The Journal of Emergency Medicine
Volume 38, Issue 3, Pages 366-367 (April 2010)
David Cheng, MD, 470 Schooleys Mountain Road, Hackettstown, NJ 07840
Received 6 May 2008; received in revised form 4 December 2008; accepted 17 December 2008. published online 23 March 2009.
Abstract
Background: The conventional approach to mandibular dislocation involves intraoral bilateral inferior-posterior downward force on the patient's molar occlusal surfaces.
Discussion/Technique: The unified hands technique is a new method for reducing a mandibular dislocation. The technique involves intraoral unilateral application of both hands on the side of the dislocated mandible. This maneuver was successful in reducing a mandibular dislocation refractory to the traditional method of intraoral bilateral inferior-posterior downward force on the patient's molar occlusal surface.
Conclusion: The technique described may be useful for the emergent reduction of mandibular dislocations when traditional methods fail.
Monday, March 29, 2010
Friday, March 26, 2010
Multicenter Study of Repeat Epinephrine Treatments for Food-Related Anaphylaxis
PEDIATRICS (doi:10.1542/peds.2009-2832)
Susan A. Rudders, MDa,b, Aleena Banerji, MDc, Blanka Corel, MDb, Sunday Clark, MPH, ScDd, Carlos A. Camargo, Jr, MD, DrPHb,c
aDivision of Allergy and Immunology, Children's Hospital Boston, Boston, Massachusetts;
bDepartment of Emergency Medicine and
cDivision of Rheumatology, Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts; and
dDepartment of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
Objective We sought to establish the frequency of receiving >1 dose of epinephrine in children who present to the emergency department (ED) with food-related anaphylaxis.
Patients and Methods We performed a medical chart review at Boston hospitals of all children presenting to the ED for food-related acute allergic reactions between January 1, 2001, and December 31, 2006. We focused on causative foods, clinical presentations, and emergency treatments.
Results Through random sampling and appropriate weighting, the 605 reviewed cases represented a study cohort of 1255 patients. These patients had a median age of 5.8 years (95% confidence interval [CI]: 5.3–6.3), and the cohort was 62% male. A variety of foods provoked the allergic reactions, including peanuts (23%), tree nuts (18%), and milk (15%). Approximately half (52% [95% CI: 48–57]) of the children met diagnostic criteria for food-related anaphylaxis. Among those with anaphylaxis, 31% received 1 dose and 3% received >1 dose of epinephrine before their arrival to the ED. In the ED, patients with anaphylaxis received antihistamines (59%), corticosteroids (57%), epinephrine (20%). Over the course of their reaction, 44% of patients with food-related anaphylaxis received epinephrine, and among this subset of patients, 12% (95% CI: 9–14) received >1 dose. Risk factors for repeat epinephrine use included older age and transfer from an outside hospital. Most patients (88%) were discharged from the hospital. On ED discharge, 43% were prescribed self-injectable epinephrine, and only 22% were referred to an allergist.
Conclusions Among children with food-related anaphylaxis who received epinephrine, 12% received a second dose. Results of this study support the recommendation that children at risk for food-related anaphylaxis carry 2 doses of epinephrine.
Abbreviations: CI = confidence interval
Susan A. Rudders, MDa,b, Aleena Banerji, MDc, Blanka Corel, MDb, Sunday Clark, MPH, ScDd, Carlos A. Camargo, Jr, MD, DrPHb,c
aDivision of Allergy and Immunology, Children's Hospital Boston, Boston, Massachusetts;
bDepartment of Emergency Medicine and
cDivision of Rheumatology, Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts; and
dDepartment of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
Objective We sought to establish the frequency of receiving >1 dose of epinephrine in children who present to the emergency department (ED) with food-related anaphylaxis.
Patients and Methods We performed a medical chart review at Boston hospitals of all children presenting to the ED for food-related acute allergic reactions between January 1, 2001, and December 31, 2006. We focused on causative foods, clinical presentations, and emergency treatments.
