Effect of local application of cidofovir on the control of recurrences in recurrent laryngeal papillomatosis.

OBJECTIVE: To study the effect of local application of cidofovir in patients with recurrent laryngeal papillomatosis (RLP) by measuring the interval between recurrences and the extent of disease at each recurrence. STUDY DESIGN AND SETTING: The study group included 10 patients with RLP. Videolaryngoscopic analysis of previous RLP operations for each patient before starting cidofovir and the number and timing of pre-cidofovir recurrences of the disease provided data for a self-control group. The cidofovir was injected with a laryngeal needle during papilloma resection operations. To evaluate the changes and the extent of the disease, the authors developed a staging system based on anatomic topography. The extent of the disease and the intervals between recurrences were analyzed and statistically compared. RESULTS: The median interval between recurrences significantly increased from 102 days before cidofovir to 239 days after treatment. No local or systemic side effects were observed. CONCLUSIONS: The study supports the hypothesis that cidofovir is an effective adjunct in treating recurrences of RLP. EBM rating: C-4.     

Surgical treatment of laryngeal papillomatosis using narrow band imaging

Laryngeal papillomatosis has a high rate of recurrence after surgery. Narrow band imaging (NBI) is a novel optical enhancement technology used for the diagnosis. This is the first report to date to indicate the availability of the combination of laryngomicro surgery and videoendoscopic surgery for laryngeal papillomatosis using NBI technology. The patients were a 34-year-old man and a 30-year-old man. Both patients underwent surgery in another hospital. However, due to recurrence, they were subsequently referred to the authors' department for further evaluation. The presence of papillomas was confirmed by NBI, and the papillomas were removed using an XPS Micro Debrider and a CO2 laser. Using the NBI system, the border between the normal mucosa and the papillomas could be clearly identified, allowing precise resection. Further treatment on the lesions has been carried out several times to date using NBI. The lesions have now been eradicated without further recurrence.     

Pilot trial of ribavirin for the treatment of laryngeal papillomatosis

The antiviral drug ribavirin was used as an adjunct to laser surgery for the treatment of patients with laryngeal papillomatosis (LP). An uncontrolled clinical trial for four patients with ribavirin treatment at a daily dose of 23 mg/kg was performed. Three adults received drug prior to laser surgery and continuing orally for 6 months. One infant was treated for 3 months. Two adults achieved complete remissions for at least 2 consecutive months, and both patients developed only minimal recurrent disease in 4 months of follow-up. The other adult and the child sustained a partial response and an increased interval between the required surgeries. Ribavirin caused only a mild, reversible reduction in hemoglobin and reticulocytosis. This preliminary trial shows that ribavirin may be an effective therapy in combination with surgery for LP in a larger controlled clinical trial.     

儿童喉乳头状瘤麻醉通气方式

喉乳头状瘤是人类喉乳头状瘤病毒6型和11型感染引起,是儿童常见的喉部良性肿瘤,此类病人的麻醉尤其特殊性,如何控制气道是喉乳头状瘤麻醉的难点.此文通过对国内外常见的气道管理技术(气管插管、高频喷射通气、间断通气技术、自主呼吸技术以及KTP激光技术)的通气方法,参数选择,优点以及相应的并发症进行综述,希望能为此类患者麻醉提供帮助.     

Office-based intralesional cidofovir injections for nasal septal papilloma: a pilot study.

OBJECTIVES: To determine if nasal septal papilloma is responsive to intralesional cidofovir injections. METHODS: Five adult males, ages 37 to 57, presented with nasal septal or columellar papilloma. Three lesions had been previously excised with the laser and recurred. The lesions were injected with cidofovir on a monthly basis until complete resolution or any residual lesion was excised afterwards with the laser. RESULTS: All patients achieved disease remission sustained over 10 to 24 months. Overall doses were much lower than those described for laryngeal papillomatosis and no toxic effects were observed. CONCLUSIONS: Office-based intralesional injections of cidofovir may show benefit in the treatment of nasal septal papilloma. EBM rating: C-4.     

