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PubMed1996

Risk factors for adult Still's disease.

OBJECTIVE: To assess risk factors for adult Still's disease (ASD). METHODS: A matched case-control study of 60 patients with ASD and 60 same sex siblings closest in age was conducted. Subjects were recruited from cohorts in Eastern Canada, Pittsburgh, and the Arthritis, Rheumatism, and Aging, Medical Information Systems (ARAMIS). A questionnaire was used to obtain data on demographic characteristics, education, income, occupation, exposure to toxic substances, stress, and medical history. RESULTS: 116 patients with ASD were identified, of which 104 participated. 86 identified same sex siblings, of which 60 replied. When compared to same sex siblings, ASD patients were similar with respect to education and occupation but had a trend to higher median income. There were no significant associations of ASD with smoking, alcohol consumption, individual toxic substances, vaccination, blood transfusion, minor or major surgery, pregnancy, or diet in the year preceding disease onset. There were no significant associations with tonsillectomy or adenoidectomy, appendectomy, asthma, hay fever, allergy shots, or pregnancy at any time preceding the onset of disease. There was a statistically nonsignificant increase in a history of exposure to coal dust [odds ratio (OR) 3.0; 95% confidence interval (CI) 0.30 to 28.84], in allergy preceding the onset of disease (OR 2.67; 95% CI 0.71 to 10.05), and in oral contraceptive use in the year preceding onset (OR 2.00; 95% CI 0.18 to 22.06). Stressful life events (OR 2.56; 95% CI 1.18 to 5.52) in the year preceding onset was significantly associated with increased risk for ASD. This positive association should be treated with caution unless confirmed by a separate study. CONCLUSION: This exploratory study of risk factors for ASD draws attention to stress as a potentially important risk factor, while likely excluding a considerable number of others.

Adult↗
PubMed1996

The role of adenoids in nasopharyngeal colonization with nontypeable Haemophilus influenzae.

Nasopharyngeal colonization with nontypeable Haemophilus influenzae (NTHi) and immune responses in the adenoid were studied in 18 patients with otitis media with effusion (OME) who underwent adenoidectomy. NTHi in excised adenoid tissue and in nasopharyngeal secretions was examined by quantitative culture assay. NTHi was detected in 13 adenoid samples and 12 nasopharyngeal secretions. In 11 cases, NTHi was cultured from both samples of nasopharyngeal secretion and adenoids, and the concentration of NTRi in nasopharyngeal secretions was significantly correlated with that in adenoids. A significant negative correlation was observed between anti-NTHi IgA antibody titers and the number of NTHi in nasopharyngeal secretions. The number of NTRi in nasopharyngeal secretions and adenoids was decreased in the cases having a large number of NTHi-specific IgA and IgG antibody-producing cells in their adenoids. The results suggest that mucosal immunity in the nasopharynx is responsible for reducing the colonization of NTHi, and that the adenoid plays an important role in regulating the immune responses.

Adenoids↗
PubMed1996

Microbipolar dissection vs. cold knife/suction cautery tonsillectomy in children: preliminary results of a prospective study.

Tonsillectomy and adenoidectomy (T&A) is a common surgical procedure for which many different surgical techniques have been described. However, detailed information is lacking regarding complications or recovery rates for any particular procedure. A newly described technique for T&A, microbipolar dissection (MBPD) is being compared with cold knife dissection with suction cautery of bleeding vessels (CKC) in a prospective study of 200 children aged 2-16 years. Patients are randomly assigned and stratified by age-group into one of two treatment arms. Intraoperative and post-operative measures of T&A effectiveness relative to complications and patient recovery rate are being studied. The preliminary data presented here focus on the reliability of the measures and potential clinical relevance of the findings in 129 of these children, with anticipated confirmation of these tentative results after completion of the larger cohort. Thus far it appears that post-operative bleeding rates are significantly reduced, recovery rate is improved, and return to normal activities are all better in the MBPD patients. Although these data reflect small numbers of children and must be interpreted with caution, it appears that MBPD T&A holds great promise in reducing the morbidity associated with the CKC technique of T&A.

Adolescent↗
PubMed1996

[Partial lower turbinectomy in children: indications, technique, results].

Inferior turbinate surgery has been proposed as a treatment modality in severe childhood hypertrophic rhinitis refractory to medical treatment. The authors present a series of 38 children treated in the otorhinolaryngology department of the Timone University Hospital, Marseille, and the Rangueil University Hospital, Toulouse. Thirty eight children between 9 and 16 years of age (27 males and 11 females) underwent a bilateral inferior turbinectomy, and followed-up for a period of 6 months to 4 years. Allergy was fund in 19 patients, asthma in 11 patients, and an underlying sinus pathology associated in 9 patients. Turbinate surgery was isolated in 16 cases, and in 22 cases, it was associated with an adenoidectomy, a septoplasty, and/or an ethmoidectomy. The authors discuss the operative indications, and describe the turbinectomy technique in children. Post-operative complications are rare (no crusting rhinitis, one non symptomatic synechia). One case of nasal bleeding was noted after nasal packing removal. Functional obstructive symptoms were improved in near 90% of cases. Asthma was improved or disappeared in 27.3% of cases, and no cases of worsening asthma was noted. The authors conclude that this type of turbinectomy is efficient and non-iatrogenic when a precise indication and a rigorous technique are applied.