Results Through random sampling and appropriate weighting, the 605 reviewed cases represented a study cohort of 1255 patients. These patients had a median age of 5.8 years (95% confidence interval [CI]: 5.3–6.3), and the cohort was 62% male. A variety of foods provoked the allergic reactions, including peanuts (23%), tree nuts (18%), and milk (15%). Approximately half (52% [95% CI: 48–57]) of the children met diagnostic criteria for food-related anaphylaxis. Among those with anaphylaxis, 31% received 1 dose and 3% received >1 dose of epinephrine before their arrival to the ED. In the ED, patients with anaphylaxis received antihistamines (59%), corticosteroids (57%), epinephrine (20%). Over the course of their reaction, 44% of patients with food-related anaphylaxis received epinephrine, and among this subset of patients, 12% (95% CI: 9–14) received >1 dose. Risk factors for repeat epinephrine use included older age and transfer from an outside hospital. Most patients (88%) were discharged from the hospital. On ED discharge, 43% were prescribed self-injectable epinephrine, and only 22% were referred to an allergist.
Conclusions Among children with food-related anaphylaxis who received epinephrine, 12% received a second dose. Results of this study support the recommendation that children at risk for food-related anaphylaxis carry 2 doses of epinephrine.
Abbreviations: CI = confidence interval
Successful treatment of cutaneous hemangioma of infancy with topical imiquimod 5%: A report of 3 cases
Ear, Nose and Throat Journal (ENT) 89 (3), E21-5 (Mar 2010)
Dann M, Cable B, Bessinger G, Senchak AJ;
Hemangioma of infancy is the most common benign tumor of childhood. Most of these tumors spontaneously regress over several years. However, many parents seek treatment for children with cutaneous hemangiomas because of the potential for disfigurement and the attendant psychosocial effects. We report our use of the nightly application of topical imiquimod 5% cream as an alternative to traditional management in 3 infants who presented with rapidly growing facial hemangiomas. After approximately 3 to 5 months of treatment, all 3 patients had experienced a near-complete resolution of their lesions without significant side effects. Based on our experience, we believe that topical imiquimod may be an important tool for the otolaryngologist who treats cutaneous hemangiomas.
Dann M, Cable B, Bessinger G, Senchak AJ;
Hemangioma of infancy is the most common benign tumor of childhood. Most of these tumors spontaneously regress over several years. However, many parents seek treatment for children with cutaneous hemangiomas because of the potential for disfigurement and the attendant psychosocial effects. We report our use of the nightly application of topical imiquimod 5% cream as an alternative to traditional management in 3 infants who presented with rapidly growing facial hemangiomas. After approximately 3 to 5 months of treatment, all 3 patients had experienced a near-complete resolution of their lesions without significant side effects. Based on our experience, we believe that topical imiquimod may be an important tool for the otolaryngologist who treats cutaneous hemangiomas.
Wednesday, March 24, 2010
Induced atelectasis of the middle ear and its clinical behavior
European Archives of Oto-Rhino-Laryngology Volume 248, Number 5 / July 1991
M. Luntz1, S. Eisman1 and J. Sade1 (1) Department of Otolaryngology, Sackler School of Medicine, The Bioengineering Program, Tel-Aviv University, Ramat Aviv, Israel
(2) 14 Hagefen Street, 47254 Ramat Hasharon, Israel
Received: 10 September 1990 Accepted: 10 October 1990
Summary Atelectatic ears are often treated with ventilating tubes for long periods of time. However, a certain percentage of atelectatic ears and retraction pockets resolve spontaneously over time. In order to determine whether self-aeration had been achieved in atelectatic ears previously fitted with ventilating tubes, the tubes were sealed and the ears were then closely followed. Out of 37 such tests, atelectasis did not recur in 4 ears, allowing their ventilating tubes to be removed. In 33 tests atelectasis redeveloped within 1–2 h after the ventilating tube was sealed, with ears reverting to the same degree and shape as the original atelectatic condition. The seals were then removed, resulting in resolution of atelectasis. These observations were enforced by previous observations of similar changes and suggest that the partial pressures of the blood gases may be an important factor in controlling the level and possibly also the pathogenesis of atelectasis. The method of testing described also can be used in selected cases to determine whether or not a given atelectatic ear still requires a ventilating tube.
