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1.
Ned Tijdschr Geneeskd ; 1662022 10 04.
Article in Dutch | MEDLINE | ID: mdl-36300468

ABSTRACT

Acute sore throat is one of the most common problems in general practice. It usually concerns a viral oropharyngeal infection, with good recovery within 10 days. In current guidelines, antibiotics are recommended only in exceptional situations. Although rare, potentially life-threatening complications can occur. Three case histories, on epiglottitis, peritonsillar abscess, and Lemierre syndrome, respectively, demonstrate that acute sore throat can result in severe illness. Early recognition of alarm symptoms, alertness on a complicated disease course, and clinical (re)evaluation (within 1-2 days), are essential. This contributes to the differentiation between a harmless and a serious course, given that serious conditions also have an innocent onset. We highly recommend to consult an ENT specialist when there is doubt about the seriousness of the disease, or correctness of therapy, so timely co-assessment, treatment or transfer can follow. ECMO can be a life-saving treatment when conventional therapy is insufficiently supportive.


Subject(s)
Epiglottitis , General Practice , Pharyngitis , Humans , Pharyngitis/diagnosis , Pharyngitis/etiology , Pharyngitis/therapy , Epiglottitis/diagnosis , Epiglottitis/therapy , Epiglottitis/complications , Anti-Bacterial Agents/therapeutic use , Family Practice
2.
Eur Arch Otorhinolaryngol ; 278(10): 3777-3787, 2021 Oct.
Article in English | MEDLINE | ID: mdl-33336300

ABSTRACT

BACKGROUND: To compare cholesteatoma care internationally and to evaluate outcomes, ear surgeons must use the same terminology. However, a clear universal definition on how to describe the extension, destruction and accompanying morbidity caused by the cholesteatoma is lacking. The practical applicability by means of interrater agreement is assessed for the STAMCO and the ChOLE classification. METHODS: A total of 134 adult patients derived from the nationwide multicentre study in the Netherlands, entitled Dutch Cholesteatoma Data (DCD) were included. Retrospective analysis of 134 surgical reports according to the STAMCO and ChOLE classification for localisation/extension of the cholesteatoma, complication status and ossicular chain status. Both the percentage agreement and the interrater agreement were determined for each item of the classifications and interrater agreement was compared between the classifications as a whole. RESULTS: Differences in interrater agreement were found for both the localisation/extension of the cholesteatoma and ossicular chain status. STAMCO classification derived from the surgical report scored better on the localisation/extension of the cholesteatoma, whereas the ChOLE classification derived from the surgical report scored better on the status of the ossicular chain. In both classifications, complication status had a low agreement level but was also poorly registered in the surgical reports. CONCLUSION: Both STAMCO and ChOLE will be beneficial in uniform registration of cholesteatoma pathology in practice. Modifications proposed for both classifications may make them even more practical applicable in the future. A common denominator obtained from these two classifications may be incorporated in a standardised surgical report to facilitate evaluation which make outcomes transferable towards both classifications.


Subject(s)
Cholesteatoma, Middle Ear , Cholesteatoma , Adult , Cholesteatoma/diagnosis , Cholesteatoma/surgery , Cholesteatoma, Middle Ear/surgery , Ear Ossicles , Humans , Netherlands , Retrospective Studies
3.
Eur Arch Otorhinolaryngol ; 278(3): 653-658, 2021 Mar.
Article in English | MEDLINE | ID: mdl-32529402

ABSTRACT

PURPOSE: Differences in the definition and classification of cholesteatoma hinders comparing of surgical outcomes of cholesteatoma. Uniform registration is necessary to allow investigators to share and compare their findings. For many years surgical cholesteatoma procedures were divided into two main groups: canal wall up mastoidectomy (CWU) and canal wall down mastoidectomy (CWD). Recently, mastoid obliteration can be added to both procedures. Because of great variation within these main groups, the International Otology Outcome Group (IOOG) proposed the new SAMEO-ATO classification system to categorize tympanomastoid operations. The aim of our study was to correlate the mastoid bone extirpation (M-stage) with the contemporary (CWU, CWD with or without obliteration) system. METHODS: Demographic characteristics and type of performed surgery were registered for 135 cholesteatoma patients from sixteen hospitals, both secondary and tertiary care institutions, across the Netherlands. In addition, the surgical reports were collected, retrospectively classified according to the contemporary system and the new system and compared. Correlations of the outcomes were calculated. RESULTS: In total, there were 112 CWU and 14 CWD (both with or without obliteration) suitable for correlation analysis. Z test for correlation between the M-stage and CWU procedure was significant for M1a and M1b procedure and significant for M2c with the CWD procedure. CONCLUSION: The newly proposed SAMEO-ATO classification seems to be more detailed in the registration of surgical procedures than surgeons currently are used to. All M-stages of the SAMEO-ATO system are correlating well to the standard CWU and CWD except one 'in between' M-stage.


