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Tonsillectomy
Kinds of Tonsillectomy Selected AbstractsQUALITY-OF-LIFE EFFECT OF TONSILLECTOMY IN A YOUNG ADULT GROUPANZ JOURNAL OF SURGERY, Issue 11 2007Amanda L. Richards Background: To examine the quality of life after tonsillectomy in a young adult group with chronic or recurrent tonsillitis. Methods: Retrospective survey of patients aged 15,25 years who underwent tonsillectomy for chronic or recurrent tonsillitis in 2002 or 2003. The Glasgow Benefit Inventory was mailed to patients who were selected from two private general otolaryngology practices. Results: Participants had an overall benefit from the procedure as well as improvement in their general well-being and physical health. A benefit in social function was not imparted. Conclusion: Tonsillectomy in a young adult group results in significant improvement in overall quality of life, physical health and general well-being. [source] Arterial dissection complicating tonsillectomyDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 9 2003E Wraige MRCPCH Tonsillectomy is a frequently performed surgical procedure. Surgical complications can be serious. We report the case of a 7,year-old female who experienced an arterial ischaemic cerebral infarction following elective adenotonsillectomy. [source] Children's Expectations of Pain, Perceptions of Analgesic Efficacy, and Experiences With Nonpharmacologic Pain Management Strategies at Home Following TonsillectomyJOURNAL FOR SPECIALISTS IN PEDIATRIC NURSING, Issue 3 2007Kimberly A. Sutters PURPOSE.,To document children's (ages 6,15 years) descriptions of their pain management at home following tonsillectomy. DESIGN AND METHODS.,Audio-taped interviews of 80 children were transcribed and coded. Data for each response category were tabulated. RESULTS.,Children reported they had more pain after surgery than expected, the pain medicine helped to take their pain away, taking the pain medicine was associated with a negative response by some children, and cold liquids/food by mouth provided pain relief. PRACTICE IMPLICATIONS.,Findings provide insight into children's perspective of pain management at home following tonsillectomy and methods for relieving their pain. [source] Preoperative information needs of children undergoing tonsillectomyJOURNAL OF CLINICAL NURSING, Issue 19-20 2010Aoife Buckley Aims and objectives., To identify the information needs of children undergoing tonsillectomy with reference to content of information, method of delivery, information providers and timing of information provision. Background., Tonsillectomy can be anxiety provoking for children and preoperative preparation programmes are long recognised to reduce anxiety. However, few have been designed from the perspectives of children and to date little is known about how best to prepare children in terms of what to tell them, how to convey information to them, who can best provide information and what is the best timing for information provision. Design., A qualitative descriptive study. Method., Data were collected from nine children (aged 6,9) using interviews supported by a write and draw technique. Data were coded and categorised into themes reflecting content, method, providers and timing of information. Results., Children openly communicated their information needs especially on what to tell them to expect when facing a tonsillectomy. Their principal concerns were about operation procedures, experiencing ,soreness' and discomfort postoperatively and parental presence. Mothers were viewed as best situated to provide them with information. Children were uncertain about what method of information and timing would be most helpful to them. Conclusion., Preoperative educational interventions need to take account of children's information needs so that they are prepared for surgery in ways that are meaningful and relevant to them. Future research is needed in this area. Relevance to clinical practice., Practical steps towards informing children about having a tonsillectomy include asking them what they need to know and addressing their queries accordingly. Child-centred information leaflets using a question and answer format could also be helpful to children. [source] Sequential clot strength analyses following diclofenac in pediatric adenotonsillectomyPEDIATRIC ANESTHESIA, Issue 11 2007MAIREAD HEANEY FCARCSI FJFICM Summary Background:, Tonsillectomy is a common pediatric surgical procedure resulting in significant postoperative pain. There is ongoing controversy as to the most satisfactory analgesic regimen. Nonsteroidal antiinflammatory drugs (NSAIDs) are an alternative to opioids in this setting. NSAID use in tonsillectomy has been shown to be opioid sparing in the recovery period and to have similar analgesic effects to opioids in pediatric patients. Because of their nonspecific action on the enzyme cyclo-oxygenase there is potential for increased bleeding which has led many practitioners to avoid NSAIDs completely in this patient population potentially resulting in suboptimal pain control. Our aim in this study was to assess the effect of preoperatively administered diclofenac on the blood clot strength in children undergoing (adeno-) tonsillectomy. Methods:, Twenty patients undergoing (adeno-) tonsillectomy were recruited into this prospective observational study. All patients received 2 mg·kg,1 of diclofenac rectally immediately preoperatively. Blood was taken for thromboelastograph analysis pre-diclofenac and 1 and 4 h post-diclofenac administration. Results:, There was a statistically significant increase in maximal clot strength (MA) at 1 and 4 h after diclofenac. Similarly there was a statistically significant reduction in time to initial fibrin formation (R time) post-diclofenac. There was no primary or secondary hemorrhage. Conclusions:, Diclofenac when given preoperatively does not adversely affect clot strength in the immediate postoperative period when the risk of primary hemorrhage is greatest. [source] Effect of an intravenous single dose of ketamine on postoperative pain in tonsillectomy patientsPEDIATRIC ANESTHESIA, Issue 9 2006MARIO JOSE DA CONCEIÇÃO MSC MD TSA Summary Background:, Tonsillectomy has a high incidence of postoperative pain. The aim of the present study was to determine whether the use of low-dose IV ketamine, before the start of surgery or after the end of the operation, would lead to significantly improved pain control after tonsillectomy in pediatric patients. Methods:, Ninety children, 5,7 years old, scheduled for elective tonsillectomy were randomly assigned to one of three groups of 30 patients each; groups I, II and III. Patients in group I received no ketamine. Patients in group II received 0.5 mg·kg,1 of ketamine before the surgical start and for group III the same dose was given after the operation ended. Postoperative pain was scored by the Oucher scale. Systolic and diastolic pressures and heart rate were recorded perioperatively. Unwanted side effects were recorded by the ward staff personnel on a 24-h study-specific questionnaire. Statistical tests consisted of Student's t -test, chi-square and anova as appropriated. Results:, The number of patients complaining of pain was greater in group I compared with patients in groups II and III with a significative statistical difference (P < 0.05). The degree of postoperative pain was significantly higher in patients of group I compared with groups II and III (P < 0.05). Eight patients in group I needed rescue doses of morphine, three for group II and none for group III. In group I, three of eight patients required two doses of morphine during the first 249h postoperatively. No unwanted side effects were noted. Conclusions:, The use of a single small dose of ketamine in a pediatric population undergoing tonsillectomy could reduce the frequency or even avoid the use of rescue analgesia in the postoperative period independent of whether used before or after the surgical procedure. [source] Retained Suture Needle After TonsillectomyTHE LARYNGOSCOPE, Issue S3 2010Sherry Fishkin MD No abstract is available for this article. [source] Efficacy of Tonsillectomy in Treatment of Recurrent Group A ,-Hemolytic Streptococcal PharyngitisTHE LARYNGOSCOPE, Issue 11 2006Laura J. Orvidas MD Abstract Objective: The objective of this study was to determine whether children with tonsillectomies experienced fewer recurrent group A ,-hemolytic streptococcal (GABHS) infections after surgery compared with children who did not receive tonsillectomies. Study Design/Methods: The authors conducted a retrospective cohort study of 290 children 4 to <16 years who experienced three or more episodes of group A ,-hemolytic streptococcal pharyngitis at least 1 month apart in 12 months. Results: Children without tonsillectomy were 3.1 times (95% confidence interval, 1.9,4.9; P < .001) more likely to develop a subsequent group A ,-hemolytic streptococcal pharyngitis infection during follow up than children who underwent tonsillectomy after adjusting for the number of group A ,-hemolytic streptococcal pharyngitis infections per patient within the previous year and the presence of preexisting conditions. Among the children who developed a subsequent group A ,-hemolytic streptococcal pharyngitis infection, the children without a tonsillectomy developed a group A ,-hemolytic streptococcal pharyngeal infection sooner (median, 0.6 vs. 1.1 years). Conclusions: Tonsillectomy is associated with a decrease in the number of group A ,-hemolytic streptococcal pharyngitis infections in children with a history of recurrent groups A ,-hemolytic streptococcal pharyngitis infection. Tonsillectomy also increased the amount of time before development of further GABHS pharyngitis. [source] Coblation versus Unipolar Electrocautery Tonsillectomy: A Prospective, Randomized, Single-Blind Study in Adult Patients,THE LARYNGOSCOPE, Issue 8 2006J Pieter Noordzij MD Abstract Objectives: To determine if the coblation tonsillectomy (subcapsular dissection) results in less postoperative pain, equivalent intraoperative blood loss, equivalent postoperative hemorrhage rates, and faster healing compared with tonsillectomy was performed using unipolar electrocautery in adult patients. Study Design: The authors conducted a prospective clinical trial. Methods: Forty-eight patients underwent tonsillectomy and were randomly assigned to have one tonsil removed with