Optimal site for throat culture: tonsillar surface versus posterior pharyngeal wall

To determine the optimal site of throat culture for the detection of potential pathogens by comparing culture results from the tonsillar surface and the posterior pharyngeal wall in children selected for adenotonsillectomy and in children without upper respiratory disease. Cotton culture swabs were taken from the tonsillar surface and the posterior pharyngeal wall of 50 children selected for adenotonsillectomy for symptoms of recurrent tonsillitis and/or adenotonsillar hypertrophy and of 50 children without upper respiratory disease. Potential respiratory pathogens were identified. In the overall group (n = 100), positive culture results were found in 67 posterior pharyngeal wall samples and 47 tonsillar surface samples (P = 0.001). Haemophilus influenzae was the most frequently isolated micro-organism both in the posterior pharyngeal wall and the tonsillar surface samples; 55 and 35%, respectively (P = 0.001). Group A beta-haemolytic streptococci were found in the samples of the posterior pharyngeal wall and the tonsillar surface in 17 and 13%, respectively (P = 0.2). When dealing with patients with sore throat, sampling both tonsillar surfaces is enough for the detection of group A beta-haemolytic streptococci. When detection of other bacteria is also important, such as for research purposes, the posterior pharyngeal wall should be sampled as well.     

A Clinicopathologic Series of 22 Cases of Tonsillar Granulomas

Objectives Tonsils are uncommonly affected by granulomatous inflammation, often with an obscure cause. This study attempts to elucidate the nature of tonsillar granulomatous inflammation. Design Retrospective clinicopathologic review. Methods Twenty‐two cases of tonsillar granulomas diagnosed between 1940 and 1999 were retrieved from the files of the Armed Forces Institute of Pathology. H&E slides and a series of histochemical stains were reviewed, and patient follow‐up was obtained. Results There were 11 males and 11 females, aged 7 to 64 years (mean, 29.9 y). Most of the cases presented bilaterally (n = 19) with sore throat, dysphagia, and/or nasal obstruction. The clinical differential included chronic tonsillitis, tuberculosis, nonspecific infection, sarcoidosis, and a neoplasm. Histologically, the granulomas were focal and scattered, or diffuse, identified in the interfollicular zones (n = 16) and/or the germinal centers (n = 13), and occasionally associated with necrosis (n = 6). Based on histochemical and clinical follow‐up information, the etiology of the granulomas included sarcoidosis (n = 8), tuberculosis (n = 3), Hodgkin's lymphoma (n = 2), toxoplasmosis (n = 1), squamous cell carcinoma (n = 1), and no specific known cause (n = 7). Twelve patients were either alive at last follow‐up or had died with no evidence of disease (mean, 12.4 y), and 9 were either alive at last follow‐up or had died with disease (mean, 24.9 y). One patient was alive with unknown disease status (lost to follow‐up after 13.3 y). Conclusions Although a cause for tonsillar granulomas is frequently identified, a number may not develop an identifiable etiology, with the granulomas probably representing an exaggerated immune response to chronic tonsillitis. However, a careful work‐up must be conducted to exclude specific causes and avoid clinical mismanagement.     

IgA肾病患者的扁桃体免疫组织化学观察

目的：了解ＩｇＡ肾病（ＩｇＡ－Ｎ）与扁桃体免疫异常的关系。方法：经肾穿刺活检确诊为ＩｇＡ－Ｎ３１例,以慢性扁桃体炎１６例作对照,扁桃体切除术后运用ＡＢＣ方法对扁桃体组织进行免疫组化标记。结果：两组扁桃体在ＩｇＡ、ＩｇＧ的表达上存在明显的区别,ＩｇＡ－Ｎ患者的扁桃体组织内产生ＩｇＡ的淋巴细胞数显著增加,结论：ＩｇＡ－Ｎ患者存在着扁桃体免疫异常,切除扁桃可预防抗原入浸,消除扁桃体来源的ＩｇＡ,减少循环中的ＩｇＡ免疫复合物形成,进一步使肾小球基底膜区的ＩｇＡ免疫复合物沉积减少。     

