EGFR expression in primary squamous cell carcinoma of the thyroid.

We present the case of a 57-year-old male with primary squamous cell carcinoma of the thyroid (PSCCT). Epidermal growth factor receptor (EGFR) staining was strongly positive. Pharmaceuticals targeting EGFR may provide an additional therapeutic option for this rare disease with extremely poor prognosis.

Immunohistochemical analysis and Epstein-Barr virus in the tonsils of transplant recipients and healthy controls.

OBJECTIVE: To compare lymphocyte immunohistochemical markers and staining for Epstein-Barr virus (EBV) in tonsillectomy specimens from healthy children and pediatric transplant recipients. DESIGN: Analysis of pathology specimens. SETTING: Tertiary care medical center. PATIENTS: Consecutive sample of tonsillectomy specimens from 60 pediatric solid organ transplant recipients and 60 healthy children. INTERVENTION: Immunohistochemical staining of tonsillectomy specimens for kappa and lambda light chains, B and T lymphocytes, EBV-encoded small nuclear RNA (EBV-EBER), and EBV-encoded latent membrane protein (EBV-LMP). MAIN OUTCOME MEASURE: Detection of a difference in EBV activity in transplant recipients vs healthy controls. RESULTS: There was 1 case of posttransplantation lymphoproliferative disorder (PTLD). All other tonsillectomy specimens from both groups demonstrated follicular hyperplasia. Tonsillectomy specimens from both groups were polyclonal, expressing kappa and lambda light-chain activity, including the case of PTLD. The number of specimens staining positive for CD3 activity, a marker of T lymphocytes, was reduced in the transplant group (85%), compared with 100% in the control group (P < .01). EBV-EBER is a nuclear stain indicating active EBV infection, whereas EBV-LMP staining denotes latent infection. Twenty-seven of 60 transplant specimens (45%) demonstrated EBV-EBER activity compared with 0 of 60 control specimens (P < .001). EBV-LMP activity was equal in both groups. CONCLUSIONS: Adenotonsillar hypertrophy in transplant recipients with no prior exposure to EBV may be a sign of active EBV infection. A high incidence of EBV-EBER was found in the tonsils of transplant recipients. Active adenotonsillar EBV infection in the setting of T-lymphocyte suppression in transplant recipients may be a potential early precursor of PTLD.

The safety of outpatient UPPP for obstructive sleep apnea: a retrospective review of 40 cases.

We retrospectively reviewed the outcomes of 40 patients who had undergone outpatient uvulopalatopharyngoplasty (UPPP) for the treatment of moderate to severe obstructive sleep apnea (OSA) in order to determine the safety of the procedure in an outpatient setting. Postoperatively, 36 of the 40 patients (90%) were discharged home the day of surgery without morbidity; 3 other patients stayed overnight for nonmedical reasons, and 1 patient who was already an inpatient remained hospitalized for unrelated medical issues. No postoperative complications occurred, and all patients reported a resolution of OSA symptoms and improvement in sleep. Based on a combination of our data and those of previous studies, we conclude that patients with significant OSA can safely undergo UPPP as an outpatient procedure. We recommend that guidelines regarding the perioperative care of patients with OSA be adjusted to include consideration of treatment in an outpatient setting.

Parental understanding and attitudes of pediatric obstructive sleep apnea and adenotonsillectomy.

OBJECTIVE: To explore parental perceptions and knowledge of pediatric obstructive sleep apnea (OSA) and adenotonsillectomy. DESIGN: Cross-sectional study. SETTING: National polling organization. PARTICIPANTS: Population-based sample of 584 parents. INTERVENTION: Online surveys. MAIN OUTCOME MEASURES: Responses to questions regarding knowledge of pediatric OSA and treatment with adenotonsillectomy. RESULTS: Ninety-five percent of parents acknowledged that pediatric OSA is a "serious condition". Fifteen percent considered themselves to be "knowledgeable" about it. One fifth understood that untreated OSA could lead to cardiopulmonary disease, failure to thrive, or behavioral problems, such as attention deficit hyperactivity disorder. Less than 20% knew that pediatric OSA could be treated with adenotonsillectomy. Thirty-seven percent believed adenotonsillectomy to be an "outdated" procedure. Upon learning that adenotonsillectomy can treat OSA, 82% reported they would be eager to have a child with OSA undergo adenotonsillectomy. CONCLUSIONS: The majority of parents do not understand symptoms, consequences and treatment of pediatric OSA secondary to adenotonsillar hypertrophy. Otolaryngologists should be diligent in communicating issues of this disorder with parents and pediatricians.

Airway evaluation of conjoined twins.

Case reports in the literature on conjoined twins discuss the difficulties with anesthesia and surgical separation; however, the role of airway endoscopy as a means of evaluating the respiratory tract has not been described. This case of thoraco-omphaloischiopagus laterally conjoined twins demonstrates the importance of videoendoscopic airway evaluation in the management of conjoined twins. Direct laryngoscopy and bronchoscopy was used to evaluate ventilator dependence and demonstrated tracheal anomalies that were partially responsible for difficulties with weaning and endotracheal tube placement. Knowledge of the airway anomalies assisted in ventilator management of the twins, and the neonatalogists were able to proceed with greater confidence because no surgically correctable airway obstruction was found. Direct laryngoscopy and bronchoscopy offer valuable information about thoracopagus conjoined twins and should be included in the preoperative evaluation of planned separation of conjoined twins, as well as being used for conjoined twins who are ventilator-dependent.

