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Recurrent Respiratory Papillomatosis (recurrent + respiratory_papillomatosi)
Selected AbstractsRecurrent respiratory papillomatosis in a survivor of extreme prematurityPEDIATRIC PULMONOLOGY, Issue 4 2004S.L. Lee MRCPCH Abstract Recurrent respiratory papillomatosis (RRP) is a rare disease in children. Previous reports suggested that prematurity and early age of presentation were poor prognostic factors. We report on a 24-week premature infant who presented with stridor, weak cry, and hoarseness of voice at age 9 months (corrected age), in whom the diagnosis of RRP was not made until age 21 months (corrected age). Laser excision of RRP was subsequently performed, and the child is still surviving at age 2.5 years. RRP should be considered in the differential diagnosis of airway problems in survivors of extreme prematurity; the prognosis is not uniformly poor in premature infants. Pediatr Pulmonol. 2004; 38:352,354. © 2004 Wiley-Liss, Inc. [source] Recurrent respiratory papillomatosis with pulmonary involvement: A case report and review of the literatureRESPIROLOGY, Issue 1 2009Sheng-Yuan RUAN ABSTRACT Recurrent respiratory papillomatosis (RRP) is a viral infection that usually affects the upper airways. Although it can spread throughout the respiratory tract, involvement of the lung parenchyma is quite rare. Radiographic images of RRP with lung involvement have been mainly presented in case reports of paediatric patients. We present the case of an adult patient with RRP and lung involvement, and detail the serial radiographic manifestations. CT and reconstructed images were obtained. The literature was also reviewed and radiographic features of RRP with lung involvement are summarized. [source] Squamous cell carcinoma associated with intralesional injection of cidofovir for recurrent respiratory papillomatosisTHE LARYNGOSCOPE, Issue 3 2009David G. Lott MD Abstract Recurrent respiratory papillomatosis is a common neoplasm of the larynx that may lead to severe, recurrent lesions. Intralesional injection of cidofovir has shown promise as an adjuvant therapy. There is concern for possible malignant transformation with its use but, to our knowledge, this has not been documented in the literature. We report a case of invasive squamous cell cancer arising from squamous papilloma in a patient treated with multiple injections of cidofovir. Although causation is not shown, we believe the association presented is a valuable addition to the literature and an important consideration in the use of cidofovir. Laryngoscope, 119:567,570, 2009 [source] Protein Expression of the Tumor Suppressors p16INK4A and p53 and Disease Progression in Recurrent Respiratory PapillomatosisTHE LARYNGOSCOPE, Issue 2 2007Truc T. Pham MD Abstract Background: Recurrent respiratory papillomatosis (RRP) is a benign condition that rarely metastasizes as invasive squamous cell carcinoma. Although this disease is associated with human papillomavirus, the role of this virus in tumorigenesis is unclear. Objectives: The aim of this study is to assess the involvement of the tumor suppressors P16INK4A and p53 in RRP tumor progression. Design: Immunohistochemistry of p16INK4A and p53 was performed on biopsies of recurrent squamous papillomas and invasive lesions in nine patients. Results: Twenty biopsies were graded as papillomas (RP), three as papillomas with high-grade dysplasia/carcinoma in situ (HGD/CIS), and two as invasive squamous cell carcinoma (SCCA). Forty-five percent of RP and 60% of HGD/CIS/SCCA expressed p16INK4A. Fifty percent of RP and 100% of HGD/CIS/SCCA expressed p53. The difference in the frequency of p53-positive staining between HGD/CIS and SCCA (100% of tissues examined) and RP (50% of tissues examined) approached statistical significance. Neither p16INK4A nor p53 was predictive of invasive transformation. Conclusions: Expression of p16INK4A, which is a surrogate for the tumor suppressor retinoblastoma (Rb), did not immediately lead to invasive disease. There is no correlation between disease severity of RRP and level of p16INK4A. [source] Epidemiology of recurrent respiratory papillomatosisAPMIS, Issue 6-7 2010DANIEL A. LARSON