558 results on '"Laryngeal papillomatosis"'
Search Results
2. Tumores de laringe infantiles (PDQ®)
- Published
- 2024
3. Childhood Laryngeal Tumors (PDQ®)
- Published
- 2024
4. Childhood Laryngeal Tumors Treatment (PDQ®)
- Published
- 2024
5. Tratamiento de los tumores de laringe infantiles (PDQ®)
- Published
- 2024
6. Laryngeal papillomatosis in a 3 year old infant: surgical and anesthesiological management.
- Author
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Castellana, G., Silvestri, J., Ciuffreda, M., Pisello, E., Buonamico, A., Brugiaferri, L., Sorrenti, S., Pennacchi, A., Piangatelli, C., and Galante, D.
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ANESTHESIOLOGY , *PAPILLOMAVIRUSES , *ANESTHESIA - Abstract
Juvenile-Onset recurrent respiratory papillomatosis (JORRP) is the most frequent benign neoplasm in children with tendency to recur. Human Papilloma Virus (HPV) types 6 and 11 are involved in its etiology. Maternal transmission during the passage through the birth canal is the most frequent modality of infection. Clinical manifestations of JO-RRP may include dysphonia, dysphagia, hoarseness, cough and, in the most severe cases, respiratory distress. We report a case of a 3-year-old infant with a history of hoarseness and persistent dysphonia. Laryngoscopy showed diffuse papillomatous warts involving the glottic space and the false vocal cords. An accurate preoperative anesthesiological evaluation was provided. Surgical intervention in microlaryngoscopy was performed under general anaesthesia. Removal of the papillomatous warty growths in microlaryngoscopy was achieved, with significant improvement of the glottic space. No intraoperative or postoperative complications occurred, the patient resumed per os feeding on the same day and was discharged the second postoperative day. At the follow up visit at 1-month, important improvement of the voice quality was evident; laryngoscopy showed the absence of pathology; a strict follow up was planned in order to detect any recurrences. [ABSTRACT FROM AUTHOR]
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- 2023
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7. The combined treatment effectiveness in adult laryngeal papillomatosis patients
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V. M. Svistushkin, V. I. Egorov, A. A. Ragimov, J. M. Mustafaev, K. B. Volkova, and A. V. Matveev
- Subjects
laryngeal papillomatosis ,human papilloma virus ,relapse prevention ,Medicine (General) ,R5-920 - Abstract
The problem of laryngeal papillomatosis remains unsolved for a long time in spite of a number of proposed treatment techniques. Frequent relapses, persistent hoarseness, repeated surgical intervention, all these call for new solutions. The article describes the findings of the study involving 50 patients of advanced age with laryngeal papillomatosis who were treated with a new method at I.M. Sechenov First Moscow State Medical University and leading clinics of the Moscow region.
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- 2022
8. Recurrent Respiratory Papillomatosis
- Author
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Dikkers, Frederik G., Seedat, Riaz Y., San Giorgi, Michel R. M., Remacle, Marc, editor, and Eckel, Hans Edmund, editor
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- 2022
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9. Comparing KTP and CO2 laser excision for recurrent respiratory papillomatosis: A systematic review
- Author
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Jimin Yang, Zhongcheng Xie, and Barnabas C. Seyler
- Subjects
532 nm potassium titanyl phosphate laser ,CO2 laser ,laryngeal papillomatosis ,recurrent respiratory papillomatosis ,systematic review ,Otorhinolaryngology ,RF1-547 ,Surgery ,RD1-811 - Abstract
Abstract Objective The CO2 laser and 532 nm potassium titanyl phosphate (KTP) laser have been applied to treat recurrent respiratory papillomatosis (RRP). This systematic review sought to compare outcome differences between these two methods. Data Sources Embase, Web of Science, PubMed, and the Cochrane Library. Review Methods CO2 laser and KTP laser studies were obtained by keyword searches of four authoritative medical databases. Articles were screened and retained when conforming to inclusion criteria. The primary outcome was cure rate; the secondary outcomes were recurrence, death, remission, clearance, and human papillomavirus (HPV)‐detected rates, as well as laser effectiveness rates. Postoperative complications rate was the safety outcome measure. All outcomes were summarized within the CO2 and KTP groups, with results statistically compared (p
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- 2022
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10. Anaesthetic challenges in recurrent respiratory papillomatosis with unyielding lesion.