M. Luntz1, S. Eisman1 and J. Sade1 (1) Department of Otolaryngology, Sackler School of Medicine, The Bioengineering Program, Tel-Aviv University, Ramat Aviv, Israel
(2) 14 Hagefen Street, 47254 Ramat Hasharon, Israel
Received: 10 September 1990 Accepted: 10 October 1990
Summary Atelectatic ears are often treated with ventilating tubes for long periods of time. However, a certain percentage of atelectatic ears and retraction pockets resolve spontaneously over time. In order to determine whether self-aeration had been achieved in atelectatic ears previously fitted with ventilating tubes, the tubes were sealed and the ears were then closely followed. Out of 37 such tests, atelectasis did not recur in 4 ears, allowing their ventilating tubes to be removed. In 33 tests atelectasis redeveloped within 1–2 h after the ventilating tube was sealed, with ears reverting to the same degree and shape as the original atelectatic condition. The seals were then removed, resulting in resolution of atelectasis. These observations were enforced by previous observations of similar changes and suggest that the partial pressures of the blood gases may be an important factor in controlling the level and possibly also the pathogenesis of atelectasis. The method of testing described also can be used in selected cases to determine whether or not a given atelectatic ear still requires a ventilating tube.
Friday, March 19, 2010
Drug-induced rhinitis
Clinical and Experimental Allergy 40 (3), 381-4 (Mar 2010)
Varghese M, Glaum MC, Lockey RF
Background: Rhinitis is characterized by inflammation of the mucous membranes lining the nose and can be divided into two categories, allergic and non-allergic. Drug-induced is a type of non-allergic rhinitis.
Objective A review of the literature was conducted. Very little is known about this topic and there are no publications to date solely devoted to drug-induced rhinitis.
Methods A PubMed and Medline search was conducted using a combination of the keywords; drug, medication, rhinitis, congestion, rhinorrhea, sneezing, pruritus, vasomotor, reflex, neurogenic, allergic and non-allergic. Medications that were found in the search were then cross-referenced with the physicians desk reference and Epocrates. The final literature search was conducted in August 2009.
Results Three categories of drug-induced rhinitis exist based on the mechanism of action. These include local inflammatory, neurogenic and idiopathic types. Rhinitis medicamentosa, a form of drug-induced rhinitis, has unique characteristics.
Conclusion When possible, the offending medication should be discontinued or substituted. Although there are no established treatment recommendations for drug-induced rhinitis other than avoidance, clinical experience suggests that it would be reasonable to initiate use of an intranasal corticosteroid spray to treat symptomatically. The addition of an intranasal antihistamine in combination with use of an intranasal corticosteroid may be considered as step-up therapy if the intranasal corticosteroid alone is not effective.
Varghese M, Glaum MC, Lockey RF
Background: Rhinitis is characterized by inflammation of the mucous membranes lining the nose and can be divided into two categories, allergic and non-allergic. Drug-induced is a type of non-allergic rhinitis.
Objective A review of the literature was conducted. Very little is known about this topic and there are no publications to date solely devoted to drug-induced rhinitis.
Methods A PubMed and Medline search was conducted using a combination of the keywords; drug, medication, rhinitis, congestion, rhinorrhea, sneezing, pruritus, vasomotor, reflex, neurogenic, allergic and non-allergic. Medications that were found in the search were then cross-referenced with the physicians desk reference and Epocrates. The final literature search was conducted in August 2009.
Results Three categories of drug-induced rhinitis exist based on the mechanism of action. These include local inflammatory, neurogenic and idiopathic types. Rhinitis medicamentosa, a form of drug-induced rhinitis, has unique characteristics.
Conclusion When possible, the offending medication should be discontinued or substituted. Although there are no established treatment recommendations for drug-induced rhinitis other than avoidance, clinical experience suggests that it would be reasonable to initiate use of an intranasal corticosteroid spray to treat symptomatically. The addition of an intranasal antihistamine in combination with use of an intranasal corticosteroid may be considered as step-up therapy if the intranasal corticosteroid alone is not effective.
Wednesday, March 17, 2010
Non-invasive evaluation of vertebral artery blood flow in cervical spondylosis with and without vertigo and association with degenerative changes
Clinical Rheumatology 0770-3198 (Print) 1434-9949 (Online), Published online: 16 February 2010 Remzi Cevik1 , Aslan Bilici2, Kemal Nas1, Zeynep Demircan1 and Rojbin Ceylan Tekin2(1) Department of Physical Medicine and Rehabilitation, Faculty of Medicine, University of Dicle, 21280 Diyarbakir, Turkey
(2) Department of Radiology, Faculty of Medicine, University of Dicle, Diyarbakir, Turkey
Received: 31 May 2009 Revised: 4 January 2010 Accepted: 8 January 2010
Abstract Cervical spondylosis is a common disease that results from degenerative changes of the cervical spine and vertigo may occur in this process.
