Acute epiglottitis: epidemiology, clinical presentation, management and outcome.

AIMS: To describe the incidence trends, clinical presentation, management and outcome of acute epiglottitis in a Danish population after the introduction of Haemophilus influenzae type b vaccine. METHODS: Retrospective review of the health records of all patients discharged with a diagnosis of acute epiglottitis from the otolaryngology department, Roskilde County Hospital, Denmark, from 1996 to 2005. RESULTS: One infant and 34 adults were identified. The incidence of acute epiglottitis in children was 0.02 cases/100,000/year. Before introduction of the H influenzae type b vaccination (1983-1992), the mean national incidence of acute epiglottitis was 4.9 cases/100,000/year. The incidence of acute epiglottitis in adults was constant, with a mean value of 1.9 cases/100,000/year. Twenty-nine per cent of the patients required an artificial airway, and respiratory distress was found to be associated with airway intervention (p = 0.010). All patients recovered completely. CONCLUSIONS: In the H influenzae type b vaccine era, acute epiglottitis in children has almost disappeared. The incidence in the adult population has been constant. A discriminate approach to airway management seems safe in adults.

Postinflammatory acquired atresia of the external auditory canal: treatment and results of surgery over 27 years.

Postinflammatory, acquired atresia of the external auditory meatus is a relatively rare consequence of chronic otitis media or recurrent external otitis with an annual incidence of 0.6 cases per 100,000 inhabitants. Primary and late results after operative treatment of this condition in 53 ears over 27 years are presented. Perioperative findings are described, and an outline of applied surgical technique is given. Six patients had bilateral involvement. The male-to-female ratio was 1:2, median age at surgery was 46 years, and the median follow-up period was 5 years (range, 4 mo to 13 y). In 11% of the cases, recurrent atresia developed. Early operation is recommended, because cholesteatoma behind the atresia was found in 9%. Hearing improvement has been considerable after removal of the atresia with primary closure of airbone gap within 20 dB in 90% of the cases.

[Suspected tumor in undiagnosed bronchial foreign body]. / Tumormistanke ved ikkeerkendt bronkialt fremmedlegeme.

A case of long term retention of a bronchial foreign body in a 62-year old female patient is presented, which mimicked lung carcinoma. Despite a negative history of choking, the diagnosis airway foreign body should be kept in mind.

[Foreign bodies in the airways and esophagus in children]. / Fremmedlegemer i luftveje og spiserør hos børn.

The hospital records of 99 children with foreign bodies in the airways (n = 51) or oesophagus (n = 48) were reviewed with respect to occurrence, course of disease and mortality. Childhood death records in Denmark over a ten year period due to asphyxiation by food were surveyed. A third of the patients with oesophageal foreign bodies had respiratory symptoms. Most children with airway foreign bodies were aged 1 to 3 years and generally had a positive history of choking. The dominating symptoms were cough, wheezing and cyanosis. Chest X-ray was normal in 25%. There were no complications during bronchoscopy. The most common foreign bodies extracted were nuts (29%). The estimated death rate due to airway foreign bodies is 0.9 per 100,000 children in Denmark per year. Rigid oesophagoscopy and bronchoscopy should be performed promptly on suspicion of foreign bodies located in the oesophagus or airways to ensure fast recovery. Nuts, tablets and other small items should not be within reach of small children.

[Surgical treatment of otosclerosis. Long-term results]. / Kirurgisk behandling af otosklerose. Langtidsresultater.