Intralesional cidofovir for the treatment of severe juvenile recurrent respiratory papillomatosis: long-term results in 4 children

OBJECTIVE: We sought to determine the efficacy of intralesional injection of cidofovir in improving resolution of recurrent respiratory papillomatosis (RRP).Study design and setting We conducted a prospective, observational trial at an academic tertiary children's hospital. RESULTS: Four children with RRP requiring more than 6 surgical excisions per year were treated with intralesional cidofovir. Cidofovir (5 mg/mL) was injected into airway sites where papillomas had just been excised using sharp technique. Each patient had 6 treatments performed 6 to 8 weeks apart. Biopsies confirmed benign papilloma lesions in all cases. During treatment with intralesional cidofovir there was diminished growth of the papillomas in each patient. Once cidofovir treatment was stopped, the rate of regrowth and frequency of surgical excision returned to pretreatment levels in 3 of the 4 patients. CONCLUSIONS: Intralesional cidofovir may provide benefit in reducing the rate of RRP growth while under treatment, but RRP severity returned to pretreatment levels once cidofovir treatment was stopped using this treatment program.     

Juvenile laryngeal papillomatosis: scary anaesthetic!

We describe three children ages 20 to 33 months who presented for surgical resection of their laryngeal papillomata. Their anaesthetic management revealed the severity of obstruction which these children presented and the obstacles that faced the anaesthesiologist trying to secure the airway and provide adequate ventilation. The airway obstruction had both a fixed and a dynamic component to it. This was evidenced by the ability of the children to maintain ventilation when spontaneously breathing. But, they exhibited total obstruction when ventilation was attempted via mask using positive pressure. It is possible to encounter obstruction to ventilation after the trachea has been intubated because of papillomata that were ‘shaved off,’ filling the tracheal tube lumen.     

Effects of cidofovir on a novel cell-based test system for recurrent respiratory papillomatosis

BACKGROUND: Cidofovir has been reported to have activity against human papillomavirus (HPV) type 16, but no laboratory studies have been performed on HPV type 6, the main cause of recurrent respiratory papillomatosis (RRP). METHODS: HPV6b E6 cDNA-based C33A (non-HPV cervical carcinoma) cell line was produced. Two different doses of cidofovir were applied to parent C33A, C33AT6E6, and C33AT16E6 (HPV 16). Growth and flow cytometry analysis were performed. RESULTS: Polymerase chain reaction confirmed HPV6 E6 expression in C33AT6E6 cells. High-dose cidofovir was found to be toxic to all cell lines. Low-dose exposure was found to be toxic to C33AT16E6 cells at 3 days, whereas C33A and C33AT6E6 showed minimal toxicity at 6 days and earlier recovery following drug withdrawal. CONCLUSIONS: Cidofovir showed nonspecific toxicity against all 3 cell lines tested. HPV16 E6 expressing cells were more sensitive than parent or HPV6 E6 expressing cells. Cidofovir has no selective advantage for the RRP-related HPV6 E6 expressing cell line.     

Current concepts in the management of laryngeal papillomatosis

A wide variety of methods have been described for the treatment of laryngeal papillomatosis. This attests to the difficulties encountered in controlling this often refractory disease. Recent trends have been directed toward immunotherapy and improved techniques of endoscopic excision. The various treatment modalities are reviewed to provide the reader with updated information and a perspective of the current management of this perplexing disease.     

Intralesional injection of vinblastine in treatment of laryngeal Kaposi sarcoma associated with AIDS

Kaposi's sarcoma (KS), is the most frequent malignant neoplasm associated with acquired immunodeficiency syndrome (AIDS). Classically arising in the skin, mucosal lesions are seen in 50 percent in oral cavity. KS rarely involves the larynx (37 cases have been reported in the world literature), when KS occurs in the larynx airway compromise can be a serious threat and immediate treatment is necessary. We report one case of KS of the supraglottic larynx, and intralesional injections were performed. A complete response was noted eleven months later. Although several modes of treatment are available (radiation therapy, systemic chemotherapy) to manage KS, intralesional injections with vinblastine sulfate may after an effective therapeutic alternative.     

