Anthony J. Mortelliti

Respiratory Syncytial Virus Infection Induces Expression of the Anti-Apoptosis Gene IEX-1L in Human Respiratory Epithelial Cells

By means of differential display reverse-transcriptase polymerase chain reaction, increased expression of the mRNA encoding the anti-apoptosis gene IEX-1L was found in respiratory epithelial cells infected with respiratory syncytial virus (RSV). IEX-1L mRNA expression increased 5-7-fold in RSV-infected cells at 72 h after infection but remained unchanged in cells exposed to irradiated, replication-incompetent RSV. Because IEX-1L is reported to protect cells from apoptosis induced by tumor necrosis factor (TNF)-alpha, the effect of TNF-alpha on epithelial cell apoptosis in the context of RSV infection was determined. Epithelial cells were exposed to vehicle, RSV, or irradiated RSV for 72 h, and then TNF-alpha was added to appropriate cultures. Cytochemical staining of cellular DNA with 4,6-diamidino-2-phenylindole demonstrated TNF-alpha-induced apoptosis in 23.4% of control cells but only 5% of RSV-infected cells. These data show that RSV infection protects epithelial cells from TNF-alpha-induced apoptosis and that this effect is temporally associated with IEX-1L gene expression.

Gastric choristoma of the hypopharynx presenting in an infant: a case report and review of the literature

Normal gastric mucosa has been found throughout the alimentary tract, ranging from scattered rests of cells to well formed mucosa with submucosal smooth muscle. Many terms have been applied to these collections; however, the term gastric choristoma seems most appropriate. We present a case of hypopharyngeal gastric choristoma presenting with dysphagia and frequent emesis. Our literature review reveals that this is the seventh reported case of gastric choristoma found in the hypopharynx, and the first to present in an infant in the absence of respiratory distress. Excision or CO(2) laser ablation is useful for symptom relief; however, complete removal often requires multiple attempts.

Microbial Flora and Antibiotic Resistance in Peritonsillar Abscesses in Upstate New York

Objectives: To identify the common bacteria in recent peritonsillar abscesses and the prevalence of antibiotic resistance and compare both between adults and children. Methods: This is a retrospective chart review at a single academic institution of patients who underwent either incision and drainage or tonsillectomy for a peritonsillar abscess between 2002 and 2012 (n = 69). Medical records were reviewed for cultures, comorbidities, and drainage procedures. Results: Cultures obtained from 62.32% of peritonsillar abscesses were polymicrobial, and 34.78% were monomicrobial. The most common pathogens were β-hemolytic Streptococcus (31.88%), α-hemolytic Streptococcus (21.74%), Neisseria (14.49%), and Streptococcus milleri (13.04%). Group A β-hemolytic streptococcus was more common in children and Streptococcus milleri was more common in adults. Alpha-hemolytic streptococcus was resistant to clindamycin (6.67%) and erythromycin (6.67%). Streptococcus milleri was resistant to clindamycin (11.11%) and erythromycin (11.11%). Staphylococcus was resistant to penicillin (37.5%), oxacillin (25%), erythromycin (25%), and clindamycin (12.5%). Conclusions: β- and α-hemolytic Streptococci, Neisseria, and Streptococcus milleri are the most common pathogens. Streptococcus milleri is more common in adults, and β-hemolytic streptococcus is more common in children. Resistance to clindamycin and erythromycin is common in Streptococci and Staphylococci, and penicillin resistance is common in Staphylococci.

Impact on hearing of routine ear suctioning at the tympanic membrane

OBJECTIVE Patient and equipment safety has become increasingly scrutinized in todays medical care. Routine otolaryngologic evaluation often involves suctioning with Frazier-type suction devices in the ear canal for improved visualization, but data are limited on the potential acoustic trauma from ear canal suction devices. This study intends to document the objective and subjective effects of ear canal suctioning to identify any risk for hearing threshold shifts or other potential negative effects. PATIENTS AND METHODS Prospective study on 21 healthy volunteers enlisted for evaluation. Presuctioning tympanogram, audiogram, and otoacoustic emissions data were obtained. Spectrum analyses were recorded during ear canal suctioning with a probe microphone placed lateral to the tympanic membrane. Subjective data were recorded, and a follow-up audiogram and otoacoustic emissions were obtained to identify any temporary threshold shifts. RESULTS Spectrum analyses revealed a high degree of variability between subjects. A peak intensity of 111 dB sound pressure level was recorded. All patients tolerated suctioning, and none reported hearing loss. No threshold shifts were observed. Subjective data failed to correlate with the objective recorded intensities. CONCLUSIONS Clinicians and patients need to be acutely aware of potential risks and benefits from any medical intervention. Routine ear canal suctioning can be extremely loud and uncomfortable for patients. This study failed to document objective proof of hearing detriment from ear canal suctioning, although the possibility exists during office and surgical intervention. Further study and potential alternative suctioning methods deserve attention.

