Nasopharyngeal glioma in a new-born girl.

Nasal gliomas are uncommon tumours of neurogenic origin that occur sporadically. They are diagnosed with MRI and a preoperative biopsy, and surgery is the treatment of choice. Most of the gliomas emerge from the nasal cavity, but only a few cases of nasopharyngeal gliomas have been reported. We present one case of a nasopharyngeal glioma and two cases of nasal gliomas.

Cervical lymph node infections with non-tuberculous mycobacteria in preschool children: interferon gamma deficiency as a possible cause of clinical infection.

UNLABELLED: Epidemiological studies have demonstrated a prevalence of positive PPD reactions to non-tuberculous mycobacteria (NTM) in 9% of 4-5-y-old children in the Göteborg area. Very few children of this age develop suppurative infections in lymph nodes that require surgical procedures. The hypothesis was that these children might have T cell deficiencies with abnormalities of macrophage functions, particularly with type 1 cytokines. Twenty-four children who needed operations were investigated immunologically and compared to 10 children of the same age operated on for non-infectious reasons. The methods used were flow cytometry analysis of lymphocytes in blood, blood lymphocyte stimulation assays and interferon gamma analyses. The patients had significantly lower levels of interferon gamma than the controls after stimulation with Candida antigens or Con A. The numbers of T and B lymphocytes were higher in patients than in controls. CONCLUSION: Children with necrotic lymph node infections in the cervical region due to NTM had lower interferon gamma production after stimulation than healthy age-matched controls.

The influence of karyotype on the auricle, otitis media and hearing in Turner syndrome.

The study has investigated the relationship between the chromosomal aberration and ear and/or hearing disorders in 115 girls/women with Turner syndrome (TS). A dose-response relationship was found between the karyotype and hearing function. Hearing deteriorated more rapidly with increasing age in TS women lacking the whole p-arm of chromosome X (i.e. monosomy 45,X, or isochromosome cases 46,X,i(Xq)) as compared to women having a partial deletion of the p-arm (structural deletions or mosaicism cases), who, in turn, had poorer hearing than a female random population sample (46,XX) (P<0.001). Moreover, TS subjects having total deletion of the p-arm were three times more likely to have auricular anomalies or conductive hearing loss due to otitis media than subjects with partial deletion (P<0. 05). The results support the hypothesis that lack of growth-regulating genes such as the short stature homeobox-containing gene (SHOX), which is located within the pseudo-autosomal region on the p-arm of the X chromosome, may increase the occurrence of auricular malformations and otitis media and also induce an earlier loss of hearing function. Accordingly, the ear and hearing disorders in TS may be a result of growth disturbances of the auricle, the mastoid, the Eustachian tube and the organ of Corti during development. It is suggested that karyotype may be used as a predictor for future ear and hearing problems in TS.

Otological problems in children with Turner's syndrome.

Ear and hearing disorders are common problems among girls and women with Turner's syndrome. During infancy and childhood the girls often suffer from repeated attacks of acute otitis media and later in life the women frequently complain of a rapid onset of social hearing problems due to sensorineural hearing impairment. A study of 56 girls aged 4-15 years with Turner's syndrome was performed to investigate the prevalence of eardrum pathology and hearing impairment in young children and teenagers with Turner's syndrome. A possible relation to karyotype was also investigated. A high prevalence (61%) of recurrent acute otitis media was found in the study group and 32% had been treated with ventilation tubes. Fifty-seven percent showed eardrum pathology, such as effusion, myringosclerosis, atrophic scars, retraction pockets and perforations. Auricular anomalies were noted in 23% of the cases, most commonly in the 45, X group. The audiometric analysis showed conductive hearing loss (air-bone gap > 10 dB HL) in 43% and the typical sensorineural dip in the middle frequencies was found in 58% of the girls, of whom the youngest was 6 years old. Four percent were using hearing aids. The data of this study further confirm that the dip is progressive over time and may be detectable as early as at the age of 6, giving a chance to predict a future hearing loss. The findings emphasize the importance of regular otological examinations and audiological evaluations of all girls with Turner's syndrome early in life.

Aetiology of acute epiglottitis in adults.

In order to determine the aetiology of acute epiglottitis in adults, blood cultures, paired sera and a urine sample were obtained from 54 patients with fever and epiglottitis visualized by indirect laryngoscopy or by direct fibreoptic nasolaryngoscopy. Antibodies were determined against the capsular polysaccharide of Haemophilus influenzae type b (Hib), 3 pneumococcal antigens (a mixture of 23 capsular polysaccharides, C-polysaccharide and pneumolysin) and antistreptolysin O. Acute sera were examined by the polymerase chain reaction (PCR) for DNA of Hib and pneumococci. The urine samples were examined for Hib capsular antigen. Blood cultures were positive in 15 patients. In another 16, serology and/or PCR verified the aetiology. Hib was the cause in 14, pneumococci in 12 and group A streptococci in 5 patients. The aetiology remained unknown in 23/54 patients (43%). In conclusion, the addition of serology and PCR to blood cultures doubled the possibilities of verifying the aetiology of acute epiglottitis in adults.

