Max Puterman

Peritonsillar abscess in children in the southern district of Israel.

OBJECTIVE Peritonsillar abscess is the most common deep neck infection and still provides a challenge to care givers in terms of diagnosis and treatment in the pediatric population. This study reviews our experience over the years 2004-2007 at the Soroka University Medical Center in the southern district of Israel in treating children with peritonsillar abscess. We compared our results with data regarding peritonsillar abscess in adults. METHODS We performed a retrospective chart review of 126 children diagnosed and proved to have a peritonsillar abscess. Data regarding: age, sex, ethnicity, number of patients per year, seasonality, prior history of tonsillar infection, prior antibiotic treatment, length of hospitalization, surgical treatment, bacterial results and in hospital antibiotic treatment was collected from the medical charts of the patients. RESULTS The average age of children with peritonsillar abscess was 12.8 years. 92 patients (73%) were above 10 years of age. We did not find an increase in the number of children with peritonsillar abscess per year over the time period of the study. The number of patients with peritonsillar abscess was significantly higher in the autumn and spring, 79 (62.6%) patients did not have prior history of tonsillar infections and 64 (67.4%) children were treated with antibiotics prior to the diagnosis of an abscess. In 95 (75.4%) patients the drainage method was needle aspiration, in 30 (28.3%) patients incision and drainage was performed and only one patient underwent bilateral quinsy tonsillectomy (0.8%). The bacterial culture was negative in 37 (36.7%) patients. In 29 patients (45% of positive cultures) the causative organism was Streptococcus group A. Mixed culture was present in 10 (15.6%) patients, nine cultures (14%) were positive for anaerobes, alone or in combination with other pathogens. Eighty-one patients (64.2%) were treated with amoxicillin-clavulanate potassium, 24 (19%) received cefuroxime and 17 (13.5%) were treated with cefuroxime+ metronidazole. The average hospital stay was 3 days. CONCLUSION Peritonsillar abscess, a potentially life threatening infection, is similar in presentation and bacteriology in the pediatric and the adult population. Based on our review we conclude that peritonsillar abscess in children can be effectively treated by the same methods used in the adult population.

Endoscopic treatment of salivary glands affected by autoimmune diseases.

PURPOSE To asses the possibility of an endoscopic technique to diagnose, treat, and maintain the salivary glands in patients with Sjögren syndrome and systemic lupus erythematosus. PATIENTS AND METHODS A total of 8 patients with Sjögren syndrome and 2 with systemic lupus erythematosus with affected salivary glands were included in the present study. The treatment approach included parotid sialoendoscopy with thorough rinsing, and Stensons duct dilation using hydrostatic pressure and a high-pressure balloon. Hydrocortisone 100 mg was injected through direct vision into the duct. The study was exempt by the Barzilai Medical Center review board. RESULTS The main diagnosis of the patients was chronic recurrent parotitis, with the exception of 1 patient, who presented with salivary stones. CONCLUSIONS The pathologic features of the salivary glands resulting from Sjögren syndrome and systemic lupus erythematosus can be managed successfully using an endoscopic approach.

Pediatric invasive sinonasal Scopulariopsis brevicaulis--a case report and literature review.

OBJECTIVE Acute invasive fungal sinusitis (AIFS) appears mainly in immunocompromized patients and may be caused by various pathogens. We describe a teenager with invasive sinonasal Scopulariopsis brevicaulis and review all the reports on this rare pathogen. METHODS A literature search on Scopulariopsis sinonasal invasive infections was performed and clinical data including age, gender, co-morbidities, treatment and prognosis was collected on all the patients. RESULTS A 17 years old boy with acute myelocytic leukemia and Scopulariopsis brevicaulis sinonasal infection was successfully treated at our department with a combination of extensive surgical debridement and antifungal antibiotics. We found six articled describing six patients with AIFS due to Scopulariopsis species. Four patients were adults and two were children, 3 males and 3 females. Two had an infection with Scopulariopsis acremoium, one with Scopulariopsis candida and for 3 patients no data was given on the specific Scopulariopsis species. All the patients except one were immunocompromized. One patient was treated with antifungal drugs, 2 with surgery and 4 patients received antifungals and were operated. One patient died due to the fungal infection and two patients died due to other causes. CONCLUSIONS Scopulariopsis AIFS is a life threatening disease affecting mainly immunocompromized patients, both children and adults. No clear treatment regimen has been established yet. We describe the first case of a teenager with Scopulariopsis brevicaulis sinonasal infection treated successfully with a combination of wide local excision and antifungal therapy.

Endoscopic treatment of salivary gland injuries due to facial rejuvenation procedures.

Objective: The purpose of this article is to describe innovative surgical techniques for treatment of salivary gland injuries caused by facial rejuvenation procedures.

