Long-term follow-up and outcome in patients with recurrent respiratory laryngeal papillomatosis.

INTRODUCTION: Recurrent respiratory papillomatosis is characterized by wart-like lesions of the upper airway and is most frequently caused by human papillomavirus (HPV). The disease has significant impact on quality of life due to potential airway obstruction, dysphonia and the need for serial surgeries. The main objective of this study was to describe patient characteristics and long-term follow-up data in a Danish cohort with the disease. METHODS: The study was a longitudinal retrospective cohort-study using data from electronic medical records and a pathology database. RESULTS: A total of 61 adult and four juvenile patients were identified. The male-to-female ratio was 2.4. In the adult population, the mean age at onset was 45 years. The median number of surgeries was four (interquartile range: 2.8). The mean follow-up time was 8.7 years (range: 7 days-30 years). Three cases of malignant transformation were observed. In the juvenile population, the mean age of onset was 8.5 years (range: 3-12 years). The mean follow-up time was 11.5 years (range: 2-23 years), and the number of surgeries per year at risk was one/year. CO2-laser and microdebrider were the surgical techniques usually employed. 43% of histopathologic analyses could detect HPV infection (subtype 6 or 11). CONCLUSIONS: More males than females suffer from respiratory papillomatosis; age of onset was either in childhood or in mid-life. Use of CO2-laser or microdebrider was the preferred surgical approach in this cohort. FUNDING: none. TRIAL REGISTRATION: not relevant.

Patients' experience of awake versus anaesthetised orotracheal intubation: a controlled study.

BACKGROUND AND OBJECTIVE: We investigated patients' self-reported experience following awake flexible fibreoptic tracheal intubation and compared this to the experience of matched patients who had undergone conventional tracheal intubation under general anaesthesia for the same type of surgical procedure. METHODS: Patients suspected of having, or known to have, a difficult airway underwent flexible fibreoptic orotracheal intubation with topical anaesthesia and sedation. A matched group of patients who underwent tracheal intubation conventionally following induction of general anaesthesia were identified in our database and questionnaires were mailed to the patients at a median of 15 months after the procedure. RESULTS: One hundred and ten patients completed the questionnaire. Feelings of discomfort, sensation of suffocation and hoarseness were reported by 14.6, 12.5, and 37.5%, respectively in the awake group and 0, 1.6, and 17.7%, respectively in the conventionally intubated group. No significant differences were reported between the groups with regard to sleeping disorders and the incidence of nightmares. CONCLUSION: Temporary discomfort is encountered more frequently following awake orotracheal intubation than after conventional intubation, but we did not find a difference in long-term problems such as sleeping disorders or nightmares.