小儿喉乳头状瘤吸入七氟烷麻醉诱导期间呼吸力学变化

目的 通过热线风速仪观察喉乳头状瘤患儿和普通小儿吸入七氟烷麻醉诱导期呼吸力学的变化,旨在获得预测通气和捕管困难的客观量化指标及对控制通气加深麻醉效果的评估.方法 选择普通患儿(C组)和喉乳头状瘤患儿(L组)各20例,静脉注射氯胺酮1 mg/kg,吸入氧气2 L/min+7%七氟烷实施麻醉诱导.热线风速仪采集四时段呼吸力学数据:静注氯胺酮1 min后(T1),开始吸入7%七氟烷时(T2),吸入7%七氟烷3min后(T3),控制通气2min后(T4).结果 L组T1期呼吸的平均速度[(1.48±0.20)m/s和(1.26±0.18m/s)]、最大速度[(1.72±0.25)m/s和(1.97±0.31)m/s]都高于c组(P<0.05),呼吸频率、吸气时间差异无统计学意义(P>0.05). L组T3、T4期平均吸气速度和最大吸气速度的比值(0.612±0.030和0.613±0.032)小于C组(P<0.05).L组T3期最大吸气速度、呼吸频率下降的幅度[(25±6)%和(19±4)%]少于C组(P<0.05).L组T4期各项指标较T3期无明显变化(P>0.05).结论 喉乳头状瘤患儿吸入七氟烷麻醉诱导期是靠加强呼吸做功来代偿通气不足的,其上气道梗阻情况随麻醉加深更加突出,通过控制通气辅助加深麻醉效果不明显.     

Hepatic artery pseudoaneurysm after liver transplantation: treatment with percutaneous thrombin injection

Pseudoaneurysms of the hepatic artery are a rare complication of liver transplantation. Early diagnosis and treatment are essential to avoid life-threatening hemorrhage. Conventional treatment consists of surgical resection and vascular reconstruction or transarterial coil embolization. More recently, percutaneous thrombin injection has been successfully used in the treatment of femoral artery pseudoaneurysms. We describe a 70-year-old woman who had a hepatic artery pseudoaneurysm after orthotopic liver transplantation, which was successfully treated by percutaneous thrombin injection.     

Use of a carbon dioxide laser for treatment of recurrent laryngeal papillomatosis in small children: Experiences with an anaesthetic technique

The carbon dioxide laser offers advantages in the treatment of recurrent laryngeal papillomatosis in small children. These advantages include precision, haemostasis and minimal surrounding tissue oedema. These patients do, however, present problems to the anaesthetist; this paper outlines a suitable anaesthetic technique and describes experience of its use in five children on 63 occasions.     

Successful treatment of parastomal varices bleeding with percutaneous N-butyl-2-cyanoacrylate glue injection

Parastomal varices are known complication of stoma creation in patients with portal hypertension. Similar to esophageal and gastric varices, bleeding can occur and can lead to hepatic decompensation and even death. Diagnosis of parastomal bleeding may be delayed if not suspected. Established treatment for bleeding parastomal varices includes transjugular intrahepatic porto-systemic shunt creation and surgery. We report a case of a patient with carcinoma of the cervix that was complicated by a rectal stricture postradiotherapy requiring a diversion colostomy. She also had end stage chronic liver disease secondary to chronic hepatitis C infection. She presented with 3 episodes of parastomal varices bleeding that was not initially suspected and was successfully treated with 1 session of percutaneous N-butyl-2-cyanoacrylate (Histoacryl) glue injection.     

Minimally invasive treatment of simple bone cysts with percutaneous autogenous bone marrow injection

Percutaneous autogeneic bone marrow injection is an effective method for managing simple bone cysts, and it might be considered before the application of more extensive procedures.     

Renoprotection following treatment of secondary hyperparathyroidism with percutaneous ethanol injection in pre-dialysis patients

What could be done for patients with chronic renal failure are marginally beneficial. Among 58 pre-dialysis patients, we found 24 of chronic glomerulonephritis (CGN) with serum creatinine >5 mg/dl and intact parathyroid hormone (i-PTH) >200 pg/ml. In this study, we determined if the residual renal function could be preserved when hyperparathyroidism was corrected by either low-dose calcitriol treatment or ethanol injection. The 58 CGN patients were divided into three groups. The first group, which comprised 11 cases with i-PTH >200 pg/ml and had parathyroid mass, were treated by ultrasonography-guided percutaneous ethanol injection therapy (PEIT). The second study group composed of 13 cases with i-PTH >200 pg/ml without parathyroid mass were treated by calcitriol 1 microg every other day. The third group made up of 34 cases with i-PTH <200 pg/ml, who did not receive calcitriol or ethanol therapy. All patients were followed up within 2 years or until dialysis. The average rate of decline in renal function (slope of reciprocal serum creatinine vs. time) was 0.0025 +/- 0.0026 dl/mg month in group 1, 0.0054 +/- 0.0024 in group 2, and 0.0067 +/- 0.0025 in group 3 (p = 0.018 in group 1 vs. group 2, p < 0.001 in group 1 vs. group 3). The declines of i-PTH, phosphorus, and alkaline phosphatase, and the increase of calcium were all significantly different between group 1 and group 3. Two cases of group 1, 6 cases of group 2, and 20 cases of group 3 entered into dialysis during this study. In conclusion, selective PEIT guided by color Doppler flow mapping is an effective therapy for treating hyperparathyroidism and protecting the residual renal function.     

