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At least 91 records · Page 5Linked to original sources

PubMed2000

The effects of mitomycin-C and stenting on airway wound healing after laryngotracheal reconstruction in a pig model.

OBJECTIVE: To assess the effects of mitomycin-C (MTC) and endoscopic stenting on airway wound healing after laryngotracheal reconstruction. DESIGN: A prospective, blinded, randomized controlled animal study. SUBJECTS: Twenty-six domestic pigs (Sus scrofula) divided into four groups. INTERVENTIONS: Each animal underwent single-stage laryngotracheal reconstruction (SSLTR) with auricular cartilage grafts and stenting. Group 1 animals were sacrificed on postoperative day 3, and group 2 animals on postoperative day 7. On postoperative day 7, groups 3 and 4 underwent endoscopy, stent removal, and application of MTC (0.5 mg/ml) or placebo (normal saline). Group 3 animals were sacrificed on postoperative day 14, group 4 animals on day 21. Two additional animals from each experimental group were prepared for election microscopy studies. Segments of reconstructed airway were evaluated grossly and histologically for all animals. Additional tonometric evaluation was performed on two stents to determine their compressive strength. MAIN OUTCOME MEASURES: Healing, reepithelization, graft incorporation, and airway diameter. RESULTS: Two-thirds of the animals demonstrated some degree of stent collapse on endoscopy. Granulation tissue formation was seen in all animals, and resolved with stent removal. No animal experienced airway compromise due to granulation tissue formation. Stenting was seen to induce a submucosal fibroproliferative response and scarring, with loss of normal glandular architecture, in all animals. MTC did not affect the acute inflammatory response, reepithelization of the graft site, or formation of the subepithelial fibroproliferative response. MTC treated animals, however, demonstrated better graft incorporation with fibrocartilage proliferation of the graft. Untreated animals demonstrated liquefactive necrosis of the graft, without evidence of neochondrification of the graft. CONCLUSIONS: The pig airway is an adequate model of wound healing following SSLTR and stenting. Metallic ballon expandable stents can be successfully used following SSLTR, allowing for immediate postoperative extubation. However, the formation of a submucosal fibroproliferative response and mucosal scarring seen in our study raises some concerns with the current stent design. Before stenting is widely clinically applied, the optimum stent design needs to be developed. Finally, MTC seems to prevent the liquefactive necrosis of SSLTR grafts and promote neochondrification, allowing improved graft incorporation. Further studies are needed to asses the long-term effects of MTC on healing and restenosis, and its effects on cartilage growth and formation, following SSLTR.

Animals↗

PubMed2002

Screening for tuberculosis among orphans in a developing country.

BACKGROUND: There has been a recent resurgence of tuberculosis (TB) as a worldwide public health concern. It is a well-documented health problem in Haiti, where the reported prevalence is 123.9 per 100,000 population. While the Centers for Disease Control and Prevention (CDC) and World Health Organization (WHO) policy papers for the eradication of TB recommend screening in shelters, prisons, and other congregate-living facilities, screening in institutional orphanages is not specifically mentioned. METHODS: A total of 445 orphans with no documentation of Bacillus Calmette-Guerin (BCG) vaccine at six orphanages representing urban, suburban, and rural Haiti were screened for TB using standardized purified protein derivative (PPD). An inoculum of 0.1 cc was introduced intradermally, with site checks for induration at 48-72 hours after inoculation. Induration >5 mm was recorded as positive. Active cases of TB were defined by symptoms such as fever, night sweats, cough greater than 1 month, or signs of extrapulmonary TB (like scrofula or Pott's disease). RESULTS: The number of positive PPD tests was 170 of the 445 children tested, or 38,202 per 100,000; there were 10 active cases. The overall prevalence of tuberculin positivity in the three orphanages with one or more active cases was 44%, compared to 13% in the three with no identified active cases. CONCLUSIONS: The data indicate that TB prevalence among the orphans screened was 1123 per 100,000. This is substantially greater than that reported for the general Haitian population. These data thus suggest children living in orphanages as a previously unidentified high-risk group for TB infection. Further investigation of TB is recommended for orphans in developing countries.

Child, Preschool↗

PubMed2002

Otolaryngologic aspects of the Lewis & Clark Expedition, 1803-1806.

Medical difficulties related to otolaryngology that occurred during the Lewis & Clark Expedition (1803-1806) are highlighted. These difficulties included ear and face frostbite, upper respiratory infections, temporal vessel laceration from an air gun accident, neck scrofula, and a pediatric neck mass. The custom of Clatsop Indian head flattening is also described. These descriptions also aim to illustrate the state of otolaryngology during the early 19th century in America.

Child↗

PubMed1979

Group III atypical mycobacterial infections.

