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Biomedical subjects

L Brodsky

Publications and source records attributed to L Brodsky.

At least 73 records · Page 4Linked to original sources
PubMed1989

Modern assessment of tonsils and adenoids.

Modern assessment of the tonsils and adenoids is based on an appreciation of new concepts pertaining to the pathogenesis of tonsil and adenoid disease. Recognition of the emergence of beta-lactamase-producing and encapsulated anaerobic bacteria in the tonsils and adenoids should lead to a reconsideration of present therapeutic recommendations for antibiotic therapy in infectious tonsil and adenoid disease. The performance of a precise history, use of a standardized physical examination, and judicious use of laboratory evaluation are all necessary for appropriate patient management and improved communication between the pediatrician and otolaryngologist. Thus, appropriate recommendation for tonsillectomy and adenoidectomy will enhance their benefits, and the result will be happier and healthier children.

Adenoids↗
PubMed1989

Otitis media in children. I. The systemic immune response to nontypable Hemophilus influenzae.

Twenty-one infants experienced 29 episodes of otitis media with effusion caused by nontypable Hemophilus influenzae (NTHI) during 2 y of observation. Bactericidal antibody was detected in acute serum of 26% of the subjects at a mean titer of 0.8 +/- 0.3 (log2) and was observed in convalescent serum of all of the individuals at a mean titer of 4.0 +/- 0.3 (log2, P less than .001). The serum bactericidal antibody response was not age-dependent (r = .08, P greater than .05). Serum concentrations of bactericidal antibody remained stable for the entire observation period in 90% of the children. The presence of serum bactericidal antibody correlated significantly with a reduction in the number of bacteria present in the middle ear fluid (P less than .025). Eight children experienced a second episode of otitis media with effusion caused by a different serotype of NTHI. All those who lacked bactericidal antibody against the organism causing the second episode possessed bactericidal antibody against the first strain at the time of the second episode. These data suggest that the immune response to NTHI in otitis media with effusion is type-specific. The occurrence of second episodes of otitis media with effusion due to different strains of NTHI in the face of preexisting heterologous bactericidal antibody suggests a lack of NTHI in the face of preexisting heterologous bactericidal antibody suggests a lack of cross-protection.

Antibodies, Bacterial↗
PubMed1989

Otitis media in children: local immune response to nontypeable Haemophilus influenzae.

Twenty children experienced 30 episodes of otitis media with effusion due to nontypeable (NT) Haemophilus influenzae in the first 2 years of life. The local and systemic immune responses to homologous strains of NT H. influenzae were determined by an immunodot assay. Strain-specific immunoglobulin G (IgG) antibody predominated in the middle ear fluid (MEF). It was detected in 91% of the children, compared with IgM in 48% (P less than 0.005), IgA in 52% (P less than 0.005), and secretory IgA in 18% (P less than 0.005). The titer (log2) of NT H. influenzae-specific IgG antibody (mean +/- standard error, 8.2 +/- 0.1) exceeded the titers of IgM (3.4 +/- 0.1), IgA (3.7 +/- 0.1), and secretory IgA (1.2 +/- 0.3). NT H. influenzae-specific antibody was detected exclusively in MEFs of individuals who possessed homologous serum antibody. Although antibody titers in MEF declined over time, serum antibody titers remained stable. These data suggest that immunity to NT H. influenzae in the middle ear, in part, reflects systemic immunity. Whereas local antibody disappears after resolution of the infection, systemic antibody persists.

Antibodies, Bacterial↗
PubMed1989

Hemorrhagic tonsillitis.

Eleven patients with acute and/or chronic tonsillitis, who presented with a spontaneous tonsillar hemorrhage are reported and discussed. Two patterns of hemorrhage were noted: 1. diffuse, parenchymal bleeding and 2. localized bleeding from dilated surface vessels. Pharyngeal culture for group A beta-hemolytic Streptococcus was positive in six patients (55%). Monospot, heterophile antibodies, complete blood cell count, prothombin time, partial thromboplastin time, and viral studies did not consistently demonstrate any abnormality. Two patients, however, did have an elevation in liver enzymes. In five patients, the bleeding stopped spontaneously; in five patients the bleeding was controlled with local chemical cautery. In two patients, Avitene was used for hemostasis. One other patient's bleeding was controlled by electrocautery while the patient was under anesthesia for endoscopic evaluation of hemoptysis. Two patients required blood transfusions; one of these patients had a history of factor IX deficiency. Four case histories are discussed in detail to illustrate the varied clinical presentation and some pitfalls in diagnosing and managing this rarely reported complication of tonsillitis. Possible mechanisms for the pathophysiology include increased tonsillar blood flow, necrosis of tonsillar surface cells, and trauma to dilated surface vessels. No common bacterial or viral etiology could be determined in this rare, but potentially serious, complication of tonsillitis.