Subject(s)
Otologic Surgical Procedures , Cholesteatoma, Middle Ear/epidemiology , Cholesteatoma, Middle Ear/surgery , Humans , Mastoid/diagnostic imaging , Mastoid/surgery , Netherlands/epidemiology , Retrospective Studies , Treatment Outcome
5.
Rhinology ; 47(1): 18-23, 2009 Mar.
Article in English | MEDLINE | ID: mdl-19382489

ABSTRACT

OBJECTIVE: Subperiosteal orbital abscesses (SPOA) are a complication of sinusitis. Traditional treatment of SPOA is surgical. Recently, a number of studies report successful medical treatment. To our knowledge, it is unclear which patients can benefit from medical management alone. Therefore, we questioned (1) what is the outcome of medical versus surgical treatment? (2) which patients can be cured with antibiotics alone? (3) what are the absolute criteria for surgical treatment? METHODS: A structured search was conducted in PubMed, EMBASE and the Cochrane Library for relevant papers which were critically appraised. RESULTS: Five studies addressing our clinical questions were included, one prospective case series and four retrospective studies. Evidence levels varied from 2b to 3. Overall, a high cure rate was achieved with combined modality treatment (95.3-100%). The cure rate of medical treatment alone varied between 26% and 93%. The outcome of medical treatment improved after prior selection of surgical cases. In general, responders to medical treatment had a medial abscess associated with ethmoid sinusitis. Criteria for initial surgical or medical management differed among authors. Most authors agreed upon initial surgical treatment for patients with non-medial abscesses, decreased visual acuity and signs of systemic involvement. Surgery was also indicated when lack of improvement or worsening of symptoms and signs after 48-72 hours of medical treatment were observed. CONCLUSIONS: The outcome of surgical versus medical management of SPOA within and between studies could not be compared. Higher cure rates were observed when both modalities were combined. There is some evidence that medical treatment can cure medially located SPOA. Loss of visual acuity, non-medial abscess, clinical detoriation and failure to improve within 48 hours of antibiotic treatment can be considered as criteria for surgical treatment. In the absence of these criteria a trial of antibiotic treatment can be considered with close monitoring of the patient.


Subject(s)
Abscess/drug therapy , Abscess/surgery , Orbital Diseases/drug therapy , Orbital Diseases/surgery , Abscess/etiology , Anti-Bacterial Agents/therapeutic use , Child , Humans , Periosteum , Sinusitis/complications
6.
Int J Radiat Oncol Biol Phys ; 74(5): 1555-62, 2009 Aug 01.
Article in English | MEDLINE | ID: mdl-19250759

ABSTRACT

PURPOSE: A multidisciplinary approach, consisting of consecutive Ablative Surgery, MOld technique with afterloading brachytherapy and immediate surgical REconstruction (AMORE) applied after chemotherapy, was designed for children with rhabdomyosarcoma in the head-and-neck region. Analysis of the first 42 patients was performed. METHODS AND MATERIALS: After macroscopically radical tumor resection, molds were constructed for each individual to fit into the surgical defect. The molds, made of 5-mm-thick layers of thermoplastic rubber, consisted of different parts. Flexible catheters were positioned between layers. After brachytherapy, the molds were removed. Surgical reconstruction was performed during the same procedure. RESULTS: Dose to the clinical target volume varied from 40 to 50 Gy for the primary treatment (31 patients) and salvage treatment groups (11 patients). There were 18 females and 24 males treated from 1993 until 2007. Twenty-nine tumors were located in the parameningeal region, and 13 were located in the nonparameningeal region. Patient age at the time of AMORE was 1.2-16.9 years (average, 6.5 years). Follow-up was 0.2-14.5 years (average, >5.5 years). Eleven patients died, 3 with local recurrence only, 6 with local and distant disease, 1 died of distant metastases only, and 1 patient died of a second primary tumor. Overall 5-year survival rates were 70% for the primary treatment group and 82% for the salvage group. Treatment was well tolerated, and acute and late toxicity were mild. CONCLUSIONS: The AMORE protocol yields good local control and overall survival rates, and side effects are acceptable.


