PURPOSE: The study analyses outcomes of the surgical treatment of odontogenic sinusitis that concurrently address sinusitis and its dental source. METHODS: A total of 364 adult patients were included, representing 13% of all patients we have operated on for any rhinosinusitis over the past 18 years. The diagnosis was based on both ENT and dental examinations including CT imaging. Patients were divided into three groups: (1) FESS with dental surgery without antrotomy, (2) FESS with intraoral antrotomy, and (3) intraoral surgery without FESS. The mean postoperative follow-up was 15 months. RESULTS: First group involved 64%, second group 31%, and third group 6% of the cases. The one-stage combined ENT and dental approach was used in 94% of cases (group 1 and 2) with a success rate of 97%. Concerning FESS, maxillary sinus surgery with middle meatal antrostomy only was performed in 54% of patients. Oroantral communication flap closure was performed in 56% of patients (success rate 98%). Healing was achieved within 3 months. The majority (87%) of patients were operated on unilaterally for unilateral findings. Over the past 18 years, a 6% increase of implant-related odontogenic sinusitis was observed. CONCLUSION: Odontogenic sinusitis is common, tending to be unilateral and chronic. Its dental source needs to be uncovered and treated and should not be underestimated. Close cooperation between ENT and dental specialists has a crucial role in achieving optimal outcomes. The one-stage combined surgical approach proves to be a reliable, safe, fast and effective treatment.
Importance: Recurrent respiratory papillomatosis (RRP) is a rare benign chronic disease of the larynx etiologically linked with the infection of low-risk human papillomavirus (HPV). Combination of surgical and immunomodulatory therapy has limited success. Possible use of prophylactic HPV vaccine that includes HPV-6 and HPV-11 antigens has been studied. Objective: To evaluate if the HPV vaccination is associated with a lower number of recurrences requiring surgical intervention in patients with new and recurrent RRP. Design, Setting, and Participants: This was a non-placebo-controlled intervention study. Enrollment data were collected from October 2011 to August 2013. The patients were followed up at 1 month, 12 months, and 5 years after the third dose of the vaccine and clinically monitored until December 31, 2018. Data were analyzed from 2019 to 2021. Altogether, 50 adults with active RRP were enrolled and followed up in referral centers. For the final outcome, follow-up data for 42 patients were available. Eight patients who did not fulfill the protocol were excluded. Interventions: All patients received HPV vaccine as an adjuvant treatment and were clinically followed up. When RRP progression or a significant recurrent lesion was detected, surgical removal via direct laryngoscopy was indicated. No adjuvant therapy with antiviral or biological agents was used. Main Outcomes and Measures: This study compared the prevaccination and postvaccination positivity for HPV-specific antibodies. The main outcome was the difference in the frequency of RRP recurrences in the prevaccination and postvaccination period. Results: A total of 50 patients with RRP were enrolled (median [SD] age, 41.5 [12.3] years [range, 21-73 years]; 39 [78%] men and 11 [22%] women). After HPV vaccination, patients with previously no HPV-specific antibodies showed seroconversion, and all patients developed 100-fold higher levels of HPV vaccine type-specific antibodies compared with the prevaccination period. In patients with recurrent RRP, decreased frequency of recurrences requiring surgical treatment was present after vaccination (from 0.85 to 0.36 recurrences/y). No difference in postvaccination recurrences was found between patients with newly diagnosed and recurrent RRP. Conclusions and Relevance: In this nonrandomized clinical trial, the frequency of RRP recurrences was significantly lower after HPV vaccination, and patients with RRP thus had a reduced burden of disease. Because no difference was detected in the frequency of recurrent postvaccination lesions in patients with new and recurrent disease, it appears that both groups showed equal benefit following HPV vaccination. These findings suggest that the earlier that patients with RRP receive HPV vaccine, the sooner they may show reduced burden of disease. Trial Registration: EudraCT Identifier: 2011-002667-14; ClinicalTrials.gov Identifier: NCT01375868.
