Trends in blunt laryngotracheal trauma in children

Objective

To examine the presentation, mechanisms, and management of blunt laryngotracheal trauma in a pediatric population, emphasizing the rise in severity.

Design

Retrospective analysis of laryngotracheal trauma evaluated from 1995 to 2008. The presentation, mechanism, management and outcomes data are detailed.

Setting

Tertiary medical center.

Patients

Thirty-five patients were identified with major laryngotracheal trauma.

Main outcome measures

Surgical results, airway patency, voicing, swallowing and other residual disabilities are tabulated.

Results

Average age was 10.8 years, with boys outnumbering girls 22-13. In cases of major trauma, mechanisms were related to motor vehicle accidents (MVAs) in seven patients. Five of 11 major trauma victims were unconscious at presentation. Definitive airway reconstruction involved laryngotracheoplasty and tracheal resection/reanastomosis. Ten of 11 remain decannulated.

Conclusions

In an increasingly mobile society, major laryngotracheal trauma is occurring in a younger population. Victims of major laryngotracheal trauma may be unconscious or have other injuries that obscure airway injury, highlighting the need for vigilance. Once the airway is secured and the patient stabilized, airway reconstruction is undertaken, achieving decannulation in most patients. Hoarseness is often a lasting morbidity.     

HLA associations in otosclerosis in Japanese patients

Otosclerosis is a disease of the otic capsule that is caused by abnormal resorption and redeposition of bony tissue. Sixty-two unrelated Japanese patients exhibiting clinical otosclerosis were typed for HLA-A, -B,-C antigens. Twenty-one of the patients were also typed for DR antigens. The frequency of HLA-Aw33 was significantly higher in otosclerosis patients than in the control group (24.2% vs 9.5%). This finding suggests that the presence of HLA-Aw33 antigens may be related to an increased susceptibility to otosclerosis or to its clinical outcome.     

Changes in immunologic response in tonsillectomized children. I Immunosuppression in recurrent tonsillitis

The possible immunoregulatory role of the tonsils was studied by determining immunoglobulins IgG, A, M, E and factors C'3, C'4 and PFB of the complement system before and after tonsillectomy. The synthesis in vitro of IgG and IgM by lymphocytes stimulated with pokeweed mitogen was also measured. There were statistically significant differences between pre and post-operative levels of serum IgG, IgA and IgM, which decreased after surgery. Practically no change in the mean values of IgE and no significant differences in the levels of serum C'3, C'4, and PFB, were found. The in-vitro synthesis of both immunoglobulins (IgG, IgM) by lymphocytes increased significantly after tonsillectomy. Our results suggest that not only does tonsillectomy have no counterproductive effect on the immune system, but that, on the contrary, it seems to improve the immune response, since it appears to unblock the suppression to which the immune system was subject.     

Immunotype findings in macrophages in aural cholesteatomas

Summary Since a heavy cellular infiltrate is seen in the stroma of most aural cholesteatomas, we attempted to characterize this cell population in more detail using monocyte/macrophage-specific monoclonal antibodies. KiM1+ (specific for CD 11c antigen, the 150kDa -chain of a leukocyte integrin), and KiM6+ phagocytes were present in two- or fourfold higher numbers in the stroma of the six excised cholesteatomas than in the control tissues. Since the stroma of the cholesteatoma is devoid of microvessles, the typical perivascular localization of dermal macrophages was not seen in the cholesteatomas studied. The density of the macrophages in the normal ear skin was much higher in the upper dermis than in the lower dermis. In the cholesteatomatous specimens, the phagocytes were evenly scattered within the connective tissue and the cellular infiltrate. In contrast to diseased skin, no Mac 387+ macrophages were detected in the cholesteatomas. A great number of phagocytic cells closely resembling dermal macrophages was found in the stroma of the cholesteatomas and probably contributes to an active autoimmune process. Offprint requests to: B. Negri     

Ciliary activity in the in vitro tubotympanum

Summary We have introduced a tissue culture technique in which the ciliary activity of the cultured tubotympanum can be studied. We have found that ciliated cells of the eustachian tube and middle ear lining continued a beating activity during 168 h of observation. The mean loss of activity of the ciliated cells from the eustachian tube or mucosal sites proximal to the tube was 20% or less, while that of mucosal sites distal to the tube was about 40% even after 168 h of cultivation in our culture medium of RPMI 1640. Our technique of tissue culture is available for studying the long-term effects of various therapeutic agents or adverse factors on the ciliary activity in the tubotympanum.     