Acute Disease↗
PubMed1988

Characteristics of in vitro production of mucosal antibody to respiratory syncytial virus in tonsillar tissue lymphocytes.

Tonsillar lymphocytes (TL) obtained from 39 subjects were established in culture in vitro, and analyzed for respiratory syncytial virus (RSV) specific antibody synthesis after stimulation with pokeweed mitogen and live or ultraviolet light inactivated RSV. Following stimulation with the virus, IgG1, IgA, and low levels of IgG3 but no IgG2, IgG4, or IgE anti-RSV antibody could be detected in the culture supernatants. The anti-RSV antibody production in TL did not show any correlation with the preexisting levels of anti-RSV antibody in the serum of the subjects. TL collected prior to RSV infection in the community exhibited low levels of RSV antibody synthesis. On the other hand, TL obtained during the months of natural exposure to RSV exhibited significantly higher anti-RSV antibody production. TL from atopic children demonstrated IgA anti-RSV antibody more frequently and in higher content than the TL from nonatopic children. There were no significant differences in antibody production in IgG1 and IgG3 subclasses in these subjects. These observations suggest that mucosal lymphoid tissue participates in IgG1 subclass antibody production. It is also suggested that mucosal infections correlate better with local antibody synthesis than with serum antibody activity.

Antibodies, Viral↗
PubMed1988

Spontaneous cerebrospinal fluid otorrhea in a deaf infant.

Spontaneous (congenital) cerebrospinal fluid (CSF) otorrhea is a rare occurrence with less than 100 cases being reported in the literature. In infants and children, it may present as otitis media with effusion. A 4-month-old infant, who was diagnosed with severe to profound sensorineural hearing impairment and spontaneous CSF otorrhea, initially presented with otitis media with effusion. The patient presentation, diagnostic dilemmas and pathophysiology of this rare but interesting problem are discussed.

Cerebrospinal Fluid Otorrhea↗
PubMed1988

Relationship between leukotriene C4 and an uteroglobin-like protein in nasal and tracheobronchial mucosa of children. Implication in acute respiratory illnesses.

Secretions from the nose and nasopharynx (NPS) are more readily accessible than tracheobronchial secretions (TBS) for clinical investigations, but it is unclear whether changes in mediator release in the nasopharynx reflect similar changes in the tracheobronchial tree. In order to clarify this question, NPS and TBS were taken from 20 children with tracheotomy and tested for the presence of leukotriene C4 (LTC4) and uteroglobin-like protein (UTG-LP). LTC4 and UTG-LP were measured both when the children were healthy and when they had clinical evidence of an acute respiratory tract illness. The mean concentration of LTC4 in NPS and TBS increased during illness although the mean concentration in NPS was significantly higher than in TBS during respiratory illness. In healthy children UTG-LP was detected only in TBS. During acute respiratory illness the concentration of UTG-LP in TBS decreased but remained significantly higher than in NPS. Data presented in this study indicate that changes in the LTC4 concentration in NPS appear to reflect changes in LTC4 concentration in TBS although the levels of LTC4 in NPS were significantly higher than in TBS. An inverse correlation between the concentrations of LTC4 and UTG-LP in NPS and TBS was demonstrated.

Acute Disease↗
PubMed1988

The immunology of tonsils in children: the effect of bacterial load on the presence of B- and T-cell subsets.