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Srinivasan, Suganya, Senthilnathan, Muthapillai, Ganesan, Sivaraman, and Mohan, V
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TRACHEOTOMY ,PAPILLOMAVIRUSES ,ANESTHESIA ,HUMAN voice ,PAPILLOMA ,DISEASE relapse ,NEUROMUSCULAR blockade ,LARYNGEAL diseases ,SEVOFLURANE ,LARYNGOSCOPY ,CHILDREN - Abstract
Recurrent respiratory papillomatosis (RRP) is one of the most common laryngeal lesions in children. A 14-year-old female presented with complaints of a change in voice and noisy breathing. She underwent excision of laryngeal papillomatosis thrice before. Fibreoptic laryngoscopy revealed that the lesion was occluding the entire glottic chink except for a small opening through which she was breathing. As there was a risk of seeding of the distal airway following tracheostomy, the initial plan of tracheostomy was deferred. Anaesthesia was induced with sevoflurane. C-MAC™ laryngoscopy revealed that the entire glottic chink was occupied with the papillomatous lesion, and no opening was visualised. The lesion could not be negotiated with a 4 mm endotracheal tube and started bleeding. Immediately, surgeon was asked to perform a tracheostomy. With each recurring incidence of RRP, the probability of the papilloma's non-yielding nature may increase, making the negotiation of the lesion impossible. [ABSTRACT FROM AUTHOR]
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- 2023
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11. Adult-onset Recurrent Respiratory Papillomatosis at a South African Referral Hospital.
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Sibeko, Samukelisiwe R. and Seedat, Riaz Y.
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PAPILLOMAVIRUS diseases , *PAPILLOMA , *HEALTH services accessibility , *HIV infections , *HUMAN papillomavirus - Abstract
Objective: The aim of this study was to describe the clinical presentation and outcome of patients with adult-onset recurrent respiratory papillomatosis (AoRRP) in a developing country with the challenges of poor health care access and high prevalence of HIV infection. Materials and methods: This was a retrospective study of patients diagnosed with AoRRP who were managed in the Department of Otorhinolaryngology at Universitas Academic Hospital in Bloemfontein, South Africa over a 10 year period. Results: There were a total of 41 patients, of which 26 (63.4%) were male. The age at diagnosis ranged between 16.4 and 67.4 years (mean 39.4 ± 14.9 years). All patients presented with a hoarse voice, with three patients also having upper airway obstruction. Eight (19.5%) patients were HIV positive. HPV typing was performed in 29 patients; 14 had HPV11 disease, 12 had HPV6 disease and in 3 patients HPV DNA was not detected. There was no significant difference in initial presentation or outcome between HIV negative and HIV positive patients, or between patients with HPV6 and HPV11 disease. Two patients had malignant transformation of the papillomas. In both these patients, HPV was not detected in the papillomas. Conclusions: HPV type and HIV infection did not appear to influence the clinical presentation and outcome in patients with AoRRP. There is a risk of malignant transformation in patients in which HPV is not detected in the papillomas. [ABSTRACT FROM AUTHOR]
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- 2022
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12. Comparing KTP and CO2 laser excision for recurrent respiratory papillomatosis: A systematic review.
- Author
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Yang, Jimin, Xie, Zhongcheng, and Seyler, Barnabas C.