UNLABELLED: At Glostrup Hospital, Copenhagen, exceptionally few stapedectomies were performed during the period 1979-1985. The audiological results five to eleven years after the operation were investigated in 64 patients. About half of the patients were operated using large fenester technique, the other half using small fenester technique. All patients but two were operated by the same expert surgeon. The initial results showed good stability with an unchanged median hearing gain of 30 dB. Eighty-five percent of the patients had an SRT < or = 35 dB HL in contrast to 89% at the 1-year follow-up (and five percent preoperatively). Eighty-two percent had an air-bone gap < or = 20 dB in contrast to 93% at 1-year follow-up (and 10% preoperatively). None of the patients had spontaneously developed severe sensorineural hearing loss, which was, however present in two patients as a direct result of the operation. In one of the patients it was caused by granuloma formation around the prosthesis, in the other patient it developed after a revision procedure. Both patients were operated using large fenester technique, which in general gave less satisfactory primary hearing improvement and less stable thresholds than small fenester technique. IN CONCLUSION: Even under conditions with few operations per year the overall long term results of stapedectomy are satisfactory when performed by few trained ear surgeons, and in particular if small fenester technique is used. The risk of sensorineural hearing loss is primarily related to the operation.

Forecasting hospital reimbursement.

The changes in reimbursement to hospitals by third party payers make it essential for hospital administrators to forecast their hospitals' reimbursement potential. Although models have been developed to predict and maximize census, forecast future demand for hospital care, and forecast the revenue budget, none of the models addresses how the physician directly affects the hospital reimbursement potential through office practice admissions. This study analyzes the admitting physician's patients by third party payer and presents a method to assist in using a physician's past hospital admissions to forecast a hospital's admissions and reimbursement potential.

Activation of metastatic potential in African green monkey kidney cell lines by prolonged in vitro culture.

Studies on the tumorigenicity of Vero kidney cells of Cercopithecus aethiops monkey origin were extended to various passage levels of BSC-1 aneuploid cells and to low passage CV-1 diploid cells (derived also from C. aethiops monkey kidney). It was found that BSC-1 cells -- like Vero cells -- showed increased tumorigenicity with increasing passage level in antithymocyte globulin (ATG) treated newborn rats and in nude mice. Cells passaged over 250 times in cultures formed invasive adenocarcinomas in newborn rats. Their malignant tumor growth was further demonstrated around the 500 passage level when tumor metastases were detected in the lungs of four of the 14 inoculated rats. Vero cells induced such lung metastases in rats already at passage 227. CV-1 diploid cells at low passage level produced small nodules of epithelioid cells in newborn rats at 6th day after inoculation that had disappeared by the 21st day, and caused no local invasion nor lung metastasis. In vitro tumorigenicity tests on BSC-1 and CV-1 cells, using chick embryo skin, human muscle and colony formation in agarose, confirmed the animal test results. The results of this study indicate that BSC-1 and Vero cell lines at low and high passage levels may prove to be useful tools to study the molecular basis of malignancy.

Heterotransplantation studies with tissue culture cell lines in various animal and in vitro host systems.

The human amnion cell line FL was found to be more tumorigenic than HeLa cells when used as a positive control in heterotransplantation assays. FL cells formed significantly larger locally invasive tumors than HeLa cells in both Balb/c/nu/nu mice and ATG-treated newborn Wistar rats. In addition, FL cells resulted in metastatic growths in the lungs of two of 12 mice six weeks and in 10 of 36 rats three weeks after inoculation. HeLa cells did not produce metastases in either mice or rats. Both these cell lines were obtained from the American Type Culture Collection. Heterotransplantation experiments with a variety of animal host systems confirmed previous findings that newborn Wistar rats treated with rat ATG were the most sensitive to tumor growth. Vero and LLC-MK2 continuous monkey kidney cells formed small, non-progressively growing tumors showing tubule formation and occasional mitoses. LLC-MK2 cells were found to be more pleomorphic in appearance and with more mitoses than Vero cells but neither cell line showed any evidence of distant metastatic growth in any of several organs examined. The human lymphoblastoid cell line Namalwa produced large invasive tumors at the inoculation site but no distant metastases. In the chick embryo skin test it was found that MI values (mitotic index--percentage of cells in mitosis) gave more reproducible results and were less time-consuming than counting mean mitoses per section. Significant differences were found between Vero, LLC-MK2, HeLa and FL cells with Vero giving the lowest and FL the highest values. The use of MI values enhanced the sensitivity of the chick embryo skin test which was found to be a rapid and valuable screening test for tumorigenicity.