Tonsil core specimens of 54 children, (3 to 12 years) with clinical evidence of chronic tonsillitis and/or "idiopathic" tonsillar hypertrophy, were studied for the effect of the magnitude of aerobic bacterial load on tonsil size and the absolute numbers of B- and T-cell subsets. Tonsillar core specimens obtained from ten children with no history of ear, nose, or throat infections and normal appearing tonsils served as controls. The findings of this study indicate that tonsil size was directly proportional to the mean bacterial load in colony forming units/g tonsil (CFU/g) even in the absence of a clinical history of infection (p less than 0.01). A mean bacterial load of 2.4 +/- 2.1 X 10(5) CFU/g tonsil was seen in diseased tonsils as compared to 1.6 +/- 2.4 X 10(4) CFU/g tonsil in normal controls (p less than 0.01). Hemophilus influenzae (type B and non-B), Staphylococcus aureus, Streptococcus pneumoniae and Streptococcus pyogenes were the most common pathogens recovered in the largest numbers from diseased tonsils; control tonsils harbored few bacteria in their cores. The absolute number of immunocompetent cells/g tonsil including T-helper, T-suppressor and B-cells (S-Ig+), were significantly greater in diseased tonsils than in controls (p less than 0.001). Increasing microbial load (CFU/g tonsil) correlated with increased numbers of T-helper (p less than 0.01) and B-cells (p less than 0.01). These data strongly support a bacterial etiology for chronic tonsillitis as well as "idiopathic" tonsillar hypertrophy. Bacterial induced proliferation of immunocompetent cells may be one underlying mechanism for chronic tonsillar disease in children.

B-Lymphocytes↗
PubMed1988

A clinical prospective study of peritonsillar abscess in children.

Distinguishing peritonsillar abscess from cellulitis is an important clinical problem, particularly in children, who may require a general anesthetic for drainage of these abscesses. In order to identify those clinical factors most significant for peritonsillar abscess, we did a prospective study of 21 patients who presented with sore throat, fever, trismus, and tonsillar bulge; all symptoms that are consistent with the diagnosis of peritonsillar abscess. On admission, the following parameters were recorded: patient age, duration of sore throat, fever, white blood cell count, drooling, the degree of trismus (measured exactly as incisor-incisor distance), the degree of pharyngotonsillar bulge, and change in voice. After 24 to 48 hours of parenteral antibiotics, 12 patients (57%) had improved sufficiently and were continued on antibiotics until resolution (cellulitis group). Nine patients (43%) had no improvement and underwent surgery for drainage of the peritonsillar abscess (abscess group). At the end of the 18-month study period, the cellulitis and abscess groups were compared. On admission, no significant difference was found in age, duration of sore throat, fever, or white blood cell count. The pharyngotonsillar bulge was mild in 58% and moderate in 42% of the cellulitis group, while in the abscess group, the pharyngotonsillar bulge was mild in only 33% and moderate in 67%. After 24 to 48 hours of parenteral antibiotics, all patients in the cellulitis group had improvement of at least one symptom; whereas, all patients in the abscess group had no change or worsening of at least one symptom, including trismus, dysphagia, voice change, drooling, or pharyngotonsillar bulge. On admission, the precise measurement of trismus was not significantly different in the two groups (24.7 mm in cellulitis group vs. 22.5 mm in abscess group). However, after 24 hours of antibiotics, trismus averaged 7 mm more in the abscess group versus the cellulitis group (p less than 0.05).

Adolescent↗
PubMed1988

The role of Haemophilus influenzae in the pathogenesis of tonsillar hypertrophy in children.