Intravenous anaesthesia for laser surgery of the airway in children with recurrent laryngeal papillomatosis.

Juvenile laryngeal papillomatosis is a recurrent condition that presents a number of challenges to the anaesthetist: varying degrees of airway obstruction, the child's airway is shared and safe use of a laser is required. As well as the usual considerations of laser use, the child's larynx should move as little as possible. At present the treatment of choice is laser vapourisation of the papillomata. Several anaesthetic techniques have been described, including jet ventilation, intermittent intubation, apnoeic techniques and insufflation of volatile gases with or without spontaneous ventilation ( 1 ). Endotracheal intubation has been associated with seeding of the papillomata into the distal airway. The technique at the Birmingham Children's Hospital for the past 5 years is described; it is based upon deep intravenous anaesthesia with spontaneous ventilation, supplemented by topical lignocaine. Children with significant stridor at rest are induced with volatile/oxygen mixture, otherwise the method of induction is determined by child and anaesthetist. Once the child is deeply anaesthetised the larynx of the child is sprayed with lignocaine (4 mg·kg^?1). The volatile agent is then discontinued and anaesthesia is provided by an intravenous infusion of propofol and alfentanil running at 10–20 mg·kg^?1·hr^?1 and 20–30 mcg·kg^?1·hr^?1 respectively. Oxygen enriched air is delivered into the pharynx via a nasopharyngeal airway. The oxygen saturation of the child is maintained at 95–97% in order to reduce the risk of ignition of the inspired oxygen by the laser. The larynx of the child is placed in suspension to produce an open airway. Depth of anaesthesia is determined primarily by the child's ventilatory pattern (adrenaline is used topically by the surgeon for haemostasis and interferes with the child's heart rate and blood pressure). End tidal CO₂ concentration was measured intermittently for the first few cases, but was always found to be in the normal range. After completion of surgery (usually 15–90 min) the child is placed in the recovery position and allowed to recover. Over the past 5 years at our hospital 11 children have undergone 112 procedures. There have been no airway complications. Recovery is not prolonged (time to spontaneous eye opening about 10–15 min). This simple technique allows excellent surgical operating conditions with unimpeded visualisation of the barely mobile larynx. There is no pollution of the operating theatre or surgeon by volatile agents. The technique is now routinely used for all microlaryngeal surgery.     

超声引导经皮无水乙醇和高温蒸馏水注射疗法治疗肝癌

目的探讨PEIT和PHDI治疗HCC的临床应用价值。方法将40例HCC患者随机平均分为两组,两组在病情、病程、分类、年龄、性别、肿瘤大小和数量等方面无明显差异。两组患者分别接受PEIT及PHDI治疗,所有病例于治疗前后定期行彩超检查,同时检测肝功能、AFP、AFPmRNA、体液介质及CD4。结果PEIT组治疗后肿瘤直径缩小有效率高于PHDI组,差异有统计学意义（P〈0．05）;两组治疗前后体液介质、CD4、AFP、AFPmRNA差异均有统计学意义（P〈0．05）,PHDI组AFP降至正常者及AFPmRNA转阴率与PEIT组比较差异有统计学意义（P〈0．05）;PEIT和PHDI治疗后谷丙转氨酶升高分别为75％及5％,局部复发分别为16．67％及7．14％。结论PEIT和PHDI治疗HCC疗效稳定可靠。     

Iatrogenic subclavian artery pseudoaneurysm causing airway compromise: treatment with percutaneous thrombin injection

Central venous cannulation is an increasingly common diagnostic and therapeutic procedure in modern medical practise. Inadvertent iatrogenic injury to an adjacent major artery during attempted central venous cannulation is an uncommon but potentially lethal complication. If injury leads to pseudoaneurysm formation, complications may arise from mass effect, embolism, or even rupture with continued hemorrhage. Traditional surgical repair of these lesions is often difficult, especially if access within the thorax is required in patients at high risk. We present a case report of successful management of a large subclavian artery pseudoaneurysm with the new approach of percutaneous thrombin injection.