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According to a national survey in Germany, the influenza virological surveillance can be improved when sentinel practitioners take throat swabs specimens only from patients who consult early after the disease onset (ie, within 48 hours), and when they use the strict clinical case definition of influenza-like illness. PCR should be used for primary detection of influenza viruses.
For all the 121 municipalities in Southern Norway where 60% or more of the inhabitants get water from registered water supplies, the municipal average concentration of natural fluoride in the water has been determined and the municipalities divided into three groups with fluoride level 0--0.05 mg/1, 0.06--0.10 mg/1, and 0.11--0.50 mg/1, respectively. The average, age-adjusted municipal mortality rate of cancer in the mouth and throat was then determined for each of these groups by sex. The resulting figures show that the mortality rate declines for both sexes with increasing fluoride level: For males from 4.7 deaths per 100 000 per year on the low fluoride level, to 3.9 deaths per 100 000 per year on the medium fluoride level, and to 3.1 deaths per 100 000 per year on the high fluoride level. For females the corresponding figures are 1.5, 1.3 and 0.5. Arguments to show that these figures are unbiased from different tobacco consumption habits, differences between urban and rural municipalities, and differences in population size are presented. Possible, explicatory models are discussed.
Distributions of spot-35 protein (S-35), calbindin (CaB), and parvalbumin (PaV), three types of calcium-binding protein, were examined immunohistochemically in sensory organs of the ear, nose and throat in guinea pigs and rats. Immunoreactivity of S-35 and CaB was found in the outer hair cells and in vestibular sensory cells situated at the top of the ampulla, and in some cells in the macula. Microvillar cells in the olfactory epithelium, periglomerular cells, and small numbers of cells in the mitral cell layer in the olfactory bulb reacted to anti-S-35 and anti-CaB antisera. In taste buds, most gustatory receptor cells reacted to anti-CaB, although a few reacted to anti-S-35 antiserum. Neuron-like cells in the upper respiratory tract reacted similarly to these antisera. No PaV-immunoreactivity was found in any region. These results indicate that S-35 and CaB play important roles in the special kinds of mechanoreceptor and chemoreceptor cells found in the otolaryngeal area.
Diagnosis and treatment of 849 sore throat patients in primary care was studied with regard to the utilization and accuracy of a latex test for group A beta-hemolytic streptococci. 78% were tested, but 11% of the rapid test results were uncertain, and 15% conflicted with traditional culture results. The negative predictive value of the test was 98%, and the positive predictive value only 59%. 52% of all patients received antibacterials, the rapid test result influencing the treatment decisions clearly but not solely. The nurses utilized the rapid test more often than the physicians. The study stresses the difficulties inherent in introducing new tests in primary care and illustrates the realities of overutilization of the test and overmedication despite test results.
Recent trends of fungal infections of the ear, nose and throat were introduced from the viewpoint of otolaryngologic practice. Aspergillus terreus was the most common pathogen of otomycosis followed by A. niger and A. flavus. Lanoconazole showed the most effective antifungal function for these Aspergillus species by drug sensitivity test. Biological differences between clinical and soil-borne strains of A. terreus were evaluated. The clinical strains showed slower growth-rate on malt extract agar and different patterns of fingerprinting by Random Amplified Polymorphic DNA. Aspergillosis is the most common fungal disease in the paranasal sinuses. Unilateral opacity of the maxillary sinus which contains flecks of calcification was specifically found by CT-study. Surgical removal of the fungus ball and establishment of a drainage route to the nasal passage by endoscopic sinus surgery are effective to manage aspergillomas in paranasal sinuses. Although candidosis is a common and mild infection in the oral mucosa, underlying problems related to immunodeficiency syndrome must be evaluated.
Structural abnormalities of the head and throat of ear-tufted embryos of the Araucana fowl are described. These abnormalities involved the opening to the external auditory meatus and such bones as the mandible, quadrate, columella auris, squamosal, and hyoid apparatus. Structural irregularities are believed to be due to the presence of the Et gene and its influence on the early embryonic closure of the hyomandibular cleft. The diversity of phenotypic expression probably is due to the varied closure of the cleft.