Adolescent↗
PubMed1997

[Surgical activity in health care facilities].

Surgical activity for 144,000 beds in 1605 health care facilities in France in 1992 are reported. Both public (49%) and private (51%) hospital beds were studied. There were 2456 surgical theaters and a representative sample of 450,000 operations was examined. There were 4723 authorized beds which were not installed and 1168 non-authorized beds which were installed. The number of authorized beds per 10,000 inhabitants ranged from 16.1 (Picardie) to 33.2 (Corsica). Operations per 10,000 inhabitants ranged from 568 (Picardie) to 992 (Languedoc-Roussillon). The most frequent operations were adenoidectomies-amygdalectomies, cataract, appendectomy, herniacure, varicose veins of the lower limbs. Among the emergency operations, 91% of the operations were performed in 1156 permantly operating theaters. In these theaters, there was, on the average, one night operation every 4 nights. Regional variations in the number of beds demonstrate the need for improvement in organization. For operations, migratory flow and age differences cannot explain all the differences observed. Medical management varies greatly suggesting that more rigorous methodology and clinical training are needed.

France↗
PubMedDate not supplied

National Survey of Ambulatory Surgery: 1994.

In 1994, 27.7 million surgical and nonsurgical procedures were performed during 18.4 million visits to ambulatory surgery settings. Eighty-five percent of the ambulatory procedures (23.4 million) were performed in hospital-based settings and 15 percent (4.3 million) were in freestanding settings. More than half of the ambulatory procedures were in three major categories: operations on the digestive system, the eye and the musculoskeletal system. The leading ambulatory procedures were extraction of lens (performed almost 2 million times), endoscopy of large intestine with or without biopsy (1.8 million) and insertion of prosthetic lens (1.6 million). Women had significantly more ambulatory surgery procedures than men. The ambulatory procedure performed most frequently on children under 15 was myringotomy. Also common for children were tonsillectomies and adenoidectomies. For those aged 15-44, frequently performed ambulatory procedures included endoscopies of large and small intestine; dilation and curettage of uterus; bilateral destruction or occlusion of fallopian tubes; and arthroscopy of knee. In the 45-64 year old group, endoscopies of large and small intestine were the most commonly performed ambulatory procedures. Extraction of lens and insertion of prosthetic lens were the leading ambulatory procedures for those 65 years and older, though endoscopies of large and small intestine were also performed frequently for this age group.

Adolescent↗
PubMed1997

Minitympanometry in detecting middle ear fluid.

OBJECTIVE: To assess the time needed to perform tympanometry, the success rate and the importance of the child's cooperation for the accuracy of minitympanometry in detecting middle ear fluid, and the relation between the static admittance of the tympanogram and the weight of the middle ear fluid. STUDY DESIGN: Two series of patients were enrolled. The first consisted of 206 consecutive children (mean age 4.7 years, range 1 month to 16 years) from the Outpatient Emergency Department of Pediatrics in the University of Oulu; the second group consisted of 162 children (age range 7 months to 8 years) who were referred to the Department of Otolaryngology for adenoidectomy, tympanostomy, or both procedures. In the first series the success rate and the time needed to complete a minitympanometric examination on each ear were recorded. In the second series, the tympanograms were evaluated according to the cooperation of the children at the time of the tympanometric examination, and the weight of the middle ear fluid was measured and compared with the static admittance of the minitympanometric curve. Sensitivity and specificity values were calculated separately for cooperative and uncooperative patients. RESULTS: In the first series, the mean time needed for tympanometry was 2.1 minutes (range 0.5 to 10 minutes), and 179 (86.9%) of the patients were cooperative. In the second series, the sensitivity and specificity calculated for tympanometry in detecting middle ear fluid were 79% and 93% among the cooperative children. In the uncooperative group, sensitivity and specificity were 71% and 38%, respectively. The weight of the middle ear fluid varied from 5 mg to 695 mg. There was a significant negative correlation (r = -0.66, p < 0.001) between the static admittance in minitympanometry and the weight of the middle ear fluid. CONCLUSION: Minitympanometry can be done quickly, it fails rarely, and in cooperative patients it is a better tool than has been earlier suggested, but it is useless in uncooperative children. The amount of middle ear fluid varies notably even among young children.

Acoustic Impedance Tests↗
PubMed1997

Effect of upper-airway passages on craniofacial growth in an animal model: a pilot study.