The aim of the present study was to assess the blood flow measurements of the vertebral artery (VA) using color Doppler ultrasonography (CDUS) in patients who have cervical spondylosis with and without vertigo. The study population included 101 patients with vertigo and spondylosis, 66 patients with spondylosis without vertigo, and 62 healthy controls. A bilateral decrease in the VA blood flow velocities were measured in patients with cervical spondylosis.
A negative correlation was found between the stage of cervical degenerative changes and the flow velocities in patients with vertigo, while this relationship was not found in patients without vertigo.
The CDUS evaluation of the pretransverse and transverse segments of VAs demonstrated significantly reduced flow velocities in patients with spondylosis.
The degenerative changes in the cervical spine seem to be related to these velocity changes in the subgroup of patients who are also affected with vertigo. The pretransverse segment of the VA provides valuable measurements as well as transverse segment of the VA, and it can be used as an appropriate segment for CDUS examination in cervical spondylosis and associated vertigo.
(2) Department of Radiology, Faculty of Medicine, University of Dicle, Diyarbakir, Turkey
Received: 31 May 2009 Revised: 4 January 2010 Accepted: 8 January 2010
Abstract Cervical spondylosis is a common disease that results from degenerative changes of the cervical spine and vertigo may occur in this process.
The aim of the present study was to assess the blood flow measurements of the vertebral artery (VA) using color Doppler ultrasonography (CDUS) in patients who have cervical spondylosis with and without vertigo. The study population included 101 patients with vertigo and spondylosis, 66 patients with spondylosis without vertigo, and 62 healthy controls. A bilateral decrease in the VA blood flow velocities were measured in patients with cervical spondylosis.
A negative correlation was found between the stage of cervical degenerative changes and the flow velocities in patients with vertigo, while this relationship was not found in patients without vertigo.
The CDUS evaluation of the pretransverse and transverse segments of VAs demonstrated significantly reduced flow velocities in patients with spondylosis.
The degenerative changes in the cervical spine seem to be related to these velocity changes in the subgroup of patients who are also affected with vertigo. The pretransverse segment of the VA provides valuable measurements as well as transverse segment of the VA, and it can be used as an appropriate segment for CDUS examination in cervical spondylosis and associated vertigo.
Friday, March 12, 2010
Rhinitis and sinusitis
Journal of Allergy and Clinical Immunology (JACI) 125 (2 Suppl 2), S103-15 (Feb 2010)
Dykewicz MS, Hamilos DL
Rhinitis and sinusitis are among the most common medical conditions and are frequently associated. In Western societies an estimated 10% to 25% of the population have allergic rhinitis, with 30 to 60 million persons being affected annually in the United States. It is estimated that sinusitis affects 31 million patients annually in the United States. Both rhinitis and sinusitis can significantly decrease quality of life, aggravate comorbid conditions, and require significant direct medical expenditures. Both conditions also create even greater indirect costs to society by causing lost work and school days and reduced workplace productivity and school learning.
Management of allergic rhinitis involves avoidance, many pharmacologic options, and, in appropriately selected patients, allergen immunotherapy. Various types of nonallergic rhinitis are treated with avoidance measures and a more limited repertoire of medications. For purposes of this review, sinusitis and rhinosinusitis are synonymous terms.
An acute upper respiratory illness of less than approximately 7 days' duration is most commonly caused by viral illness (viral rhinosinusitis), whereas acute bacterial sinusitis becomes more likely beyond 7 to 10 days.
Although the mainstay of management of acute bacterial sinusitis is antibiotics, treatment of chronic sinusitis is less straightforward because only some chronic sinusitis cases have an infectious basis.
