet and Odense University Hospital Foundation. TRIAL REGISTRATION: Clinicaltrials NCT03824288.


Assuntos
Biópsia por Agulha , Drenagem/métodos , Boca/diagnóstico por imagem , Abscesso Peritonsilar/diagnóstico por imagem , Celulite (Flegmão)/diagnóstico por imagem , Celulite (Flegmão)/patologia , Dinamarca , Método Duplo-Cego , Humanos , Modelos Logísticos , Boca/patologia , Estudos Multicêntricos como Assunto , Abscesso Peritonsilar/terapia , Ensaios Clínicos Controlados Aleatórios como Assunto , Padrão de Cuidado , Ultrassonografia
16.
Dan Med J ; 66(9)2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31495372

RESUMO

INTRODUCTION: It remains unclarified if bacterial co-infection is common in patients with infectious mononucleosis (IM) and acute tonsillitis and/or peritonsillar abscess (PTA). Recent studies suggest that Fusobacterium necrophorum is a prevalent pathogen in acute tonsillitis and PTA. We hypothesised that this anaerobe may play a significant role for the aggravated infection and the development of PTA among teenagers and young adults with IM. METHODS: All patients with IM and clinical findings of acute tonsillitis or PTA admitted to our department in the 2001-2015 period were included in the study. RESULTS: In total, 257 patients with IM and acute tonsillitis (n = 220) or PTA (n = 37) were included. Positive bacterial cultures were obtained in 28% of patients with AT and in 50% with PTA. The most prevalent bacterial findings were Group C/G streptococci (14%) among patients with acute tonsillitis and Staphylococcus aureus (22%) in patients with PTA. F. necrophorum was recovered in 9% and 2% of patients with acute tonsillitis and PTA, respectively. CONCLUSIONS: We were unable to substantiate a prevalent role for F. necrophorum in patients with IM and acute tonsillitis/PTA. S. aureus may play a role in PTA development in patients IM. The majority of our findings did not support the use of antibiotics in patients with IM, even in this selected group of patients with severe symptoms and a high risk of PTA. FUNDING: This work was funded by the Lundbeck Foundation (Grant number R185-2014-2482). TRIAL REGISTRATION: The Danish Data protection Agency approved the project.


Assuntos
Coinfecção , Mononucleose Infecciosa/epidemiologia , Abscesso Peritonsilar/epidemiologia , Adolescente , Adulto , Antibacterianos/uso terapêutico , Criança , Pré-Escolar , Coinfecção/epidemiologia , Feminino , Humanos , Masculino , Abscesso Peritonsilar/diagnóstico , Abscesso Peritonsilar/microbiologia , Abscesso Peritonsilar/terapia , Estudos Prospectivos , Infecções Estafilocócicas/microbiologia , Infecções Estreptocócicas/microbiologia , Tonsilectomia/estatística & dados numéricos , Adulto Jovem
17.
Int J Pediatr Otorhinolaryngol ; 125: 32-37, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31238159

RESUMO

OBJECTIVE: Population-based studies analyzing peritonsillar abscess in children are lacking. In this study, a population-based survey of the epidemiology of pediatric peritonsillar abscess in Taiwan was conducted. METHODS: This cross-sectional study was conducted using the Taiwan National Health Insurance Research Database. All cases of inpatient pediatric peritonsillar abscess (age < 18 years) in Taiwan between 2000 and 2012 were identified using the International Classification of Diseases, Ninth Revision, Clinical Modification. Incidence rates of inpatient peritonsillar abscess in children were calculated. Characteristics such as age, gender, hospital level, treatment modalities, imaging studies, drug administration, and length of hospital stays during the study period were analyzed. RESULTS: A total of 12,965 children with peritonsillar abscess were included (mean age, 6.6 years [standard deviation, 4.8 years]; 56.5% boys). The overall incidence was 18 per 100,000 children. Incidence rates decreased from 2000 to 2012 (19.1/100,000 to 8.3/100,000 children) (ptrend < 0.001). During the study period, the proportion of peritonsillar abscess treatments at medical centers increased from 4.6% to 15.0%. The proportion of treatments involving incision and drainage or needle aspiration increased significantly (1.3%-4.1% and 49.4%-65.6%, respectively), whereas treatments with antibiotics only decreased significantly (48.9%-29.0%). The use of computed tomography (CT) increased (1.4%-12%, ptrend < 0.001). The use of nonsteroidal anti-inflammatory drugs, steroids, and penicillin increased during the study period. The mean length of hospital stays increased from 3.78 to 4.67 days. CONCLUSIONS: The incidence of peritonsillar abscess in children decreased between 2000 and 2012 in Taiwan. Moreover, increasing trends were observed in the use of CT, the rates of incision and drainage and needle aspiration procedures, and the length of hospital stay in this study cohort.


Assuntos
Abscesso Peritonsilar/epidemiologia , Abscesso Peritonsilar/terapia , Adolescente , Corticosteroides/uso terapêutico , Antibacterianos/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Criança , Pré-Escolar , Estudos Transversais , Drenagem/estatística & dados numéricos , Feminino , Humanos , Incidência , Lactente , Tempo de Internação/estatística & dados numéricos , Masculino , Paracentese/estatística & dados numéricos , Penicilinas/uso terapêutico , Taiwan/epidemiologia , Tomografia Computadorizada por Raios X/estatística & dados numéricos
18.
Int J Pediatr Otorhinolaryngol ; 124: 200-202, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31212167

RESUMO

Peritonsillar abscess is extremely rare in infants and is potentially life-threatening. We report the case of a 3 month old infant with a background of congenital bone marrow failure who presented with sepsis and desaturation requiring intubation and PICU care. Ultrasound and CT scan revealed an inflammatory mass. Examination in theatre revealed a self-draining quinsy. Following formal drainage in theatre, the child improved and was extubated uneventfully 1 day later. Prompt surgical and medical management as well as the presence of a well-coordinated multidisciplinary team are crucial in ensuring the adequate management of complex paediatric patients.


Assuntos
Anemia de Fanconi/complicações , Abscesso Peritonsilar/etiologia , Feminino , Humanos , Lactente , Abscesso Peritonsilar/diagnóstico , Abscesso Peritonsilar/terapia , Tomografia Computadorizada por Raios X
19.
Arch Argent Pediatr ; 117(3): e297-e300, 2019 06 01.
Artigo em Espanhol | MEDLINE | ID: mdl-31063321

RESUMO

Peritonsillar abscess is the most common complication of acute bacterial tonsillitis, defined as the presence of purulent exudate between the peritonsillar capsule and the superior constrictor muscle of the pharynx. Usually, its presentation is unilateral; its bilateral involvement is rare. It is more common in adults, being uncommon in children. Clinically, it presents odynophagia, trismus, sialorrhea, fever, guttural voice, symptoms that it shares with the unilateral abscess, evidencing in the physical examination bulging of both anterior pillars, edema of the uvula and soft palate, but without asymmetries of pharyngeal structures. A high level of clinical suspicion is required to achieve early diagnosis. The management of the airway, which could be difficult, is an important aspect in the treatment. It is reported the clinical case of a child with bilateral peritonsillar abscess, the diagnostic and therapeutic process.


Assuntos
Abscesso Peritonsilar/diagnóstico , Tonsilite/complicações , Adolescente , Humanos , Masculino , Abscesso Peritonsilar/terapia
20.
Emerg Med Clin North Am ; 37(1): 69-80, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30454781
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