Nir Hirshoren

WOUND-HEALING MODULATION IN UPPER AIRWAY STENOSIS—MYTHS AND FACTS

Wound healing plays a major role in the development of acquired subglottic stenosis. Pharmacologic treatment of subglottic stenosis must address both physiologic and pathologic healing processes. The relevant Pubmed and Ovid databases from 1960 to 2007 were systematically searched. Several modulating agents have been tested. Most of them were poorly investigated. Three modalities were thoroughly studied—steroids and antibiotics, mitomycin, and antireflux medications. However, there are conflicting data regarding their role in preventing and treating subglottic stenosis. Current data support to some extent the textbook suggestions of antibiotics, steroids, and antireflux treatment. As no other treatment options exist, we recommend using these modalities for pharmacologic modulation of subglottic stenosis. Mitomycin should still be considered as an unproven treatment; its use may be considered as an adjunct.

The imperative of the Sistrunk operation: Review of 160 thyroglossal tract remnant operations

Objective: Analysis of the pre- and postoperative features, long-term follow-up, and complications. Study Design and Methods: Case series with chart review of 160 thyroglossal tract remnant excisions over a 20-year period (1988-2007). Results: The mean age of diagnosis was 10.9 ± 14.2 years with 63.8 percent male predominance. There was a prior history of thyroglossal tract remnant infections in 70 percent of patients, and 30 percent presented with cutaneous fistulas. The majority had ultrasound imaging that identified cysts mainly (66.7%) in the infrahyoid region. Preoperative fine-needle aspirations in 18 patients were benign. On pathological reevaluation, 26.5 percent had thyroid tissue inside the remnant, with one case of papillary carcinoma. After the Sistrunk operation, postoperative complications occurred in 7.5 percent including a 1.9 percent recurrence rate. Conclusions: All age groups had similar clinical presentations and outcomes. Ultrasound is a reliable and appropriate imaging modality for most patients. Surgery must effectively incorporate the tract and cyst to allow low recurrence rates (<2%). Clinically diagnosed thyroglossal tract remnant may, in fact, be other pathologies in 10 percent of cases. Nevertheless, our recommendation is a Sistrunk procedure for all midline neck lesions suspected to be a thyroglossal tract remnant.

Hydroxychloroquine for subglottic stenosis: a novel therapy in the battle for air.

Upper airway obstruction due to subglottic edema and granulation tissue proliferation may cause severe morbidity and may be life threatening. Hydroxychloroquine interferes with antigen processing by means of raising lysosomal pH and immune response modulation. Herein, we present the outcome of a steroid‐sparing treatment using hydroxychloroquine in an 80‐year‐old man with acquired subglottic stenosis and steroid dependency. Twice daily oral hydroxychloroquine at 2 mg/kg/day allowed cessation of systemic steroids without recurrence of the stenosis. Successful weaning of the hydroxychloroquine took place over a 5‐month period. Laryngoscope, 2010

False negative β‐2 transferrin in the diagnosis of cerebrospinal fluid leak in the presence of Streptococcus pneumoniae

The objectives of this study were to examine the presence of β‐2 transferrin (β2TRNSF) in cerebrospinal fluid (CSF) contaminated in vitro by various bacteria and explore the mechanism (passive or active) responsible for β2TRNSF elimination. Early diagnosis of CSF leakage may change treatment decisions and minimize the risk of meningitis and encephalitis. β2TRNSF is a protein present exclusively in CSF. Its detection is highly useful in cases of CSF leakage, although it has never been examined in the presence of central nervous system infection.

Computed tomography scan findings in refractory acute rhinosinusitis

Several sinonasal anatomical variants may be related to the etiology of acute rhinosinusitis. The same is true with intrusion of teeth into the maxillary sinus cavity. Patients with acute rhinosinusitis not responding to maximal medical treatment were prospectively enrolled. Deviation of the nasal septum towards the infected sinus may be associated with the pathogenesis of refractory acute rhinosinusitis. Intrusion of teeth into the maxillary sinus is a common finding and is not necessarily associated with the formation of sinusitis.

Is Surgery for an FNA proven Warthin's Tumor Passé?

Abstract Background: Warthin tumor is a common benign salivary gland lesion. Its optimal treatment mode is controversial. We analyze the accuracy of Warthin tumor pre-operative fine-needle aspiration (FNA)-based

Otolaryngology/head and neck region manifestations of Brucella : Brucella of the Head and Neck Region

Patients with Brucella infection present with nonspecific symptoms originating from different organs. In this study, we investigated the manifestations involving principally the otolaryngology/head and neck region.

Maxillary Air Density Measurements for Differentiating Between Acute and Chronic Rhinosinusitis

OBJECTIVE Maxillary sinus air-fluid levels and sinus opacification may appear similar in cases of acute and chronic rhinosinusitis. Our aim was to evaluate whether air density analysis in addition to air-fluid level can be used as a metric to differentiate between cases of acute and chronic rhinosinusitis. SUBJECTS AND METHODS A prospective study of three patient groups (n = 73) who underwent sinus CT was performed. A study group composed of 23 patients with clinical acute rhinosinusitis was compared with two different control groups (one with chronic rhinosinusitis and the other with healthy sinuses) with 25 patients in each. In each case air density within the maxillary sinus was measured using a region of interest of 1 cm(2), 0.5 cm away from the sinus wall. The mean and SD of air density of each maxillary sinus were calculated from five sequential CT slices. We compared the results of each group using a paired Student t test and analysis of variance. RESULTS Mean air density was significantly higher in the acutely inflamed sinuses compared with chronic sinusitis and healthy aerated sinuses (-846.6 vs -980 and -975.8 HU, respectively; p < 0.05). Sinus air density SD was greater in the acutely inflamed sinus than in chronic sinusitis and healthy sinuses (78.3 vs 17.9 and 6.8 HU, respectively; p < 0.05). CONCLUSION Increased sinus air density and heterogeneity may help differentiate acute from chronic rhinosinusitis.

Is That a Fish Bone

Background: Impacted foreign bodies in the esophagus can easily cause mucosal ulceration, inflammation and infections which may result in various fatal complications. Computed tomography was determined to be very useful in the diagnosis of impacted fish bones in the esophagus. Aim: Demonstrate incorrect imaging interpretation as result of enteric opacification following oral administration of medications. Case presentation: A seventy-seven year old woman was referred regarding odynophagia after eating fish. A computed tomography scan of the neck and chest showed a 5 cm long bone in the upper esophagus. However, rigid esophagoscopy failed to identify a bone. Amiodarone is fat-soluble iodine rich antiarrhythmic agent. In our case the high iodine content of amiodarone caused the deceptive computed tomography scan. Conclusion: Medications’ radio-opacification may confuse the physician while searching for foreign bodies.

Imaging is essential before aggressive management of refractory acute rhinosinusitis

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