Željka Roje

Globus Pharyngeus: A Symptom of Increased Thyroid or Laryngopharyngeal Reflux?

SUMMARY – The aim of this study was to investigate the relationship between globus pharyngeus and laryngopharyngeal reflux, as well as between globus and thyroid volume. A two-year prospective study included 56 patients aged 18-75 with globus symptom. Anthropometric, clinical and laboratory data were collected. All patients filled-out the Glasgow Edinburgh Throat Scale (GETS) and then underwent thyroid ultrasound. Morphological changes of the larynx were detected by direct laryngoscopy and classified by the Reflux Finding Score (RFS). If RFS >7, the diagnosis of laryngopharyngeal reflux was made and therapy with proton pump inhibitors initiated. According to GETS, there was significant difference between patients with normal volume and those with large thyroid volume. There was no statistically significant difference between patients with RFS <7 and RFS >7. In conclusion, the incidence and severity of globus pharyngeus do not definitely indicate laryngopharyngeal reflux. It is more common in patients with normal thyroid volume.

Coblation tonsilloadenoidectomy - treatment of choice for very small children

Tonsillectomy is one of the most common operative procedures in childhood. According to the Croatian national guidelines for the treatment of sore throat (ISKRA guidelines), apsolute indications for tonsillectomy are recurrent tonsillitis (>4 per year) and sleep disordered breathing (including snoring and obstructive sleep apnea). Most children in Croatia undergo conventional cold steel tonsillectomy with bipolar diathermy coagulation using reusable surgical accessories. Estimated blood loss during this type of surgery is about 10% of complete blood volume. That is why, tonsillectomy is performed mostly in children 3 years of age and above because their weight and blood volume. Coblation tonsillectomy results in less postoperative blood loss and less postoperative morbidity and is therefore the method of choice for operating on very small children. We present the case of a 3-year-old girl with somatic retardation (height 92 cm, weight 9,280 kg) who underwent coblation tonsilloadenoidectomy. As far as we now, this procedure has never been performed in a child of lower weight.

The impact of general anaesthesia for elective adenotonsillectomy in children aged 6-12 years on biomarkers of cerebral injury S100B and NSE.

Background and Goal of Study: S100B protein and NSE (neuron specific enolase) can be considered as early markers of cerebral injury. The impact of general anesthesia for elective noncardiac surgery in children on these markers has not been studied before. The goal was to find out whether these markers can be used to access the short term neurological outcome after general anesthesia. The secondary goal was to determine whether different types of anesthesia influence the levels of S100B and NSE. Materials and methods: Prospective study was conducted at the University Hospital on 64 children (aged 6-12, ASA I-II) undergoing elective adenotonsillectomy. The children were randomized into 2 groups:TIVA (n=32) and sevoflurane(S) (n=32). In TIVA group anesthesia was induced with propofol, fentanyl and vecuronium and maintained with continuous infusion of propofol. In S group, anesthesia was induced with fentanyl, sevoflurane and vecuronium and maintained with sevoflurane. S100B and NSE were measured before and after the surgery. S100B and NSE assays were performed using the electrochemiluminiscence immunoassay “ECLIA” used on Roche Cobas e601 immunoassay analyzer (Roche Diagnostics GmbH, Mannheim, Germany). Statistical significance of the differences was accessed by two-tailed asymptotic Wilcoxon Signed Rank test. The 95% CI for median difference was calculated by bootstrapping on 1000 samples in IBM SPSS Statistics version 21. Results and discussion: There was statistically significant increase of S100B median value after surgery with regard to preoperative values (P< 0.001). Median(interquartile range) values of S100B before and after surgery were 0.08 (0.064-0.102) and 0.1 (0.072-0.179), respectively. There was no statistically significant change of NSE median value af ter surgery regarding preoperative values (P=0.567). The prevalence of elevated S100B (≥0.105 ug/l) after the surgery was statistically significantly higher than before (McNemar test, two sided exact P=0.003). There were 12/60 children (20.0% ; 95% CI=(10.5%-29.8%)) with elevated S100 B before and 28/60 (46.7% ; 95% CI=33.3%-59.6%)) after surgery. Conclusion(s): The values of neurological biomarker S100B, but not of NSE, were significantly increased af ter general anesthesia for elective adenotonsillectomy in children, indicating possible cerebral injury.There were no differences regarding 2 types of anaesthesia, TIVA or inhalational.