Intralesional cidofovir in severe juvenile respiratory papillomatosis.

UNLABELLED: Recurrent respiratory papillomatosis causes significant morbidity among affected children and usually requires frequent surgeries. We present a prospective case series including nine children at a Mexican tertiary referral center. All enrolled patients had severe disease that had required at least four surgical procedures, with a median of 6. Two children had tracheobronchial involvement, one had lung parenchymal disease, and one had a tracheostomy performed during his first surgery. OBJECTIVE: To assess the efficacy of intralesional cidofovir in lowering the surgery rate. STUDY DESIGN: Prospective case series. SETTING: Tertiary referral center in Mexico City. METHODS: Nine Mexican children with severe disease were enrolled. Intralesional cidofovir was applied after surgical debulking at a concentration of 5 mg/mL with a four to six week interval. RESULTS: Six of the nine patients had a notable decrease in the rate of surgeries, with three patients remaining disease-free with follow up ranging from 1.8 to 3.3 years. No patient demonstrated laboratory abnormalities. Two patients showed moderate and mild dysplasia on papilloma biopsy distinguished by a lack of epithelial maturation with no mitoses or cellular atypia. Two patients died several months after the last injection. CONCLUSIONS: Intralesional cidofovir appears to be effective in the treatment of recurrent respiratory papillomatosis, although further studies are required to determine its safety.

Functionality of CD4+ and CD8+ T cells from tonsillar tissue.

For many years, tonsillectomy has been used routinely in children to treat chronic or recurrent acute tonsillitis. Palatine tonsils are secondary lymphoid organs and the major barrier protecting the digestive and respiratory tracts from potential invasive microorganisms. They have been used as sources of lymphoid tissue; however, despite the hundreds of papers published on tonsillectomy, no studies addressing the functionality of the CD4(+) and CD8(+) T cells from chronically infected tonsils have yet been published. The aim of this study was to analyse the functionality of the CD4(+) and CD8(+) T cells with respect to tonsillar tissue. We used an affordable approach to measure the frequency of antigen-specific CD4(+) T cells, the direct ex-vivo cytotoxicity of CD8(+) T cells, memory T cell phenotype, cytokine profile and DC phenotype. Our results demonstrate that CD4(+) and CD8(+) T cells from tonsillar tissue are totally functional, as shown by their ability to produce cytokines, to degranulate and to differentiate into effector-memory T cells.

Surgical treatment of labyrinthine fistula caused by cholesteatoma.

In a 144-month period, 27 cases of labyrinthine fistula (LF) were seen, and 360 mastoid operations were performed; the LF prevalence was 7.5%. Primary symptoms were hypoacusis, otorrhea, vertigo, tinnitus, and otalgia. All patients underwent preoperative CT scans and preoperative audiometry. LF diagnosis was made before surgery for 93% of patients on the basis of symptoms, signs, and imaging studies. With respect to surgical technique, the canal-wall-down procedure was performed in 92%, and the canal-wall-up procedure was performed in 8%. In 88% of patients the fistula was located in the horizontal semicircular canal. In 96% of patients the cholesteatoma matrix was removed, and the fistula was sealed; in 4% of patients the matrix was left. With a follow-up of 13 years, vertigo disappeared in 96% of patients, and hearing remained unchanged in 70% of patients. Further complications of chronic otitis media existed in approximately half of the patients with LF. Open surgery with removal of the cholesteatoma matrix and sealing of the fistula with temporalis fascia in a canal-wall-down manner is a safe procedure that can make vertigo disappear and helps to preserve cochlear function.

[The comparative test of nasal mucociliary function in healthy subjects, smokers and non-smokers]. / Prueba comparativa de función mucociliar nasal en sujetos sanos, fumadores y no fumadores.

Little is known about the changes produced in the nasal respiratory epithelium in individuals with an important smoking habit. The purpose of this study is to compare the nasal mucociliary function in healthy subjects, smokers and non-smokers. The nasal mucociliary transport of aspartame particles was measured in 50 healthy non-smokers and in 50 healthy smokers under similar conditions. The average time taken for the displacement of the test substance from the middle third of the inferior turbinate to the oropharynx was found to be in the smokers 13.62 min., and in the non-smokers, 10.34 min. The results were compared using student's "t" test and a significant difference (p < 0.001) was found between both groups. This result is taken as a simple clinical test that evaluates the smoking effects on the nasal mucociliary function.

[The surgical management of tracheal stenosis]. / Manejo quirúrgico de las estenosis traqueales.

We analyzed 26 cases of tracheal stenosis treated (ET) surgically at the National Institute of Respiratory Diseases between March 1987 and June 1990. The surgical technique practiced was end-to-end anastomosis of the trachea (ATT). The most important cause of stenosis was oro-tracheal intubation (69.2 percent). Followed by tracheostomy, respiratory scleroma, thyroid carcinoma with tracheal invasion and neck trauma. We describe the treatment of the patients and discussed the results, which were satisfactory from the functional anatomical point of view in all patients except one who died of hepatic coma 2 weeks postoperatively. We conclude that end-to-end anastomosis of the trachea is the treatment of choice to tracheal stenosis.

[Surgical management of the congenital atresia of the ear]. / Manejo quirúrgico de la atresia congénita del oído.

This study presents a 15 year experience of surgical treatment in 47 patients with congenital atresia of the ear. Emphasizing on the importance of pre-surgical evaluation of the patients for a better prognostic indicator. The ages of 40 patients were between 5-15 years. 24 patients (61%) had complete atresia and 23 (49%) incomplete. 27 patients (57%) with bilateral disease and 20 (43%) unilateral. Auditory test before surgery showed a conductive hearing loss of approximately 60 decibels (dB) and one case with total sensorineural hearing loss. There was an auditory average gain of 28.3 dB. 3 patients (6.4%) had associated cholesteatoma. Complications presented: Closure of the external auditory canal in 6 patients (12.7%), and facial nerve paralysis in 2 patients with recovery. The different surgical technics are described. In conclusion, for this type of surgery, combination between the otologist and plastic surgeon should be done for better results.

Scleroma of the lower respiratory tract: case report and review of literature.

The case of a 46-year-old man who presented with acute respiratory distress due to a tracheal mass is reported. The patient underwent endoscopic resection of the mass and the histopathology revealed scleroma. No other sites of involvement by scleroma were found. This case is reported because laryngotracheal involvement by scleroma as the only manifestation of this disease is extremely rare.