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PAPILLOMAVIRUS diseases , *CARBON dioxide lasers , *LASERS , *MEDICAL databases , *POTASSIUM phosphates , *LASER therapy , *KEYWORD searching - Abstract
Objective: The CO2 laser and 532 nm potassium titanyl phosphate (KTP) laser have been applied to treat recurrent respiratory papillomatosis (RRP). This systematic review sought to compare outcome differences between these two methods. Data Sources: Embase, Web of Science, PubMed, and the Cochrane Library. Review Methods: CO2 laser and KTP laser studies were obtained by keyword searches of four authoritative medical databases. Articles were screened and retained when conforming to inclusion criteria. The primary outcome was cure rate; the secondary outcomes were recurrence, death, remission, clearance, and human papillomavirus (HPV)‐detected rates, as well as laser effectiveness rates. Postoperative complications rate was the safety outcome measure. All outcomes were summarized within the CO2 and KTP groups, with results statistically compared (p <.05). Results: Overall, the cure rates were 87.25% (KTP group) and 75.98% (CO2 group; p <.05). Complication rates significantly differed between the KTP (2.32%) and CO2 (17.71%) groups (p <.0001). There was a relatively higher but not significant difference in the recurrence rates between the CO2 (18.6%) and KTP (10.87%) groups (p =.1595). The CO2 group remission rate was considerably lower (38.9%) than the KTP group (88.46%, p <.0001). HPV‐detected and clearance rates were only reported for the CO2 group. The bias risks were 13.1 ± 1.45 (CO2) and 13.6 ± 1.52 (KTP) for the two groups, indicating evidence was of fair quality. Conclusion: Overall, KTP laser excision showed significantly better postoperative clinical outcomes than the CO2 laser, with a lower failure rate. Available fair‐quality evidence suggests KTP laser excision might be better for treating RRP. Nevertheless, more high‐quality randomized controlled studies are needed to compare these two surgical techniques, particularly in terms of reporting functional data such as vocal outcomes. [ABSTRACT FROM AUTHOR]
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- 2022
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13. Complete response of laryngeal papillomatosis after HPV vaccination.
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Paderno A, Dohin IM, and Gennarini F
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- 2024
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14. Reports Outline Laryngeal Papillomatosis Research from Institute of Microbiology and Virology (Loss of Recurrent Laryngeal Papillomatosis following Postsurgical Treatment with dsRNA Interferon Inducer).
- Abstract
A recent study conducted by the Institute of Microbiology and Virology has provided insights into laryngeal papillomatosis, the most common benign laryngeal tumor in children. The study highlights the challenges in treating this condition, which can negatively impact patients' quality of life and require repeated medical intervention. The researchers describe a case report of a White male who experienced recurrent laryngeal papillomatosis from 2009 to 2016 and achieved complete resolution of the condition through treatment with a dsRNA-based antiviral drug. This research contributes to the understanding of potential adjuvant therapies for laryngeal papillomatosis. [Extracted from the article]