OBJECTIVE: The process of postnatal growth and development of the face and skull is of major interest to otolaryngologists. Surgery is often considered as an option for the treatment of benign and malignant tumours, traumatic facial deformities, and congenital abnormalities of the head and neck in children and adolescents. The extent of surgery and the type of reconstruction is frequently influenced by concerns about the potential effect on future craniofacial growth. Surgery is also sometimes recommended as a method to influence facial growth as in tonsillectomy and adenoidectomy for 'adenoid facies syndrome.' There are a number of different theories concerning the factors that influence the growth of the face and cranium. None of these is universally accepted. The predominant theory is the functional matrix theory. This study was designed to evaluate the validity of this theory in an animal model. A new animal model had to be developed to perform the study. This pilot study was then conducted. METHOD: A laryngotracheal separation procedure was performed on juvenile goats. This effectively eliminated the use of the upper airway by the animals, thereby removing one of the major functional matrices from the model. The animals were allowed to grow. A control group was used, and comparisons were made between the two groups. RESULTS: The results of the study suggest that the functional matrix theory is not valid in this experimental model. CONCLUSIONS: Further research is required to confirm this finding. This would have important implications for our understanding of the biology of craniofacial growth and have clinical ramifications for otolaryngologists and other clinicians with an interest in the head and neck.

Adolescent↗
PubMedDate not supplied

[The nasopharynx in secretory otitis media].

INTRODUCTION: Nasopharyngeal airway obstruction by adenoidal tissue was studied in children with otitis media with effusion compared with children with healthy ears. Adenoidal and nasopharyngeal development with age also were studied. PATIENTS AND METHODS: The study included 44 children with bilateral effusive otitis media and 32 children without ear disease, all of whom were scheduled for adenoidectomy. In a preoperative lateral radiograph of the nasopharyngeal cavity, adenoidal tissue and the nasopharynx were measured. Adenoidal volume and weight were measured after surgery. RESULTS: The group with effusive otitis media had a larger adenoidal volume, smaller nasopharyngeal cavity, and greater nasopharyngeal airway obstruction (all significant differences) than children without ear disease. All the children had an increase in the nasopharyngeal cavity with age and a decrease in adenoidal volume and nasopharyngeal obstruction after the age of seven years.

Adenoids↗
PubMed1997

[Effect of surgical treatment of otitis media with effusion on children. Personal experience].

The authors present their observations upon surgically treated children with otitis media with effusion. The results are indicative of usefulness of ventilation tubes, myringotomy and adenoidectomy in the treatment of the otitis media with effusion in children. The efficiency of the treatment is based on the hearing examination and tympanometry, and the lack of recurrence of inflammation of the middle ear. 67.6% of cases revealed normal hearing.

Child↗
PubMedDate not supplied

[Outpatient ENT surgery in a district hospital].

Our experience in out-patient surgery from October 1994 to July 1996 is reported. Patients were selected using anesthesiology criteria (anesthetic risk I or II, psychosocial criteria, operation time less that 1 h 30 min, age > 6 years). One hundred seventy-eight patients underwent surgery: 61 direct suspension laryngoscopy, 50 adenoidectomy, 48 septoplasty, 10 functional endoscopic sinus surgery, 8 myringotomy, and 1 nasal decortication. Fourteen patients (7.86%) required hospital admission. No patients required ENT care in the first 24 hours after release from the Ambulatory Surgery Unit.

Ambulatory Surgical Procedures↗
PubMed1998

[A radiological assessment of the nasopharynx in healthy children from the Madrid area].

OBJECTIVE: The objective of this study was to assess the adenoid size of each pediatric age group in our media and to compare the subjective visual assessment with a confronted measurement, the Fujioka's adenoidal-nasopharyngeal (AN) ratio. These data would allow the composition of a map, a guide for pediatricians useful in predicting the degree of upper airway obstruction, the role of adenoids in the etiology of serious otitis media and/or in selecting patients for adenoidectomy. PATIENTS AND METHODS: We studied 1,033 radiographs of the nasopharynx taken in the emergency room of children between 5 months and 15 years of age that did not have any otorhinolaryngological (ENT) pathology. These individuals had no history of ear, nose or throat disease and the ENT evaluation was done in order to discard any ENT pathology. The subjective review and the AN ratios were calculated by experienced observers, tabulated and statistically analyzed. RESULTS: Only 692 infants and children passed the careful selection. The differences in mean values among the ages were statistically significant (p < 0.001). The mean AN ratio reached its highest value (0.575) at 5 years of age. The AN ratio as an indicator of adenoid size was comparable to the visually estimated classifications of adenoid size (p < 0.0001). In addition, 85% of the radiographs selected were in the group normal to slightly enlarged (AN = 0.48). CONCLUSIONS: The distribution of the mean AN ratios for age groups in healthy children shows a line which we could use as a standard, or guideline, to compare the AN ratio of any infant or child with any pathology related to the adenoids.

Adenoids↗