Larson DA, Derkay CS. Epidemiology of recurrent respiratory papillomatosis. APMIS 2010; 118: 450,454. Recurrent respiratory papillomatosis (RRP) was first described in the 1800s, but it was not until the 1980s when it was convincingly attributed to human papilloma virus (HPV). RRP is categorized into juvenile onset and adult onset depending on presentation before or after the age of 12 years, respectively. The prevalence of this disease is likely variable depending on the age of presentation, country and socioeconomic status of the population being studied, but is generally accepted to be between 1 and 4 per 100 000. Despite the low prevalence, the economic burden of RRP is high given the multiple procedures required by patients. Multiple studies have shown that the most likely route of transmission of HPV in RRP is from mother to child during labor. Exceptions to this may include patients with congenital RRP who have been exposed in utero and adult patients who may have been exposed during sexual contact. Although cesarean section may prevent the exposure of children to the HPV virus during childbirth, its effectiveness in preventing RRP is debatable and the procedure itself carries an increased risk of complications. The quadrivalent HPV vaccine holds the most promise for the prevention of RRP by eliminating the maternal reservoir for HPV. [source] Recurrent respiratory papillomatosis: a complex defect in immune responsiveness to human papillomavirus-6 and -11APMIS, Issue 6-7 2010VINCENT R. BONAGURA Bonagura VR, Hatam LJ, Rosenthal DW, DeVoti JA, Lam F, Steinberg BM, Abramson AL. Recurrent respiratory papillomatosis: a complex defect in immune responsiveness to human papillomavirus-6 and -11. APMIS 2010; 118: 455,470. Recurrent respiratory papillomatosis (RRP) is a rare disease of the larynx caused by infection with human papillomaviruses (HPV) -6 or -11, associated with significant morbidity and on occasion mortality. Here we summarize our current understanding of the permissive adaptive and innate responses made by patients with RRP that support chronic HPV infection and prevent immune clearance of these viruses. Furthermore, we provide new evidence of TH2-like polarization in papillomas and blood of patients with RRP, restricted CD4 and CD8 V, repertoires, the effect of HPV-11 early protein E6 on T-cell alloreactivity, enriched Langerhans cell presence in papillomas, and evidence that natural killer cells are dysfunctional in RRP. We review the immunogenetic mechanisms that regulate the dysfunctional responses made by patients with RRP in response to HPV infection of the upper airway. In addition, we are identifying T-cell epitopes on HPV-11 early proteins, in the context of human leukocyte antigen (HLA) class II alleles enriched in RRP that should help generate a therapeutic vaccine. Taken together, RRP is a complex, multigene disease manifesting as a tissue and HPV-specific, immune deficiency that prevents effective clearance and/or control of HPV-6 and -11 infection. [source] Investigation into the effects of cidofovir on an in vitro model of recurrent respiratory papillomatosisCLINICAL OTOLARYNGOLOGY, Issue 3 2006A.J. Donne Problem. Recurrent respiratory papillomatosis (RRP) has no cure, and cidofovir is currently the most contemporary adjuvant treatment. Cidofovir has reported activity against Human Papilloma Virus type 16, but no laboratory studies have yet been performed on HPV type 6 which is the main cause of RRP. This work describes the generation of a novel HPV 6 related cell line and its use to evaluate the effects of Cidofovir. Method. HPV6b E6 cDNA was stably introduced into HPV negative C33A cervical carcinoma cells to produce the C33AT6E6 cell line. Two different doses of Cidofovir were applied to parent C33A, C33AT6E6 and C33AT16E6 (type 16 cell line) with appropriate controls. Growth and FACS cell cycle analysis were performed after 3 and 6 days of continuous exposure followed by 2 and 3 days post-drug withdrawal. Result.PCR analysis confirmed HPV6 E6 expression in C33AT6E6 cells. High dose cidofovir was toxic at 3 and 6 days exposure in all cells tested. Low dose exposure was toxic for C33AT16E6 cells at 3 days whereas C33A