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- 2024
15. Benralizumab as an Adjuvant Therapy for Recurrent Laryngeal Papillomatosis.
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Krause, Kayla J., Goldrich, David, and Gniady, John
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Recurrent respiratory (RRP) or laryngeal papillomatosis is the result of human papillomavirus‐mediated benign tumor growth on the larynx and is challenging to manage. Benralizumab is a monoclonal antibody targeted against the alpha subunit of the IL‐5 receptor on eosinophils. A 61‐year‐old male patient presented with refractory RRP following multiple surgical excisions. His disease course improved substantially when benralizumab was added to his asthma regimen. There is no clear mechanistic role suggested for benralizumab directly treating RRP. This case may represent a novel application of benralizumab as an adjuvant treatment for patients with RRP and comorbid asthma. Laryngoscope, 133:863–865, 2023 [ABSTRACT FROM AUTHOR]
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- 2023
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16. Complete atrio-ventricular block with coronary artery spasm due to direct laryngoscopy in a pediatric patient with laryngeal papillomatosis: a case report
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Katsuyuki Matsushita, Risa Arai, Tetsuzo Nakayama, Toshiaki Nakagaki, Tadashi Kandabashi, and Ken Yamaura
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Coronary artery spasm ,Direct laryngoscopy ,Atrio-ventricular block ,Laryngeal Papillomatosis ,Anesthesiology ,RD78.3-87.3 ,Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Abstract
Abstract Background Coronary artery spasm has rarely been reported in pediatric patients. Previous studies have reported comorbidities and risk factors for coronary artery spasms. We present the case of a complete atrio-ventricular (AV) block that occurred in the absence of other risk factors immediately after direct laryngoscopy. Case presentation A 2-year-old girl developed severe coronary artery spasm after direct laryngoscopy for elective laryngeal papillomatosis resection. Immediately after the initiation of laryngoscopy, complete AV block and ST elevation on lead II of the electrocardiogram were observed. These findings indicated that the complete AV block was caused by a right coronary artery spasm. Conclusion Coronary artery spasm resulting in lethal arrhythmia rarely occurs in healthy pediatric patients. To the best of our knowledge, this is the first pediatric case of a severe coronary artery spasm resulting in a complete AV block due to direct laryngoscopy in a healthy patient.
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- 2021
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17. Obstructive fibrinous tracheal pseudomembrane: Sudden child death following laser removal of papillomata.
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Rhame, Caroline, Verster, Janette, Dempers, Johan, and Goussard, Pierre
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CHILD death , *SUDDEN death , *RESPIRATORY obstructions , *TRACHEA intubation , *LASERS - Abstract
Obstructive fibrinous tracheal pseudomembrane (OFTP) is a rare complication usually following endotracheal intubation, occurring when a collection of inflammatory exudate coalesces at the site of damaged epithelium within the trachea and along the tracheal mucosa, creating a luminal narrowing and subsequent airway obstruction. [ABSTRACT FROM AUTHOR]
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- 2022
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18. Obstructive fibrinous tracheal pseudomembrane: Sudden child death following laser removal of papillomata
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Caroline Rhame, Janette Verster, Johan Dempers, and Pierre Goussard
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inflammatory pseudomembrane ,laryngeal papillomatosis ,obstructive fibrinous tracheal pseudomembrane ,sudden death ,upper airway obstruction ,Medicine ,Medicine (General) ,R5-920 - Abstract
Abstract Obstructive fibrinous tracheal pseudomembrane (OFTP) is a rare complication usually following endotracheal intubation, occurring when a collection of inflammatory exudate coalesces at the site of damaged epithelium within the trachea and along the tracheal mucosa, creating a luminal narrowing and subsequent airway obstruction.
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- 2022
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19. Infantile recurrent respiratory papillomatosis: review of adjuvant therapies.
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Patel, A and Orban, N
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ONLINE information services , *MEDICAL databases , *INFORMATION storage & retrieval systems , *MEDICAL information storage & retrieval systems , *AIRWAY (Anatomy) , *ORGANOPHOSPHORUS compounds , *SYSTEMATIC reviews , *PAPILLOMA , *PEDIATRICS , *RESPIRATORY obstructions , *LARYNGEAL diseases , *HUMAN papillomavirus vaccines , *COMBINED modality therapy , *MEDLINE ,RESPIRATORY infection treatment - Abstract
