Microdebrider removal of tracheal papilloma via tracheostomy in the child with an obliterated larynx.

In children, recurrent respiratory papillomatosis is the most common benign neoplasm of the airway. The disease frequently involves the larynx and may spread to extralaryngeal sites. Use of a microdebrider has been suggested as a safe and low-cost technique which reduces operating time, compared with laser removal of laryngeal lesions. We describe a technique for using a microdebrider to remove tracheal papillomas when the larynx is obliterated with the disease.

Pneumococcal antibiotic resistance and rates of meningitis in children.

OBJECTIVES/HYPOTHESIS: Recent studies have shown alarmingly high rates of antibiotic resistance in Streptococcus pneumoniae isolates from patients with otitis media. A recent study has implicated resistant S pneumoniae for rising rates of acute mastoiditis. The purpose of this study was to determine whether S pneumoniae antibiotic resistance has similarly affected the rate of pediatric community-acquired meningitis, the most common intracranial complication of otitis media. STUDY DESIGN: Retrospective chart review. METHODS: All cases of pediatric community-acquired meningitis treated at an academic tertiary care hospital during a 10-year period were reviewed, and meningitis rates were calculated as a proportion of yearly admissions. RESULTS: The overall rate of meningitis decreased linearly during the study period (P = .001). This was largely because of a drop in the rate of Haemophilus influenzae meningitis (P = .001), corresponding with the introduction of H influenzae type B vaccine. Annual rates of S pneumoniae meningitis did not change. Only one case of S pneumoniae meningitis was due to a highly penicillin-resistant strain and isolates from four cases had intermediate sensitivity. Twenty-four of 83 cases were associated with antecedent acute otitis media and 63% of these had been treated with antibiotics before admission. Otitis media, as a cause of meningitis, did not increase during the study period. CONCLUSION: S pneumoniae is responsible for a greater proportion of cases of pediatric community-acquired meningitis. However, this is because of a decline in the rate of H influenzae cases, not the rise in S pneumoniae antibiotic resistance.

Expression of matrix metalloproteinases and tissue inhibitor of metalloproteinases in laryngeal and pharyngeal squamous cell carcinoma: A quantitative analysis.

Squamous cell carcinomas of the head and neck are known for their aggressive growth and propensity to metastasize. Invasion is facilitated by matrix metalloproteineases (MMPs). Tissue inhibitors of MMPs (TIMPs) negatively regulate MMP activity. MMP and TIMP expression in head and neck squamous cell carcinomas was determined by quantitative reverse transcriptase polymerase chain reaction (qRT-PCR). qRT-PCR allows measurement of several mRNAs from as little as 4 microg of total cellular RNA. We measured MMP-1, MMP-2, MMP-9, and TIMP-1 expression in 8 specimens of primary tumors and adjacent normal tissue. MMP-1 was overexpressed in 6 of 8 tumors, and MMP-9 was overexpressed in 4 of 7 tumors. MMP-2 was expressed in 3 of 8 tumors and 3 of 8 normal samples. TIMP-1 was expressed in all specimens. This work demonstrates that qRT-PCR can be used to examine expression of specific mRNAs in clinical specimens. Therefore this method provides another tool for the molecular analysis of tumors.

Chronic invasive fungal rhinosinusitis.

Chronic invasive fungal rhinosinusitis is an increasingly recognized, but inadequately characterized, disease entity which is separate and distinct from acute fulminant invasive fungal sinusitis and allergic fungal sinusitis. Chronic invasive fungal rhinosinusitis is divided into granulomatous and nongranulomatous subtypes based on histopathology, but the clinical distinction between the two subtypes is not clear. Current management includes varying degrees of surgical débridement and a prolonged course of antifungal agents. A protracted clinical course with recurrence after treatment is common.

Length of stay after free flap reconstruction of the head and neck.

OBJECTIVES: To analyze the incidence and timing of postoperative complications after free tissue transfer (FTT) and relate that to length of stay (LOS.) STUDY DESIGN: We reviewed one surgeon's experience with 97 patients undergoing 100 head and neck reconstructions via FTT for a variety of traumatic and ablative defects METHODS: Charts were reviewed for demographic data, type of defect and flap, complications, LOS, length of intensive care unit (ICU) stay, date of decannulation, and first oral intake, any readmission to the hospital, and preoperative radiation status. RESULTS: Using strict guidelines, 31% of patients had some form of complication, including a 9% flap failure rate. Average postoperative LOS for all patients was 11 days. Average LOS for uncomplicated cases was 9 and for complicated cases was 16 days. For cases with flap-related complications the average LOS rose to 20 days. All reconstructive failures (defined as patients requiring subsequent surgical procedures after a flap-related complication, regardless of outcome) occurred within the first 7 postoperative days. Three patients were readmitted for various reasons: a partial flap dehiscence (postoperative day [POD] 9), meningitis (POD 24), and orocutaneous fistula (POD 22), for a 3.2% readmission rate. Fourteen percent of patients were on a regimen of oral intake, and 13% had decannulation by the time of discharge. Resumption of oral intake and tracheostomy decannulation were accomplished on an outpatient basis in the remainder of patients. CONCLUSIONS: There were no preventable complications associated with early hospital discharge, nor was there evidence of adverse patient outcome. We conclude that early hospital discharge is feasible after FTT reconstruction and is consistent with quality care.