- MeSH
- Alphapapillomavirus * MeSH
- dospělí MeSH
- infekce dýchací soustavy * prevence a kontrola MeSH
- infekce papilomavirem * prevence a kontrola MeSH
- lidé MeSH
- vakcinace MeSH
- vakcíny proti papilomavirům * MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- klinické zkoušky MeSH
- práce podpořená grantem MeSH
Úvod: Tyreoidektomie patří k nejčastěji prováděným výkonům v endokrinologické chirurgii. Operace jsou potenciálně spojeny s rizikem komplikací, které mohou způsobovat celoživotní zdravotní následky. Cílem studie bylo analyzovat incidenci pooperačních paréz zvratného nervu a hypokalcemií. Materiál a metody: Retrospektivní analýza operovaných za období deseti let, kde kromě pohlaví, věku, zastoupení benigních onemocnění a maligních nádorů, počtu provedených operací, byla sledována incidence pooperační parézy zvratného nervu (NLR) a hypokalcemie. K objektivnímu porovnání výsledků chirurgické léčby z hlediska incidence paréz NLR byl stanoven index IRI (index of recurrent injury). Podle počtu provedených operací byli operatéři zařazeni do 4 skupin, (A-D) a v každé skupině byla analyzována incidence pooperační parézy zvratného nervu a hypokalcemie. Výsledky: Operováno bylo 1334 pacientů s průměrným věkem 52,2 let; žen bylo 1113 (83,4 %). Maligní nádory byly diagnostikovány u 227 operovaných (17 %), z toho bylo 222 karcinomů (97,8 %). Totální tyreoidektomie byla provedena u 1067 operovaných (80,0 %) a hemityreoidektomie u 267 operovaných (20,0 %). Trvalou jednostrannou parézu zvratného nervu má 1,4 % operovaných s maligním nádorem a 0,7 % pacientů s benigním onemocněním (p=0,045). Permanentní hypokalcemii mají 2 % pacientů s maligním nádorem a 0,7 % s benigním onemocněním (p=0,011). Nejvyšší incidence komplikací byla u skupiny středně pokročilých chirurgů, permanentní hypokalcemii mělo 4,2 %, jednostrannou parézu zvratného nervu u 2,8 % operovaných. Závěr: Výsledky analýzy potvrzují, že pooperační komplikace jsou srovnatelné s velkými renomovanými centry. Znalosti a zkušenosti tyreoidálního chirurga jsou větší zárukou bezpečnosti výkonu než volba minimální radikality.
Introduction: Thyroidectomy belongs to most frequently performed operations in endocrinology surgery. The operations and potentially associated with the risk of complications, which may cause lifelong health consequences. The aim of the study was to analyze incidence of postoperative pareses of recurrent nerve and hypocalcemia. Material and methods: Retrospective analysis of patients operated on over the period of ten years included, in addition to sex, age, representation of benign diseases and malignant tumors, the number of performed operations, also the incidence of postoperative paresis of recurrent nerve (NLR) and hypocalcemia. For an objective comparison of the results of surgical therapy from the standpoint of incidence of NLP pareses the index of recurrent injury (IRI index) was determined. The surgeons were divided into four groups according to number of performed operations and the incidence of complications was analyzed there. Results: A total of 1334 patients at the average age of 52.5 years, 1113 of them were women (83.4%). Malignant tumors were diagnosed in 227 patients (17%), 222 of them were carcinomas (97.8%). Total thyroidectomy was performed in 1067 patients (80%) and hemithyroidectomy included 267 patients (20.0%). A unilateral paresis of recurrent nerve affected 1.4% of patients with malignant tumors and 0.7% of those with a benign disease (p=0.045). Permanent hypocalcemia affected 2% of patients with malignant tumors and 0.7% of those with a benign disease (p=0.011). The highest incidence of complications were encountered with medium advanced surgeons, permanent hypocalcemia affected 4.2% of the patients and unilateral paresis of recurrent nerve in 2.8% of the patients undergoing surgery. Conclusion: Results of the analysis confirm that postoperative complications are comparable with the large respected centers. The knowledge and experience of a thyroidal surgeon represent a higher guarantee of the intervention safety than the selection of a minimally radical surgery.