Background: Recurrent respiratory papillomatosis is a potentially life-threatening condition characterised by the growth of exophytic lesions within the larynx and trachea. The principal aim of management is maintenance of an adequate airway by surgical debulking. Several adjuvant therapies have been used to varying effect to reduce the burden of this disease and increase the interval between debulking procedures. The most severe cases present in children aged under three years, who are therefore most likely to need adjuvant therapies. The current evidence base on adjuvant treatments relating to children who present aged under three years has been reviewed. Methods: A literature review of articles in Cochrane, PubMed and Embase databases was carried out. Given the rarity of the condition in this age group, all the literature relates to case reports and case series. Results and conclusion: The following adjuvant therapies have been used in children who presented under three years of age: quadrivalent human papilloma virus vaccine, intralesional cidofovir, pegylated interferon, alpha-interferon, cimetidine and cetuximab. [ABSTRACT FROM AUTHOR]
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- 2021
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20. Dynamics of immunological reactivity indices in patients with laryngal papillomatosis at different periods after complex treatment with antivirus qudrivalent vaccine 'Gardasil'
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D. I. Zabolotny, M. B. Sambur, T. D. Savchenko, L. D. Krіvokhatskaуа, T. A. Zayets, and M. D. Tymchenko
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laryngeal papillomatosis ,immunological reactivity ,antirelapse therapy ,antiviral quadrivalent vaccine ,Medicine - Abstract
The aim of the study is to determine disorders of immune homeostasis in patients with laryngeal papillomatosis at different periods after complex treatment with the inclusion of the “Gardasil” quadrivalent vaccine in the adjuvant therapy. Studies of the immunity state were conducted in 26 patients with laryngeal papillomatosis (LP) before, 2-12 and 13-29 months after complex treatment, consisting of surgical removal of papillomas and anti-relapse therapy, including inhalation of Laferobion, taking a vitamin-mineral complex and a course of vaccination with antiviral “Gardasil” quadrivalent vaccine according to which the second and third injections were administered in 2 and 6 months after the first. Significant disorders of cellular and humoral immunity indices in patients with LP were revealed in the form of multidirectional changes in the functional activity of natural killer cells, a decrease in the total number of T lymphocytes, mainly due to CD4 + subpopulation, increase in circulating immune complexes level in blood serum and concentration of secretory IgA in the secretion of the oropharynx. Disbalance in the patient’s cytokine system resulted in increased γ-IFN and TNF-α serum levels, an increase in spontaneous production of interferon and inhibition of stimulated production of λ - and γ-interferon by blood cells in vitro. Complex treatment with the use of the “Gardasil” quadrivalent antiviral vaccine in the postoperative period contributed to the normalization of most immunological reactivity indices that were altered in patients. The results indicate the prospects of using the antiviral vaccine as part of adjuvant antirelapse therapy after surgical treatment of LP patients and indicate the advisability of long-term clinical and immunological monitoring at different periods after vaccination.
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- 2020
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21. Promotion of BZW2 by LINC00174 through miR-4500 inhibition enhances proliferation and apoptosis evasion in laryngeal papilloma
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Jiajia Liu, Tao Yang, Ying Zhang, and Shuhui Wang
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Laryngeal papillomatosis ,BZW2 ,miR-4500 ,LINC00174 ,Apoptosis ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 ,Cytology ,QH573-671 - Abstract
Abstract Background We aimed to explore the roles of basic leucine zipper and W2 domains (BZW) 2 in the human papillomavirus-infected laryngeal papillomatosis. Methods In the present study, BZW 2 knockdown and overexpressed cell lines were constructed. CCK-8 and colony formation assays were used to determine cell proliferation. Caspase-3 activity and nucleosomes fragmentation assays were used to determine cell apoptosis. qRT-PCR and Western blot were employed to evaluate the mRNA and protein levels of target genes, respectively. Luciferase and biotin-coupled miRNA pulldown assays were used to examine the interactions between mRNA and mRNA. Results We observed the levels of BZW2 were up-regulated in the laryngeal papilloma (LP) tissues as compared with adjacent tissues. The knockdown of BZW2 significantly inhibited cell proliferation and promoted cell apoptosis in the LP cells. Additionally, we identified the expressions of BZW2 negatively regulated by miR-4500. Luciferase and biotin-coupled miRNA pulldown assays demonstrated that LINC00174 competed with the BZW2 for binding with miR-4500. Moreover, the results showed that LINC00174/miR-4500/BZW2 axis regulated cell proliferation and apoptosis. Conclusion Our results demonstrated that the regulation of LINC00174/miR-4500/BZW2 axis might be used as an effective strategy for treatment of human papillomavirus-infected laryngeal papillomatosis.
