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Follow-up results of cervical tuberculous lymphadenitis
Research Posters
R060 A Clinical and Histopathological Study of the Oral Component in Sjo ¨ gren’s Syndrome
Liverpool United Kingdom; Liverpool United Kingdom; Liverpool United Kingdom; Liverpool United Kingdom; Liverpool United Kingdom; Huddersfield United Kingdom; Miami FL; Miami FL
Problem: Sjo¨ gren’s syndrome (SS) is a chronic autoimmune disease, characterized by a progressive lymphocytic and plasma cell infiltration of the exocrine glands, particularly of the salivary and lacrimal glands. The progression of the disease leads to the decrease of the glandular function and consequently to the development of xerostomia and keratoconjunctivitis sicca. SS may occur alone (primary) or in association with another autoimmune disease (secondary) such as rheumatoid arthritis, systemic lupus erythematosus, polymyositis, and scleroderma. Methods: The goal of this study was to assess the clinical and histopathological characteristics of the oral component of SS in patients assisted at the Stomatology Division of the Otorhinolaryngology and Head and Neck Surgery Department of Universidade Federal de Sa˜ o Paulo, Brazil. Twenty-four adult female patients were enrolled in the study and classified according to the European Criteria for Sjo¨ gren’s Syndrome. All patients were submitted to a detailed oral evaluation, and the oral signs and symptoms were correlated to the focal sialadenitis present in the labial salivary gland biopsy. Results: The patients were predominantly of white ethnicity (79.1%) in their sixth decade of life. Xerostomia was the most relevant oral symptom, present in 79.1% of patients. We found a positive correlation between the enlargement of the major salivary gland and the decrease or thickening of saliva during the oral examination and a higher number of lymphoplasmocitary foci / 4 mm2⬎4 mm2. Conclusion: Although the oral symptoms, chronic and/or recurrent salivary gland enlargement, and oral mucosa dryness are strongly suggestive of SS, they cannot be considered the only oral criteria for the diagnosis of this syndrome. Lymphoplasmocitary infiltration of the minor salivary gland was found even in patients without oral symptoms, corroborating the importance of the minor salivary gland biopsy as part of the SS diagnosis. Significance: This study provides a better understanding of the oral characteristics of Sjo¨ gren’s Syndrome, and the importance of proper criteria use for its clinical diagnosis. Support: None reported.
Problem: Impacted meat bolus in the oesophagus carries an increased risk of morbidity and mortality if it requires retrieval by endoscopic procedures. Certain naturally occurring fruit juices and Coke have been implicated to dissolve meat boluses but without conclusive evidence. This study aimed to ascertain the efficacy of various fruit juices and Coke in dissolving and dislodging meat boluses in vitro. Methods: Eighty 10 mL syringes were modified by removing the tapered ends and pistons. Boiled chicken meat was tightly packed between the 8 mL and 10 mL markers of each syringe. Syringes were positioned vertically with the 10 mL marker above. Two mL each of 8 reagents (fresh pineapple juice (FPJ), frozen-thawed fresh (FTPJ), fresh kiwi juice (FKJ), commercially pasteurized pineapple juice, fresh papaya juice, fresh lemon juice, Coke, and saliva) were poured over the bolus of each syringe, thus dividing them equally into 8 separate groups (n ⫽ 10 in each group). Bolus movements were observed over a 23-hour period at 37°C ambient temperature. Movements were noted by recording the upper border of the meat bolus periodically in arbitrary syringe units. Results: At 4 hours and 30 minutes, mean movements (99% CI) for the FPJ, FTPJ, FKJ groups were 3.4 (1.2–5.6), 4.5 (0.9 – 8.0), and 3.9 (1.1– 6.8), respectively. At 23 hours, they were 1.3 (0.6 –2.1), 0.3 (0 –1.1), and 0.9 (0.5–2.3), with the saliva group (control) being 9.5 (8.9 –10.1). The differences in the mean bolus movement between FPJ, FTPJ, FKJ, and saliva were 8.15 (7.1–9.2), 9.15 (8.1–10.2), and 8.55 (7–10.1), respectively. Mann-Whitney U test showed P ⬍ 0.001 for all 3 groups. The papaya and Coke groups showed some bolus movement but did not reach statistically significant levels. Conclusion: Fresh pineapple and kiwi fruit juices, which contain proteolytic enzymes bromelain and actinidin respectively, appeared to dissolve chicken boluses effectively. The freezing process for 24 hours preserved Bromelain activity. Significance: Natural pineapple and kiwi fruit juices may be used to disimpact chicken bolus obstruction prior to endoscopic procedures. Support: We wish to thank Mr Bijoux and his team of microbiologist technicians at the Department of Medical Microbiology, Duncan Building 8th floor, University of Liverpool, UK, for their support.
