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PubMed2002

Clinical value of somatostatin receptor imaging in patients with suspected head and neck paragangliomas.

Paragangliomas or glomus tumours of the head and neck region are rare somatostatin receptor-expressing neuroendocrine tumours. Precise preoperative diagnosis is of special importance in order to adequately weigh the potential benefit of the operation against the inherent risks of the procedure. In this study, the clinical value of somatostatin receptor imaging was assessed in 19 patients who underwent somatostatin receptor scintigraphy because of known or suspected paraganglioma of the head and neck region. The results were compared with the results of computed tomography and/or magnetic resonance imaging, histology and clinical follow-up. [(111)In-DTPA- D-Phe(1)]-octreotide scintigraphy was performed 4-6 and 24 h after i.v. injection of 140-220 MBq (111)In-octreotide. Whole-body and planar images as well as single-photon emission tomography images were acquired and lesions were graded according to qualitative tracer uptake. Somatostatin receptor imaging was positive in nine patients, identifying paragangliomas for the first time in three patients and recurrent disease in six patients. In one patient, a second, previously unknown paraganglioma site was identified. Negative results were obtained in ten patients. These patients included one suffering from chronic hyperplastic otitis externa, one with granuloma tissue and an organised haematoma, one with an acoustic neuroma, one with an asymmetric internal carotid artery, two with ectasia of the bulbus venae jugularis and one with a jugular vein thrombosis. In two patients with a strong family history of paraganglioma, individual involvement could be excluded. In only one patient did somatostatin receptor imaging and magnetic resonance imaging yield false negative results in respect of recurrent paraganglioma tissue. It is concluded that somatostatin receptor scintigraphy provides important information in patients with suspected paragangliomas of the head and neck region and has a strong impact on further therapeutic management.

Adolescent↗
PubMed2005

Drainage of retro-parapharyngeal abscess: an additional indication for endoscopic sinus surgery.

Deep neck abscesses are life-threatening conditions, in early stages preferably treated by intravenous antibiotic therapy; in advanced stages, surgical drainage is mandatory. We report two cases of retro-parapharyngeal abscess with prevalent retronasopharyngeal extension in two men aged 60 and 82, both of whom underwent transnasal endoscopic drainage. The main surgical steps were incision of the posterior pharyngeal mucosal wall, widening of the incision, drainage of purulent collection and careful dissection and removal of the necrotic tissue. The first patient, with an abscess associated with chronic otitis media and presenting hypoglossal nerve palsy, quickly recovered from pharyngodinia, otalgia and trismus. Twenty-six months after surgery, he is symptom-free, with hemitongue atrophy due to denervation as the only residual sign. The second patient, affected by skull base osteomyelitis secondary to malignant external otitis, after a first successful drainage, underwent a second endoscopic procedure for the reoccurrence of an abscess in the contralateral retroparapharyngeal space. Twelve months after the first surgery, the patient reported an improvement of symptoms, except for persistent dysphonia related to vagal nerve palsy. At follow-up MR, another abscess was detected in the left retro-parapharyngeal space. In selected cases of abscess, transnasal endoscopic drainage may be an effective alternative to external approaches. Minimal morbidity, the absence of cervical or palatal scars and a short hospitalization time can be considered as important advantages in comparison to external approaches. Patients with abscess secondary to skull base osteomyelitis require close imaging surveillance because of the difficulty of definitive control of the disease.

Aged, 80 and over↗
PubMed1986

Cefoperazone for empiric therapy in patients with impaired renal function.

Thirty-five patients with serious infections and impaired renal function were treated empirically with 2 to 8 g of cefoperazone per day. Infections included sepsis in 14, nonbacteremic urinary infections in nine, pneumonia in five, intra-abdominal infection in five, fasciitis in one, and malignant otitis externa in one. The average age of this group was 64.3 years, 25 had ultimately fatal underlying diseases, and their average serum creatinine level was 5.2 mg/dl. Infections were caused by Enterobacteriaceae in 23 patients, Streptococcus faecalis in five, Pseudomonas aeruginosa in four, Staphylococcus aureus in four, Hemophilus influenzae in three, and Staphylococcus epidermidis, Streptococcus pneumoniae, and Clostridium sordelli in one each. Overall, 32 patients had clinical and microbiologic cures, two had improvement, and one had failure. Hypoprothrombinemia occurred in 18 of 28 patients not given vitamin K for prophylaxis and occurred more often in those with serum albumin concentrations below 3.5 g/dl. Prothrombin times returned to normal within 36 hours of treatment with vitamin K, although two patients experienced mild hematemesis. In anicteric patients with liver function abnormalities, 2 g every 12 hours produced peak and trough serum concentrations that averaged 254 and 125 micrograms/ml, respectively, compared with 179.5 and 19.5 micrograms/ml, respectively, in five with normal liver function test results. In jaundiced patients treated with 1 g every 12 hours, trough concentrations were comparably elevated. Serum concentrations did not correlate with hypoprothrombinemia, but high levels throughout the dosing interval may have contributed to the excellent cure rate in this study.