Chronic rhinosinusitis (CRS) has been subdivided into 3 types, namely CRS without nasal polyps, CRS with nasal polyps, and allergic fungal rhinosinusitis. Depending on the type of CRS present, a variety of medical and surgical approaches might be required
Dykewicz MS, Hamilos DL
Rhinitis and sinusitis are among the most common medical conditions and are frequently associated. In Western societies an estimated 10% to 25% of the population have allergic rhinitis, with 30 to 60 million persons being affected annually in the United States. It is estimated that sinusitis affects 31 million patients annually in the United States. Both rhinitis and sinusitis can significantly decrease quality of life, aggravate comorbid conditions, and require significant direct medical expenditures. Both conditions also create even greater indirect costs to society by causing lost work and school days and reduced workplace productivity and school learning.
Management of allergic rhinitis involves avoidance, many pharmacologic options, and, in appropriately selected patients, allergen immunotherapy. Various types of nonallergic rhinitis are treated with avoidance measures and a more limited repertoire of medications. For purposes of this review, sinusitis and rhinosinusitis are synonymous terms.
An acute upper respiratory illness of less than approximately 7 days' duration is most commonly caused by viral illness (viral rhinosinusitis), whereas acute bacterial sinusitis becomes more likely beyond 7 to 10 days.
Although the mainstay of management of acute bacterial sinusitis is antibiotics, treatment of chronic sinusitis is less straightforward because only some chronic sinusitis cases have an infectious basis.
Chronic rhinosinusitis (CRS) has been subdivided into 3 types, namely CRS without nasal polyps, CRS with nasal polyps, and allergic fungal rhinosinusitis. Depending on the type of CRS present, a variety of medical and surgical approaches might be required
Fluticasone Reverses Oxymetazoline Induced Tachyphylaxis of Response and Rebound Congestion
American Journal of Respiratory and Critical Care Medicine (Mar 2010)
Clearie K, Khan F, Lipworth B, Vaidyanathan S, Williamson P
Read/Add Comments | Email This | Print This | PubMed | Get Full Text
RATIONALE: Chronic use of intranasal decongestants like oxymetazoline leads to tachyphylaxis of response and rebound congestion, due to alpha-adrenoceptor mediated down-regulation and desensitization of response OBJECTIVES: We evaluated if tachyphylaxis can be reversed by intranasal fluticasone propionate, as well as the relative alpha1-/alpha2-adrenoceptor components of tachyphylaxis using the alpha1-antagonist prazosin. METHODS: In a randomized, double-blind, placebo-controlled, crossover design, 19 healthy subjects received intranasal oxymetazoline 200Amicrog tid for 14 days, followed by addition of fluticasone 200Amicrog bid for a further 3 days. At day 1, 14 and 17, participants received a single dose of oral prazosin 1mg or placebo with measurements made before and 2 hours later.
MEASUREMENTS AND MAIN RESULTS: Outcomes evaluated were peak nasal inspiratory flow, nasal resistance, blood flow and oxymetazoline dose-response curve (DRC). On day 14 vs. day 1, inspiratory flow decreased (mean difference, 95% CI) (â 47.9 L.min(-1);, â63.9 to â31.9, P<.001), the DRC shifted downward (24.8 L.min-1, 20.3 to 29.3, P<.001). On day 17 vs. day 14, after fluticasone, inspiratory flow increased (45.0 L.min(-1), 30.0 to 61.0, P<.001), the DRC shifted upward (26.2 L.min(-1), 21.7 to 30.7, P<.001). On day 1, prazosin reduced inspiratory flow (â52.6 L.min(-1), â19.2 to â86.0) compared to baseline. This effect was abolished on day 14 (7.9 L.min-1, â41.3 to 25.5).
CONCLUSIONS: Oxymetazoline induced tachyphylaxis and rebound congestion is reversed by intranasal fluticasone. Further studies are indicated to evaluate if combination nasal sprays of decongestant and corticosteroid are an effective strategy to obviate tachyphylaxis and rebound in rhinitis. Clinical trials registration information available at www.clinicaltrials.gov, i.d. #NCT00487032.
Clearie K, Khan F, Lipworth B, Vaidyanathan S, Williamson P
Read/Add Comments | Email This | Print This | PubMed | Get Full Text
RATIONALE: Chronic use of intranasal decongestants like oxymetazoline leads to tachyphylaxis of response and rebound congestion, due to alpha-adrenoceptor mediated down-regulation and desensitization of response OBJECTIVES: We evaluated if tachyphylaxis can be reversed by intranasal fluticasone propionate, as well as the relative alpha1-/alpha2-adrenoceptor components of tachyphylaxis using the alpha1-antagonist prazosin. METHODS: In a randomized, double-blind, placebo-controlled, crossover design, 19 healthy subjects received intranasal oxymetazoline 200Amicrog tid for 14 days, followed by addition of fluticasone 200Amicrog bid for a further 3 days. At day 1, 14 and 17, participants received a single dose of oral prazosin 1mg or placebo with measurements made before and 2 hours later.