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- 2020
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22. A Case Report of Juvenile-Onset Recurrent Respiratory Papillomatosis.
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Kamaruzaman F, Ibrahim R, Nik Mohd NK, and Mohd Shakri N
- Abstract
The most common benign laryngeal neoplasm in children is a papilloma. Laryngeal papillomatosis is a chronic disease and is rare in children. We report the case of a four-year-old Malay girl in whom chronic laryngeal papillomatosis, most likely acquired vertically during labor, was detected. She presented with hoarseness of voice for three years, and a flexible laryngoscopy examination revealed features of papilloma in the glottis area. The patient underwent direct laryngoscopy followed by excision of mass using the cold instrument. Surgical intervention is the primary treatment modality for laryngeal papillomatosis to maintain airway patency and voice quality., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Kamaruzaman et al.)
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- 2024
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23. Correlation Between E6 and E7 Oncogenes and Malignant Transformation of Laryngeal Papillomatosis (LP) with Human Papillomavirus (HPV) in Pediatric Population.
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Khreefa, Zaid, Isaac, Vivian, Poulik, Janet, Felix, Richard, Selwanes, Wasim, Mangal, Ruchi, Dereje, Pheven, Fatouh, Khairya A., and Shehata, Bahig M.
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ONCOGENES , *RESPIRATORY mucosa , *PAPILLOMAVIRUSES , *ONCOGENIC viruses , *BENIGN tumors - Abstract
Laryngeal papillomatosis (LP) is the most common benign neoplasm affecting the upper respiratory tract mucosa in children. The most common genotypes of HPV associated with LP are types 6 and 11. Methods: Among 187 patients identified in our institution with LP, four cases showed malignant transformation to invasive squamous carcinoma. Results: These patients had tumors with HPV viruses that showed high expression of oncogene E6 and E7 and low expression of E2. Conclusion: Malignant transformation of LP is associated with oncogenic expression of E6 and E7. [ABSTRACT FROM AUTHOR]
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- 2021
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24. Larynx: Anatomy, Nonneoplastic, Benign, and Malignant
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Brandwein-Weber, Margaret S. and Brandwein-Weber, Margaret S.
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- 2018
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25. Contemporary Management of Recurrent Respiratory Papillomatosis in Children
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Bowe, Sarah N., Hartnick, Christopher J., and Campisi, Paolo, editor
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- 2018
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26. Papilomatosis laríngea como causa de muerte materna.
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Jiménez-Herrera, Rebeca, Fernández-Vázquez, María Urbelina, Cristina Quiterio-Montiel, Elia, Hernández y Ballinas, Ariadna, and Palmer-Márquez, María de Lourdes
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MATERNAL mortality ,PAPILLOMAVIRUSES ,PREGNANCY ,ASPHYXIA ,AUTOPSY ,LARYNGEAL tumors ,PAPILLOMAVIRUS disease diagnosis ,HISTOPATHOLOGY - Abstract
Copyright of Ginecología y Obstetricia de México is the property of Federacion Mexicana de Ginecologia y Obstetricia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
- Published
- 2021
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- View/download PDF
27. 5-Aminolevulinic acid photodynamic diagnosis of laryngeal papillomatosis
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I. G. Guseinov, K. Sh. Davudov, T. I. Garashchenko, I. I. Nazhmudinov, V. V. Vavin, B. K. Davudova, K. M. Magomedova, M. Yu. Khoranova, and B. Z. Abdullaev
- Subjects
laryngeal papillomatosis ,photodynamic diagnosis ,5-aminolevulinic acid ,Medicine - Abstract
Photodynamic diagnosis is a promising method in the treatment of laryngeal papillomatosis, which includes an assessment of the increased visual and spectrometric contrast of papillomatosis masses against the background of the introduction of the photosensitizer. We have developed a method of treatment of laryngeal papillomatosis in two stages: intraoperative diagnosis using the domestic preparation of 5-aminolevulinic acid hydrochloride and subsequent surgical treatment using a carbon dioxide laser. Using the new method, we treated 21 patients, of which 13 (61.9%) had the inter-recurrent period longer than 12 months.