Acute Kidney Injury↗
PubMed1982

Antigen-specific desensitization of patients allergic to penicillin.

Three penicillin-allergic patients with life-endangering infections requiring beta-lactam antibiotic therapy were desensitized by means of increasing oral then parenteral doses and were treated with full doses of beta-lactam agents. Malignant otitis externa caused by Pseudomonas aeruginosa, osteomyelitis caused by Staphylococcus aureus, and bacterial endocarditis caused by an enterococcus were treated with carbenicillin, nafcillin, and benzylpenicillin G, respectively. No acute allergic reactions occurred during desensitization or within 1 wk of the onset of therapy. Immediate wheal and flare skin-test reactions to beta-lactam determinants diminished or became negative after the desensitization procedure in each patient. Wheal and flare responses provoked by histamine, compound 48/80, and environmental antigens were not affected by the desensitization procedure or continued beta-lactam drug therapy. Mild urticaria appeared after 15 days of penicillin therapy in one patient and after 23 days of carbenicillin therapy in another patient. Skin-test reactions to penicillin reagents had reverted to positive at the time of the urticarial reactions. One patient developed a severe immune hemolytic anemia after 10 days of therapy with nafcillin. The results of this study indicate that acute clinical desensitization of these three penicillin-allergic patients was associated with antigen-specific desensitization of tissue mast cells.

Adult↗
PubMed1985

Computed tomography of internal jugular vein thrombosis.

Thrombosis of the internal jugular vein was diagnosed by computed tomography in two cases. On contrast computed tomography, the thrombosed vein appeared as an enlarged vein containing a low density lumen surrounded by a sharply defined wall. This entity should be looked for whenever a patient is examined by computed tomography for acute cervical swelling or inflammatory ear disease.

Adolescent↗
PubMed1991

Hydrotherapy pools of the future--the avoidance of health problems.

The need to minimize the threat of infection to patients and the high incidence of health problems in hydrotherapy pool workers, have led to recommendations especially tailored to the design and operation of the water and air treatment plant of hydrotherapy pools. Hitherto unpublished surveys are detailed which confirm that pathogenic species of Pseudomonas aeruginosa in pools (in which ears may be wetted) cause a high incidence of otitis externa, but rarely cause body rashes (pseudomonas folliculitis) unless there has also been prolonged skin wetting. In brominated pools contact dermatitis is common and can be distinguished clinically from pseudomonas folliculitis by the onset of a pruritic rash less than 12 hours after exposure to the pool and reactivation of the rash on re-exposure to the brominated pool.

Cross Infection↗
PubMed1992

An outbreak of infection due to Staphylococcus aureus phage type 52 in a neonatal intensive care unit.

An outbreak of infection due to Staphylococcus aureus phage-type 52, resistant only to penicillin, occurred in children's wards primarily in a neonatal intensive care unit. The outbreak involved 86 infants; the majority presented with conjunctivitis, wound infections, boils, omphalitis and otitis externa. Seven per cent of these infants (six of 86) also had septicaemia. In addition, 6% (five of 86) were colonized by this phage type and the most common site of carriage was the umbilicus. The outbreak was contained by eradication of nasal carriage among the staff members and also by standard infection control measures.

Bacteriophage Typing↗
PubMedDate not supplied

Head and neck cellulitis in hospitalized adults.

INTRODUCTION: Our purpose was to review the clinical features of head and neck cellulitis in hospitalized patients. MATERIAL AND METHODS: A retrospective review was undertaken of 147 cases of head and neck cellulitis seen over a 15-year period at a community Hawaiian hospital. RESULTS: Otologic cellulitis was mainly related to otitis externa, caused by Pseudomonas aeruginosa, although some cases had infected pierced ears or ear cysts. Cervical cellulitis was associated with malignancy, dental infection, or lymphadenitis; these patients often had positive blood cultures. Facial cellulitis was almost always caused by Staphylococci and Streptococci, usually preceded by dental infections, traumatic abscesses, or sinusitis. All study patients recovered completely, except for one patient who developed cavernous vein thrombosis and oculomotor palsy. Seventy-five percent of the patients recovered with parenteral antibiotics alone; the other patients required abscess drainage and/or other surgical procedures, especially if neck infection was present. CONCLUSION: Although head and neck cellulitis cases have grave potential consequences, most patients do very well with proper antibiotics and appropriate surgical drainage.

Abscess↗
PubMedDate not supplied

Perilymph fistula: a cause of auditory, vestibular, neurological and psychiatric disorder.

It is suggested that damage by mild trauma, viruses or bone disease to the otic capsule or to the membranes between the cochlea and the middle ear is common, and involved in many syndromes of obscure etiology. The clinical perilymph fistula (PF) syndrome can consist of any combination of the following: tinnitus, deafness, phonophobia, vertigo, ataxia, otalgia, facial palsy, headache, diplopia, blackouts, psychological distress. The following testable hypotheses are proposed: otitis media is due to perilymph in the middle ear, with secondary changes resulting from infection or inflammation: otosclerosis results from a slow leak in the presence of enzymes promoting bone growth: Meniere's syndrome follows reduced perilymph support for the endolymphatic system: Bell's palsy results from a perilymph provoked oedema in the bony facial nerve canal: PFs may be responsible for progressive rubella deafness, and for some cases of migraine, epilepsy, anxiety neurosis and hysteria: psychiatric sequelae of the PF syndrome predominate in the post-concussional syndrome and infantile autism: organisms can pass from the throat into the spinal fluid, causing meningitis or encephalitis. The tinnitus and vertigo are caused by random labyrinthine fluid movements, the headache and diplopia by reduced spinal fluid pressure.

Deafness↗
PubMed2004

Otic flushing.

Otic flushing has the potential to help a number of patients with ear disease. Because the diagnostic and therapeutic benefits of this procedure exceed its risks, veterinarians should offer otic flushing for patients with poorly responsive or chronic otitis externa.

Animals↗
PubMed2006

Canal atresia: "surgery or implantable hearing devices? The expert's question is revisited".

OBJECTIVES: (1) Evaluate hearing results in patients managed with external auditory canal reconstruction; (2) compare results to the expectations from treatment with surgical; placement of an osteo-integrated bone-conduction device (BAHA system); (3) assess complications of both interventions; (4) evaluate the medical cost-effectiveness of each avenue of management at 2005 rates for billings based upon relative value units (RVUs). METHODS: (1) Retrospective chart review for 36 ears in 29 pediatric patients who underwent surgical canal reconstruction at a tertiary-care pediatric hospital in a major urban center with assessment of management techniques and surgical and audiologic outcomes. (2) Retrospective chart review of six pediatric patients who underwent BAHA placement in a major urban center with assessment of management techniques and surgical and audiologic outcomes. (3) Cost reassessment at 2005 billings rates based upon RVUs for canal reconstruction versus BAHA system and comparative analysis. RESULTS: (1) The average post-operative hearing loss in the right ear was 34.3 dB left ear was 31.6 dB. The average gain per ear was 17.3 dB. (2) Twenty-seven (93%) of EAC reconstruction patients required some form of amplification post-operatively. (3) Data available for three of the BAHA patients reflected the predicted average gain in dB (predicted 34.3 dB, observed 31.8 dB). (4) Early complications of canal reconstruction included removal of the packing by the patient, post-operative bleeding and post-operative hematoma. (5) Late complications included recurrent canal stenosis, recurrent otitis externa, canal prolapse and canal cholesteatoma. (6) Uncomplicated external auditory canal reconstruction cost $51,505.98 or $2909.94/dB of hearing gain based upon billings fro RVUs. (7) Uncomplicated two-staged BAHA system placement cost $42,448.85 or $1237.57/dB of hearing gain based upon billings for RVUs. (8) Uncomplicated single-staged BAHA system placement cost $28,341.00 or $826.27/dB of hearing gain based upon billings for RVUs. CONCLUSIONS: Study results indicate that even with significant investments in EAC reconstruction, most patients still required some form of amplification. There are also significant risks of early and late complications from the reconstructive procedure. Studies indicate and our results support that the osteo-integrated bone-conduction device (BAHA system) can achieve truly acceptable hearing (<or=15 dB) in school-aged children with normal bone curves, and it can match the bone-curves for children with sensorineural hearing loss. The two-staged BAHA system placement may be provided at almost one-third the cost to the medical system, on a decibel-for-decibel basis. The single-stage BAHA system placement yields even greater cost savings at just over one-quarter of the cost of surgical EAC reconstruction on a decibel-for-decibel basis. Additionally, there are fewer complications and fewer follow-up visits for the care of the implant system. This is an added value to the parents and patient for the savings in opportunity costs related to the lost time at work and school for office visits and peri-operative care. Overall, it appears that osteo-integrated bone-conduction devices may provide a higher quality of outcome for patients while resulting in significant economic savings.