Comparison of clinical data, CT, and bone histopathology in unilateral chronic maxillary sinusitis.

Objectives To evaluate bone changes demonstrated by computed tomography (CT) as a predictor of the severity of chronic rhinosinusitis. Study Design Cross-sectional study. Settings Tertiary referral university medical center. Subjects and Methods Thirty-eight patients diagnosed with unilateral chronic maxillary sinusitis underwent endoscopic sinus surgery from 2003 to 2009. Preoperative CTs of all patients were reviewed by a single radiologist blinded to the pathologic diagnosis. Bone density was evaluated and expressed in Hounsfield units (HU). Sinus wall thickness (WT) was also measured and compared with the contralateral side. All the histopathologic specimens were reviewed. A database was constructed containing demographic data, clinical symptoms, CT measurements, and histopathologic findings. Results Average age was 44.07 years, with 22 women (57.9%) and 16 men (42.1%). The average wall density (WD) was 828.7 HU, and no correlation was found between the density of the diseased maxillary sinus bony walls and the severity of the histopathologic inflammatory process of the soft tissue (P = .474). The average wall thickness of the diseased sinuses was 2.6 mm, and a correlation was found between inflammation severity and wall thickness (P = .018). Wall thickening was found in 97.3% of the cases and an increase in density in 78.9% without correlation between WD and WT. Conclusion Wall thickness but not WD obtained from CT scans may be a simple index for evaluation of unilateral chronic rhinosinusitis and its severity. Further studies confirming these results and comparing them with clinical correlates are indicated.

The role of tinnitus evaluation tests in differentiating functional versus organic tinnitus.

Objective To evaluate the usefulness of tinnitus tests in differentiating patients with functional tinnitus from patients with organic tinnitus. Design One hundred ninety-six patients with tinnitus were divided into 2 groups. Forty-three patients, group 1, were not exposed to noise and had sensorineural hearing loss. One hundred fifty-three patients, group 2, were exposed to noise and claimed disability. All the patients underwent 4 tinnitus evaluation tests: pitch matching, intensity matching, residual inhibition, and tinnitus masking. We compared the results of the tinnitus tests between the 2 groups. Results Group 1 patients had a high-frequency, low-intensity tinnitus that tended to be more inhibited by narrow-band noise, was usually consistent with type I Feldman masking curve, and could be effectively masked. Group 2 patients had tinnitus that could not be characterized. The results of the tinnitus tests were significantly different between the groups. Conclusion Tinnitus tests may help us differentiate functional tinnitus that is not of cochlear origin from genuine tinnitus.

The influence of epidural anesthesia on the hearing system after normal labor

Abstract Objective: The purpose of our study was to evaluate the influence of epidural anesthesia on the hearing system in women undergoing normal labor. Design: We examined two groups of patients: women with epidural anesthesia underwent four tests of distortion product otoacoustic emissions(DPOAEs): on admission, and fifteen minutes, one hour, and three hours after the last epidural bolus of local anesthetic. Auditory brainstem response (ABR) tests were performed on admission, and one hour, and three hours after the last epidural bolus. Women who gave birth without epidural anesthesia underwent DPOAEs tests on admission, during a uterine contraction, during active delivery, and three hours after labor. ABR tests were performed on admission, during a uterine contraction, and three hours after labor Study sample: twenty patients participated in the study. Twelve gave birth with epidural anesthesia and eight without anesthesia. Results: No significant changes in DPOAEs and ABR recordings were found between the two groups. Conclusions: Epidural anesthesia does not impair the sensory or the neural elements of the hearing system and therefore does not influence hearing. Sumario Objetivo: El propósito de este studio fue evaluar la influencia de la anestesia epidural en el sistema auditivo de mujeres en trabajo de parto normal. Diseño: examinamos dos grupos de pacientes: uno de mujeres con anestesia epidural, realizaron cuatro pruebas con emisiones otoacústicas por productos de distorsión (DPOAE): al ingreso y a los 15 minutos, una hora y tres horas después del último bolo de anestesia local epidural. También se obtuvieron Respuestas Auditivas de Tallo Cerebral (ABR) al ingreso y una y tres horas después del último bolo epidural. Al grupo de mujeres que dieron a luz sin anestesia epidural se les practicaron pruebas de DPOAE al ingreso, durante una contracción uterina durante el parto activo y tres horas después del mismo. También se hicieron pruebas de ABR al ingreso, durante una contracción uterina y tres horas después del parto. Muestra de estudio: veinte pacientes participaron en el estudio. Doce dieron a luz con anestesia epidural y ocho sin anestesia. Resultados: No se encontraron cambios significativos en los registros de las DPOAE y de las ABR entre los dos grupos. Conclusiones: La anestesia epidural no afecta los elementos sensoriales y neurales del sistema auditivo y consecuentemente, no influencia la audición