微波热疗联合放疗治疗扁桃体癌(附40例临床分析)

探讨微波热疗放疗治疗扁桃体癌的疗效。方法：对２０例扁桃体癌应用放射治疗,２０例应用微波与放射综合治疗,观察并比较其疗效。结果：热疗－放疗综合治疗组临床近期肿瘤消退率９０％,明显高于单纯放疗组,前者肿块消退速度亦明显优于单纯放疗组,且全部病例在治疗期内未发生严重毒副作用。结论微波热疗联合放疗对扁桃体癌的治疗具有协同增敏作用。     

Diagnosing Respiratory Events and Tracing Air Flow by Internal Thermistors

We have developed a new method to measure flow in patients with sleep-related breathing disorders (SRBD). These flow sensors are modified thermistors located in the same sensors we use for pressure measurement in the upper airways to find the obstructive segments during apnoeas. The aim of this study was to test if using internal thermistors as indicator of air flow has advantages compared with the external thermistor method in detecting respiratory events. A total of 50 consecutive patients with an apnoea-hypopnoea index (AHI) of more than 15 were studied. A standard nocturnal polysomnography (PSG) with both internal and external thermistors was performed in all patients. To estimate the patients' AHI, a detailed analysis viewing all parameters except external and internal thermistors was performed. This was followed by an analysis viewing only internal thermistors signals indicating airflow in the pharynx, and finally an analysis viewing only external thermistor signals indicating air flow at the mouth and nose. Mean AHI measured by the three methods showed 49.8 (SD 23.4) by the PSG, 47.8 (SD 24.9) by internal thermistors alone, and 31.5 (SD 22.2) by external thermistors. There was no statistical difference between AHI detected by PSG and internal thermistors, but highly significant differences between PSG and external thermistors (p<0.001). The external thermistors missed an average of almost 20 respiratory events per hour.     

Bilateral lymphangiomatous polyps of the palatine tonsils

Lymphangiomatous polyps of the tonsils are rare with less than 30 cases reported in the literature. All have been unilateral. We report a case of a child with bilateral lymphangiomatous polyps of the palatine tonsils that was suspected on preoperative examination as opposed to an incidental postoperative histologic finding. These findings were also correlated with a further imaging study to establish this entity as a localized rather than a generalized histologic phenomenon.     

腺样体肥大或伴扁桃体肥大的睡眠呼吸障碍儿童平均血小板体积和血小板分布宽度变化的临床意义

目的 探讨腺样体肥大或伴扁桃体肥大的睡眠呼吸障碍(SDB)儿童的平均血小板体积(MPV)和血小板分布宽度(PDW)变化的临床意义。方法 选择2018年1月至2019年1月安徽医科大学附属巢湖医院耳鼻咽喉-头颈外科住院患儿99例,均诊断为SDB(腺样体肥大或伴扁桃体肥大),设为病例组。另选取同时期因SDB以外原因(包括先天性耳前瘘管,鼻骨骨折,先天性鳃裂瘘管,颈部良性肿瘤,外耳道异物)而收住入院的51例患儿为对照组,并经过仔细询问病史,否认有SDB,体格检查均无腺样体肥大或伴有扁桃体肥大。记录病例组与对照组的血常规各项指标数值,比较两组血常规相关指标的差异。结果 病例组平均血小板体积(MPV)为(10.89±1.30)fL,对照组为(11.38±1.28)fL,差异有统计学意义(P<0.05)。对照组血小板分布宽度(PDW)为[13.60(12.00,15.90)]fL,病例组为[12.70(10.85,15.35)]fL,差异有统计学意义(P<0.05)。其余血常规指标在病例组与对照组间差异均无统计学意义(P>0.05)。Pearson积差相关分析显示,病例组的MPV和PDW均与年龄呈正相关,Spearman秩相关显示,MPV和PDW均与腺样体肥大等级呈负相关。结论 MPV和PDW可能作为判断腺样体肥大或伴有扁桃体肥大SDB患儿病情严重程度的潜在指标。