We retrospectively and prospectively examined the clinical presentation, course of disease, and response to therapy in 63 patients whose mycobacterial isolates were identified as Runyon group III atypical mycobacteria. All of the patients except four had pulmonary disease similar to typical pulmonary tuberculosis. The others had scrofula or abxcess. There was a male predominance and whites were slightly more frequently infected in our series. Forty-six percent of the patients were from rural Oklahoma. Skin testing and chest roentgenography were important, but culture of the organism appeared to be the only productive method of distinguishing the atypical disease from typical tuberculosis. Eighty-one percent had an associated disease. The isolates showed a very high rate of primary drug resistance, and this was reflected in the difficulty in controlling the infection.

Adolescent↗

PubMed2001

Cervical tuberculous lymphadenopathy: changing clinical pattern and concepts in management.

Tuberculosis is one of the biggest health challenges the world is facing. In this study the clinical pattern of patients with cervical lymphadenitis, who presented to the ear, nose, and throat outpatient department of the Government Medical College Hospital, Chandigarh, India between June 1997 and May 1998 is recorded. Tuberculosis accounted for 60 out of 94 cases of cervical lymph node enlargement. The commonest age group affected was 11-20 years. Constitutional symptoms were not present in most of the patients. Multiple matted nodes were seen in 23 patients but a single discrete node was seen in 18 patients. Upper deep jugular nodes were the most commonly affected lymph nodes. Discharging sinus and abscess formation were uncommon. Fine needle aspiration cytology yielded a positive diagnosis in 52 out of 56 patients. Chest lesions on radiography were evident in 16% of the patients. Mantoux test was positive and was more than 15 mm in most of the patients. This study shows that the classical picture of "scrofula" is no longer seen nowadays and can probably be explained by the earlier presentation of the disease. All the patients were treated with short course daily chemotherapy for six months. Surgery was not required in the majority of patients except in four cases where excision biopsy was performed. Patients with abscess formation were managed with wide bore needle aspiration only. With a minimum six month period of follow up, no patient was found to have a recurrence of local or systemic disease. This study emphasises the role of fine needle aspiration cytology in diagnosis and confirms the efficacy of six months short course chemotherapy.

Adolescent↗

PubMedDate not supplied

[Lymphadenopathies in American cutaneous leishmaniasis: comments on 2 cases].

Two patients, with cervical lymphadenopathies and a presumptive diagnosis of lymphoma or scrofula, were submitted to biopsies of the affected lymph nodes. Unexpectedly, the histological picture revealed a necrotic-granulomatous reaction and the presence of leishmania (amastigotes) in some vacuolated macrophages. The patients were from different endemic areas of leishmaniasis in Brazil, and had no perceptible cutaneous or mucosal lesions. Later, however, one of them developed such lesions, probably as an effect of a treatment for toxoplasmosis. These findings support the idea that the agents of the disease, once in the host organism, would invade the organs of the phagocytic-mononuclear system, there remaining for a long time, maybe for the rest of the host life. Eventually, under the action of several factors, that could modify the host resistance, the parasites migrate to the skin or the mucosal membranes, causing secondary or reactivating lesions.

Adult↗

PubMed1997

Cervical tuberculous lymphadenitis in a frequent traveler to endemic areas of tuberculosis.

Scrofula or cervical tuberculous lymphadenitis (CTBL) should be suspected in patients with a history of potential exposure to tuberculosis present with cervical lymphadenopathy. A 55 year-old frequent traveler to Philippine and Thailand developed swelling of the bilateral cervical lymph nodes, and positive conversion of purified protein derivative of tuberculin (PPD) without pulmonary manifestations. The excisional biopsy of the cervical lymph nodes was useful for prompt diagnosis of CTBL, and the patient was successfully treated with isoniazid (INH) and rifampicin (RFP).

Antitubercular Agents↗

PubMed1996

[Von Siebold's prescriptions (2)].

I have interpreted and explained 20 of von Siebold's prescriptions 4 times. Of the 20 prescriptions, 6 were stored at the Siebold's Memorial Museum (questionable 1 was excluded) and 14 at the Municipal Museum of Ohzu City, Ehime Prefecture. The 20 prescriptions used 39 types of drugs (different forms of the same drug such as crude glycyrrhiza, glycyrrhiza extract, and glycyrrhiza powder were regarded as 3 types). The prescriptions were classified according to the drug form: powders, 6 prescriptions; pills, 3; decoctions 2; confections, 2; eye drops, 2; drugs for internal and external use, 2; applications, 1; solutions (?), 1; and unknown 1. There were 2 prescriptions that use oil-sugars as correctives. The classification of the prescriptions according to drug efficacy and disease was difficult because one drug had various effects, or some diseases could be considered depending on symptoms. However, the following classification was done: digestives, 4 prescriptions; drugs for syphilis-suppuration, 3; drugs for eye diseases, 3; cathartics, 2; alteractives and resolvents, 2; drugs for scrofula, 1; drugs for scabies, 1; antitussives and expectorants, 1; rubefacients, 1; diuretics-antiphlogistic-laxative (niter), 1; and unknown, 1. Siebold's medical activities were performed mainly in the last days of the Tokugawa shogunate in Japan. Therefore, there may be only a few prescriptions remaining in other countries. Such important cultural heritage should be carefully stored.

