[The effectiveness of propranolol therapy of subfold hemangioma in the children during the first year of life].

The objective of the present study was to estimate the effectiveness and tolerance of propranolol therapy prescribed to the children presenting with vascular hyperplasia of the larynx. The experience with propranolol therapy of 12 patients suffering vascular hyperplasia of the larynx (subfold hemangioma) is analysed. Nine of these children had been given systemic glucocorticoid therapy prior to the present study that failed to produce a clinically significant effect. On the contrary, the treatment with propranolol resulted in a well apparent clinical effect in the form of the marked decrease in the size of subfold hemangioma and the reduction in the degree of laryngeal stenosis from grade 2-3 to 0-1 as early as 10-14 days after the onset of propranolol therapy at a daily dose of 2 mg/kg. None of the patients developed adverse reactions related to the treatment with propranolol. The results of the study indicate that the treatment of vascular hyperplasia, such as subfold hemangioma with the non-selective beta-blocker propranolol is both efficacious and safe for the patients. This gives reason to recommend this therapeutic modality as the first-line treatment of the children starting from the first weeks of life.

[The results of adjuvant therapy of juvenile recurring respiratory papillomatosis with the use of indole-3-carbinol].

The authors analyse the efficacy of anti-relapse therapy of juvenile recurring respiratory papillomatosis in 87 children aged from 2 to 15 years with the use of indole-3-carbinol. Prior to inclusion into this study, the patients underwent from 2 to 86 (mean 12 +/- 14) surgical interventions for the ablation of papillomas. The average interval between successive relapses of papillomas ranged between 2 weeks and 12 months (mean 4.9 +/- 2.33 months). The patients remained under observation in the clinic during 2 years--6 years 5 months (mean 44.8 +/- 15.93 months). The duration of therapy with indole-3-carbinol varied from 12 weeks to 2 years (mean 8.9 +/- 4.72 months). The stable remission of pathology was documented in 28.7% of the patients within the 2 to 6 year follow-up period. A significant (1.5-10-fold) increase in the duration of interval between successive relapses occurred in 41.1% of the children. In 29.9% of the patients, therapy produced no apparent clinical effect; 18.4% of them showed an insignificant shortening of the interval between relapses that remained unaltered in the remaining 11.5%. No adverse effects of the treatment were recorded. It is concluded that treatment with indole-3-carbinol can be recommended as a starting therapeutic modality for the management of juvenile recurring respiratory papillomatosis and the reduction of the intervals between relapses of the disease.

[Recurrent respiratory papillomatosis: update review].

This paper updates information on epidemiology, etiology, clinical features, surgical and anti-relapse treatment of recurrent respiratory papillomatosis in children.

[Infection of the upper respiratory tract with human papilloma virus in children without clinical signs of respiratory papillomatosis].

The objective of this study was to evaluate the frequency of infection of pharyngeal mucosa, palatal and pharyngeal tonsils with types 6, 11, 16, 18, 31, and 33 human papilloma virus (HPV). A total of 57 children (30 boys and 27 girls) aged from 2 yr 10 mo to 14 yr 5 mo (mean 82+/-28.9 months) were examined. The patients were hospitalized for preplanned adenotomy, tonsillotomy or tonsillectomy. None of them exhibited clinical signs of recurrent respiratory papillomatosis. DNA of HPV was detected by means of the polymerase chain reaction (PCR assay) in mucosal cells obtained by scraping from the posterior pharyngeal wall (57 samples) and in biopsies from palatal (8 samples) and pharyngeal (52 samples) tonsils. The presence of HPV DNA was documented in 24 of the 57 (42.1%) children. In was found in ten (17.5%) samples from mucosal cells of the posterior pharyngeal wall, in pharyngeal tonsil biopsies from 16 of the 52 (30.8%) children, and in palatal tonsil biopsies from one of the 8 (12.5%) patients. Type 6 HPV was identified in 8 (14%) children, type 11 HPV in 1 (1.7%), type 16 HPV in 5 (8.8%), type 31 in 4 (7%), and type 33 in 12 (21%) patients. None of the samples contained type 18 HPV. Two types of HPV were simultaneously found in 4 (7%) children and three types in one patient. The frequency of HPV infection was comparable in children of preschool and school age.

[Gastroesophageal reflux disease and pharyngolaryngeal reflux in children with chronic laryngeal pathology].

A prospective non-randomized trial was made to evaluate incidence of gastroesophageal reflux disease (GERD) and pharyngolaryngeal reflux (PLR) in children with chronic laryngeal pathology. A total of 46 children aged 6 to 15 years were examined including 16 patients with recurrent respiratory papillomatosis, 15 patients with acquired laryngotracheal scarry stenosis and 15 patients with vocal nodules and functional dysphonia. Combination of GERD with PLR is a factor of risk for scarry laryngostenosis in a child with recurrent respiratory papillomatosis. If it is impossible to perform 24-h pH-monitoring of the esophagus for detection of GERD or PLR in patients with chronic laryngeal pathology, antireflux therapy is prescribed empirically. It is necessary to establish significant diagnostic criteria of PLR.

[Efficacy of indinol in antirecurrence therapy of juvenile respiratory papillomatosis].

The study of indinol efficacy in antirecurrence therapy of respiratory papillomatosis was performed in 46 children aged 2-14 years. The treatment lasted at least 12 weeks. Duration of a recurrence-free period before and after indinol administration was analysed. The response was observed in 30 (65.2%) patients. In 5 (10.9%) patients the remission continued from 2 to 3 years 10 months. In 25 (54.3%) patients recurrence-free period increased 1,5-6-fold. Side effects were not registered. Simple in use, cheap, well tolerated, usable with other treatments, indinol is recommended as a method of choice in antirecurrence treatment of recurrent respiratory papillomatosis.

[Papillomatosis of the lower respiratory tracts in children].

Papillomatosis of the trachea, bronchi and lungs was investigated in 40 children with papillomatosis of the lower airways in comparison with 408 children with laryngeal papullomatosis. All the patients were operated in 1988-2003 with histological verification of the diagnosis. Papillomas involved the lower airways because of tracheotomy (92.5%) or tracheal intubation (7.5%). Papillomatosis of the lower airways runs a more aggressive course than laryngeal papillomatosis, its treatment efficacy is worse. All the patients suffering from laryngeal papillomatosis with a history of tracheotomy need a regular endoscopic and x-ray control as papillomatosis of the trachea and/or lungs may develop in them several years after decanulation. Pulmonary papillomatosis has an invariably poor prognosis.

[Clinical symptoms of vascular laryngeal tumors in children depending on their location]. / Osobennosti klinicheskoi simptomatiki sosudistykh opukholei gortani u detei v zavisimosti ot lokalizatsii.

To study peculiarities of clinical symptoms of laryngeal angiomas in children, 71 case histories for children with vascular tumor aged 27 days to 14 years have been analysed. The cases were divided into two groups by location of the tumor: group 1--with hemangioma located in the subvocal larynx (45 children admitted to hospital at the age of 27 days to 2 years); group 2--with laryngeal vascular tumor located in the vocal or supravocal larynx (26 children admitted to hospital at the age of 3 months to 14 years). It was established that the age of the first angioma symptoms and the symptoms manifestation depend on the tumor location. Subvocal hemangioma should be considered an independent nosological unit of the disease.