ABSTRACT
OBJECTIVE To identify the clinical risk factors related to the increasing likelihood of surgical drainage and the medical therapy failure in deep space neck abscess. METHODS The clinical data of 111 consecutive patients from January 2009 to June 2016 with deep space neck abscess were reviewed retrospectively. Logistic regression analysis was used to study the clinical risk factors by stepwise forward regression. RESULTS All patients had successful resolution of their infections by medical therapy and(or) surgical drainage. At the level of α=0.05, dyspnea was the risk factor of increasing likelihood of surgical drainage (β=3.001, OR=20.099); the maximum dimension of abscess>2.0 cm was not only the risk factor of increasing likelihood of surgical drainage(β=2.396, OR=10.979), but also that of medical therapy failure(β =4.618, OR=101.313). Age, sex, white blood cell count at presentation, fever, diabetes, neck swelling, and multiple space abscess of neck did not increase the risk of surgical treatment (P>0.05, respectively). CONCLUSION Active preoperative preparation and surgical intervention should be used with those who have dyspnea and the maximum dimension of abscess >2.0 cm as soon as possible. However, those who without dyspnea and abscess size less than or equal to 2.0 cm may be recovered without incision and drainage of operation by only sufficient and effective intravenous antibiotics treatment under close guarded surveillance.
ABSTRACT
OBJECTIVE@#In order to investigate the interaction between the cytokines and keratinocyte and determine the role of cytokines in hyperproliferative of chronic otitis media with cholesteatoma, we observe the expression of matrix metalloproteinase 9 (MMP9), vascular endothelial growth factor (VEGF), keratinocyte growth factor (KGF) and its receptor (KGFR) in middle ear cholesteatoma.@*METHOD@#We examined the expression of MMP9, VEGF, KGF, KGFR and Ki-67 by immunohistochemistry in 50 specimens from chronic otitis media with cholesteatoma and 15 specimens from the normal skin of external auditory meatus. Ki-67 as an evaluation of cholesteatoma proliferation markers were used to detect the keratinocyte proliferative activity.@*RESULT@#(1) The expression of VEGF and MMP9 in cholesteatoma specimens was higher than normal skin, and the difference was statistically significant (t = 4.914, P < 0.01; t = 3.284, P < 0.01). (2) The expression of KGF and KGFR in middle ear tissues was higher than normal skin, and the difference was statistically significant (t = 4.814, P < 0.01; t = 3.104, P < 0.01); The expression of KGF and KGFR increased, and the expression of Ki-67 also correspondly increased in the cholesteatoma. (3) In the tissue MMP9 and VEGF were positive. Mean optical density increased as well. KGF expression also increased accordingly.@*CONCLUSION@#MMP9, VEGF, KGF and KGFR proteins played an important role in hyperproliferation of cholesteatoma tissues. VEGF, MMP9 and KGF had a synergistic effect in hyperproliferation of cholesteatoma tissues.