Reliability of the reflux finding score for infants in flexible versus rigid laryngoscopy.

OBJECTIVES: The Reflux Finding Score for Infants (RFS-I) was developed to assess signs of laryngopharyngeal reflux (LPR) in infants. With flexible laryngoscopy, moderate inter- and highly variable intraobserver reliability was found. We hypothesized that the use of rigid laryngoscopy would increase reliability and therefore evaluated the reliability of the RFS-I for flexible versus rigid laryngoscopy in infants. METHODS: We established a set of videos of consecutively performed flexible and rigid laryngoscopies in infants. The RFS-I was scored twice by 4 otorhinolaryngologists, 2 otorhinolaryngology fellows, and 2 inexperienced observers. Cohen's and Fleiss' kappas (k) were calculated for categorical data and the intraclass correlation coefficient (ICC) was calculated for ordinal data. RESULTS: The study set consisted of laryngoscopic videos of 30 infants (median age 7.5 (0-19.8) months). Overall interobserver reliability of the RFS-I was moderate for both flexible (ICC = 0.60, 95% CI 0.44-0.76) and rigid (ICC = 0.42, 95% CI 0.26-0.62) laryngoscopy. There were no significant differences in reliability of overall RFS-I scores and individual RFS-I items for flexible versus rigid laryngoscopy. Intraobserver reliability of the total RFS-I score ranged from fair to excellent for both flexible (ICC = 0.33-0.93) and rigid (ICC = 0.39-0.86) laryngoscopies. Comparing RFS-I results for flexible versus rigid laryngoscopy per observer, reliability ranged from no to substantial (k = -0.16-0.63, mean k = 0.22), with an observed agreement of 0.08-0.35. CONCLUSION: Reliability of the RFS-I was moderate and did not differ between flexible and rigid laryngoscopies. The RFS-I is not suitable to detect signs or to guide treatment of LPR in infants, neither with flexible nor with rigid laryngoscopy.

[Classical Swine Fever in wild boar in Rhineland-Palatinate: evaluation of the official control measures from 2005-2011]. / Klassische Schweinepest bei Wildschweinen in Rheinland-Pfalz: Bewertung der offiziellen Kontrollmaßnahmen von 2005-2011.

The present study describes the control strategy for fighting Classical Swine Fever in wild boar in Rhineland-Palatinate from 2005 to 2011 and evaluates its effectiveness. The official control measures were based on the following three main pillars:--Serological and virological monitoring: By means of serological monitoring Classical Swine Fever outbreaks could be detected very early. Increasing antibody prevalences indicated an imminent Classical Swine Fever outbreak. This could be confirmed by the virological investigations. The geographical evaluations of the virological investigations showed that the outbreaks occurred only in localized areas and a spreading of the virus had not taken place yet or could be prevented.--Oral immunization: After virological detection of Classical Swine Fever Virus oral immunization was started immediately. This oral immunization achieved antibody prevalence rates of 57% on an average. The analysis of the distribution of the antibodies in the vaccination areas concerning the different age groups in the vaccination areas showed that 41% of the young animals, 66% of animals from one to two years and 77% of the adult animals were immunized.--Hunting measures: For the reduction of the wild boar population an all-year, intensive hunt with special attention to the young animals and the female animals was carried out. The hunting bag increased on more than 80 000 wild boar per hunting season. Out of the total 108,772 hunted wild boar were 47% of young animals, 40% of animals from one to two years and 13% of adult animals. Concerning the gender distribution on an average 53% female and 47% male animals were shot. in summary, the current control strategy was effective because there had been no further proof of Classical Swine Fever in wild boar in Rhineland-Palatinate since 2009. Nevertheless, the fight strategy can be optimized even further. For an optimum monitoring the development of a marker vaccine which allows a differentiation of field antibody and vaccination antibody is desirable. The oral immunization would have to be improved in such a way that also the young wild boar can take up increasingly vaccination bait and raise antibody. The introduction of another vaccination in winter should be considered to the preservation of the high level of antibody prevalence.

Long-term follow-up of tracheoplasty using autologous pericardial patch and strips of costal cartilage.

OBJECTIVES: To evaluate long-term results of tracheoplasty using autologous pericardial patch and strips of costal cartilage for relieving severe long-segment tracheal stenosis. METHODS: Data were collected retrospectively by clinical chart review. Between 1995 and 2013, 21 patients underwent tracheoplasty. Follow-up was performed by outpatient chart review; otherwise, referring physicians and parents were contacted and asked to fill in a questionnaire. RESULTS: Median age at the time of operation was 0.9 (range 0.5-44) years. Aetiology of tracheal stenosis was double aortic arch in 9 patients, right arch with a left ductus in 3, innominate artery compression in 1 patient, complete tracheal rings in 7, 3 of whom with pulmonary artery sling and 2 with agenesis of one lung, and other causes in 1 patient. Previous surgery was performed in 6 (29%) patients. Patch tracheoplasty was performed using autologous pericardial patch and external stenting using costal cartilage. Major complications were mediastinitis and patch dehiscence in 2 patients, 2 patients needed tracheal cannula and 1 patient had stent implantation. Three (14%) patients died in the late postoperative period: 1 patient died of sepsis, 1 had patch dehiscence and 1 erosion of tracheal stent and consequently intractable bleeding. Follow-up was 6.1±2.7 years (0.75-10 years). At follow-up, 2 (11%) patients were still symptomatic, 4 (22%) had occasionally mild symptoms and 12 (67%) were free of symptoms. CONCLUSIONS: Treatment for severe tracheal stenosis remains challenging. With tracheoplasty using autologous pericardial patch and strips of costal cartilage, long and narrow tracheal stenosis can be repaired. There are no limitations as to the length and location and severity of the stenosis. Tracheoplasty is associated with a high complication rate. A multidisciplinary approach is mandatory to ensure favourable long-term outcomes.

Development of the reflux finding score for infants and its observer agreement.

OBJECTIVE: It is hypothesized that laryngeal edema is caused by laryngopharyngeal reflux (LPR) (ie, gastroesophageal reflux extending into the larynx and pharynx). The validated reflux finding score (RFS) assesses LPR disease in adults. We, therefore, aimed to develop an adapted RFS for infants (RFS-I) and assess its observer agreement. STUDY DESIGN: Visibility of laryngeal anatomic landmarks was assessed by determining observer agreement. The RFS-I was developed based on the RFS, the found observer agreement, and expert opinion. An educational tutorial was developed which was presented to 3 pediatric otorhinolaryngologists, 2 otorhinolaryngologists, and 2 gastroenterology fellows. They then scored videos of flexible laryngoscopy procedures of infants who were either diagnosed with or specifically without laryngeal edema. RESULTS: In total, 52 infants were included with a median age of 19.5 (0-70) weeks, with 12 and 40 infants, respectively, for the assessment of the laryngeal anatomic landmarks and the assessment of the RFS-I. Overall interobserver agreement of the RFS-I was moderate (intraclass correlation coefficient = 0.45). Intraobserver agreement ranged from moderate to excellent agreement (intraclass correlation coefficient = 0.50-0.87). CONCLUSION: A standardized scoring instrument was developed for the diagnosis of LPR disease using flexible laryngoscopy. Using this tool, only moderate interobserver agreement was reached with a highly variable intraobserver agreement. Because a valid scoring system for flexible laryngoscopy is lacking up until now, the RFS-I and flexible laryngoscopy should not be used solely to clinically assess LPR related findings of the larynx, nor to guide treatment.