and C33AT6E6 only showed minimal toxicity at 6 days. C33A and C33AT6E6 cells also showed earlier recovery following drug withdrawal. Conclusion.Cidofovir showed varying degrees of non-specific toxicity against all three cell lines tested. However, HPV16 E6 expressing cells were more sensitive than either parent or HPV6 E6 expressing cells indicating that cidofovir has no selective advantage for the RRP related HPV6 E6 expressing cell line. [source] Do human papillomavirus vaccines have any role in newborns and the prevention of recurrent respiratory papillomatosis in children?JOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 9 2007Andrea Schaffer No abstract is available for this article. [source] Yet another ten stories on antiviral drug discovery (part D): Paradigms, paradoxes, and paraductionsMEDICINAL RESEARCH REVIEWS, Issue 4 2010Erik De Clercq Abstract This review article presents the fourth part (part D) in the series of stories on antiviral drug discovery. The stories told in part D focus on: (i) the cyclotriazadisulfonamide compounds; (ii) the {5-[(4-bromophenylmethyl]-2-phenyl-5H -imidazo[4,5- c]pyridine} compounds; (iii) (1H,3H -thiazolo[3,4- a]benzimidazole) derivatives; (iv) T-705 (6-fluoro-3-hydroxy-2-pyrazinecarboxamide) and (v) its structurally closely related analogue pyrazine 2-carboxamide (pyrazinamide); (vi) new strategies for the treatment of hemorrhagic fever virus infections, including, as the most imminent, (vii) dengue fever, (viii) the veterinary use of acyclic nucleoside phosphonates; (ix) the potential (off-label) use of cidofovir in the treatment of papillomatosis, particularly RRP (recurrent respiratory papillomatosis); and (x) finally, the prophylactic use of tenofovir to prevent HIV infections. © 2009 Wiley Periodicals, Inc. Med Res Rev, 30, No. 4, 667,707, 2010 [source] Solitary squamous cell papilloma of the lung in a 40-year-old woman with recurrent laryngeal papillomatosisPATHOLOGY INTERNATIONAL, Issue 5 2000Hidekazu Harada A rare case of recurrent respiratory papillomatosis (RRP) is reported with a review of the literature. A 40-year-old Japanese woman had suffered from RRP since 1 year of age. She developed a pulmonary squamous papilloma with a thin-walled cavity, which was suspected as being lung carcinoma. The trachea and bronchi around the tumor were intact, and no malignant transformation was present. Two types of human papillomavirus, 6 and 16, were detected, both in the laryngeal and pulmonary papillomas by in situ hybridization and the polymerase chain reaction method. To date, only 40 cases of juvenile laryngeal papilloma with pulmonary involvement have been reported in the English literature. [source] Squamous cell carcinoma associated with intralesional injection of cidofovir for recurrent respiratory papillomatosisTHE LARYNGOSCOPE, Issue 3 2009David G. Lott MD Abstract Recurrent respiratory papillomatosis is a common neoplasm of the larynx that may lead to severe, recurrent lesions. Intralesional injection of cidofovir has shown promise as an adjuvant therapy. There is concern for possible malignant transformation with its use but, to our knowledge, this has not been documented in the literature. We report a case of invasive squamous cell cancer arising from squamous papilloma in a patient treated with multiple injections of cidofovir. Although causation is not shown, we believe the association presented is a valuable addition to the literature and an important consideration in the use of cidofovir. Laryngoscope, 119:567,570, 2009 [source] Pediatric Laryngotracheal Obstruction: Current Perspectives on StridorTHE LARYNGOSCOPE, Issue 7 2006John Bent MD Abstract Objectives/Hypothesis: To assess how medical advances have impacted the diagnosis, management, and outcomes of pediatric laryngotracheal obstruction, and to describe the advantages of audio-video documentation of stridorous children. Study Design and Methods: Retrospective. Methods and Materials: 268 patients were referred for suspected laryngotracheal obstruction during the 30 months between September 1, 1995 and March 1, 1998: 173 had 206 flexible fiberoptic laryngoscopies, and 160 had 273 direct laryngoscopies. One hundred and forty-one