Association of Computed Tomography With Treatment and Timing of Care in Adult Patients With Peritonsillar Abscess.

Peritonsillar abscess (PTA) is a common occurrence in adult patients, and an important question in such often-seen disease processes is whether we are treating these patients effectively, efficiently, and economically. We sought to determine if a diagnostic computed tomography (CT) scan was associated with a difference in clinical intervention in adult patients with PTA and if CT was associated with delaying this intervention. We conducted a retrospective case-control study examining therapeutic interventions in adults with PTA.

Establishing the Need for an Evidence-Based Treatment Algorithm for Peritonsillar Abscess in Children.

In this retrospective case series, we report clinical factors associated with pediatric peritonsillar abscess (PTA), with hopes of contributing to the design of an evidenced-based, economic treatment approach. Charts were examined for presenting symptoms and signs. Each of these were analyzed for association with the presence of PTA and for association with treatment.

Reducing Opioid Prescribing Rates in Emergency Medicine.

Background: Pain management is one of the most common reasons patients visit the emergency department. Understanding the contributions of emergency medicine-and specifically Ochsner Health System's emergency providers-to the opioid crisis is important. Benchmark prescribing data indicated that Ochsner Health System emergency medicine providers' opioid prescription rates were significantly higher than the national average in emergency medicine.

Unusually high illness severity and short incubation periods in two foodborne outbreaks of Salmonella Heidelberg infections with potential coincident Staphylococcus aureus intoxication.

We describe the investigation of two temporally coincident illness clusters involving salmonella and Staphylococcus aureus in two states. Cases were defined as gastrointestinal illness following two meal events. Investigators interviewed ill persons.

Neonatal nasal septal deviation: Two cases of successful early surgical intervention.

Neonatal nasal septal deviations can occur as a result of trauma in utero or during birth. They are associated with significant clinical implications, including respiratory distress and failure to thrive. The incidence and classification of these deformities are varied in the otolaryngology literature.

Association Between Computed Tomographic Scan and Timing and Treatment of Peritonsillar Abscess in Children.

Importance: There is not a consensus on the best diagnostic algorithm for children with a potential peritonsillar abscess. The association of computed tomographic (CT) scanning in children with a pertonsillar abscess and intervention chosen by the treating physician, or the potential delay of treatment associated with such imaging, has not yet been explored.

Objectives: To determine if use of a CT scan is associated with a difference in clinical intervention for peritonsillar abscess and to determine if use of a CT scan is associated with delay of this intervention.

Respiratory failure after superior-based pharyngeal flap for velopharyngeal insufficiency: A rare complication.

Velopharyngeal insufficiency (VPI) is an uncommon pediatric disorder often associated with congenital syndromes. After speech therapy, surgery is the standard management. Many surgical approaches to VPI repair have been reported and the complications of these procedures are well documented.

Improving outcomes in a high-output pediatric otolaryngology practice.

Objectives: To identify factors associated with efficient operating room work flow on high volume pediatric otolaryngology days and the effects on provider and perceived parent satisfaction.

Methods: Retrospective review was performed of a sample of 20 days with greater than 10 cases per day performed by a pediatric otolaryngologist operating in 2 rooms. Turnover time and complications were the main outcome measures.

The efficacy of mitomycin and stenting in choanal atresia repair: a 20 year experience.

Objective: To determine the efficacy of topical mitomycin and stenting in patients that have undergone endoscopic repair of choanal atresia.

Methods: Retrospective review of 37 endoscopic operations on pediatric patients for choanal atresia.

Results: Twenty-six sides were operated on in 17 patients; 37 total operations were performed.

Community health assessment following mercaptan spill: Eight Mile, Mobile County, Alabama, September 2012.

Context: In 2008, a lightning strike caused a leak of tert-butyl mercaptan from its storage tank at the Gulf South Natural Gas Pumping Station in Prichard, Alabama. On July 27, 2012, the Alabama Department of Public Health requested Centers for Disease Control and Prevention epidemiologic assistance investigating possible health effects resulting from airborne exposure to mercaptan from a contaminated groundwater spring, identified in January 2012.

Objective: To assess the self-reported health effects in the community, to determine the scope of the reported medical services received, and to develop recommendations for prevention and response to future incidents.

Balloon dilation in the management of severe airway stenosis in children and adolescents.

Background/purpose: Children and adolescents with airway stenosis pose a clinical challenge. Recently, balloon dilation has been described, primarily for the treatment of early, immature, less severe airway stenosis. We describe our experience with 8 children and adolescents managed with balloon dilation, including severe, mature subglottic and tracheal stenosis.

Multiple branchial cleft anomalies in conjunction with a congenital dermal fistula of the lower extremity: first report of the Guarisco-Winters syndrome.

Branchial cleft anomalies are congenital remnants of the embryologic branchial clefts persisting past the embryo stage. Most occur singly and sporadically, though syndromic associations are described. Multiple branchial cleft anomalies coincident in the same patient are exceptionally rare, and rarer still are peripheral dermal sinus tracts on the extremities, with one prior documented case.

The oxime pro-2-PAM provides minimal protection against the CNS effects of the nerve agents sarin, cyclosarin, and VX in guinea pigs.