coblation and the other with unipolar electrocautery. Outcome measures included time to remove each tonsil, intraoperative blood loss, patient-reported pain, postoperative hemorrhage, and amount of healing 2 weeks after surgery. Results: Mean time to remove a single tonsil with coblation and electrocautery was 8.22 minutes and 6.33 minutes, respectively (P = .011). Mean intraoperative blood loss for each technique was less than 10 mL. Postoperative pain was significantly less with coblation as compared with electrocautery: 18.6% less painful during the first week of recovery. Seventy percent of blinded patients identified the coblation side as less painful during the overall 14-day convalescent period. Postoperative hemorrhage rates (2.1% for coblation and 6.2% for electrocautery) were not significantly different. No difference in tonsillar fossa healing was observed between the two techniques 2 weeks after surgery. During nine of the 48 surgeries, wires on the tip of the coblation handpiece experienced thinning to the point of discontinuity while removing a single tonsil. Conclusions: Coblation subcapsular tonsillectomy was less painful than electrocautery tonsillectomy in this 48-patient group. On average, intraoperative blood loss was less than 10 mL for both techniques. Postoperative hemorrhage rates and the degree of tonsillar fossa healing were similar between the two techniques. The coblation handpiece experienced degradation of vital wires in 18% of cases necessitating the use of a second, new handpiece. [source] Ligasure versus Cold Knife TonsillectomyTHE LARYNGOSCOPE, Issue 9 2005Vassilios A. Lachanas MD Abstract Objective: To assess parameters related to ligasure tonsillectomy (LT) versus cold knife tonsillectomy (CKT) procedure. Study Design: Prospective randomized study. Methods: A prospective study was conducted on 200 consecutive adult patients undergoing tonsillectomy. Indications included chronic tonsillitis and obstructive sleep apnea syndrome. Patients undergoing adenoidectomy, or any procedure together with tonsillectomy, and patients with peritonsillar abscess history or bleeding disorders were excluded. Patients were randomly assigned to either the LT or CKT group. Intraoperative bleeding, operative time, postoperative pain using a visual analogue scale, and complication rates were evaluated. Results: The LT and CDT groups consisted of 108 and 92 individuals, respectively. In the LT group, there was no measurable intraoperative bleeding, whereas mean bleeding for CKT group was 125 mL. The mean operative time was 15 ± 1.43 minutes for the LT group and 21 ± 1.09 minutes for the CKT group (P < .001). The overall mean pain score for the LT group was 3.63, whereas for the CKT group it was 5.09 (P < .001). Primary hemorrhage occurred in one subject of the CKT group. Secondary postoperative hemorrhage was noticed two subjects of the LT group and two subjects of the CKT group. In 21 subjects of the LT group, limited peritonsillar edema was noticed. No other complication occurred in both groups. Conclusion: LT procedure provides sufficient hemostasis, lower postoperative pain, and reduced operative time, as well as safety against Creutzfeld Jakob disease transmission. [source] Laser-Assisted Uvulopalatoplasty and Tonsillectomy for the Management of Obstructive Sleep Apnea SyndromeTHE LARYNGOSCOPE, Issue 7 2003Robert C. Kern MD Abstract Objectives/Hypothesis Laser-assisted uvulopalatoplasty (LAUP) is a widely accepted procedure for the management of snoring, but its role in the treatment of obstructive sleep apnea syndrome is currently unclear. The objective of the study was to evaluate the role of LAUP in treating moderate and severe obstructive sleep apnea syndrome. Study Design Retrospective review of a surgical treatment protocol for obstructive sleep apnea syndrome. Methods Between October 1993 and January 1999, 80 patients with moderate or severe obstructive sleep apnea syndrome and a significant component of retropalatal obstruction were treated with surgery at the Department of Otolaryngology at Northwestern University Medical School (Chicago, IL). Surgery consisted of LAUP with tonsillectomy (if tonsils were present) with the patient under general anesthesia or LAUP alone with local anesthesia (if the tonsils were absent). No patients received traditional uvulopalatopharyngoplasty. Sixty-four of the 80 patients underwent both preoperative and postoperative polysomnograms. Surgical "response" was defined as a 50% decrease in the apnea-hypopnea index (AHI) (the total number of apneic and hypopneic events per hour of sleep); surgical "cure" was defined as a 50% decrease in AHI and a final AHI of less than 20. Results The surgical response rate was 59% (38 of 64 patients), and the surgical cure rate was 39% (25 of 64 patients). Twelve patients (18.8%) had a higher AHI after surgery. The AHI (mean ± SD) changed significantly from 51.4 ± 30.9 preoperatively to 26.3 ± 20.8 on postoperative polysomnogram (P = 7.0 × 10,9). Laser-assisted uvulopalatoplasty alone was performed in 33 patients with a response rate of 61% and a cure rate of 42%. Laser-assisted uvulopalatoplasty with tonsillectomy was performed in 31 patients with a response