Subject(s)
Head and Neck Neoplasms , Rhabdomyosarcoma , Adolescent , Brachytherapy/methods , Child , Child, Preschool , Clinical Protocols , Combined Modality Therapy/methods , Feasibility Studies , Female , Head and Neck Neoplasms/drug therapy , Head and Neck Neoplasms/mortality , Head and Neck Neoplasms/radiotherapy , Head and Neck Neoplasms/surgery , Humans , Infant , Male , Models, Anatomic , Neoplasm, Residual , Radiotherapy Dosage , Plastic Surgery Procedures/instrumentation , Rhabdomyosarcoma/drug therapy , Rhabdomyosarcoma/mortality , Rhabdomyosarcoma/radiotherapy , Rhabdomyosarcoma/surgery , Salvage Therapy/methods , Survival Rate
7.
J Neurosurg ; 110(3): 482-6, 2009 Mar.
Article in English | MEDLINE | ID: mdl-19072311

ABSTRACT

OBJECT: Patients treated for aneurysmal subarachnoid hemorrhage (SAH) often report a loss of smell. To discriminate between the effects of aneurysmal rupture and treatment, the authors assessed the occurrence of anosmia after clipping and coiling of unruptured aneurysms as well as after the coiling of ruptured aneurysms. METHODS: The authors interviewed patients in whom an unruptured aneurysm was treated by clipping (32 cases) or endovascular coiling (26 cases) as well as patients with SAH who underwent coil therapy (32 cases). A geographically defined subset of 20 patients per group was invited to undergo olfactory testing. RESULTS: Nine clip-treated patients (28% [95% CI 14-47%]) in the unruptured group reported having anosmia, and no coil-treated patient in the unruptured group (95% [CI 0-13%]) reported having anosmia; in the SAH group, 7 patients (22% [95% CI 9-40%]) reported having anosmia. Anosmia had improved over time in 3 of the clip-treated patients and in all but 1 of the patients with SAH. Examination revealed olfactory disturbance in 13 (65% [95% CI 41-85%]) of the clip-treated and 8 (42% [95% CI 20-67%]) of the coil-treated patients with unruptured aneurysms, and also in 7 (35% [95% CI 15-59%]) coil-treated patients with SAH. In 20 patients who underwent clip therapy for unruptured aneurysms, 19 (95% [95% CI 75-100%]) had olfactory dysfunction on the side ipsilateral to surgery (anosmia reported by 8 of them). CONCLUSIONS: Both clip treatment and SAH contribute to the occurrence of anosmia, with different chances of improvement. Olfactory dysfunction occurs in almost all patients on the side of surgery and can occur subclinically after coil deployment.


Subject(s)
Intracranial Aneurysm/surgery , Olfaction Disorders/etiology , Adult , Aged , Aneurysm, Ruptured/surgery , Female , Humans , Male , Middle Aged , Postoperative Complications , Subarachnoid Hemorrhage/complications , Vascular Surgical Procedures/methods
8.
Head Neck ; 27(5): 390-6, 2005 May.
Article in English | MEDLINE | ID: mdl-15825203

ABSTRACT

BACKGROUND: The AMORE protocol is a local treatment for patients with nonorbital pediatric head and neck rhabdomyosarcoma (HNRMS). The objectives of this study were: (1) to assess the adequacy of the concept, and (2) to identify factors associated with relapse. METHODS: We performed a retrospective multidisciplinary review of 22 children primarily treated according to the AMORE protocol, excluding two children with inadequate imaging data. RESULTS: Seven patients had a local relapse, six within and one outside the residual tumor area. Five of the six patients with relapse in the residual area had gross total or debulking (incomplete) surgery, suboptimal position of the mold for brachytherapy, or both. In the 15 nonrecurrent cases, four patients had either incomplete surgery or suboptimal mold position. Both surgical and brachytherapeutic factors seem to be associated with relapse. CONCLUSIONS: AMORE is an adequate concept. More rigid preoperative imaging and intraoperative verification of the brachytherapy mold position might lead to a reduction in the number of local failures.


Subject(s)
Clinical Protocols , Head and Neck Neoplasms/therapy , Rhabdomyosarcoma/therapy , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Brachytherapy/methods , Child , Child, Preschool , Combined Modality Therapy , Dactinomycin/therapeutic use , Humans , Infant , Iridium Radioisotopes/therapeutic use , Muscle, Skeletal/transplantation , Neck Dissection/methods , Neoplasm Recurrence, Local , Netherlands , Radiotherapy Dosage , Retrospective Studies , Treatment Outcome , Vincristine/therapeutic use
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