Drug Prescriptions↗

PubMed1998

[Studies on the chemical constituents of the leaves from Artabotrys hexapetalus].

Artabotrys hexapetalus (annonaceae) is distributed in southern China. As a Chinese folk herb medicine, its root and fruits are used to treat malaria and scrofula, respectively. Two new flavonol glycosides, artabotryside-A (1), -B (2), three known flavonoids: taxifolin (3), 7-O-glucoluteolin (4), apigenin-7-O-apiosyl(1-->2) glycoside (5), and two organic acid: succinic (6) and fumaric acid (7) have been isolated from the leaves of A. hexapetalus. The structures of 1 and 2 were elucidated as quercetin-3-O-alpha-L-rhamnopyranosyl (1-->2)-alpha-L-arabinofuranoside (1) and kaempferol-3-O-alpha-L-rhamnopyranosyl(1-->2)-alpha-L-arabinofuranoside (2), respectively, on the basis of spectral analysis. The compounds 3 through 7 were found from A. hexapetalus for the first time.

Annonaceae↗

PubMedDate not supplied

Samuel Johnson's illnesses.

The handwritten note of the post-mortem examination of Dr Samuel Johnson resides in the library of the Royal College of Physicians of London. Headed 'asthma' it suggests that he had only one functioning kidney, probably had hypertension, left ventricular hypertrophy and congestive heart failure. This article describes an imaginary presentation by Dr James Wilson, who did the autopsy, and alludes to Johnson's life, and medical history, including impaired vision and hearing, scrofula, abnormal limb movement, gout, abdominal cramps, melancholia and episodes of 'asthma' which were, more than likely to have been episodes of left ventricular failure. Johnson's personality as a demanding patient who took things into his own hands are described based upon reports from his physicians.

Autopsy↗

PubMed1995

Scratch and sniff. The dynamic duo.

Are odors diagnostic? In this age of polymerase chain reactions, in situ hybridization, and immunohistochemical staining, is there any room left for the nose in diagnosing disease? Long ago, and perhaps far away, smell was crucial to describing an illness. Infectious diseases were known by their characteristics odors--scrofula as smelling like stale beer; typhoid, like freshly baked brown bread; rubella, like plucked feathers; and diphtheria, as "sweetish." Anosmics might be banned from medical school. Perhaps we have left the descriptions behind along with these illnesses we rarely encounter today. After all, how many young physicians, residents, or medical students have ever seen a case of diphtheria or even rubella, and how many fewer have ever plucked a chicken? We have learned that pellagra (that "must appear" diagnosis in our differential by rote, but not by example, for photosensitive dermatoses) should smell like sour bread and that the exotic favus should smell "mousy" (Table 1). What does Candida smell like--a "heavy sweetness"? Darier's disease in poor control--"organic"? Pseudomonal infections--"foul and biting"? And are not our patients with noninfected eczematous dermatitis distinct for lacking any peculiar odor, do they not actually smell "dry"? We cannot blame the abandonment of our olfactory skills on the younger generation, for how many of us could describe those odors we smell every day? Would we be able to detect a subtle change in the odor of our patient with psoriasis, a change perhaps signifying superinfection?

Animals↗

PubMed1995

[Cervical granulomatous lymphadenitis: report of 13 cases].

The most common manifestation of mycobacterial infection encountered in E.N.T. practice is cervical lymphadenitis. Mycobacterial cervical lymphadenitis, the so-called scrofula, remains a diagnostic challenge, because it mimics other resembling processes. We present 13 cases of cervical granulomatous lymphadenitis treated from 1967 until 1990.

Adolescent↗

PubMed1996

Mycobacterial cervical lymphadenitis: a review.

Over the last decade mycobacterial infections have been shown to be on the rise in the United States and worldwide. The diagnosis of mycobacterial cervical lymphadenitis, otherwise known as scrofula, should thus be entertained when faced with the hallmark presentation of chronic, nontender cervical lymphadenopathy. This article reviews current epidemiology, bacteriology, diagnostic techniques, and treatment options for tuberculous and nontuberculous mycobacterial cervical lymphadenitis.

Humans↗

PubMed1952