R061
R062
The Efficacy of Fruit Juices in Disimpacting Meat Bolus Obstruction
Follow-Up Results of Cervical Tuberculous Lymphadenitis
Christopher Low, MBChB MRCS (presenter); Christopher J Webb, FRCS; Ligy Thomas, FRCS; Emeline Ramos, MBChB; Alessandro Panarese, MD FRCS; Raymond W Clarke, DCH FRCS(O); Tiffany Raynor, MD; W Jarrard Goodwin, Jr, MD
Mehmet F. Oktay, MD (presenter); Ismail Topcu, MD; Sebahattin Cureoglu, MD; Abdurrahman Senyigit, MD; Adem Arslan, MD Minneapolis MN; Diyarbakir Turkey; Saint Paul MN; Diyarbakir Turkey; Diyarbakir Turkey
Miriam S Teixeira, MD (presenter); Cleonice H.W. Hirata, MD; Vilma C.C. Filizzola, MD PhD; Luc Louis Maurice Weckx, MD PhD New York NY; Sao Paulo Brazil; Sao Paulo Brazil; Sao Paulo Brazil
POSTERS
P166
Otolaryngology– Head and Neck Surgery August 2004
Otolaryngology– Head and Neck Surgery Volume 131 Number 2
R063 Alterations in the Timing of Protrusive Tongue Muscle Forces in Aged Rats Hiromi Nagai, MD (presenter); John Russell, MS; Michelle Ragan, BS; Richard Konopacki, MS; Nadine P Connor, PhD Madison WI; Madison WI; Madison WI; Madison WI; Madison WI
Problem: Reductions in tongue force magnitudes or alterations in temporal parameters of tongue muscle contraction may be found in elderly people and may contribute to age-related swallowing impairment. Tongue muscle contractile properties have been understudied, however, and the pathophysiology and sequelae of age-related changes in tongue function are relatively undefined. To help clarify the manner in which protrusive tongue forces may be altered by aging, we measured maximum protrusive tongue forces in old and young rats. Methods: Young and old Fischer 344/Brown Norway rats were anesthetized, the hypoglossal nerves were exposed bilaterally, and the medial branches were isolated and stimulated at supramaximal levels. Maximum protrusive twitch force, tetanic
force, contraction time, and half-relaxation time were measured via a force transducer attached to the tongue tip with a suture. Results: Maximum protrusive tongue forces were not altered as a function of aging in rats, while temporal parameters were prolonged in the old animals. Conclusion: With supramaximal stimulation of the medial branches of the hypoglossal nerves bilaterally, temporal characteristics of protrusive force generation were impaired in aged tongue muscle. Significance: Altered temporal properties of swallowing have been reported in human videofluroscopic studies as a function of aging. Our results suggest that temporal parameters of muscle contraction in the upper airway may contribute to these age-related decrements in cranial motor function. Support: National Institute on Deafness and Other Communication Disorders R064 Withdrawn. R065 Dynamic Evaluation of the Velopharynx in SleepDisordered Breathing Patients Beom Cho Jun, MD; Sang-Won Yeo, MD PhD; Kwang-Jae Cho, MD; Dong-Hee Lee, MD Uijungbu-Kyongg South Korea; Seoul South Korea; Uijongbu City South Korea; Uijongbu South Korea
Problem: Polysomnography is a functional diagnostic tool for recording the actual sleep apnea, but it fails to show the anatomical changes of the velopharyngeal area that occur during the sleep cycle, and it is not always feasible as a postoperative test because of its cost, and time-consuming nature. The purpose of this study was to evaluate the role of the fiberoptic endoscope video recording as an alternative pre- and postoperative test of the OSA patients. Methods: Fifteen OSA patients who underwent UPPP were enrolled pre- and postoperatively. Snoring and daytime sleepiness were evaluated subjectively. The status of the velopharynx was recorded with fiberoptic videonasoendoscopy during voluntary palatal snoring and expiration. The images were reconstructed according to time sequence. The Compliance and Collapsibility Indexes were calculated. Results: The average postoperative compliance of the velopharyngeal area decreased significantly. The Collapsibility Index significantly decreased after UPPP and was correlated with subjective symptoms. Conclusion: Fiberoptic nasoendoscopy is a simple but useful method that can be used in the dynamic evaluation of the pre-and postoperative velopharynx of OSA patients on an outpatient basis. Significance: This method will help us to evaluate the dynamic movement of velopharynx on an outpatient basis, before and after sugery.
