PubMed · 5873945
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V A Belousov, L A Zemlianskaia. 1965. [Tonsillectomy in pediatric practice].. https://pubmed.ncbi.nlm.nih.gov/5873945/
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The presence of coagulation pathology in children who are candidates for adenotonsillectomy (AT) is a challenge to the otolaryngologist. von Willebrand's disease (vWD) is the most common hereditary coagulopathy and is due to a quantitative and/or qualitative deficiency of von Willebrand's factor (vWF). In recent years, the administration of 1-deamino-8-D-arginine vasopressin (DDAVP) has been recommended as coadjuvant therapy for surgical procedure. This synthetic hormone promotes the release of vWF and factor VIII from endothelial cells. In this report, the authors describe the history of a child with vWD undergoing successful AT after administration of DDAVP. Furthermore, a review of the literature with particular emphasis on the use of DDAVP is made.
The adenoids and tonsils are thought to be essential parts of the system protecting organism against pathogens invading the upper respiratory tracts. Human adenoids and tonsils are known to be immunologically reactive lymphoid organs, which manifest specific antibodies and B and T cells activity in response to variety of antigens carrying out the functions of humoral and cellular immunity. The purpose of the study was to observe the changes in systemic immunity in children with hypertrophy of adenoids and tonsils treated in Department of Laryngology, Children's Hospital in Warsaw in period 1994-1999. The study comprised 80 patients (33 girls and 47 boys, aged from 3 to 14 years, mean age 6.8 years) with diagnosed hypertrophy of adenoids and tonsils. The diagnosis of hypertrophy of adenoids and tonsils was based on characteristic history and laryngological examination. All patients were scheduled for adenotonsillotomy. The control group comprised 40 people (14 girls and 26 boys, aged from 3 to 15 years, mean age 7.6 years) without history of the recurrent upper tract infections. In all patients we carried out following examinations: serum levels of immunoglobulins A, G, M (humoral immunity); percentage of T lymphocytes (CD3); percentage of T helper (CD4) and T cytotoxic (CD8) lymphocytes (cellular immunity) and delayed cutaneous hypersensitivity-Multitest CMI (cell mediated immunity). Our study demonstrate that in children with hypertrophy of adenoids and tonsils exist changes in the immunological parameters. The observed changes appear not only locally but also generally. In the early period after adenotonsillotomy there was statistically significant decrease of the values of humoral and cellular immunity parameters. However, 6 months after operation we observed normalization of examined immunological parameters. We think that the examinations of parameters of immunological system (humoral and cellular) are necessary before planned adenotonsillotomy.
OBJECTIVE: To evaluate the isotype and IgG subclass distribution of anti-pneumococcal antibodies and response to polysaccharide vaccination in otitis prone children. METHODS: IgG1, IgG2 and IgA antibodies to pneumococcal serotypes 3, 4, 6B, 9V, 14, 19F and 23F were determined in otitis prone children and in an age-matched healthy control population. Patients were immunized with a 23-valent pneumococcal polysaccharide vaccine. The antibody response was measured 4 weeks later. RESULTS: Geometric mean IgA and IgG2 antibody levels for all seven pneumococcal serotypes tested were significantly lower in otitis prone children than in the control population. After immunization, there was no significant increase in geometric mean IgG2 anti-serotype 6B, 19F and 23F pneumococcal polysaccharide (weak immunogenic), but also no increase for IgG2 anti-serotype 4 and 14. Post immunization IgG2 antibody titers for serotypes 6B, 9V and 19F even remained below titers of non-vaccinated controls. Nine out of 29 otitis prone children were colonized nasopharyngeally with Streptococcus pneumoniae during the time of vaccination; these children had an even more severely impaired systemic antibody response. CONCLUSIONS: Otitis prone children, while having normal IgG1 antibody levels, have low IgG2 and IgA anti-polysaccharide antibody levels and fail to respond in these subclasses upon vaccination with pneumococcal polysaccharide vaccine.