Transoral resection of extensive pediatric supraglottic neurofibroma: Pediatric TOS

This case report describes the novel use of transoral robotic surgery (TORS) with delayed transoral laser microsurgery (TLM) for residual disease in the resection of a pediatric neurofibroma with supraglottic and parapharyngeal space extension. Postoperatively, the patient had excellent functional outcomes. This case demonstrates that pediatric TORS is feasible, safe, and complementary to TLM. Neurofibroma is just one of the diverse pathologic processes of the pediatric airway that can be managed via transoral surgery, and applications of TORS with TLM will continue to broaden as our experience develops. Laryngoscope, 2525–2528, 2018

Changes in Tonsil B Cell Phenotypes and EBV Receptor Expression in Children Under 5-Years-Old: TONSIL B CELL PHENOTYPES AND EBV RECEPTOR IN CHILDREN

Palatine tonsils are principally B cell organs that are the initial line of defense against many oral pathogens, as well as the site of infection for others. While the size of palatine tonsils changes greatly in the first five years of life, the cellular changes during this period are not well studied. Epstein Barr virus (EBV) is a common orally transmitted virus that infects tonsillar B cells. Naïve B cells are thought to be the target of primary infection with EBV in vivo, suggesting that they are targeted by the virus. EBV enters B cells through CD21, but studies of older children and adults have not shown differences in surface CD21 between naïve B cells and other tonsil B cell populations.

Incremental change in cross sectional area in small endotracheal tubes: A call for more size options

OBJECTIVE To elucidate the relatively large incremental percent change (IPC) in cross sectional area (CSA) in currently available small endotracheal tubes (ETTs), and to make recommendation for lesser incremental change in CSA in these smaller ETTs, in order to minimize iatrogenic airway injury. METHODS The CSAs of a commercially available line of ETTs were calculated, and the IPC of the CSA between consecutive size ETTs was calculated and graphed. The average IPC in CSA with large ETTs was applied to calculate identical IPC in the CSA for a theoretical, smaller ETT series, and the dimensions of a new theoretical series of proposed small ETTs were defined. RESULTS The IPC of CSA in the larger (5.0-8.0 mm inner diameter (ID)) ETTs was 17.07%, and the IPC of CSA in the smaller ETTs (2.0-4.0 mm ID) is remarkably larger (38.08%). Applying the relatively smaller IPC of CSA from larger ETTs to a theoretical sequence of small ETTs, starting with the 2.5 mm ID ETT, suggests that intermediate sizes of small ETTs (ID 2.745 mm, 3.254 mm, and 3.859 mm) should exist. CONCLUSION We recommend manufacturers produce additional small ETT size options at the intuitive intermediate sizes of 2.75 mm, 3.25 mm, and 3.75 mm ID in order to improve airway management for infants and small children.

Acute chest syndrome following adenotonsillectomy in a pediatric patient with Hemoglobin SC disease

Hemoglobinopathies involving Hemoglobin S, like Hemoglobin SC disease, are characterized by anemia and vaso-occlusive crises. Vaso-occlusive crises can range in severity from localized pain to acute chest syndrome and myocardial infarction. These crises are usually brought on by stressors that induce hypothermia, hypoxia or acidosis, such as surgery [1]. Here we report a case of acute chest syndrome in a child with Hemoglobin SC disease following adenotonsillectomy and review of the literature regarding acute chest syndrome following adenotonsillectomy.

Nasal Obstruction and Epistaxis

A preteen boy presented with a 1-year history of right-sided nasal obstruction and a 4-day history of intermittent right-sided epistaxis following blunt trauma to the nose. The epistaxis occurred 3 to 4 times a day and resolved with pressure. He did not have facial pain, facial paresthesia, or visual changes. There was no family or personal history of bleeding disorders. Nasal endoscopy revealed a large, well-vascularized, polypoid mass filling the right anterior nasal cavity. A computed tomographic scan showed a right nasal cavity mass (4.5 × 1.7 cm) extending to the posterior choana with opacification and bony remodeling of the right maxillary sinus. The mass had heterogeneous intermediate signal intensity on T2-weightedmagnetic resonance imaging (Figure, A). The patient was taken to the operating room for biopsy and possible excision of the nasal mass. As the lesion was biopsied, there was brisk bleeding. However, the lesion was found to have a narrow pedicle of attachment and was resected in its entirety. The mass was based on the superior aspect of the nasal septum and cribriform plate. Hematoxylin-eosin stain showed a sheet-like proliferation of epithelioid and polygonal cells with pale eosinophilic granular cytoplasm and relatively uniform vesicular nuclei (Figure, B). The cells were arranged in nests. Branching, staghorn-like blood vessels were scattered throughout the tumor. The tumor cells stained positive for smooth muscle actin (Figure, C), muscle specific actin, Bcl-2, INI-1, and transcription factor E3 (Figure, D). A B