Antibodies to pneumococcal polysaccharides in human milk: lack of relationship to colonization and acute otitis media.

BACKGROUND: This study analyzed antibodies to pneumococcal polysaccharides in human milk and their effect on nasopharyngeal colonization and acute otitis media in breast-fed infants. METHODS: A total of 503 milk samples were collected from 310 mothers. Nasopharyngeal cultures were obtained from their children at 2, 6 and 10 months postpartum, and the capsular groups/types of the Streptococcus pneumoniae isolates were determined. RESULTS: Types 6A, 6B, 19A, 19F and 23F accounted for 54% of the pneumococcal isolates, but type 3 isolates were uncommon. Milk samples were analyzed for antibody activity to the common capsular polysaccharide types 6A, 19F and 23F; to the type 3 polysaccharide; to C-polysaccharide; and to phosphorylcholine (PC), a major component of the pneumococcal cell wall polysaccharide (CWPS). Anti-capsular antibody activity was low or absent in > 90% of the milk samples. In contrast anti-PC antibody activity was detected in 88% and anti-CWPS in 84% of the samples. The frequency of acute otitis media did not vary with the milk anti-capsular, anti-PC or anti-CWPS antibody activity. CONCLUSIONS: There was no reduction in nasopharyngeal carriage of S. pneumoniae among children fed milk with anti-capsular or anti-PC antibody activity, but carriage was increased in those children who received milk with anti-CWPS antibody activity. A protective role of antipolysaccharide or anti-CWPS antibodies in milk was not detected under the study conditions.

Incidence, aetiology, and prognosis of acute epiglottitis in children and adults in Sweden.

A retrospective study of the incidence, aetiology and case fatality rate of acute epiglottitis in children and adults was performed. The study covered the whole of Sweden (population 8.4 million) during the years 1987-89, before general vaccination against Haemophilus influenzae (Hi) type b was started. Patients were included if it was documented that they fulfilled all 3 of the following criteria: (a) red and swollen epiglottis visualized by indirect laryngoscopy, (b) inspiratory stridor or difficulties in swallowing, and (c) a temperature > or = 38 degrees C. A total of 306 children and adolescents (0-19 years) and 502 adults (> or = 20 years) were found. The age-specific incidence was highest in children aged 0-4 years, (14.7/100,000 per year). The total incidence was 3.2/100,000 per year. In the age group 0-19 years, blood cultures had been obtained from 195 (64%) and Hi was isolated from 154 (79%). In adults (> or = 20 years), 114 of 298 blood cultures yielded Hi, while pneumococci were isolated from 5 and group A streptococci from 3 patients. A total of 220 children (72%) and 114 adults (23%) needed an artificial airway. Five children and 12 adults died. In conclusion, the incidence of acute epiglottis in Sweden is very high. Compared to a previous country-wide study covering the years 1981-83 that used the same methods for case finding and case definition, the incidence in children had decreased while the incidence in adults had increased.

A prospective cohort study on breast-feeding and otitis media in Swedish infants.

This study analyzed the effect of breast-feeding on the frequency of acute otitis media. The protocol was designed to examine each child at 2, 6 and 10 months of age. At each visit nasopharyngeal cultures were obtained, the feeding pattern was recorded and the acute otitis media (AOM) episodes were documented. The analysis was based on 400 children from whom complete information was obtained. They represented 83% of the newborns in the study areas. By 1 year of age 85 (21%) children had experienced 111 AOM episodes; 63 (16%) had 1 and 22 (6%) had 2 or more episodes. The AOM frequency was significantly lower in the breast-fed than in the non-breast-fed children in each age group (P < 0.05). The first AOM episode occurred significantly earlier in children who were weaned before 6 months of age than in the remaining groups. The frequency of nasopharyngeal cultures positive for Haemophilus influenzae, Moraxella catarrhalis and Streptococcus pneumoniae was significantly higher in children with AOM. At 4 to 7 and 8 to 12 months of age, the AOM frequency was significantly higher in children with day-care contact and siblings (P < 0.05 and < 0.01, respectively). The frequency of upper respiratory tract infections was increased in children with AOM but significantly reduced in the breast-fed group.

Nasopharyngeal bacterial flora in otitis prone children treated with immunoglobulin.

