Patient: Male, 59Final Diagnosis: Emphysematous epiglottitisSymptoms: Dysphonia • odynophagia • sore throatMedication: —Clinical Procedure: Direct laryngoscopy with incision and drainage of abscessSpecialty: OtolaryngologyObjective:Rare diseaseBackground:Despite a shift in the epidemiology of epiglottitis following the introduction of the Haemophilus influenzae type B vaccine, acute infectious epiglottitis continues to be a relatively common and potentially life-threatening infection in adults. Epiglottitis complicated by abscess is rare, and emphysematous abscess is even less common. Early diagnosis and intervention is paramount in reducing morbidity and mortality. Although case reports exist, photographic depiction of this complication is not readily available.Case Report:We present the case of a 59-year-old male with rapidly progressive emphysematous epiglottitis managed with awake fiber optic intubation followed by incision, drainage, and antibiotic therapy. Early recognition and intervention in this patient led to complete resolution of the infection, with no long-term sequelae.Conclusions:Clinicians should be familiar with the radiographic and endoscopic findings which support an emphysematous abscess, as well as the treatment and airway management concerns in such cases.
Objective The human papillomavirus (HPV) is common and carries a significant burden of disease. This is increasingly apparent in males with the rising incidence of HPV-related oropharyngeal cancer. Unfortunately, vaccination rates remain poor and are lowest in males. It is unclear if pediatricians are aware of the alarming rise of HPV-mediated head and neck cancers and the disproportionate effect on males. Study Design This investigation used a cross-sectional descriptive survey research design. Setting The survey was developed by investigators in the University of Wisconsin Division of Otolaryngology. Subjects and Methods The survey was distributed to 831 members of the Wisconsin Chapter of the American Academy of Pediatrics. Results A total response rate of 49.6% was achieved. Most supported routine vaccination in both sexes. Females are regarded as being at higher risk of an HPV-related cancer and are more often recommended vaccination. Most providers are unaware of the magnitude of HPV-related oropharyngeal cancer and the greater affliction in males. Conclusions Male vaccination is overwhelmingly supported by Wisconsin pediatricians, yet there is a preponderance toward vaccinating females, who are perceived as having greater risk for HPV-associated disease. This is likely because providers are unaware of the magnitude of HPV-driven oropharyngeal cancer and its predilection for males. A lack of provider awareness, in combination with out-of-date education material for parents, likely contributes to poor vaccination rates in males.
Pretracheotomy with tracheal exposure simplifies emergent surgical access to the airway. We believe tracheal exposure in the appropriately selected patient is a safe and cost-effective alternative to elective tracheotomy. © 2016 Wiley Periodicals, Inc. Head Neck 38: E2446-E2448, 2016.
The purpose of this investigation is to directly compare G175-405 and E6H4 p16-specific antibodies as immunomarkers of HPV-driven oropharyngeal carcinoma. The investigators designed a retrospective analysis using specimens from an archived tissue bank with known in situ hybridization and polymerase chain reaction status for HPV DNA. Fifty randomly selected oropharyngeal specimens were evaluated with both the G175-405 and E6H4 p16-specific monoclonal antibodies. Two pathologists, blinded to the HPV-specific testing status, evaluated p16 positivity for both antibody clones. Interrater agreement was determined using a Cohen κ coefficient. Sensitivity and specificity values were calculated using a standard 2×2 contingency table, then compared using McNemar test. Interrater agreement for interpretation of p16 expression was 92% (κ=0.84) for the G175-405 clone and 100% for the E6H4 clone (κ=1.0). The G175-405 stain had a sensitivity of 0.917 and specificity of 0.846. The E6H4 stain had a sensitivity of 1.000 and specificity of 0.769. Using McNemar test, there were no significant differences found for sensitivity (P=0.480) or specificity (P=0.480) values. The results of this study suggest that though both G175-405 and E6H4 antibody stains are statistically comparable immunomarkers for HPV-driven oropharyngeal carcinoma, the E6H4 clone offers improved interobserver reliability.
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