POSTERS
Problem: To investigate the efficacy of medical antituberculous treatment in patients with tuberculous cervical lymphadenitis without pulmonary tuberculosis. Methods: We followed 46 patients with tuberculous cervical lymphadenitis who were treated at Dicle University, Diyarbakir, Turkey between 1996 and 2001. Mean age at presentation was 32.2 ⫾ 14.9. Diagnosis was based on clinical findings, results of the PPD tests (Mantoux test) and histopathologic appearance of caseating granuloma, which was consistent with tuberculosis in all cases. The chief complaint was a cervical mass localized mostly to the posterior cervical and/or submandibular regions. Treatment included standard antituberculous medications including isoniasid, rifampisin, and etambutol. Treatment period was between 9 and 12 months with a mean of 7.8 months. During follow-up, excisional biopsy was performed when the lymphadenopathy was bigger than 1 cm in diameter. Results: After clinical and histopathological evaluation, recurrent disease was observed in 8 patients (17 %). Lymphadenopathy was detected in the cervical region (6 patients) mesentery (1 patient) and spleen (1 patient). Cervical excisional biopsy was consistent with tuberculosis in these 6 patients. Conclusion: Patients with tuberculous cervical lymphadenitis should have follow-ups regularly. When there is no cure, the treatment period should be extended to eradicate the disease and other treatment alternatives such as surgery should be kept in mind. Significance: Mycobacterial infections have been shown to be increasing in number worldwide. Standard anti-tuberculous drugs are used for medical treatment. Anti-tuberculous drug resistance is also becoming more frequent. Support: None reported.
Research Posters P167
R060 A Clinical and Histopathological Study of the Oral Component in Sjo ¨ gren’s Syndrome
Liverpool United Kingdom; Liverpool United Kingdom; Liverpool United Kingdom; Liverpool United Kingdom; Liverpool United Kingdom; Huddersfield United Kingdom; Miami FL; Miami FL
Problem: Sjo¨ gren’s syndrome (SS) is a chronic autoimmune disease, characterized by a progressive lymphocytic and plasma cell infiltration of the exocrine glands, particularly of the salivary and lacrimal glands. The progression of the disease leads to the decrease of the glandular function and consequently to the development of xerostomia and keratoconjunctivitis sicca. SS may occur alone (primary) or in association with another autoimmune disease (secondary) such as rheumatoid arthritis, systemic lupus erythematosus, polymyositis, and scleroderma. Methods: The goal of this study was to assess the clinical and histopathological characteristics of the oral component of SS in patients assisted at the Stomatology Division of the Otorhinolaryngology and Head and Neck Surgery Department of Universidade Federal de Sa˜ o Paulo, Brazil. Twenty-four adult female patients were enrolled in the study and classified according to the European Criteria for Sjo¨ gren’s Syndrome. All patients were submitted to a detailed oral evaluation, and the oral signs and symptoms were correlated to the focal sialadenitis present in the labial salivary gland biopsy. Results: The patients were predominantly of white ethnicity (79.1%) in their sixth decade of life. Xerostomia was the most relevant oral symptom, present in 79.1% of patients. We found a positive correlation between the enlargement of the major salivary gland and the decrease or thickening of saliva during the oral examination and a higher number of lymphoplasmocitary foci / 4 mm2⬎4 mm2. Conclusion: Although the oral symptoms, chronic and/or recurrent salivary gland enlargement, and oral mucosa dryness are strongly suggestive of SS, they cannot be considered the only oral criteria for the diagnosis of this syndrome. Lymphoplasmocitary infiltration of the minor salivary gland was found even in patients without oral symptoms, corroborating the importance of the minor salivary gland biopsy as part of the SS diagnosis. Significance: This study provides a better understanding of the oral characteristics of Sjo¨ gren’s Syndrome, and the importance of proper criteria use for its clinical diagnosis. Support: None reported.