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- 2019
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28. Complete atrio-ventricular block with coronary artery spasm due to direct laryngoscopy in a pediatric patient with laryngeal papillomatosis: a case report.
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Matsushita, Katsuyuki, Arai, Risa, Nakayama, Tetsuzo, Nakagaki, Toshiaki, Kandabashi, Tadashi, and Yamaura, Ken
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CORONARY arteries ,CHILD patients ,LARYNGOSCOPY ,SPASMS ,CORONARY vasospasm ,ARRHYTHMIA - Abstract
Background: Coronary artery spasm has rarely been reported in pediatric patients. Previous studies have reported comorbidities and risk factors for coronary artery spasms. We present the case of a complete atrio-ventricular (AV) block that occurred in the absence of other risk factors immediately after direct laryngoscopy. Case presentation: A 2-year-old girl developed severe coronary artery spasm after direct laryngoscopy for elective laryngeal papillomatosis resection. Immediately after the initiation of laryngoscopy, complete AV block and ST elevation on lead II of the electrocardiogram were observed. These findings indicated that the complete AV block was caused by a right coronary artery spasm. Conclusion: Coronary artery spasm resulting in lethal arrhythmia rarely occurs in healthy pediatric patients. To the best of our knowledge, this is the first pediatric case of a severe coronary artery spasm resulting in a complete AV block due to direct laryngoscopy in a healthy patient. [ABSTRACT FROM AUTHOR]
- Published
- 2021
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29. Juvenile Larynxpapillomatose: Therapieoptionen und Literaturübersicht
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Huebner, M. J., Schützenberger, A., Traxdorf, M., Dittrich, S., Iro, H., and Mueller, S. K.
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- 2022
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30. ДИНАМІКА ПОКАЗНИКІВ ІМУНОЛОГІЧНОЇ РЕАКТИВНОСТІ ХВОРИХ НА ПАПІЛОМАТОЗ ГОРТАНІ В РІЗНІ СТРОКИ ПІСЛЯ КОМПЛЕКСНОГО ЛІКУВАННЯ ЗАСТОСУВАННЯМ ПРОТИВІРУСНОЇ КВАДРИВАЛЕНТНОЇ ВАКЦИНИ «ГАРДАСИЛ».
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Заболотний, Д. І., Самбур, М. Б., Савченко, Т. Д., Кривохатська, Л. Д., Заєць, Т. А., and Тимченко, М. Д.
- Subjects
- *
KILLER cells , *SERUM , *T cells , *IMMUNE complexes , *BLOOD cells , *MINERAL supplements , *BCG vaccines , *IMMUNIZATION of children - Abstract
The aim of the study is to determine disorders of immune homeostasis in patients with laryngeal papillomatosis at different periods after complex treatment with the inclusion of the “Gardasil” quadrivalent vaccine in the adjuvant therapy. Studies of the immunity state were conducted in 26 patients with laryngeal papillomatosis (LP) before, 2-12 and 13-29 months after complex treatment, consisting of surgical removal of papillomas and anti-relapse therapy, including inhalation of Laferobion, taking a vitamin-mineral complex and a course of vaccination with antiviral “Gardasil” quadrivalent vaccine according to which the second and third injections were administered in 2 and 6 months after the first. Significant disorders of cellular and humoral immunity indices in patients with LP were revealed in the form of multidirectional changes in the functional activity of natural killer cells, a decrease in the total number of T lymphocytes, mainly due to CD4 + subpopulation, increase in circulating immune complexes level in blood serum and concentration of secretory IgA in the secretion of the oropharynx. Disbalance in the patient’s cytokine system resulted in increased γ-IFN and TNF-α serum levels, an increase in spontaneous production of interferon and inhibition of stimulated production of λ - and γ- interferon by blood cells in vitro. Complex treatment with the use of the “Gardasil” quadrivalent antiviral vaccine in the postoperative period contributed to the normalization of most immunological reactivity indices that were altered in patients. The results indicate the prospects of using the antiviral vaccine as part of adjuvant antirelapse therapy after surgical treatment of LP patients and indicate the advisability of long-term clinical and immunological monitoring at different periods after vaccination. [ABSTRACT FROM AUTHOR]
