Medical and surgical outcome of retropharyngeal abscess and its prognosis

Although retropharyngeal abscess is not a common condition, it can impact the quality of life of the affected patients, and can even be life-threatening. Asphyxia, upper respiratory tract obstruction, and respiratory distress might then develop secondary to this abscess which continues to grow even larger increasing the seriousness of the complications. Surgical incisions and long-course medical and antibiotic therapies have been described in the literature for the management of retropharyngeal abscess. In this study, the literature review discusses the surgical and medical treatment of retropharyngeal abscesses and the predicted prognosis of the disease after treatment based on evidence obtained from studies in the literature. Early presentation and management are important in achieving better outcomes and enhancing the prognosis. Therefore, patients should be aware enough of the symptoms that might suggest the presence of a retropharyngeal abscess. Using intravenous antibiotics can achieve favorable outcomes. However, some adverse events might be associated and the treatment might not be completed as a result of reduced patient compliance. Surgical management is also efficacious and can be done by different approaches as discussed earlier. Nevertheless, it can also be associated with some complications. Therefore, providing optimal care for these patients should be considered in all scenarios to enhance the prognosis.

Recurrent episodes of viral croup in children: potential causes and approaches to its prevention

Viral croup is one of the most common causes of upper respiratory tract obstruction in children under 6 years of age. Frequent acute respiratory infections (ARIs) and a burdened history of allergies might be triggers for recurrent episodes of viral croup. Purpose — to study vitamin D status in infants with viral croup and the efficacy of cholecalciferol supplements for recurrent episodes prevention. Materials and methods. Hospital(based survey included 128 children aged 4–36 months with viral croup. Vitamin D status was evaluated by measuring serum 25 (OH) D levels. Control studies were performed after 12 weeks. A prospective follow(up study lasted for three years. Results. 32.8±4.1% (42/128) of hospitalized children with viral croup had a history of frequent episodes of ARIs (>6 episodes per year). Recurrent episodes of viral croup were more frequent in children with a burdened history of allergies compared to those who did not have allergies — 46.4±9.4% (13/28) vs. 23.0±4.2% (23/100) (р=0.028). At the time of enrollment, 47.6±4.4% (61/128) of children had optimal concentration of 25 (ОН) D (30–100 ng/ml). Serum 25 (OH) D levels in children who regularly received supplements were 33.5 ng/ml (27.2–44.5) at the time of control. Patients with a level of 25 (OH) D>30 ng/ml were less likely to have recurrent ARIs (0/29) during the observation period compared to those with a level of 25 (OH) D 20–30 ng/ml (25.0±10.8%, 4/16) (p=0.023). In children with a concentration of 25 (OH) D>30 ng/ml, the risks for recurrent episodes of viral croup in the future were 9 times lower (OR=9.00; 95% CI: 1.55–52.27), and the risks of more mild viral croup course were 11.4 times lower (OR=11.40; 95% CI: 1.20–108.29). Conclusions. Insufficient levels of vitamin D were recorded in 46.1±4.4% of children with viral croup. When the concentration of 25 (OH) D in serum increased to >30 ng/ml, the frequency of recurrent ARIs decreased (p=0.023); the risks for recurrent episodes of viral croup decreased, as well as the risks of more severe viral croup course. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the author. Key words: recurrent episodes, viral croup, children, causes, prevention.

Age Characteristics and Concomitant Diseases in Patients with Angioedema

BACKGROUND: Angioneurotic oedema (AE) is an unpredictable and dangerous disease directly threatening the patient's life due to a sudden onset of upper respiratory tract obstruction. The disease is associated with various causes and triggering factors, but little is known about the conditions that accompany AE. AIM: The study aims to determine the age-specificities and the spectrum of concomitant diseases in patients with AE. MATERIAL AND METHODS: The subjects of observation were 88 patients (53 women and 35 men) with angioneurotic oedema who underwent diagnostics and treatment in the Department of Occupational Diseases and Clinical Allergology of University hospital “Saint George”-Plovdiv. RESULTS: The highest level of disease prevalence was found in the age group over 50 years, both in males (45.71%) and females (54.72%). We found that the most often concomitant diseases in our patients with AE are cardiovascular (33%). On second place are the patients with other accompanying conditions outside of the target groups (27.3%). Patients with AE and autoimmune thyroiditis were 14.8%, and those with AE and skeletal-muscle disorders-10.2%. Given the role of hereditary factors in this disease, the profession of the patients is considered insignificant. CONCLUSION: Angioedema occurs in all age groups, but half of the cases are in people over 50 years of age. The most common concomitant diseases in angioedema are cardiovascular diseases.