rate of 58% and a cure rate of 35%. The overall incidence of nasopharyngeal insufficiency was 0%. Conclusion The results of the study suggested that LAUP with adjunctive tonsillectomy is an effective treatment for patients with obstructive sleep apnea syndrome and retropalatal obstruction with a lower complication rate than standard surgical therapy (uvulopalatopharyngoplasty). [source] History and Current Practice of TonsillectomyTHE LARYNGOSCOPE, Issue S100 2002Ramzi T. Younis MD Abstract Objective To review important developments in the history of adenotonsillectomy and describe current methods and results for the operation. Study Design Review. Methods Tonsillectomy practices since antiquity were reviewed, with emphasis on introductions of new surgical tools and procedures, anesthesia methods, and patient care practices. Past and current indications for and complications associated with tonsillectomy were also reviewed. Results Devices used for adenotonsillectomy have included snares, forceps, guillotines, various kinds of scalpels, lasers, ultrasonic scalpels, powered microdebriders, and bipolar scissors. General anesthesia, the Crowe-Davis mouth gag, and methods for controlling bleeding have contributed greatly to success with the operation. Past and current indications for adenotonsillectomy are similar, although the relative importance of some indications has changed. The complication rate has declined, but the problems that do occur remain the same. Currently, cost-effectiveness is a principal concern. Conclusion The instruments and procedures used for adenotonsillectomy have evolved to render it a precise operation. Today, the procedure is a safe, effective method for treating breathing obstruction, throat infections, and recurrent childhood ear disease. [source] Prevention of Vomiting After Tonsillectomy in Children: Granisetron Versus RamosetronTHE LARYNGOSCOPE, Issue 2 2001Yoshitaka Fujii MD Abstract Objective/Hypothesis Granisetron, a selective 5-hydroxytryptamine type 3 receptor antagonist, is effective for the prevention of vomiting after tonsillectomy in children. Ramosetron (Nasea; Yamanouchi; Tokyo, Japan), another new antagonist of 5-hydroxytryptamione type 3 receptor, has more potent and longer-acting properties than granisetron (Kytril; Smith Kline Beecham, London, UK) against cisplatin-induced emesis. This study was undertaken to compare the efficacy and safety of granisetron and ramosetron for the prevention of vomiting after pediatric tonsillectomy. Study Design Prospective, randomized, double-blinded study. Methods Ninety pediatric patients, aged 4 to 10 years, received intravenously granisetron 40 ,g/kg or ramosetron 6 ,g/kg (n = 45 each) at the end of surgery. The same standard general anesthetic technique and postoperative analgesia were used throughout. Emetic episodes and safety assessment were performed during the first 24-hour period and the next 24-hour period after anesthesia. Results The rates of patients being emesis-free during the period from 0 to 24 hours after anesthesia were 89% with granisetron and 93% with ramosetron, respectively (P = .357); the corresponding rates during the period from 24 to 48 hours after anesthesia were 71% and 93%, respectively (P = .006). No clinically serious adverse events attributable to the study drugs were observed in any of the groups. Conclusion Ramosetron is a better antiemetic than granisetron for the long-term prevention of postoperative vomiting in children undergoing general anesthesia for tonsillectomy. [source] Acetaminophen Versus Acetaminophen With Codeine After Pediatric Tonsillectomy ,THE LARYNGOSCOPE, Issue 11 2000Melinda S. Moir MD Abstract Objective To compare the effectiveness of acetaminophen versus acetaminophen with codeine after pediatric tonsillectomy and adenoidectomy. Study Design Prospective, randomized, double-blind study. Methods Fifty-one children ages 3 to 12 years scheduled for outpatient tonsillectomy and adenoidectomy were studied. Patients were randomly assigned to receive acetaminophen or acetaminophen with codeine in unlabeled bottles for postoperative pain control. The Wong-Baker FACES pain rating scale was used to help children quantify their level of pain after surgery. The level of pain, quantity of pain medication required, presence of side effects, and the percentage of a normal diet consumed was recorded for 10 postoperative days. Results There was no difference (P > .05, all time points) in the level of postoperative pain reported by the parents and children in the two groups. The acetaminophen with codeine group tended to have increased problems with nausea, emesis, and constipation, but these differences did not reach statistical significance. Children in the acetaminophen group consumed a significantly higher percentage of a normal diet on the first 6 postoperative days (P < .05, all time points). Conclusion There was no difference in the level of pain control provided by acetaminophen and acetaminophen with codeine as measured by the Wong-Baker FACES pain rating scale. Postoperative oral intake was significantly higher in children treated with acetaminophen alone. [source] QUALITY-OF-LIFE EFFECT OF TONSILLECTOMY IN A YOUNG ADULT GROUPANZ JOURNAL OF SURGERY, Issue 11 2007Amanda L. Richards Background: To examine the quality of life after tonsillectomy in a young adult group with chronic or recurrent tonsillitis. Methods: Retrospective survey of patients aged 15,25 years who underwent tonsillectomy for chronic or recurrent tonsillitis in 2002 or 2003. The Glasgow Benefit Inventory was mailed to patients who were selected from two private general otolaryngology practices. Results: Participants had an overall benefit from the procedure as well as improvement in their general well-being and physical health. A benefit in social function was not imparted. Conclusion: Tonsillectomy in a young adult group results in significant improvement in overall quality of life, physical health and general well-being. [source] Interdigitating dendritic cell sarcoma of the tonsilASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY, Issue 3 2010Sun Young KIM Interdigitating dendritic cell sarcoma (IDCS) is an extremely rare malignancy derived from antigen-presenting cells, with 55 cases reported thus far. A standard treatment modality is still being debated. This report describes a 56-year-old female who presented with right tonsillar enlargement and right submandibular swelling for 6 months. Treatment with empiric antibiotics did not result in improvement of her symptoms. Fine needle aspiration of the tonsil revealed no malignant cells. Tonsillectomy was eventually performed due to persistent symptoms. Based on microscopic findings, immunohistochemical stains, and review of the literature, the present case was finally diagnosed as IDCS of the tonsil with cervical lymph node involvement. The patient received four cycles of CHOP (cyclophosphamide, doxorubicin, vincristine and prednisone) chemotherapy, and a clinically complete response was achieved followed by adjuvant radiation. [source] How we do it: Jain Tonsil ,A' Frame , a solution to slipping rodsCLINICAL OTOLARYNGOLOGY, Issue 3 2005K. Parmod Jain Keypoints ,,Tonsillectomy is the commonest ENT procedure performed in UK. ,,A Boyle-Davis mouth gag with tongue blade is used to keep the mouth open during the surgery. ,,Draffin bipod rods are commonly used to keep the gag in place. ,,These rods can slip during the procedure and can cause considerable harm especially when laser is in use. ,,The tonsil ,A' frame is a useful instrument to overcome the disadvantages of other suspension devices. [source] Safety of laryngeal mask airway and short-stay practice in office-based adenotonsillectomyACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 2 2009R. GRAVNINGSBRÅTEN Background: It is still disputed whether laryngeal mask airway (LMA) is safe and convenient for adenotonsillectomy, and whether these procedures can be safely undertaken in an office-based short-stay ambulatory setting. We report the result of this practice in 1126 consecutive children <16 years of age. Methods: The patients received general anaesthesia with propofol and remifentanil. For analgesic prophylaxis, they received paracetamol, fentanyl and local anaesthetic administration. NSAIDs were given to patients weighing above 15 kgs. A surgical technique with elevation, scissors and electrocoagulation was used. Post-operatively, the tonsillectomies were observed in the unit for at least 1.5 h and the adenoidectomies for at least 15,20 min. Results: Conversion from LMA to an endotracheal tube was carried out in six patients (0.5%), mostly due to airway leakage during ventilation. One patient had a pulmonary atelectasis and was re-intubated. No re-operation was needed in the clinic after surgery, and all patients, except for the one with atelectasis (0.1%), were discharged home as planned. In 122 patients answering a questionnaire, after discharge, two patients (1.6%) were admitted to hospital and re-operated due to bleeding; a further six patients (4.9%) were admitted for observation. In 25% of the patients, nausea and vomiting occurred after discharge, including 21% vomiting of swallowed blood during home travel. Only 5.6% reported significant post-discharge pain. Conclusion: With a well-trained team, adenotonsillectomy on children can be carried out safely in an office-based setting with LMA and a short post-operative stay. [source] Efficacy of Tonsillectomy in Treatment of Recurrent Group A ,-Hemolytic Streptococcal PharyngitisTHE LARYNGOSCOPE, Issue 11 2006Laura J. Orvidas MD Abstract Objective: The objective of this study was to determine whether children with tonsillectomies experienced fewer recurrent group A ,-hemolytic streptococcal (GABHS) infections after surgery compared with children who did not receive tonsillectomies. Study Design/Methods: The authors conducted a retrospective cohort study of 290 children 4 to <16 years who experienced three or more episodes of group A ,-hemolytic streptococcal pharyngitis at least 1 month apart in 12 months. Results: Children without tonsillectomy were 3.1 times (95% confidence interval, 1.9,4.9; P < .001) more likely to develop a subsequent group A ,-hemolytic streptococcal pharyngitis infection during follow up than children who underwent tonsillectomy after adjusting for the number of group A ,-hemolytic streptococcal pharyngitis