children were identified with laryngotracheal obstruction, yielding 40 different diagnoses that could be classified into 9 major categories. Thirty-six children (25.5%) had multiple sites of upper airway obstruction. Results: 138 children had follow-up >1 month. Twelve children died (8.7%), leaving 126 survivors (mean follow-up = 21.1 months). Outcomes were classified as resolved (44.2%), improved (37.0%), stable (9.4%), failed (0.7%), or death (8.7%). Better outcomes were seen in more readily treated diagnostic categories, such as tracheobronchial foreign body, chronic laryngitis, and suprastomal granulation tissue; laryngeal stenosis, tracheomalacia, and recurrent respiratory papillomatosis, had less favorable outcomes (P <.001). The former group also showed superior outcome compared to laryngomalacia (P <.001) and vocal cord mobility disorders (P = .004). Ninety-four patients (68.1%) had comorbidities complicating their management. Comorbid conditions were universal among deceased patients and least common in the resolved outcomes category (56.7%), supporting the premise that patients with poor outcomes are more likely to have comorbidities than patients with resolution of laryngotracheal symptoms (P = .034). Conclusions: Audio-video recording of pediatric laryngotracheal obstruction offers numerous advantages. Children classified into an array of diagnostic categories usually have favorable outcomes, but opportunities for continued advances exist, particularly regarding management of comorbidity and chronic obstruction. [source] Recurrent Respiratory Papillomatosis: A Longitudinal Study Comparing Severity Associated With Human Papilloma Viral Types 6 and 11 and Other Risk Factors in a Large Pediatric Population,THE LARYNGOSCOPE, Issue S104 2004Brian J. Wiatrak MD Abstract Objectives/Hypothesis: A database was developed for prospective, longitudinal study of recurrent respiratory papillomatosis (RRP) in a large population of pediatric patients. Data recorded for each patient included epidemiological factors, human papilloma virus (HPV) type, clinical course, staged severity of disease at each surgical intervention, and frequency of surgical intervention. The study hypothesizes that patients with HPV type 11 (HPV-11) and patients younger than 3 years of age at diagnosis are at risk for more aggressive and extensive disease. Study Design: The 10-year prospective epidemiological study used disease staging for each patient with an original scoring system. Severity scores were updated at each surgical procedure. Methods: Parents of children with RRP referred to the authors' hospital completed a detailed epidemiological questionnaire at the initial visit or at the first return visit after the study began. At the first endoscopic debridement after study enrollment, tissue was obtained and submitted for HPV typing using polymerase chain reaction techniques and in situ hybridization. Staging of disease severity was performed in real time at each endoscopic procedure using an RRP scoring system developed by one of the authors (B.J.W.). The frequency of endoscopic operative debridement was recorded for each patient. Information in the database was analyzed to identify statistically significant relationships between extent of disease and/or HPV type, patient age at diagnosis, and selected epidemiological factors. Results: The study may represent the first longitudinal prospective analysis of a large pediatric RRP population. Fifty-eight of the 73 patients in the study underwent HPV typing. Patients infected with HPV-11 were significantly more likely to have higher severity scores, require more frequent surgical intervention, and require adjuvant therapy to control disease progression. In addition, patients with HPV-11 RRP were significantly more likely to develop tracheal disease, to require tracheotomy, and to develop pulmonary disease. Patients receiving a diagnosis of RRP before 3 years of age had significantly higher severity scores, higher frequencies of surgical intervention, and greater likelihood of requiring adjuvant medical therapy. Patients with Medicaid insurance had significantly higher severity scores and required more frequent surgical debridement. Birth