The role of specific bacteria in the pathogenesis of tonsillar hypertrophy in children in unknown. To determine the effect of specific bacteria on the presence and nature of tonsillar hypertrophy (measured both clinically and by tonsil weight), quantitative aerobic bacteriology was performed on 54 tonsil-core specimens from 54 children undergoing tonsillectomy for chronic tonsillitis and/or tonsillar hypertrophy. Twelve tonsil-core biopsies from 12 children with no history of tonsil disease served as controls. Haemophilus influenzae (HI), Streptococcus pyogenes (SP), Streptococcus pneumoniae (SPn), and Staphylococcus aureus (SA) were the most common microorganisms cultured from diseased tonsils. Few bacteria were cultured from the cores of controls. HI was cultured as the dominant aerobic bacteria in 15 of 54 tonsils (27%). For HI alone, the number of bacteria/gram tonsil showed a significant positive correlation to tonsil weight (p less than 0.05). Fourteen of 15 (94%) tonsils with HI were found in patients with clinical tonsillar hypertrophy, while only 6 of 10 patients (60%) with SP and SPn had tonsillar hypertrophy. Of the 38 tonsils removed for obstructive symptoms (clinical hypertrophy), 14 of 38 (37%) cultured HI as the dominant microorganisms, whereas only 6 of 38 (16%) cultured SP. Neither the type of HI (b vs. non-b) nor the presence of beta-lactamase production had a significant correlation to tonsil weight, bacterial load or the number of B- or T-cell subsets. The number of T-helper (Th), T-suppressor (Ts) and B-cells (per gram/tonsil) was markedly greater in all diseased tonsils than in controls. For both HI and SP the total number of bacteria/gram tonsil correlated positively to the number of Ts cells (p less than 0.003 and p less than 0.007, respectively). In patients with HI type b (HI-b), the tonsil weight correlated to an increase in Ts and B-cells (p less than 0.004 and p less than 0.007, respectively). An increased presence of the Ts and B-cells in the HI-b tonsils (and not in tonsils with HI non-b) suggests a differential response by the tonsil to these distinct but related bacteria. The above data strongly support an etiological role for HI in the pathogenesis of tonsillar hypertrophy in children. Alterations in the relationship between Th and Ts cells may affect normal B-cell function and be implicated in this phenomenon. Clinical implications for pathogenesis, antimicrobial therapy, and future directions for research are discussed.

Child↗
PubMed1987

Massive oropharyngeal papillomatosis causing obstructive sleep apnea in a child.

Obstructive sleep apnea in children is most often secondary to severe adenotonsillar hypertrophy. A 5 1/2-year-old boy presented with loud snoring, increasing dysphagia, nocturnal choking, and apnea. Extensive papillomatosis of the uvula, soft palate, and nasopharynx was found to be causing the obstruction. Although multiple papillomas of the larynx and tracheobronchial tree are well known, the occurrence of extensive papillomas of the oral cavity is rare. The unusual clinical presentation and pathologic significance are discussed.

Child, Preschool↗
PubMed1987

Self-induced pneumoparotitis in an adolescent. Report of a case and review of the literature.

Pneumoparotitis is a rare cause of parotid inflammatory disease in both adults and children. A 12-year-old girl is reported who presented with recurrent bilateral parotid swelling. Radiologic evaluation revealed pneumoparotitis associated with masseter muscle hypertrophy. Further investigation revealed the self-induced nature of the condition in this teenager. Self-induced pneumoparotitis has been reported almost exclusively in adolescents who often have psychosocial problems. The clinical presentation, proposed pathophysiology, diagnosis and management of this rare condition are discussed and a review of the literature is presented.

Air↗
PubMed1987

The effects of suctioning techniques on the distal tracheal mucosa in intubated low birth weight infants.

Microscopic pathology of the distal trachea at autopsy was retrospectively reviewed in 51 low birth weight infants (less than 1250 g). Twenty-six patients from 1977 who had nasal and/or orotracheal intubation and who underwent suctioning with uncontrolled deep suctioning technique were compared to 25 patients from 1980 who had orotracheal intubation with suctioning to the tube tip only. Clinical diagnoses, duration of intubation and number of intubations were correlated to degree of distal tracheal injury: absent (normal epithelium), mild (focal epithelial loss), moderate (diffuse epithelial loss/some inflammation), or severe (submucosal ulceration/squamous metaplasia). From 1977 to 1980 the mortality rate, mean gestational age and mean birth weight all decreased by 20% (P less than 0.05), 1.1 week (P less than 0.05) and 118 g (P less than 0.01) in both autopsied and non-autopsied infants. In 1977, 15 of 26 autopsies (58%) revealed mild (6), moderate (5) or severe (4) pathology. The mean duration of intubation was 71.3, 11.8, and 265 h. respectively. No history of intubation was obtained in two patients with mild injury. No significant tracheal pathology was seen in 11 patients (42%) in 1977. In 1980, fewer patients, 10 of 24 autopsies (42%), revealed mild (3), moderate (4) or severe (3) pathology. The mean duration of intubation was 19.3, 318.3 and 1391.3 h, respectively. One patient with no history of intubation had mild tracheal injury. No significant tracheal pathology was seen in 15 patients (58%) in 1980. The diagnoses of hyaline membrane disease, anemia, hyperbilirubinemia and coagulation disorder were seen more frequently in patients with moderate and severe tracheal pathology both in 1977 and 1980. Despite factors which should lead to greater tracheal injury--longer duration of intubation, lower birth weights and younger gestational age--less tracheal injury was seen in infants undergoing careful suctioning techniques. Clinical implications for the low birth weight neonate are discussed.