infections per patient within the previous year and the presence of preexisting conditions. Among the children who developed a subsequent group A ,-hemolytic streptococcal pharyngitis infection, the children without a tonsillectomy developed a group A ,-hemolytic streptococcal pharyngeal infection sooner (median, 0.6 vs. 1.1 years). Conclusions: Tonsillectomy is associated with a decrease in the number of group A ,-hemolytic streptococcal pharyngitis infections in children with a history of recurrent groups A ,-hemolytic streptococcal pharyngitis infection. Tonsillectomy also increased the amount of time before development of further GABHS pharyngitis. [source] Readability and content of postoperative tonsillectomy instructions given to patients in ScotlandCLINICAL OTOLARYNGOLOGY, Issue 2 2004W.A. Clement Readability and content of postoperative tonsillectomy instructions given to patients in Scotland All NHS hospitals in Scotland where tonsillectomies were being performed routinely were contacted. Thirty-two wards were identified. A copy of each ward's postoperative tonsillectomy discharge information sheet was obtained, if available. Twenty-six information sheets were obtained. Of these, 13 were for adults, 11 for children and 2 for both adults and children. The information sheets were assessed for readability using two readability formulae. Content was also assessed. The average reading grade/age required to understand these information sheets was above those recommended by patient-education experts. Postoperative safety instructions were similar and overall of a good standard, but variations did arise in what information was included. None of the units had adopted the British Association of Otolaryngologists , Head and Neck Surgeons (BAO-HNS) tonsillectomy postoperative advice sheet. This advice sheet is evidence based and meets recommended readability criteria. [source] Arterial dissection complicating tonsillectomyDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 9 2003E Wraige MRCPCH Tonsillectomy is a frequently performed surgical procedure. Surgical complications can be serious. We report the case of a 7,year-old female who experienced an arterial ischaemic cerebral infarction following elective adenotonsillectomy. [source] Use of combined molecular biomarkers for prediction of clinical outcomes in locally advanced tonsillar cancers treated with chemoradiotherapy aloneHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 1 2009Yih-Lin Chung MD Abstract Background. Environmental exposures to tobacco, alcohol, human papillomavirus (HPV) and/or Epstein-Barr virus (EBV), all of which can perturb multiple cell cycle proteins or tumor suppressors, have been implicated in the pathogenesis of different subsets of head and neck cancers. The aim of this study was to investigate to which extent the virus infection by itself, and/or the altered cell cycle proteins, contributes to prognosis in locally advanced tonsillar squamous cell carcinomas (TSCCs) treated with concurrent chemoradiotherapy (CCRT) alone. Methods. Serial tumor tissue arrays from archival samples were tested for the presence of HPV genome integration or EBV episome by means of DNA sequencing, real-time polymerase chain reaction (PCR), and in situ hybridization. Alterations of cell cycle proteins (p53, pRb, and p21) were evaluated by immunohistochemical staining. The association of viral presence with altered cell cycle proteins was correlated to clinical outcomes. Results. Of the 46 patients with the same T2N2bM0 stage IVA among consecutive patients with TSCC, 23 (50%) had integrated HPV DNA and only 1 (2%) had EBV episome. The HPV types detected were almost all HPV-16. A reduced expression pattern of p53, pRb, and p21 was noted in HPV-positive tumors, and the incremental number of alterations in the 3 proteins was significantly associated with HPV-negative tumors. The presence or absence of HPV together with the number of altered expression of the 3 cell cycle markers resulted in further identification of 4 biologically and clinically distinct subgroups with different outcomes after CCRT. Conclusions. Use of combined biomarkers of oncogenic HPV and tumor suppressors of p53, pRb, and p21 in advanced TSCC provides prognostic molecular classification superior to the TNM stage system and identifies low-risk patients for organ preservation by CCRT alone and high-risk patients who might benefit from planned tonsillectomy and neck dissection before or after CCRT. © 2008 Wiley Periodicals, Inc. Head Neck, 2009 [source] Spectral entropy monitoring allowed lower sevoflurane concentration and faster recovery in childrenACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 7 2010S. R. CHOI Background: Anesthetic titration using spectral entropy monitoring reduces anesthetic requirements and shortens recovery in adult surgical patients. This study was performed to evaluate the effect of entropy monitoring on end-tidal sevoflurane concentration and recovery characteristics in pediatric patients undergoing sevoflurane anesthesia. Methods: Seventy-eight children (aged 3,12 years) scheduled for a tonsillectomy and/or an adenoidectomy were randomly divided into one of two groups: standard practice (Standard) or entropy-guided (Entropy). In the Standard group, sevoflurane was adjusted to maintain the heart rate and systolic blood pressure (BP) within 20% of the baseline values. In the Entropy group, sevoflurane was adjusted to achieve a state entropy of 40,50. We compared the entropy values, end-tidal sevoflurane concentration and recovery times between groups. Results: During maintenance of anesthesia, the entropy and BP values were higher in the Entropy group (P<0.05). The end-tidal sevoflurane concentration during maintenance was lower in the Entropy group (2.2 (0.3) vol%) compared with the Standard group (2.6 (0.4) vol%) (P<0.05). Recovery times were faster in the Entropy group (P<0.05). Conclusions: Compared with standard practice, we found that entropy-guided anesthetic administration was associated with a reduced sevoflurane concentration and a slightly faster emergence and recovery in 3,12-year-old children. [source] Children's Expectations of Pain, Perceptions of Analgesic Efficacy, and Experiences With Nonpharmacologic Pain Management Strategies at Home Following TonsillectomyJOURNAL FOR SPECIALISTS IN PEDIATRIC NURSING, Issue 3 2007Kimberly A. Sutters PURPOSE.,To document children's (ages 6,15 years) descriptions of their pain management at home following tonsillectomy. DESIGN AND METHODS.,Audio-taped interviews of 80 children were transcribed and coded. Data for each response category were tabulated. RESULTS.,Children reported they had more pain after surgery than expected, the pain medicine helped to take their pain away, taking the pain medicine was associated with a negative response by some children, and cold liquids/food by mouth provided pain relief. PRACTICE IMPLICATIONS.,Findings provide insight into children's perspective of pain management at home following tonsillectomy and methods for relieving their pain. [source] Does 1 or 2 g paracetamol added to ketoprofen enhance analgesia in adult tonsillectomy patients?ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 9 2009A. SALONEN Background: We have evaluated whether co-administration of intravenous (i.v.) paracetamol could enhance the analgesic efficacy of ketoprofen (a non-steroidal anti-inflammatory drug or NSAID) in patients undergoing a tonsillectomy. Methods: This prospective, randomized, double-blinded and placebo-controlled add-on study with three parallel groups included 114 patients, aged 16,50 years, and scheduled for elective tonsillectomy. All patients were given ketoprofen 1 mg/kg i.v. after surgery, followed 5 min later by paracetamol 1 or 2 g i.v., or normal saline as a placebo. The primary outcome measure was the proportion of patients requiring oxycodone for rescue analgesia over the first 6 h (pain score >30/100 mm at rest or >50/100 mm during swallowing) after surgery. Results: No difference was detected in the proportion of patients receiving oxycodone (31/37 in the paracetamol 1 g group, 29/39 in the paracetamol 2 g group and 30/38 in the ketoprofen-alone group) between the three groups. However, significantly less doses of rescue analgesia were provided in the paracetamol groups than in the ketoprofen-alone group (P=0.005); among those who required rescue analgesia, 27% less oxycodone was required in the paracetamol 1 g group (80 doses, P=0.023) and 38% less in the paracetamol 2 g group (64 doses, P=0.002) than in the ketoprofen-alone group (106 doses). Conclusion: Combining paracetamol i.v. with ketoprofen at the end of tonsillectomy did not reduce the proportion of the patients requiring rescue analgesia, but the number of opioid doses was less in the add-on groups. [source] Preoperative information needs of children undergoing tonsillectomyJOURNAL OF CLINICAL NURSING, Issue 19-20 2010Aoife Buckley Aims and objectives., To identify the information needs of children undergoing tonsillectomy with reference to content of information, method of delivery, information providers and timing of information provision. Background., Tonsillectomy can be anxiety provoking for children and preoperative preparation programmes are long recognised to reduce anxiety. However, few have been designed from the perspectives of children and to date little is known about how best to prepare children in terms of what to tell them, how to convey information to them, who can best provide information and what is the best timing for information provision. Design., A qualitative descriptive study. Method., Data were collected from nine children (aged 6,9) using interviews supported by a write and draw technique. Data were coded and categorised into themes reflecting content, method, providers and timing of information. Results., Children openly communicated their information needs especially on what to tell them to expect when facing a tonsillectomy. Their principal concerns were about operation procedures, experiencing ,soreness' and discomfort postoperatively and parental presence. Mothers were viewed as best situated to provide them with information. Children were uncertain about what method of information and timing would be most helpful to them. Conclusion., Preoperative educational interventions need to take account of children's information needs so that they are prepared