This study examined whether pro-2-PAM, a pro-drug dihydropyridine derivative of the oxime 2-pralidoxime (2-PAM) that can penetrate the brain, could prevent or reverse the central toxic effects of three nerve agents; sarin, cyclosarin, and VX. The first experiment tested whether pro-2-PAM could reactivate guinea pig cholinesterase (ChE) in vivo in central and peripheral tissues inhibited by these nerve agents. Pro-2-PAM produced a dose-dependent reactivation of sarin- or VX-inhibited ChE in both peripheral and brain tissues, but with substantially greater reactivation in peripheral tissues compared to brain.

In vivo oxime administration does not influence Ellman acetylcholinesterase assay results.

Organophosphorus compounds (OPs) are potent inhibitors of acetylcholinesterase (AChE). Treatment for OP poisoning is by administration of atropine sulfate, an oxime, and diazepam. Oximes such as 2-PAM are used to reactivate OP-inhibited AChE so as to restore normal enzymatic function and serve as a true antidote.

Update on the diagnosis and treatment of caustic ingestion.

Caustic ingestion is a serious medical problem with a variety of clinical presentations and a complicated clinical course. This article reviews the epidemiology and pathophysiology of caustic ingestion as well as the most current approaches to diagnosis and treatment. Finally, a recent case will be presented that highlights the difficulty this problem poses to a medical team.

Butylated hydroxytoluene chemoprevention of aflatoxicosis - effects on aflatoxin B(1) bioavailability, hepatic DNA adduct formation, and biliary excretion.

The extreme sensitivity of turkeys to aflatoxin B(1) (AFB(1)) is associated with efficient hepatic cytochrome P-450 (P450)-mediated bioactivation, and deficient glutathione S-transferase (GST) mediated detoxification. Butylated hydroxytoluene (BHT) protects against AFB(1) toxicity in turkeys through mechanisms that include competitive inhibition of P450-mediated AFB(1) bioactivation. To test whether dietary BHT alters hepatic AFB(1)-DNA adduct formation, excretion, and bioavailability of AFB(1)in vivo, turkeys were given diets with BHT (4000ppm) for 10 days, given a single oral dose of [(3)H]-AFB(1) (0.

Intraoperative fistulograms in the management of branchial apparatus abnormalities in children.

Objective: We sought to evaluate the role and efficacy of intraoperative fistulograms in visualizing branchial apparatus (fistula/sinus) abnormalities in the pediatric age group (3 months-12 years).

Methods: This was a retrospective analysis of 20 pediatric patients who underwent fistula and/or sinus excision during a period of 18 years (1988-2006).

Results: The male:female ratio was 11:9.

Obstructive lesions of the pediatric subglottis.

Purpose: To compile information regarding obstructive subglottic lesions in children, including anatomy, pathogenesis, prevention, evaluation, and treatment options, required for implementation of a multi-faceted treatment plan.

Method: Review of the literature.

Conclusions: Although they are infrequent, obstructive subglottic lesions pose significant challenges to treating physicians, from airway management and injury prevention to decannulation and voice rehabilitation.

Mechanisms of butylated hydroxytoluene chemoprevention of aflatoxicosis--inhibition of aflatoxin B1 metabolism.

Chemoprevention of toxicoses and/or cancer through the use of nutrients or pharmacologic compounds is the subject of intense study. Among the many compounds examined, food additives such as antioxidants are being considered due to their ability to reduce disease formation by either induction or inhibition of key enzyme systems. One such compound, butylated hydroxytoluene (BHT), has been found to protect against cancer formation caused by exposure to aflatoxin B1 (AFB1) in rodents.

Intracapsular versus standard tonsillectomy: review of literature.

For the past century, standard (total) tonsillectomy has been the preferred method for treating illness resulting from tonsillar infection and hypertrophy. With the advent of antibiotics, however, more cases of tonsillitis are treated medically. As a result, tonsillectomies are being performed less frequently for infection than for obstructive symptoms associated with tonsillar hypertrophy and sleep-disordered breathing.

Serum citrulline levels correlate with enteral tolerance and bowel length in infants with short bowel syndrome.

Objective: To determine if serum levels of CIT (a nonprotein amino acid synthesized by the intestine) correlate with total parenteral nutrition (PN)-independence in children with short bowel syndrome (SBS).

Study Design: We prospectively obtained serum amino acid profiles over a 24-month interval from all infants with SBS 3 weeks to 4 years of age. Remaining small intestine length was recorded at surgery, and percent enteral calories tolerated (enteral calories divided by enteral plus parenteral calories x 100) was determined in 24 infants with SBS and 21 age-matched controls (blood drawn for non-gastrointestinal symptoms).

Hemifacial microsomia.

Hemifacial microsomia is the second most common congenital facial anomaly, second only to cleft lip and palate. While its precise etiology is not yet known, it is likely caused by a disruption in the development of the first two branchial arches early in embryologic development. The resulting phenotype is one of varying degrees of unilateral hypoplasia of the mandible, ear deformity, and macrostomia.

Power-assisted partial adenoidectomy.

Objective: To describe partial adenoidectomy using a powered microdebrider and review the experience with the procedure.

Study Design: Prospective study and review.

Methods: To perform a power-assisted partial adenoidectomy, the surgeon directs the window in the microdebrider blade tip toward the tissue, which is drawn in by suction; the rotating blade then shaves the tissue.

Powered partial adenoidectomy.

Objective: To confirm our clinical impression that the powered microdebrider is superior to curettes for performing partial adenoidectomy (removal of the superior one half to three fourths of the adenoid pad).

Design: Observational study of 100 children undergoing partial adenoidectomy with the powered microdebrider compared with 40 children undergoing conventional partial adenoidectomy with curettes.

Setting: Private and public tertiary care centers.