Abnormal sensations, such as a lump, itchiness or choking, in the throat (AST) may develop as symptoms of autonomic nerve dysfunction (AND). If this is true, the subjects with AST should show more subjective symptoms and objective signs of AND than those without AST. We classified 500 otolaryngological and neurological patients [172 males and 328 females, age 58.4 +/- 14.0 years (mean +/- SD)] with various signs and symptoms suggesting autonomic nerve dysfunction into 2 groups: 370 patients with AST (AST group) and 130 without AST (non-AST group). For the subjective evaluation of AND symptoms, we calculated the number of positive answers to 33 questions concerning AND symptoms which appear in the Cornell Medical Index (Health Questionnaire). Objective evaluation of AND was done by analyzing the coefficient of variation (%) of 100 R-R intervals on electrocardiograms [CV R-R (%)], as previous studies by others have shown that CV R-R (%) decreases with age and/or with the severity of autonomic nerve dysfunction. The following results were obtained in the comparison between the two groups. 1) There were significantly more complaints of AND symptoms in the AST group (7.3 +/- 5.5, mean +/- SD) than in the non-AST group (5.3 +/- 4.4) (p < 0.0005 by Wilcoxon test). 2) The relative CV R-R (%) value calculated by dividing the CV R-R (%) actually obtained by the formula [5.13 - 0.0419 x age of subject (years)] was significantly smaller in the AST group (0.98 +/- 0.40) than in the non-AST group (1.06 +/- 0.39) (p < 0.05 by Wilcoxon test).(ABSTRACT TRUNCATED AT 250 WORDS)
The diagnosis and treatment of sore throat in pediatric patients attending one of two facilities at a university hospital: pediatric ambulatory facility (PAF) and emergency unit (EU) in a period of 14 months are described. There were 421 patients at the PAF and 289 at the EU, of whom 65% and 76% were studied for Streptococcus pyogenes respectively. Streptococcus were detected in both centers in 37% of cases, with a peak detection of 50% at ages 6 to 10 years. There were 217 patients without any bacteriological study, of whom 162 (75%) received antibiotics. The importance of bacteriological confirmation prior to antibiotic prescription in this disease is emphasized.
An anisakid nematode, identified as Phocanema sp. fourth-stage larva, was "pulled" from the throat of a 46-year-old Alaskan Eskimo. The nematode is described and illustrated.
CONTEXT: Participation in proficiency testing is required under the Clinical Laboratory Improvement Amendments of 1988. Although the primary purpose of this testing is evaluation of current laboratory performance, a major secondary benefit of such testing is postulated to be progressive improvement in laboratory performance over time as laboratories learn from their previous experiences and feedback. OBJECTIVE: To test the hypothesis that a secondary result of proficiency testing is improvement over time of laboratory performance. DESIGN: The performance of participants in a large proficiency testing program (EXCEL), designed for clinic and office laboratories, on a specific problematic competence, the ability to differentiate group A streptococcus from group C streptococci, was monitored during a 6-year period (1996-2001) for changes in participant performance. INTERVENTIONS: With each testing cycle, feedback on performance relative to peers and an educational discussion analyzing performance and suggesting best practices was submitted to participants. RESULTS: Despite consistent feedback, there was no significant change in participant performance throughout the period studied. CONCLUSIONS: In a large, stable proficiency testing program, a significant throat culture competence, which demonstrated less than optimal performance, did not improve over time, suggesting that current utilization of proficiency testing results in laboratory improvement programs is suboptimal.
A 24-year-old active duty male smoker presented with 3 days of fatigue, rhinorrhea, and sore throat. The diagnosis and management of pharyngitis, including a field friendly approach, are reviewed. The impact of the discontinuation of the adenovirus vaccine to military recruits is highlighted. The effects of smoking among military personnel are discussed, and smoking cessation measures are reviewed.
We studied the prevalence and the clinical and laboratory findings of infectious mononucleosis in ambulatory adult patients with the presenting symptom of sore throat. Extensive clinical data, heterophil antibody test, and differential leukocyte count were obtained prospectively for 709 patients, aged 16 to 73 years, seen in four primary care settings. Heterophil tests were positive in 15 of 709 patients (2%); four of the 15 had greater than 10% atypical lymphocytes. No heterophil-negative patient had greater than 10% atypical lymphocytes. Heterophil-positive patients had mild disease; none was older than 40 years. Of 70 symptoms and signs evaluated, four were found significantly more often (p less than 0.005 for each) in the heterophil-positive patients: palatine petechiae, posterior auricular adenopathy, marked axillary adenopathy, and inguinal adenopathy. If any of these four easily shown physical findings was present, the likelihood of the patient having heterophil antibody was considerably increased; if absent, the probability of infectious mononucleosis was so low that not ordering a heterophil test or differential leukocyte count would have been efficient and safe.