Tonsilitis difteri dengan sumbatan jalan napas atas

Latar belakang: Difteri adalah penyakit infeksi yang disebabkan oleh kuman bacillus grampositif Corynebacterium diphtheriae. Bakteri ini terutama menyebabkan infeksi pada saluran napasberupa tonsilofaringitis, laringitis, maupun keduanya secara bersamaan, ditandai dengan terbentuknyapseudomembran. Kematian pada anak dengan penyakit ini umumnya terjadi karena sumbatan jalannapas atas, ataupun efek sistemik toksin difteri. Tujuan: Melaporkan dan menganalisis kasus tonsilitisdifteri yang berakhir dengan kematian meskipun telah mendapat tatalaksana sumbatan jalan napas atas.Laporan kasus: Kasus anak perempuan usia 4 tahun, dan anak laki-laki usia 5 tahun dengan tonsilitisdifteri disertai sumbatan jalan napas atas. Metode: Telaah literatur berbasis bukti mengenai tonsilitisdifteri, komplikasi, dan status imunisasi melalui database Cochrane, Pubmed Medline, dan EBSCOHost Medline. Berdasarkan kriteria inklusi dan eksklusi didapatkan 3 jurnal yang relevan dengan kasusyang dilaporkan. Hasil: Studi tersebut menyatakan tonsilitis difteri sebagai penyakit dengan komplikasisumbatan jalan napas dan jantung. Komplikasi jantung adalah penyebab kematian tertinggi pada tonsilitisdifteri. Status imunisasi pada kasus meninggal sebagian besar tidak lengkap, dan cakupan imunisasi totalmasih rendah. Kesimpulan: Tonsilitis difteri merupakan kasus jarang dengan tingkat kematian tinggiakibat komplikasi sumbatan jalan napas dan jantung. Kematian dapat terjadi akibat efek sistemik toksindifteri, meskipun sumbatan jalan napas telah diatasi. Status imunisasi yang tidak lengkap dan rendahnyacakupan imunisasi pada wilayah tempat tinggal penderita meningkatkan mortalitas kasus tonsilitis difteri. Kata kunci: tonsilitis difteri, sumbatan jalan napas atas, imunisasi difteri, toksin sistemik ABSTRACTBackground: Diphtheria is an acute infectious disease caused by Corynebacterium diphthe­riae, a gram-positive bacillus. The organism infects primarily the respiratory tract, where it causestonsillopharyngitis, laryngitis, or both, typically marked by the forming of pseudomembrane. In children,either the upper respiratory tract obstruction or the effects of diphtheria toxin are the most common causeof death. Purpose: To report and analyze tonsillitis diphtheria cases that ended up in fatality, althoughthe upper airway obstruction had been managed. Case report: Two cases of a 4-years girl and 5-yearsold boy with tonsillitis diphtheria with upper respiratory tract obstruction. Method: The evidence basedliterature regarding tonsillitis diphtheria, its complication and diphtheria immunization status wereconducted on Cochrane database, Pubmed Medline, and EBSCO Host Medline. Based on the inclusionand exclusion criteria, three studies were found relevant to our cases. Result: These studies stated thattonsillitis diphtheria is a disease with upper airway obstruction and cardiac complications. Cardiaccomplications are the leading cause of death. Immunization status in fatal cases was largely incompleteand total immunization coverage was still low. Conclusion: Tonsillitis diphtheria is a rare case with highmortality rate due to upper airway obstruction and cardiac complication. Systemic effect of diphtheriatoxin can lead to fatality although the airway obstruction had been managed. The incomplete immunizationstatus and the low immunization coverage increased the mortality of tonsillitis diphtheria. Keywords: tonsillitis diphtheria, upper airway obstruction, diphtheria immunization, systemic toxin

Isolated Primary Subglottic Laryngeal Amyloidosis Presenting as Sudden Airway Obstruction

ABSTRACT Laryngeal amyloidosis of head and neck is a rare benign disease of unknown etiology. It accounts for less than 1% of all the benign laryngeal tumors. It is seen most commonly in the 5th to 7th decade of life with 3:1 male to female predominance. It may present with hoarseness, pain or difficulty in breathing. We report a case of isolated laryngeal amyloidosis in a 46-year-old female who presented to us as a surgical emergency in stridor, requiring a tracheostomy. The patient was managed by staged microlaryngoscopy and CO2 laser excision, and is on regular follow-up. Laryngeal amyloidosis is an uncommon benign pathology, and can present with acute airway obstruction. Isolated subglottic laryngeal amyloidosis should be kept in mind in any case presenting with acute upper respiratory tract obstruction. Longterm follow-up is essential because of the slowly progressive nature of the disease. How to cite this article Vamanshankar H, Kakkillaya SB, Tandon S, Nayar RC. Isolated Primary Subglottic Laryngeal Amyloidosis Presenting as Sudden Airway Obstruction. Int J Phonosurg Laryngol 2012;2(1):30-32.

Toxicities of raw Alocasia odora

Alocasia, the Araceae family, is a genus of more than 100 species of perennial, herbaceous, diminutive to extremely large, usually robust herbs with a clear-to-milky latex. They are distributed throughout subtropical and tropical Asia and in the tropical western pacific as well as eastern Australia. Despite easy access to A odora, there have been no published reports in English regarding the toxic symptoms following the ingestion of raw A odora. Here, the clinical manifestations of 2 patients that ingested raw A odora are described. Two patients experienced oral numbness and intractable tongue pain, and 1 patient required endotracheal intubation because of upper respiratory tract obstruction. Although conservative treatment is the primary approach to A odora poisoning, physicians should be aware of the potential for upper respiratory obstruction in patients exposed to A odora, as well as the need for controlling tongue pain.