for surgery in ways that are meaningful and relevant to them. Future research is needed in this area. Relevance to clinical practice., Practical steps towards informing children about having a tonsillectomy include asking them what they need to know and addressing their queries accordingly. Child-centred information leaflets using a question and answer format could also be helpful to children. [source] Immunoglobulin A deficiency and oral health status: a case,control studyJOURNAL OF CLINICAL PERIODONTOLOGY, Issue 1 2010Gudmundur H. Jorgensen Abstract Introduction: Immunoglobulin A (IgA) is important for mucosal health. Selective IgA deficiency (IgAD) is the most common primary immunodeficiency but its effect on oral health is unclear. The aim of this study was to investigate dental, periodontal and oral mucosal health in IgAD individuals. Material and methods: In total, 32 adult IgAD subjects were compared with 63 randomly selected individuals. Participants answered questionnaires regarding general and oral health and underwent oral examination, including examination using the periodontal screening and recording (PSR) system and dental examination using the DMF system. Results: The IgAD individuals had significantly more often undergone tonsillectomy (44%versus 24%, p=0.046) and adenoidectomy (31%versus 8%, p=0.003) compared with the controls. Furthermore, the IgAD subjects reported having pharyngitis, stomatitis and herpes labialis significantly more often. There was no significant difference in periodontal health (mean PSR index; 1.87 versus 1.77) or dental health (mean DMFS; 51.3 versus 53.7) between the two cohorts. A positive correlation between Helicobacter pylori infection and severity of periodontitis was found (p=0.036). Conclusion: IgAD predisposes to oral mucosal infections but does not influence periodontal or dental health. This is the first controlled study to include detailed clinical history and investigations, together with full oral and dental examination, in adults with IgAD. [source] Safe use of a laryngeal mask airway in children undergoing a tonsillectomyACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 5 2009F. S. Xue No abstract is available for this article. [source] Comparison of selected reasons for hospitalization of children among children's/tertiary hospitals, Australia, 1996,97 and 1997,98JOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 7 2004JB Ford Objectives: To describe the major characteristics of admissions to children's/tertiary hospitals (compared to other hospitals) and to compare characteristics of local and non-local admissions to specialist children's hospitals. Methods: A cross-sectional analysis of a routinely collected data set of hospitalizations in Australia in 1996,97 and 1997,98. Results: Hospital-specific proportions of asthma and bronchitis, tonsillectomy and/or adenoidectomy and gastroenteritis varied considerably. Multivariate analysis comparing the characteristics of admitted patients by locality showed that non-local admissions of patients with asthma and bronchitis and gastroenteritis to selected children's hospitals were significantly more likely to be Indigenous children and/or children who had been transferred from another hospital. Non-local admissions of tonsillectomy and/or adenoidectomy patients to selected hospitals were significantly more likely to be public patients. Conclusions: Differences in the characteristics of admitted patients to children's hospitals by locality raise issues about equality of access and availability of appropriate services for these children and their families. [source] Human salivary immunoglobulin and antigen-specific antibody activity after tonsillectomyMOLECULAR ORAL MICROBIOLOGY, Issue 5 2001N. K. Childers The importance of the lymphoid tissue collectively known as Waldeyer's ring, which includes the palatine, lingual and nasopharyngeal tonsils, in the induction and contribution of specific antibody responses in human saliva is not clear. The purpose of this study was to determine whether salivary immunoglobulin A (IgA) levels differ in quantity and quality between subjects who have had a tonsillectomy and age, sex and race-matched controls. Parotid saliva, whole saliva, and blood serum samples were collected from 25 volunteer children who had undergone tonsillectomy (T,) within 6,14 months of sampling and from 25 age, sex and race-matched controls. The levels of total IgA (and subclasses) in saliva, and of antigen-specific salivary IgA and serum IgA and IgG antibodies to 4,9 relevant antigens were analyzed by ELISA. No significant difference was observed in the mean total IgA and IgA subclass levels in parotid and whole saliva, although the mean levels for children with a T, were slightly lower. Children with a T, had significantly higher parotid salivary IgA and IgA1 specific/total activity than controls. The total and specific whole saliva IgA and the specific serum IgA or IgG activities were not significantly different from controls. These results indicate an association between the removal of tonsils and increased levels of specific IgA activity in parotid saliva within the first year after a T,. [source] | |||||||||||||||||||||||||||||||