The natural history of recurrent acute tonsillitis and a clinical trial of azithromycin for antibiotic prophylaxis.

The pharmacokinetics of azithromycin (Zitromax), Pfizer Inc., USA) in tonsil tissue warranted the present trial. In 110 patients eligible for tonsillectomy because of recurrent acute tonsillitis, surgery was replaced by randomized medication with azithromycin 500 mg or placebo once per week for 6 months. Subsequently, their clinical condition and microbiology was monitored for 12 months. Acute tonsillitis developed in 40% of the patients who received azithromycin and in 49% of the patients in the placebo group (P > 0.05). Accordingly, 45% of all patients developed acute tonsillitis. Resistance to azithromycin was not detected. In this trial long-term medication with azithromycin was not efficacious in recurrent acute tonsillitis. As all patients were eligible for tonsillectomy according to current criteria, it is surprising that only 45% developed acute tonsillitis during the trial period. Therefore, the criteria for tonsillectomy in recurrent acute tonsillitis must be revised.

Percutaneous dilatational tracheostomy versus conventional surgical tracheostomy. A clinical randomised study.

BACKGROUND: As no clinical randomised studies have previously been performed comparing complications with the Ciaglia Percutaneous Dilatational Tracheostomy Introducer Set (PDT) and conventional surgical tracheostomy (TR), we designed a study with the aim of comparing the efficacy and safety of the two techniques. METHODS: Sixty patients selected for elective tracheostomy were randomised for either PDT (30 patients) or TR (30 patients). All patients had general anaesthesia and were ventilated with 100% oxygen. Furthermore, lidocaine with epinephrine 1% (3-5 ml) was used for local analgesia and to minimise bleeding during the procedure. RESULTS: The median time for insertion of the tracheostomy tube was 11.5 min (range 7-24 min) in the PDT group and 15 min (range 5-47 min) in the TR group (P<0.01). Complications during the procedure were cuff puncture of the endotracheal tube in 5 cases in the PDT group. Minor bleeding was encountered in 6 cases in the PDT group as opposed to 24 cases in the TR group (P<0.01), major bleeding in none versus 2 cases, respectively. In 8 cases in the PDT group, increased resistance to insertion of the tracheostomy tube was met by further dilatation. During the post-tracheostomy period, complications occurred with minor bleeding in 2 cases in the PDT group as opposed to 9 cases in the TR group (P<0.05), and major bleeding was encountered in 1 case in each group. Minor infections were encountered in 3 cases in the PDT group as opposed to 11 cases in the TR group (P<0.01). Major infection was encountered in none versus 8 cases, respectively (P<0.01). CONCLUSION: Our results indicate that the percutaneous dilatational tracheostomy technique performed with the Ciaglia Introducer Set is effective, safe and superior to conventional surgical tracheostomy as immediate complications as well as complications with the tracheostomy tube in situ are fewer and of less severity.

[Percutaneous dilatation tracheostomy. A preliminary study]. / Perkutan dilatationstrakeostomi. En proeliminoer undersøgelse.

Fifteen patients electively selected for percutaneous dilatational tracheostomy as performed with the Ciaglia Percutaneous Tracheostomy Introducer Set are reported in this preliminary study. The median time for insertion of the tracheostomy tube was 13.1 min. Complications were cuff puncture of the translaryngeal tube at an early stage of the procedure in one case, and minor bleeding controllable by the compressible effect of the dilatational procedure in three cases. During the posttracheostomy period complications included one case of minor bleeding controllable by digital compression and one case of minor infection, i.e. cellulitis in a few millimetres around the stoma without purulent secretion. Our preliminary results indicate that the technique as performed with the Ciaglia Introducer Set is effective and safe with only minor complications. Furthermore, we now use it as a bed-side procedure in the ICU, thus avoiding the transportation of critically ill patients to the operating theatre. A conclusion on the superiority of percutaneous tracheostomy to dissectional tracheostomy has to await clinical randomized studies including more patients.

Percutaneous dilatational tracheostomy.

METHODS: Fifteen patients electively selected for percutaneous dilatational tracheostomy as performed with the Ciaglia Percutaneous Tracheostomy Introducer Set are reported in this preliminary study. RESULTS: The median time for insertion of the tracheostomy tube was 13.9 min. Complications were cuff puncture of the translaryngeal tube at an early stage of the procedure in one case, and minor bleeding controllable by the compressible effect of the dilatational procedure in three cases. During the posttracheostomy period, complications were one case of minor bleeding controllable by digital compression and one case of minor infection, i.e. cellulitis in a few millimetres around the stoma without purulent secretion. CONCLUSIONS: Our preliminary results indicate the technique as performed with the Ciaglia Introducer Set to be effective and safe with only minor complications. Furthermore, we now use it as a bedside procedure in the ICU, thus avoiding the transportation of critically ill patients to the operating theatre. The conclusion of the superiority of percutaneous tracheostomy to dissectional tracheostomy has to await clinical randomized studies, including more patients.

Inverted papilloma: incidence and late results of surgical treatment.