- MeSH
- dospělí MeSH
- hyperkalcemie * MeSH
- incidence MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- nádory štítné žlázy chirurgie komplikace MeSH
- paréza MeSH
- pooperační komplikace * chirurgie MeSH
- poranění nervus laryngeus recurrens * epidemiologie chirurgie MeSH
- retrospektivní studie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- statistika jako téma MeSH
- tyreoidektomie * škodlivé účinky MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
Elektroléčba je část fyzikální léčby, při které je využíván léčebný účinek různých forem elektrické energie. Impulzoterapie je část elektroléčby, která využívá léčebný účinek přesně tvarovaných proudových impulzů. Od roku 2010 jsme zařadili tuto metodu jako doplněk terapie pacientů s iatrogenní i idiopatickou parézou hlasivky. Pokusili jsme se modifikovat metodiku tak, aby vyhovovala našim podmínkám a současně dosahovala pokud možno maximálního terapeutického efektu. Dle dosavadních zkušeností považujeme tuto metodu za vhodný doplněk terapie u výše zmíněné skupiny pacientů. Jako optimální se nám jeví její použití ve spojení s hlasovou terapií. Pacienty je velmi dobře snášena a podílí se výrazně i na psychologické složce léčby. Klíčová slova: elektroléčba, impulzoterapie, iatrogenní a idiopatická paréza hlasivky
Electrotherapy is a component of physical therapy, where the therapeutic influence of various forms of electric energy is used. Impulse therapy is a part of electrotherapy, which makes use of therapeutic effects of precisely shaped current impulses. Since 2010 we included this method as a supplement in the therapy of patients with iatrogenic and idiopathic paresis of vocal cord. We made an attempt to modify the method in a way that would suit to our conditions and, at the same time, to reach maximum possible therapeutic effect. According to our experience the method can be considered as a suitable supplement of therapy in the above mentioned group of patients. It appears to be optimally used in connection with vocal cords therapy. The method is well tolerated by patients and significantly participates in the psychological component of therapy. Keywords: electrotherapy, impulse therapy, iatrogenic and idiopathic paresis of vocal cord
Rekurentní respirační papilomatóza je onemocnění vyvolané infekcí lidskými papilomaviry, typy 6 a 11. Onemocnění postihuje děti i dospělé a významným způsobem snižuje kvalitu života nemocných. V současné době je léčba onemocnění chirurgická a adjuvantní. Výsledky léčby respirační papilomatózy nejsou uspokojivé, proto se stále hledají nové možnosti v terapii. Předmětem studie je vliv vakcinace proti human papilloma viru na vznik rekurentních respiračních papilomových lézí a interval remisí u pacientů s rekurentní respirační papilomatózou. Vakcinace proti human papilloma viru by mohla sloužit jako sekundární prevence rekurentní respirační papilomatózy.
The recurrent respiratory papillomatosis is a disease caused by the human papillomavirus type 6 and 11 infection. The disease affects both children and adults, and has a significant negative impact on their quality of life. Currently the treatment of the disease is surgical and adjuvant. Therapeutical results are not satisfactory, and thus new options are still being searched for. The subject of the study is the impact of vaccination against the human papilloma virus on development of recurrent respiratory papilloma lesions, and the remission intervals in patients with recurrent respiratory papillomatosis. The vaccination against the human papilloma virus could serve as secondary prevention of the recurrent respiratory papillomatosis.
- Klíčová slova
- papilomatóza hrtanu, HPV vakcinace, human papilloma virus, rekurentní respirační papilomatóza,
- MeSH
- financování organizované MeSH
- infekce papilomavirem etiologie prevence a kontrola terapie MeSH
- lidé MeSH
- nádory hrtanu etiologie prevence a kontrola terapie MeSH
- papilom etiologie prevence a kontrola terapie MeSH
- sekundární prevence MeSH
- vakcinace metody trendy MeSH
- vakcíny proti papilomavirům terapeutické užití MeSH
- Check Tag
- lidé MeSH
- MeSH
- lidé MeSH
- nemoci ucha klasifikace komplikace MeSH
- osteoskleróza chirurgie terapie MeSH
- otorinolaryngologické nemoci diagnóza MeSH
- otorinolaryngologie metody trendy MeSH
- poruchy sluchu klasifikace terapie MeSH
- presbyakuze diagnóza MeSH
- sluchové pomůcky klasifikace využití MeSH
- získané deformity ucha etiologie klasifikace terapie MeSH
- Check Tag
- lidé MeSH