The present study was undertaken to evaluate possible beneficial effects of regularly given, long term immunoglobulin prophylaxis of children below 2 years of age with recurrent acute otitis media (RAOM). The nasopharyngeal bacterial flora and the frequency of acute otitis media (AOM) and secretory otitis media SOM were studied. Every second of 44 children with 3 or more periods of AOM during the last year received immunoglobulin intramuscularly (Gammaglobulin Kabi 165 mg/l, 0.45 ml/kg b.w.) every third week for 6 months, while the other 22 children served as controls. All children were followed for 12 months. Immunoglobulin prophylaxis neither influenced the nasopharyngeal flora, nor the frequency of AOM or SOM periods. Children with AOM or SOM more often harbored bacterial pathogens in their nasopharynx than children with normal middle ear status. Also, the immunoglobulin prophylaxis did not influence the increased frequency of bacterial pathogens in the nasopharynx of children attending public day care or family day care as compared to those taken care of at home.

Teratoma in the pterygopalatine fossa extending into the orbit: a case report.

An unusual case of intraorbital teratoma is presented. It was observed for the first time after 4 months when it caused increasing swelling of the maxillary region and proptosis of the eye. The diagnosis was difficult to establish. Repeated computed tomography scans were very helpful in evaluating the progress of the tumor. Surgical intervention with an infratemporal approach was undertaken and proved to be very successful.

Gamma-globulin treatment of recurrent acute otitis media in children.

This study examined the hypothesis that children prone to acute otitis media have a reduced concentration of circulating antibodies of the IgG2 subclass and that this defect can be compensated for by gamma-globulin treatment. Infants and children below 18 months of age with at least three episodes of acute otitis media were randomized to intramuscular gamma-globulin or no treatment and were followed for 6 months. We could demonstrate neither reduced IgG2 nor specific anti-polysaccharide antibody activity in the otitis-prone children. In contrast they had higher concentrations of IgG2 and antibodies to phosphorylcholine than did age-matched controls. There was neither a relationship between the IgG2 concentration and the number of otitis episodes prior to enrollment nor a reduction in otitis frequency in the gamma-globulin-treated group.

Acute epiglottitis in children and adults in Sweden 1981-3.

In a retrospective study of the incidence of acute epiglottitis in Sweden, 485 children and 356 adults fulfilled the following criteria: (a) red and swollen epiglottis visualised at laryngoscopy; (b) stridor or difficulties in swallowing own saliva or water; and (c) temperature greater than or equal to 38 degrees C. The age specific incidence in children (0-14 years) was 10 and in adults (greater than or equal to 15 years) 1.8/100,000/year. These incidence rates were higher than the incidence of Haemophilus influenzae meningitis in the same population. Blood cultures were obtained from 290 children (60%) and 185 adults (52%). H influenzae was isolated from 267 blood cultures (92%) from children and 98 blood cultures from adults (53%). Other organisms were isolated from six adults (3%). An artificial airway was established in 352 children (73%) and in 68 adults (19%); the remainder were treated conservatively. Six children and two adults died. Sweden has a high incidence of acute epiglottitis in children and the disease also occurs in adults. The importance of H influenzae in the aetiology of epiglottitis in all age groups is confirmed, but in adults many cases occur without septicaemia. The mortality is currently very low.

Acute otitis media and facial palsy in children.

Two cases of facial palsy in connection with acute otitis media are presented. The patients were 2 months and 2 years old, respectively. In both cases the facial palsy disappeared after treatment with myringotomy and antibiotics. The etiological mechanisms behind and the different approaches to the treatment of facial palsy in children with acute otitis media are discussed.

Follow-up study of recurrent parotitis in children.

Recurrent parotitis in children is a well-described but rare condition of unknown cause. In this follow-up investigation the long-term course of the disease was studied both clinically and radiographically. In 23 of 25 patients investigated, the clinical symptoms disappeared before the patients were 22 years of age, independent of a given therapy. However, sialographic changes, mostly in the form of sialectasis, were seen on follow-up in the majority of cases, in spite of the fact that the patients were clinically symptom free.

Delayed healing of fractures of the mandibular body.

401 mandibular body fractures occurring during a 5-year period were analysed retrospectively. Out of these, 38 fractures (9.5%) were not consolidated by 50 days and made up the delayed healing group (DHG). A control group (CG) of another 38 fractures was constituted using the first mandibular body fracture consecutively following one in the DHG. The mean time until consolidation of the fractures was 116 days in the DHG and 35 days in the CG. The 2 groups were statistically analysed and mutually compared using a great number of variables including patient-, fracture site-, treatment- and end-result characteristics. It was concluded that a few days delay between trauma and treatment did not necessarily lead to a delayed healing. Uncooperative alcoholics with psycho-social handicaps, and general as well as local periodontitis, were found to be especially liable to consolidate their fractures at a slower rate than the average patient. The DHG more often required changes of unstable dental fixation, prolonged maxillo-mandibular fixation time and treatment for late infections at the fracture site. The patients in this group lost more teeth than those in the CG but above all required considerably extended therapeutic efforts. It is suggested that patients with the above-mentioned characteristics should be given special attention and care.