Bronchi↗
PubMed1987

A comparison of tonsillar size and oropharyngeal dimensions in children with obstructive adenotonsillar hypertrophy.

Hypertrophy of the tonsils and adenoids is the most common cause of obstructive sleep apnea in children. There is relatively little known about the occurrence of subclinical variations in the dimensions of the oropharynx which may predispose to the development of obstructive sleep apnea in children without obvious craniofacial abnormalities. Fifty-one children (3-10 years) were divided into two groups: the first group consisted of 18 patients with small tonsils and no history of snoring who underwent tonsillectomy for chronic tonsillitis. They were compared to a second group of 33 patients with large tonsils who underwent tonsillectomy and adenoidectomy for symptoms of obstructive sleep apnea. Age, height, weight, body surface area and tonsil weight were correlated to the dimensions of the oropharynx obtained by direct measurement intraoperatively including the length of the soft palate, anterior-posterior depth of the nasopharynx and the distances between the medial tonsillar surfaces, anterior tonsillar pillars and lateral pharyngeal walls at mid-tonsil level. Increased patient height, weight and surface area correlated positively to increased distance between the lateral pharyngeal walls and to the length of the soft palate in the patients with small tonsils. No such correlation existed in the patients with obstructive adenotonsillar hypertrophy. In addition, the distance between the lateral pharyngeal walls was significantly decreased in the group with large, obstructing tonsils as compared to those with small tonsils and no history of obstruction (P less than 0.01). However, the patients with small tonsils and no obstruction had significantly longer soft plates (P less than 0.01) and less depth tot eh nasopharynx (P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adenoidectomy↗
PubMed1987

A quantitative comparison of the early histopathological changes from tracheotomy and endotracheal intubation on the distal trachea in fetal lambs.

Twenty-four premature fetal lambs underwent tracheotomy (n = 11) or endotracheal intubation (n = 13) for 3-9 h for an unrelated experiment. All were maintained with 100% oxygen on a pressure cycled ventilator. No suctioning was performed. At sacrifice, sections of the distal trachea were studied for histopathological changes in epithelium, submucosa and mucous glands. All changes were confined to the epithelium and were reported as either partial or total epithelial erosion in regards to preservation of the basal cell layer. In tracheotomized and intubated animals, both partial and total erosion were seen as early as 3 and 3.5 h, respectively. In the intubated animals, 13.5% of the cumulative tracheal circumference showed total erosion; 19.8% showed partial erosion. In animals undergoing tracheotomy, 9.6% of the cumulative tracheal circumference had total erosion; 19.1% had partial erosion. Possible etiological factors include oxygen toxicity, lack of humidification, effects of mechanical ventilation and indirect trauma from surgery or intubation. The clinical significance for premature infants is discussed.

Animals↗
PubMed1987

Necrotizing external otitis in children: report of two cases and review of the literature.

Necrotizing external otitis is described almost exclusively in elderly diabetics. A review of the literature revealed 12 children, ages 2 months to 21 years, who have been described with this problem. Two additional patients are reported here. In children the male:female ratio is 1:1, whereas in adults a 2:1 male preponderance is seen. Diabetes mellitus, present in 94.7% of adults, is seen in only 21% of children. Facial nerve paralysis occurs in 35% of the children as compared to 52% of the adults. Facial paralysis was permanent in 100% of the children, but only 36.3% of the surviving adults had permanent facial paralysis. Surgical intervention had no significant effect on either group. Other pediatric complications include external auditory canal stenosis (29%), auricular cartilage deformity (11%), and sensorineural hearing loss (18%). A 40% to 50% mortality rate is seen in adults whereas no deaths have been reported in children. The clinical presentation of necrotizing external otitis in children shares some features with the disease as described in adults. However, notable differences do exist and form the basis of this report. The proposed pathophysiology of necrotizing external otitis in adults and its significance for disease in children are also discussed.

Adolescent↗