MEASUREMENTS AND MAIN RESULTS: Outcomes evaluated were peak nasal inspiratory flow, nasal resistance, blood flow and oxymetazoline dose-response curve (DRC). On day 14 vs. day 1, inspiratory flow decreased (mean difference, 95% CI) (â 47.9 L.min(-1);, â63.9 to â31.9, P<.001), the DRC shifted downward (24.8 L.min-1, 20.3 to 29.3, P<.001). On day 17 vs. day 14, after fluticasone, inspiratory flow increased (45.0 L.min(-1), 30.0 to 61.0, P<.001), the DRC shifted upward (26.2 L.min(-1), 21.7 to 30.7, P<.001). On day 1, prazosin reduced inspiratory flow (â52.6 L.min(-1), â19.2 to â86.0) compared to baseline. This effect was abolished on day 14 (7.9 L.min-1, â41.3 to 25.5).
CONCLUSIONS: Oxymetazoline induced tachyphylaxis and rebound congestion is reversed by intranasal fluticasone. Further studies are indicated to evaluate if combination nasal sprays of decongestant and corticosteroid are an effective strategy to obviate tachyphylaxis and rebound in rhinitis. Clinical trials registration information available at www.clinicaltrials.gov, i.d. #NCT00487032.
Wednesday, March 10, 2010
Overexpression of glucocorticoid receptor-beta in severe allergic rhinitis
Auris Nasus Larynx (Feb 2010)
Ishida A, Ohta N, Koike S, Aoyagi M, Yamakawa M;
OBJECTIVE: To clarify the role of glucocorticoid receptor-beta in resistance to glucocorticoid therapy for allergic rhinitis, we studied 37 tissue samples from 20 patients with severe allergic rhinitis, and samples from age-matched controls.
METHODS: Patients were treated with intranasal fluticasone for 6 months and inferior turbinectomy was performed for patients with poor response to glucocorticoid treatment. The expression of glucocorticoid receptor-alpha (GR-alpha), glucocorticoid receptor-beta (GR-beta), and nuclear factor-kappaB (NF-kappaB) in nasal mucosa was studied immunohistochemically.
RESULTS: GR-alpha and NF-kappaB were expressed to a similar extent in patients and controls, but GR-beta was expressed significantly more in patients, resulting in an increased GR-beta/GR-alpha ratio.
CONCLUSION: Our findings suggest that GR-beta plays an important role in resistance to glucocorticoid therapy for allergic rhinitis, and its expression might be used as an additional parameter indicating steroid resistance in allergic rhinitis
Ishida A, Ohta N, Koike S, Aoyagi M, Yamakawa M;
OBJECTIVE: To clarify the role of glucocorticoid receptor-beta in resistance to glucocorticoid therapy for allergic rhinitis, we studied 37 tissue samples from 20 patients with severe allergic rhinitis, and samples from age-matched controls.
METHODS: Patients were treated with intranasal fluticasone for 6 months and inferior turbinectomy was performed for patients with poor response to glucocorticoid treatment. The expression of glucocorticoid receptor-alpha (GR-alpha), glucocorticoid receptor-beta (GR-beta), and nuclear factor-kappaB (NF-kappaB) in nasal mucosa was studied immunohistochemically.
RESULTS: GR-alpha and NF-kappaB were expressed to a similar extent in patients and controls, but GR-beta was expressed significantly more in patients, resulting in an increased GR-beta/GR-alpha ratio.