Bone Conduction↗
PubMed2006

Fibrin sealant as a treatment for canine aural haematoma: a case history.

Aural haematomas occur commonly in dogs in which predisposing factors include trauma to the pinna, a history of violent head shaking, and acute or chronic otitis externa. Treatment usually involves invasive surgery performed under general anaesthesia but these techniques can create wounds requiring intensive aftercare. Furthermore, certain breeds of dog and/or older animals are often at greater risk due to complications arising from the use of anaesthetics. Therefore, a need exists for a less invasive procedure which can be performed easily in general practice and with minimal reliance on anaesthetics. Fibrin sealants fulfil these criteria and have been used successfully to treat aural haematomas in humans. This is the first known report on the use of fibrin sealant to treat a canine aural haematoma. In the present case, the haematoma recurred shortly after removal of the protective collar, and was subsequently treated by conventional surgery. Possible reasons for initial success of the fibrin sealant and then later recurrence of the haematoma (e.g. premature removal of the collar) are discussed.

Animals↗
PubMed1996

Malassezia pachydermatis with special reference to canine skin disease.

A review of the diseases caused by Malassezia pachydermatis has led to the conclusion that the yeast is an opportunistic pathogen that depends on predisposing host factors and different immune suppressive mechanisms for clinical manifestation. Until recently, the role of M. pachydermatis in seborrhoeic dermatitis and otitis externa in dogs has been largely unrecognized. The clinical manifestation, aetiology, diagnosis and treatment of disease conditions in dogs caused by M. pachydermatis are reviewed. Human Malassezia furfur infections are briefly described.

Animals↗
PubMed2003

Otalgia.

The patient presenting with otalgia poses a diagnostic challenge for which orderly and diligent evaluation and management is needed. The etiology of otalgia can be either primary or referred, and a detailed history and physical examination with directed studies as indicated can elucidate the cause of the pain.

Diagnosis, Differential↗
PubMed1998

Allergy for the otologist. External canal to inner ear.

Allergy may affect the outer, the middle, or the inner ear. Although the otologic manifestations of allergy are not by themselves diagnostic, the history, including family history and associated symptoms in other target organs, will often help lead to the correct diagnosis and institution of therapy. Patients with significant and chronic symptoms, including those with labyrinthine symptoms of allergy, will respond well to specific immunotherapy and/or dietary elimination.

Anti-Allergic Agents↗
PubMed1999

Canine atopic dermatitis in Greece: clinical observations and the prevalence of positive intradermal test reactions in 91 spontaneous cases.

Atopic dermatitis was diagnosed in a total of 91 dogs by combining the compatible historical evidence and clinical signs with the presence of one or more positive intradermal test reactions well correlated with the exposure to the aeroallergens and the seasonality of the clinical signs. Compared to the general hospital population Yorkshire terriers, Chinese Shar-Peis and cocker spaniels showed a strong predilection. No such predilection was found regarding the sex of the animals. The age of the dogs at the onset of the clinical signs ranged from 2 months to 8 years (median: 2.5 years). Moderate to severe pruritus, noticed in all the 91 dogs, was either localized (29/91) or generalized (64/91) and non-seasonal (43/91), seasonal (19/91) or of unknown seasonality (29/91). The most common cutaneous lesions included erythema, hyperpigmentation, hypotrichosis and crusts; their body distribution was generalized (64%) or localized (36%) with the feet as the most common site of involvement. Five dogs that had unlesional skin were significantly younger and had been pruritic for a shorter period of time compared to the majority of our study population. Otitis externa (43/91) and bacterial pyoderma (30/91) were the most common conditions associated with atopic dermatitis, while the prevalence of Malassezia dermatitis was very low (2/91). Of the other allergic skin diseases flea allergic dermatitis was the most common (29/91) followed by food hypersensitivity (2 out of the 15 dogs tested). The majority of the dogs demonstrated multiple sensitivities to the 50 aeroallergens tested, while domestic mites (77/91), and particularly Dermatophagoides farinae (64/91), were the most commonly implicated. The total number of the positive intradermal test reactions was increasing parallel to the age of the dogs but it was negatively associated with the presence of skin lesions on the carpal and tarsal joints.

Animals↗