Nurses working in A&E departments throughout the UK frequently encounter patients with ear, nose and throat conditions. While the majority of these are straightforward, a small number are serious and even life-threatening. Tanya Reynolds discusses the nursing management of this group of patients and stresses the importance of appropriate assessment, pain management and referral.
The patient has a right to information about his or her disease and therapeutic options. A retrospective study was made of the opinion that 40 patients who underwent ear, nose and throat surgery had of this information. After receiving verbal and written information, they completed a questionnaire. Only 1 patient (2.9%) wanted no information, 100% wanted information about the evolution of the disease without treatment, 20.6% were more alarmed after receiving information, and 41.1% thought that written information was essential.
OBJECTIVE: To determine the spread of respiratory infection with Mycoplasma pneumoniae in an institute for mentally disabled persons. DESIGN: Descriptive. METHODS: In the period from mid-April to mid-September in a certain year the transmission of M. pneumoniae in the facility was evaluated using questionnaires and laboratory investigations. The laboratory investigations consisted of an M. pneumoniae specific polymerase chain reaction (PCR) on throat swab specimens and detection of antibodies in serum. RESULTS: 21 Residents and 26 staff members from 2/36 units were involved in the initial investigation. 17 Persons had complaints of a (recent) respiratory infection (cough, malaise and fever). In 9 cases an M. pneumoniae infection was confirmed, in 5 cases by PCR and in 4 cases by serology. Two PCR positive persons had only complaints of coughing. During the investigation period 2 more persons were diagnosed with a respiratory infection due to M. pneumoniae. No new cases were found by investigation of contacts outside the facility. CONCLUSION: M. pneumoniae can cause an outbreak of M. pneumoniae respiratory infection in an institute for mentally disabled persons. Rapid detection of this pathogen is possible by PCR and is important for proper antibiotic therapy and epidemic-control measures.
33 children with affected lymphadenoid throat ring and 15 healthy children were examined for local and general immunity status. Assessment of general immunity provided poor information. Measurements of secretion immunoglobulins levels with enzyme immunoassay was informative and demonstrated close similarity of the clinical and immunological indices. Concentrations of immunoglobulins in the lacunar secretion can serve a prognostic criterium.
After total laryngectomy, the voice can be restored successfully with a silicone tracheo-oesophageal voice prosthesis. Biofilm formation and subsequent deterioration of the silicone material of the prosthesis often limit the mean life of the device to an average of 3-5 months. Although device replacement can be considered an easy outpatient procedure, frequent replacements are inconvenient for the patient and may lead to malfunction of the tracheo-oesophageal fistula. Further understanding of the process of development and inhibition of the colonization of these polymer surfaces requires several comprehensive clinical studies. However, in vivo research of the biomaterials of the voice prostheses is difficult and time consuming. In order to simulate the natural process of biofilm development under dynamic nutrient conditions, an artificial throat was developed. Biofilm developed on Groningen button voice prostheses in vitro could not be distinguished from that formed over several months in vivo. This method can be used as a standardized approach for studying functional and structural aspects of all commercially available indwelling and non-indwelling voice prostheses, including the Groningen button, Provox, Voice Master, Blom-Singer and others under various laboratory conditions.
Viral infection is one of important factors to cause the exacerbation of bronchial asthma. We have investigated 167 adults of asthmatics to clarify the correlation between viral infection and exacerbation of asthma. Patients were classified to four group by the symptoms of common cold and asthma attack. Furthermore, we have examined Picornavirus and Human rhino virus RNA from throat gargles of patients using RT-PCR (reverse transcription--polymerase chain reaction) method. Forty of 65 (61.5%) asthmatics with common cold revealed asthma attack and common cold was significantly associated with acute exacerbation of asthma (p < 0.01). We identified Picornavirus RNA, which include 113 of Human rhino virus serotypes and enterovirus, from the samples of 16 of 52 (30.8%) patients who had acute exacerbation. It was significantly higher than the detection rate of viral RNA from patient without asthma attack. Furthermore, we analyzed Human rhino virus RNA from the same samples by RT-PCR and 93.7% of Picornavirus were identified as Human rhino virus. Taken together, these findings suggest that common cold is significantly associated with the exacerbation of bronchial asthma. Human rhino virus infection might be one of important virus in this procedure.