by cesarean section appeared to be a significant risk factor for more severe disease and necessity of more frequent surgical intervention. Conclusion: Statistical analysis of the relationships among epidemiological factors, HPV type, and clinical course revealed that patients with HPV-11 and patients younger than 3 years of age at RRP diagnosis are prone to develop more aggressive disease as represented by higher severity scores at endoscopic debridement, more frequent operative debridement procedures per year, a greater requirement for adjuvant therapy, and greater likelihood of tracheal disease with tracheotomy. [source] Intralesional Cidofovir and Surgical Excision for Laryngeal PapillomatosisTHE LARYNGOSCOPE, Issue 12 2003Ana Nusa Naiman MD Abstract Objective To evaluate the efficacy of cidofovir intralesional therapy in recurrent respiratory papillomatosis and the role of surgical excision as an associated treatment. Study Design Prospective study and case series. Method Twenty-six patients received intralesional cidofovir. Three endoscopies were performed at monthly intervals, with intralesion injections of cidofovir at 5 mg/mL. Further endoscopic evaluation was made at 3 or 6 months depending on whether there was persistent papillomatosis. Cidofovir was again injected in the case of persistent papillomas, and treatment was repeated as long as papillomas were observed. Surgical excision of the papilloma was only performed in cases of airway obstruction or in cases proving resistant to cidofovir. Results Complete remission was obtained in 8 (31%) patients after an average of 2.6 endoscopic treatment. Seventeen (65%) patients presented slight or mild disease at endpoint (final severity score 1,4). Significant results were obtained in both adults and children. A greater response was obtained in the supraglottis and glottis subsites than in subglottis, tracheal, and other sites. Patients conforming to the 1 month interinjection schedule showed better responses in supraglottis subsite than those receiving their injections with intervals longer than 1 month. Combined therapy (cidofovir plus excision) was necessary in persistent papillomas. No patients presented with any systemic or local side effects. Conclusions Cidofovir therapy was an effective treatment in adults and in children, allowing papillomatosis to be controlled without observed side effects. Surgical excision associated with cidofovir injections remained necessary in persistent papillomatosis after cidofovir treatment. [source] Epidemiology of recurrent respiratory papillomatosisAPMIS, Issue 6-7 2010DANIEL A. LARSON Larson DA, Derkay CS. Epidemiology of recurrent respiratory papillomatosis. APMIS 2010; 118: 450,454. Recurrent respiratory papillomatosis (RRP) was first described in the 1800s, but it was not until the 1980s when it was convincingly attributed to human papilloma virus (HPV). RRP is categorized into juvenile onset and adult onset depending on presentation before or after the age of 12 years, respectively. The prevalence of this disease is likely variable depending on the age of presentation, country and socioeconomic status of the population being studied, but is generally accepted to be between 1 and 4 per 100 000. Despite the low prevalence, the economic burden of RRP is high given the multiple procedures required by patients. Multiple studies have shown that the most likely route of transmission of HPV in RRP is from mother to child during labor. Exceptions to this may include patients with congenital RRP who have been exposed in utero and adult patients who may have been exposed during sexual contact. Although cesarean section may prevent the exposure of children to the HPV virus during childbirth, its effectiveness in preventing RRP is debatable and the procedure itself carries an increased risk of complications. The quadrivalent HPV vaccine holds the most promise for the prevention of RRP by eliminating the maternal reservoir for HPV. [source] Current concepts on human papillomavirus infections in childrenAPMIS, Issue 6-7 2010STINA SYRJÄNEN Syrjänen S. Current concepts on human papillomavirus infections in children. APMIS 2010; 118: 494,509. Current evidence is