Problem: Impacted meat bolus in the oesophagus carries an increased risk of morbidity and mortality if it requires retrieval by endoscopic procedures. Certain naturally occurring fruit juices and Coke have been implicated to dissolve meat boluses but without conclusive evidence. This study aimed to ascertain the efficacy of various fruit juices and Coke in dissolving and dislodging meat boluses in vitro. Methods: Eighty 10 mL syringes were modified by removing the tapered ends and pistons. Boiled chicken meat was tightly packed between the 8 mL and 10 mL markers of each syringe. Syringes were positioned vertically with the 10 mL marker above. Two mL each of 8 reagents (fresh pineapple juice (FPJ), frozen-thawed fresh (FTPJ), fresh kiwi juice (FKJ), commercially pasteurized pineapple juice, fresh papaya juice, fresh lemon juice, Coke, and saliva) were poured over the bolus of each syringe, thus dividing them equally into 8 separate groups (n ⫽ 10 in each group). Bolus movements were observed over a 23-hour period at 37°C ambient temperature. Movements were noted by recording the upper border of the meat bolus periodically in arbitrary syringe units. Results: At 4 hours and 30 minutes, mean movements (99% CI) for the FPJ, FTPJ, FKJ groups were 3.4 (1.2–5.6), 4.5 (0.9 – 8.0), and 3.9 (1.1– 6.8), respectively. At 23 hours, they were 1.3 (0.6 –2.1), 0.3 (0 –1.1), and 0.9 (0.5–2.3), with the saliva group (control) being 9.5 (8.9 –10.1). The differences in the mean bolus movement between FPJ, FTPJ, FKJ, and saliva were 8.15 (7.1–9.2), 9.15 (8.1–10.2), and 8.55 (7–10.1), respectively. Mann-Whitney U test showed P ⬍ 0.001 for all 3 groups. The papaya and Coke groups showed some bolus movement but did not reach statistically significant levels. Conclusion: Fresh pineapple and kiwi fruit juices, which contain proteolytic enzymes bromelain and actinidin respectively, appeared to dissolve chicken boluses effectively. The freezing process for 24 hours preserved Bromelain activity. Significance: Natural pineapple and kiwi fruit juices may be used to disimpact chicken bolus obstruction prior to endoscopic procedures. Support: We wish to thank Mr Bijoux and his team of microbiologist technicians at the Department of Medical Microbiology, Duncan Building 8th floor, University of Liverpool, UK, for their support.
R061
R062
The Efficacy of Fruit Juices in Disimpacting Meat Bolus Obstruction
Follow-Up Results of Cervical Tuberculous Lymphadenitis
Christopher Low, MBChB MRCS (presenter); Christopher J Webb, FRCS; Ligy Thomas, FRCS; Emeline Ramos, MBChB; Alessandro Panarese, MD FRCS; Raymond W Clarke, DCH FRCS(O); Tiffany Raynor, MD; W Jarrard Goodwin, Jr, MD
Mehmet F. Oktay, MD (presenter); Ismail Topcu, MD; Sebahattin Cureoglu, MD; Abdurrahman Senyigit, MD; Adem Arslan, MD Minneapolis MN; Diyarbakir Turkey; Saint Paul MN; Diyarbakir Turkey; Diyarbakir Turkey
Miriam S Teixeira, MD (presenter); Cleonice H.W. Hirata, MD; Vilma C.C. Filizzola, MD PhD; Luc Louis Maurice Weckx, MD PhD New York NY; Sao Paulo Brazil; Sao Paulo Brazil; Sao Paulo Brazil
POSTERS
P166
Otolaryngology– Head and Neck Surgery August 2004
Otolaryngology– Head and Neck Surgery Volume 131 Number 2
R063 Alterations in the Timing of Protrusive Tongue Muscle Forces in Aged Rats Hiromi Nagai, MD (presenter); John Russell, MS; Michelle Ragan, BS; Richard Konopacki, MS; Nadine P Connor, PhD Madison WI; Madison WI; Madison WI; Madison WI; Madison WI
Problem: Reductions in tongue force magnitudes or alterations in temporal parameters of tongue muscle contraction may be found in elderly people and may contribute to age-related swallowing impairment. Tongue muscle contractile properties have been understudied, however, and the pathophysiology and sequelae of age-related changes in tongue function are relatively undefined. To help clarify the manner in which protrusive tongue forces may be altered by aging, we measured maximum protrusive tongue forces in old and young rats. Methods: Young and old Fischer 344/Brown Norway rats were anesthetized, the hypoglossal nerves were exposed bilaterally, and the medial branches were isolated and stimulated at supramaximal levels. Maximum protrusive twitch force, tetanic