CONCLUSION: Our findings suggest that GR-beta plays an important role in resistance to glucocorticoid therapy for allergic rhinitis, and its expression might be used as an additional parameter indicating steroid resistance in allergic rhinitis
Autoimmune sialadenitis
Hals-Nasen-Ohrenheilkunde (HNO) (Mar 2010)
Guntinas-Lichius O, Vissink A, Ihrler S
Using the European-American classification criteria the diagnosis of autoimmune sialadenitis in Sjögren's syndrome can generally be easily established or excluded. In addition, sonography performed by the ENT physician is helpful in diagnosing and especially in follow-up screening for MALT lymphomas, which 5%-10% of patients develop. Therapy of sicca symptoms is primarily symptomatic using substitution with fluids and stimulation with oral cholinergic drugs. Corticosteroids and/or antibiotics may play a role in patients with severe inflammatory episodes of autoimmune sialadenitis. Systemic therapy with immunomodulatory drugs such as azathioprine or cyclophosphamide is reserved for patients with extraglandular manifestations. However, the efficacy of this therapy is not proven by clinical studies. Rituximab, a new monoclonal CD20 antibody, seems to offer the first possibility of a causal therapy, under which the lymphoepithelial lesions in the salivary glands can disappear and saliva production improves. However, larger clinical studies are needed to evaluate the efficacy of this new therapy.
Optimal treatment of autoimmune sialadenitis requires interdisciplinary collaboration between ENT physician, oral and maxillofacial surgeon, rheumatologist, ophthalmologist, dentist, and pathologist.
Guntinas-Lichius O, Vissink A, Ihrler S
Using the European-American classification criteria the diagnosis of autoimmune sialadenitis in Sjögren's syndrome can generally be easily established or excluded. In addition, sonography performed by the ENT physician is helpful in diagnosing and especially in follow-up screening for MALT lymphomas, which 5%-10% of patients develop. Therapy of sicca symptoms is primarily symptomatic using substitution with fluids and stimulation with oral cholinergic drugs. Corticosteroids and/or antibiotics may play a role in patients with severe inflammatory episodes of autoimmune sialadenitis. Systemic therapy with immunomodulatory drugs such as azathioprine or cyclophosphamide is reserved for patients with extraglandular manifestations. However, the efficacy of this therapy is not proven by clinical studies. Rituximab, a new monoclonal CD20 antibody, seems to offer the first possibility of a causal therapy, under which the lymphoepithelial lesions in the salivary glands can disappear and saliva production improves. However, larger clinical studies are needed to evaluate the efficacy of this new therapy.
Optimal treatment of autoimmune sialadenitis requires interdisciplinary collaboration between ENT physician, oral and maxillofacial surgeon, rheumatologist, ophthalmologist, dentist, and pathologist.
Cavitating Otosclerosis: Clinical, Radiologic, and Histopathologic Correlations
Otology & Neurotology Feb 2010
Makarem AO, Hoang TA, Lo WW, Linthicum FH, Fayad JN
BACKGROUND:: Despite the high prevalence of otosclerosis and its having long been a subject of scrutiny, cavitary changes in otosclerosis are rare and not well known. Here, we describe and introduce into the literature the unusual histologic and radiologic findings of cavitation and its possible clinical relevance in patients with advanced cochlear otosclerosis.
METHODS:: Cases with clinical otosclerosis and presence of cavitation were selected from our temporal bone collection and correlated with premortem imaging and clinical manifestations.
RESULTS:: Two cases of cochlear otosclerosis presented with a clinical syndrome possibly attributed to the existence of a cavity within the otosclerotic foci.
CONCLUSION:: Cavitating otosclerosis is a not well-known occurrence in patients with advanced cochlear otosclerosis, and it is a possible cause of a "third window" syndrome and surgical complications.
Makarem AO, Hoang TA, Lo WW, Linthicum FH, Fayad JN
BACKGROUND:: Despite the high prevalence of otosclerosis and its having long been a subject of scrutiny, cavitary changes in otosclerosis are rare and not well known. Here, we describe and introduce into the literature the unusual histologic and radiologic findings of cavitation and its possible clinical relevance in patients with advanced cochlear otosclerosis.
METHODS:: Cases with clinical otosclerosis and presence of cavitation were selected from our temporal bone collection and correlated with premortem imaging and clinical manifestations.
RESULTS:: Two cases of cochlear otosclerosis presented with a clinical syndrome possibly attributed to the existence of a cavity within the otosclerotic foci.
CONCLUSION:: Cavitating otosclerosis is a not well-known occurrence in patients with advanced cochlear otosclerosis, and it is a possible cause of a "third window" syndrome and surgical complications.
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