The validity of the OSA-18 among three groups of pediatric patients.

OBJECTIVE: To compare the signs and symptoms of obstructive sleep apnea syndrome in three groups of pediatric patients; solid organ transplant recipients, healthy children, and children with leukemia; in order to examine the effects of chronic illness on the obstructive sleep apnea-18-item questionnaire and to investigate its validity as a screening tool for obstructive sleep apnea in the pediatric solid organ transplant population. METHODS: In this cross-sectional study, there were two hundred and six subjects; 46 kidney transplant recipients, 59 liver transplant recipients, 34 patients with leukemia, and 67 healthy children. Adenotonsillar enlargement was assessed by using the obstructive sleep apnea-18-item questionnaire and by performing a focused physical examination of the oral and nasal cavity at the time of the child's routine visit in either the transplant clinic, outpatient oncology center, or general pediatric clinic. RESULTS: Comparison of questionnaire scores amongst the three groups showed significant differences between the healthy children and liver transplant recipients as well as those with leukemia. There was a significant difference in the physical examination scores of the children with leukemia as compared to the other groups. CONCLUSIONS: Adenotonsillar enlargement in pediatric transplant recipients can be an early indication of post-transplantation lymphoproliferative disorder. However, the prevalence of adenotonsillar enlargement in the transplant population does not appear to differ from that of the healthy population. Additionally, scores on the OSA-18 in the transplant population were confounded by chronic illness. Further prospective studies need to be performed to develop a screening tool to identify transplant recipients at risk for post-transplantation adenotonsillar lymphoma.

Risk factors for adenotonsillar hypertrophy in children following solid organ transplantation.

OBJECTIVE: Post-transplantation lymphoproliferative disorder (PTLD), or its precursor, Epstein-Barr virus (EBV)-related lymphoid hyperplasia, may first present in the tonsils and adenoids in the pediatric solid organ transplant population. We sought to identify signs and symptoms of and risk factors for adenotonsillar hypertrophy (ATH), a potential precursor to PTLD in children following solid organ transplantation. METHODS: We performed a cross-sectional study of 132 consecutive pediatric solid organ transplant patients at our institution. Questionnaire, physical examination, and laboratory data collection were obtained. Correlation of signs and symptoms of ATH with objective laboratory data was conducted. RESULTS: 132 pediatric transplant recipients (64 renal, 68 liver) were enrolled. Mean age at transplantation was 7.4 (S.D. 6.0) years with a mean follow-up of 49.0 (S.D. 48.4) months post-transplantation. The mean questionnaire score was 8.4 (S.D. 7.9) out of a maximum 65 and the mean physical examination score was 3.9 (S.D. 1.9) out of a maximum 8, with a statistically significant correlation between the two (Pearson's r=0.352, P<0.001). A multivariate linear regression model found recipient EBV seronegativity and younger age at transplantation to be statistically significant risk factors for development of ATH (P=0.024 and 0.035, respectively). CONCLUSIONS: Young age and EBV seronegativity confer increased risk for ATH in pediatric patients undergoing solid organ transplantation. As ATH may be the earliest sign of PTLD, long-term surveillance is required to determine the impact of ATH on quality of life and survival in these patients.

Adenotonsillar enlargement in pediatric organ transplant recipients: a cross-sectional analysis.

OBJECTIVE: Our goal was to statistically correlate adenotonsillar hypertrophy (ATH) in the pediatric posttransplant population with potential risk factors and to monitor the progression of ATH over time. STUDY DESIGN AND SETTING: Participants were evaluated for ATH through a standardized 65-point questionnaire and an 8-point physical examination. They were also evaluated for current age, age at time of transplantation, type of organ transplant, gender, tacrolimus use, history of transplant rejection, Epstein-Barr virus (EBV) serology, and cytomegalovirus (CMV) serology. We evaluated 243 pediatric solid organ transplant recipients, with 116 patients undergoing repeat evaluation. RESULTS: A statistically significant negative correlation was noted between age at time of transplantation and both questionnaire scores (P = 0.0075) and examination scores (P = 0.013). A significant negative correlation was also seen between age at time of evaluation and questionnaire score (P = 0.028) but not examination score (P = 0.49). Recipient EBV seronegativity significantly increased questionnaire score (P = 0.05). Liver transplant recipients also had a significantly higher questionnaire score than did kidney transplant recipients (P = 0.0048). Gender, CMV recipient status, and tacrolimus (immunosuppressant) use did not significantly impact questionnaire or examination scores. Repeat evaluation of 116 patients after a 2- to 9-month interval did not demonstrate any significant increases in questionnaire scores. A statistically significant drop in examination scores was noted (P = 0.003). CONCLUSIONS AND SIGNIFICANCE: These findings support previous reports in the literature that correlate EBV seronegativity, younger age at transplant, and liver versus kidney transplantation with increased incidence of PTLD.