force, contraction time, and half-relaxation time were measured via a force transducer attached to the tongue tip with a suture. Results: Maximum protrusive tongue forces were not altered as a function of aging in rats, while temporal parameters were prolonged in the old animals. Conclusion: With supramaximal stimulation of the medial branches of the hypoglossal nerves bilaterally, temporal characteristics of protrusive force generation were impaired in aged tongue muscle. Significance: Altered temporal properties of swallowing have been reported in human videofluroscopic studies as a function of aging. Our results suggest that temporal parameters of muscle contraction in the upper airway may contribute to these age-related decrements in cranial motor function. Support: National Institute on Deafness and Other Communication Disorders R064 Withdrawn. R065 Dynamic Evaluation of the Velopharynx in SleepDisordered Breathing Patients Beom Cho Jun, MD; Sang-Won Yeo, MD PhD; Kwang-Jae Cho, MD; Dong-Hee Lee, MD Uijungbu-Kyongg South Korea; Seoul South Korea; Uijongbu City South Korea; Uijongbu South Korea
Problem: Polysomnography is a functional diagnostic tool for recording the actual sleep apnea, but it fails to show the anatomical changes of the velopharyngeal area that occur during the sleep cycle, and it is not always feasible as a postoperative test because of its cost, and time-consuming nature. The purpose of this study was to evaluate the role of the fiberoptic endoscope video recording as an alternative pre- and postoperative test of the OSA patients. Methods: Fifteen OSA patients who underwent UPPP were enrolled pre- and postoperatively. Snoring and daytime sleepiness were evaluated subjectively. The status of the velopharynx was recorded with fiberoptic videonasoendoscopy during voluntary palatal snoring and expiration. The images were reconstructed according to time sequence. The Compliance and Collapsibility Indexes were calculated. Results: The average postoperative compliance of the velopharyngeal area decreased significantly. The Collapsibility Index significantly decreased after UPPP and was correlated with subjective symptoms. Conclusion: Fiberoptic nasoendoscopy is a simple but useful method that can be used in the dynamic evaluation of the pre-and postoperative velopharynx of OSA patients on an outpatient basis. Significance: This method will help us to evaluate the dynamic movement of velopharynx on an outpatient basis, before and after sugery.
POSTERS
Problem: To investigate the efficacy of medical antituberculous treatment in patients with tuberculous cervical lymphadenitis without pulmonary tuberculosis. Methods: We followed 46 patients with tuberculous cervical lymphadenitis who were treated at Dicle University, Diyarbakir, Turkey between 1996 and 2001. Mean age at presentation was 32.2 ⫾ 14.9. Diagnosis was based on clinical findings, results of the PPD tests (Mantoux test) and histopathologic appearance of caseating granuloma, which was consistent with tuberculosis in all cases. The chief complaint was a cervical mass localized mostly to the posterior cervical and/or submandibular regions. Treatment included standard antituberculous medications including isoniasid, rifampisin, and etambutol. Treatment period was between 9 and 12 months with a mean of 7.8 months. During follow-up, excisional biopsy was performed when the lymphadenopathy was bigger than 1 cm in diameter. Results: After clinical and histopathological evaluation, recurrent disease was observed in 8 patients (17 %). Lymphadenopathy was detected in the cervical region (6 patients) mesentery (1 patient) and spleen (1 patient). Cervical excisional biopsy was consistent with tuberculosis in these 6 patients. Conclusion: Patients with tuberculous cervical lymphadenitis should have follow-ups regularly. When there is no cure, the treatment period should be extended to eradicate the disease and other treatment alternatives such as surgery should be kept in mind. Significance: Mycobacterial infections have been shown to be increasing in number worldwide. Standard anti-tuberculous drugs are used for medical treatment. Anti-tuberculous drug resistance is also becoming more frequent. Support: None reported.
Research Posters P167