Deafness gene mutations in newborns in Beijing

Objective To determine the incidence of congenital hearing loss (HL) in newborns by the rate of deafness-related genetic mutations. Design Clinical study of consecutive newborns in Beijing using allele-specific polymerase chain reaction-based universal array. Study sample This study tested 37 573 newborns within 3 days after birth, including nine sites in four genes: GJB2 (35 del G, 176 del 16, 235 del C, 299 del AT), SLC26A4 (IVS7-2 A?>?G, 2168 A?>?G), MTRNR1 (1555 A?>?G, 1494 C?>?T), and GJB3 (538 C?>?T). The birth condition of infants was also recorded. Results Of 37 573 newborns, 1810 carried pathogenic mutations, or 4.817%. The carrier rates of GJB2 (35 del G, 176 del 16, 235 del C, 299 del AT), GJB3 (538 C?>?T), SLC26A4 (IVS7-2 A?>?G, 2168 A?>?G), and MTRNR1 (1555 A?>?G, 1494 C?>?T) mutations were 0.005%, 0.104%, 1.924%, 0.551%, 0.295%, 0.253%, 1.387%, 0.024%, and 0.274%, respectively. Logistic regression analysis indicated no statistically significant relationship between mutations and infant sex, premature delivery, twin status, or birth weight. Conclusions The 235delC GJB2 mutation was the most frequent deafness-related mutation in the Chinese population. Genetic screening for the deafness gene will help detect more cases of newborn congenital HL than current screening practices.     

氨基糖苷类抗生素耳毒性研究

由于抗菌谱广和价格便宜等原因，氨基糖苷类抗生素被广泛应用于临床。然而氨基糖苷类抗生素的耳毒性和肾毒性却使其在临床应用中受到一定限制。氨基糖苷类抗生素在耳蜗毛细胞中的主要积聚部位是线粒体和溶酶体。氨基糖苷类抗生素引起的细胞内氧自由基活动增强是毛细胞损害的重要因素之一，因此局部或者全身应用氧自由基清除剂可以保护耳蜗免受氨基糖苷类抗生素的损害。钙激活的蛋白酶在氨基糖苷类抗生素引起的毛细胞破坏过程中同样扮演了重要的角色，因此抑制钙激活蛋白酶的活性也能有效保护耳蜗毛细胞。急性氨基糖苷类抗生素耳中毒引起的毛细胞破坏大都死于细胞凋亡．其凋亡原因主要是因为线粒体被药物特异性结合并破坏后．其内部的细胞色素C被释放到细胞质中，因而刺激了Caspase-9并激发其下游的Caspase-3，从而导致毛细胞的程序化死亡。与此不同的是，慢性氨基糖苷类抗生素耳中毒引起的毛细胞破坏不仅包括细胞凋亡而且涉及细胞坏死。在氨基糖苷类抗生素引起的毛细胞坏死过程中．溶酶体的超载破裂最终造成毛细胞自溶性坏死是其典型特征。氨基糖苷类抗生素对螺旋神经节没有直接的毒性作用，但是在耳蜗毛细胞被破坏之后，螺旋神经节往往由于缺乏神经营养因子而发生延迟性神经元死亡，应用转基因技术将神经营养因子基因片段转染到耳蜗支持细胞使之产生分泌神经营养因子的功能，可以有效减轻延迟性神经元死亡的发生率。     

Changes in serum levels of IGF-1 and in growth following adenotonsillectomy in children

OBJECTIVE: Adenotonsillar hypertrophy can cause upper airway obstruction and may be associated with growth delay in children. The objective of this study was to evaluate the long-term effects of adenotonsillectomy on height, weight, and body mass index (BMI) in children with sleep-disordered breathing (SDB). METHODS: Fifty-two children (mean age 6.2+/-2.3 years) clinically diagnosed with SDB were enrolled. Children were diagnosed and scheduled for adenotonsillectomy (T&A) based on their responses to the validated, 22-item Sleep Related Breathing Disorder (SRDB) scale and a physical examination that showed adenotonsillar hypertrophy. Weight, height, and BMI were evaluated before and 5 years after T&A. Serum levels of insulin-like growth factor-1 (IGF-1) were measured before and 1 month after T&A. RESULTS: Serum levels of IGF-1 were significantly higher at 1 month after T&A compared to before T&A (p<0.001). Thirty children (58%) returned for follow-up testing 5 years later. Their Z scores (standard deviation scores) for weight, height, and BMI of 30 children were significantly higher 5 years after T&A compared to before T&A (p<0.01). CONCLUSION: Children with SDB who undergo adenotonsillectomy show significant, long-term increases in weight, height and BMI, as well as a significant increase in serum levels of IGF-1.     

Histopathological changes in the temporal bone in kwashiorkor

Histopathological changes in the temporal bone in kwashiorkor The histopathological changes in human temporal bones are described for 2 cases of kwashiorkor–a protein/calorie malnutrition (PCM) state. There is photographic evidence of severe damage to the middle and inner ears and to the vestibulocochlear nerve. The middle ear shows evidence of chronic otitis media, a common clinical finding in kwashiorkor. Significantly, the round window membranes in both cases showed thickening and infiltration with inflammatory cells. The inner ear showed the loss of cellular elements and hair cell loss in the spiral organ. A marked decrease of spiral ganglion cells and demyelination of the vestibulocochlear nerve were also seen.