Anxiety symptoms present immediately following parental death and approximately 8 weeks following the death were evaluated in 38 prepubertal children. Comparison groups included 38 hospitalized depressed children and 19 normal children. Bereaved children and parents were administered the Grief Interview and all were administered standard diagnostic interviews (DICA-C/P). While no bereaved children met DSM-III-R criteria for any anxiety disorder, anxiety regarding other family members dying was reported in 55% of bereaved children immediately after death and in 63% approximately 8 weeks later. When DSM-III-R anxiety symptoms were assessed, bereaved children did not report significantly more anxiety symptoms in the approximate 8-week interval post-parental death than normal comparison children, and had significantly fewer anxiety symptoms than depressed children (p < 0.0001). Bereaved children who had the most anxiety symptoms were also likely to have a depressive disorder (p < 0.002). Age and sex of child, sex of surviving parent, anticipation of death, and family history of anxiety or depressive disorders were not significantly associated with increased anxiety.
Background
Immunoglobulin G4-related disease (IgG4-RD) is a recently recognized fibro-inflammatory pathology that has been reported to affect principally the retroperitoneum, hepatobiliary system, salivary glands, orbital structures or lymph nodes. However, IgG4-RD with laryngeal involvement is a very rare entity. Our aims were to describe a case of subglottic stenosis as first and only manifestation of IgG4-RD and review the literature. A patient with IgG4-RD affecting the larynx that presented as subglottic stenosis is described. A MEDLINE database search of IgG4-RD cases with laryngopharyngeal manifestations was also conducted. A 30-year-old Caucasian woman was referred to a tertiary care hospital for dyspnea on exertion, which had been increasing for the last 4 months. Medical and surgical procedures revealed a subglottic stenosis, with a histological finding of IgG4 positive plasma cell infiltration. There was no evidence of other organ involvement. She was successfully treated with oral glucocorticoids and rituximab infusions. Glucocorticoids were rapidly tapered and the rituximab regimen was optimized, with no evidence of relapses. In the literature review, we found a total of 12 reported cases with laryngopharyngeal involvement, two of them with subglottic stenosis. IgG4-RD of the larynx is rare but should be considered after excluding more common disorders.
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