strong enough to conclude that human papillomavirus (HPV) can be transmitted both sexually and non-sexually. The debate on HPV infections in children still continues but it is more focused on HPV prevalence than on transmission modes. HPV DNA detection in amniotic fluid, foetal membranes, cord blood and placental trophoblastic cells all suggest HPV infection in utero, i.e. prenatal transmission. Based on recent meta-analysis, vertical transmission occurs in approximately 20% of cases. Most of the mucosal HPV infections in infants are incident, persistent infections in oral and genital mucosa being found in less than 10% and 2% respectively. The mother seems to be the main transmitter of HPV to her newborn, but subsequent HPV infections are acquired horizontally via saliva or other contacts. Bimodal peak prevalence is seen for skin warts, oral papillomas and recurrent respiratory papillomatosis (RRP) in younger and older age groups, suggesting similar epidemiology. Of the clinical HPV diseases, juvenile-onset-RRP and genital condylomata are problematic; the former because of its life-threatening potential and the latter because of possible sexual abuse. HPV6 and 11 are the most common genotypes in both the lesions. Early in life, infections by the high-risk HPV genotypes may also remain persistent for a considerable period, and should be of considerable importance for HPV vaccination strategies. [source] Should intralesional cidofovir be used for recurrent respiratory papillomatosis?CLINICAL OTOLARYNGOLOGY, Issue 1 2010A. Donne No abstract is available for this article. [source] Investigation into the effects of cidofovir on an in vitro model of recurrent respiratory papillomatosisCLINICAL OTOLARYNGOLOGY, Issue 3 2006A.J. Donne Problem. Recurrent respiratory papillomatosis (RRP) has no cure, and cidofovir is currently the most contemporary adjuvant treatment. Cidofovir has reported activity against Human Papilloma Virus type 16, but no laboratory studies have yet been performed on HPV type 6 which is the main cause of RRP. This work describes the generation of a novel HPV 6 related cell line and its use to evaluate the effects of Cidofovir. Method. HPV6b E6 cDNA was stably introduced into HPV negative C33A cervical carcinoma cells to produce the C33AT6E6 cell line. Two different doses of Cidofovir were applied to parent C33A, C33AT6E6 and C33AT16E6 (type 16 cell line) with appropriate controls. Growth and FACS cell cycle analysis were performed after 3 and 6 days of continuous exposure followed by 2 and 3 days post-drug withdrawal. Result.PCR analysis confirmed HPV6 E6 expression in C33AT6E6 cells. High dose cidofovir was toxic at 3 and 6 days exposure in all cells tested. Low dose exposure was toxic for C33AT16E6 cells at 3 days whereas C33A and C33AT6E6 only showed minimal toxicity at 6 days. C33A and C33AT6E6 cells also showed earlier recovery following drug withdrawal. Conclusion.Cidofovir showed varying degrees of non-specific toxicity against all three cell lines tested. However, HPV16 E6 expressing cells were more sensitive than either parent or HPV6 E6 expressing cells indicating that cidofovir has no selective advantage for the RRP related HPV6 E6 expressing cell line. [source] Quality of life issues in recurrent respiratory papillomatosisCLINICAL OTOLARYNGOLOGY, Issue 2 2000D.S. Hill Twenty-six adult patients attending the Royal National Throat, Nose, and Ear Hospital with Recurrent Respiratory Papillomatosis completed two postal questionnaires. One was the generic Short Form-36 (SF-36) quality of life instrument. Severely affected patients had lower scores in all dimensions of this instrument, with large differences from normal controls in dimensions of pain, physical limitation, and energy/vitality. The second questionnaire was newly devised, and designed to ask about a wide variety of larynx-specific symptoms. Answers by patients were compared with those of normal controls, and symptoms selected as significantly more likely to be reported by patients were studied further. Correlation was seen with clinical parameters, and questions likely to be responsive to clinical change in disease burden were identified. [source] | ||||||||||||||||||||||