Necrotic adenoids in post-transplant lymphoproliferative disorders.

PROBLEM: Post-transplant lymphoproliferative disorders (PTLD) are a potentially fatal complication after solid organ transplantation. The majority of cases are associated with Epstein Barr virus infection (EBV). The first manifestations of PTLD are frequently observed in the ENT area with adenoidal and/or tonsillar enlargement. METHODOLOGY: We present the case of a 12-year old girl with a total nasal obstruction and tonsillitis five months after a kidney transplantation for bilateral congenital kidney hypoplasia. RESULTS: The EBV genome was detected by polymerase reaction three months after surgery. Fiberoptic examination revealed an obstructive necrotic mass in the naso-pharynx. The anatomic-pathologic analysis revealed necrotic adenoids. CONCLUSIONS: Necrotic tonsillitis is common. Necrosis of the adenoids, although rarer, can also occur and explains the important respiratory distress. Since two thirds of PTLD patients present with clinical symptoms in the ENT area, the otorhinolaryngologist should be aware of this complication.

Intranasal endoscopic surgery in traumatic optic neuropathy--the Belgian experience.

The management of traumatic optic neuropathy remains controversial. In this report we present the results of 8 patients treated by means of an intranasal endoscopic approach to the optic canal after at least 12 hours of corticosteroid therapy without improvement. Vision improved in four of the eight patients who underwent the surgery. There was no morbidity or mortality. As the results of the endoscopic optic nerve decompression are comparable to those reported using other surgical procedures, we feel that this approach merits consideration by surgeons.