The 452,000 inhabitants of the County of Funen are considered to constitute a representative section of the population of Denmark. The county is geographically well-defined, surrounded by sea. Specimens from the two Departments of Pathology in the county have been histologically reviewed. Our incidence material consists of 96 patients suffering from inverted papillomas, during a 14-year period, which corresponds to 1.5 cases per 100,000 inhabitants per year. During the same 14-year period, 67 patients have been operated upon at the ENT Department of Odense University Hospital. In 1992, a clinical re-examination was performed regarding late surgical results. Fourteen per cent (9/67) have developed recurrences from 6 to 56 months after the first operation. No major late surgical complications have been observed. It is our experience that lesions limited to the nasal septum and minor lesions on the lateral nasal wall can be treated primarily by an intranasal procedure. Large lesions on the lateral wall with best results have been treated by lateral rhinotomy.

CO2-laser therapy for carcinoma of the larynx.

A retrospective study was undertaken to assess the outcome of 19 consecutive patients, who underwent endolaryngeal resection with a CO2-laser for laryngeal carcinomas. Sixteen of these patients had recurrences after primary curative radiotherapy. Seventeen of the patients had a curative operation carried out. So far, four CO2-laser treatment failures have been observed (median observation time 35 months). None of the patients needed tracheostomy in connection with the operation. Voice quality was in all cases acceptable. It is recommended, that small recurrences (after radiotherapy of laryngeal squamous cell carcinomas) should be considered for a partial laryngectomy with the aid of a laser.

Effect of surface-active substance on nasal mucociliary clearance time: a comparison of saccharin clearance time before and after the use of surface-active substance.

Mucociliary clearance measured by saccharin clearance time is depending on ciliary function and on the physiological characteristics of mucus. The aim of this study was to determine whether the application of surface-active substances changed the mucociliary transport time. Twenty healthy persons were manually sprayed with surface-active substance in one of their nose cavities. The saccharin clearance time was measured before spraying and statistically compared with saccharin clearance time after spraying. Saccharin clearance time was significantly shortened immediately after spraying with surface-active substances. This difference was not found 2 h later. Our assay indicates that surfactant increases the rate of mucociliary transport in the upper respiratory tract.

Inverted papilloma of the nose and paranasal sinuses: a study of 67 patients.

Retrospectively, 67 patients with inverted nasal papillomas were studied. In 12, the lesions were localized exclusively on the nasal septum. In 55, the lesion involved the lateral wall and/or the paranasal sinuses. There was a male predominance of 3:1. After histological revision the most dominating epithelial type was found to be transitional. Inverted papilloma was in one patient associated with squamous cell carcinoma. Ten per cent suffered recurrences from 6 to 37 months after the primary surgical procedure. We found that limited septal lesions could be managed by an intranasal procedure but lateral rhinotomy is recommended as the procedure of choice in the treatment of inverted papilloma of the lateral wall.

[Pneumothorax during jet ventilation in laryngobronchoscopy]. / Pneumothorax under jetventilation ved laryngobronkoskopi.

A case of unilateral pneumothorax which occurred during anaesthesia for laryngobronchoscopy is presented. The possible causes are discussed. Pneumothorax should always be suspected in cases of complicated anaesthesia where jet ventilation is employed.

Septorhinoplastic procedures versus submucous resection of the septum, using septum perforation as an indicator.

Comparison of the results following submucous resection (SMR) and septoplastic surgery has shown that significantly more perforations of the nasal septum develop after the latter than the former procedure. However, submucosal resection of the septum is a rapid, but traumatic surgical method, which has its merits in duration and tradition. It has been described in textbooks from edition to edition in an unchanged form. The main drawbacks are that SMR leads to mucosal atrophy, a high rate of septum perforation, and conchal hypertrophy. Septorhinoplastic procedures are more time-consuming and require considerable study, training and knowledge of various surgical approaches. However, the advantages of these procedures in the long-term are in the light of the above mentioned drawbacks, evident.

Relief of pain and trismus in patients treated with naproxen or acetylsalicylic acid after tonsillectomy.

The pain-relieving efficacy of naproxen and acetylsalicylic acid (ASA) in tonsillectomized patients was compared in a double blind parallel clinical trial comprising 83 patients, among whom 42 were treated with naproxen and 41 with ASA. The patients were treated post-operatively for two days with either naproxen suppositories 500 mg. twice, or ASA effervescent tablets 1000 mg. three times, daily. The therapeutic gain was evaluated by recording the intensity of pain, reduced ability to open the mouth (trismus), consumption of supplementary analgesic (parcetamol), and pain-related sleep disturbances. The statistical analysis of the results revealed no differences in pain intensity, consumption of additional analgesics or pain-related sleep disturbances in the two treatment groups. A considerable degree of trismus was demonstrated in most of the tonsillectomized patients. This reduced ability to open the mouth was gradually overcome in the naproxen group while it remained unchanged in the ASA group, however, no statistical significant difference could be demonstrated. Additionally, no significant positive correlation between pain intensity and trismus was proven. The pain-relieving effect, however, was unsatisfactory in both the naproxen and the ASA group, and clinical controlled trial studies of alternative analgetics in tonsillectomized patients are still to be encouraged.

Leiomyosarcoma of the trachea.

A case of primary leiomyosarcoma in the trachea of a 63-year-old woman is presented. Owing to the rare occurrence of this tumour in this site, the clinical diagnosis and pathological classification are difficult. In the English literature, only six cases of primary leiomyosarcoma in the trachea are on record.