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- 2020
- Full Text
- View/download PDF
31. Angiolytische Laserverfahren am Kehlkopf: Phonochirurgische Aspekte bei transoraler Lasermikrochirurgie.
- Author
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Strieth, S., Hagemann, J., and Hess, M.
- Abstract
Copyright of HNO is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
- Published
- 2020
- Full Text
- View/download PDF
32. Topical 5-aminolevulinic acid photodynamic therapy for laryngeal papillomatosistosis treatment.
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Liang, Faya, Han, Pin, Chen, Renhui, Lin, Peiliang, Luo, Mingrui, Cai, Qian, and Huang, Xiaoming
- Abstract
• HPV infection is closely associated with the pathogenesis of Laryngeal papillomatosis. • Laryngeal papillomatosis recurrence can occur when latent HPV is activated. • Current surgical tools commonly used can't solve the latency and seeding of HPV. • Topical ALA-PDT can treat Laryngeal papillomatosis efficaciously and reduces tumor recurrence significantly. To explore the therapeutic effect of topical 5-Aminolevulinic Acid photodynamic therapy (ALA-PDT) on laryngeal papillomatosis (LP) treatment. 13 patients with LP underwent topical ALA-PDT after tumor resection (CO 2 laser or/and microdebrider resection). All patients were irradiated 3–4 times. After ALA-PDT treatment, the laryngoscopic examination was performed every 1–2 months to observe the therapeutic effect. All 13 patients were followed up for more than 1 year. Eleven cases (84.6%) showed no recurrence; two cases (15.4%) had relapses. One child developed III° inspiratory dyspnea caused by laryngeal mucosal edema and need endotracheal intubation again. Four patients had adhesion of the anterior commissure of the vocal cord. The detection rate of HPV infections was 76.9% and two patients had multiple HPV subtype co-infection. The preliminary effect of topical ALA-PDT significantly reduces recurrence and improves the cure rate of LP. Further research on this treatment is still required. [ABSTRACT FROM AUTHOR]
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- 2019
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33. [Epidemiological features of laryngeal papillomatosis in adults in Moscow].
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Kryukov AI, Romanenko SG, Oteyami AB, Amegan NH, Pavlikhin OG, Eliseev OV, Kurbanova DI, and Lesogorova EV
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- Humans, Moscow epidemiology, Male, Female, Adult, Retrospective Studies, Middle Aged, Risk Factors, Incidence, Prevalence, Neoplasm Recurrence, Local epidemiology, Papilloma epidemiology, Laryngeal Neoplasms epidemiology, Laryngeal Neoplasms pathology
- Abstract
Objective: To evaluate the incidence of laryngeal papillomatosis (LP) and LP recurrence in adults and to determine the risk factors for the development of LP recurrence in adults in Moscow. To solve the tasks set, a survey of patients carried out, including the collection of complaints and anamnesis, a standard examination of the ENT organs, an assessment of the condition of the larynx, and a histological examination., Material and Methods: We conducted a retrospective analysis of the case histories of 299 patients with LP observed and treated at the Sverzhevsky Research and Clinical Institute of Otorhinolaryngology in the period 2010-2020., Results: On average, over the entire study period, the prevalence of PG was 17.80%. It was found that out of 299 patients, 69.6% ( n =208) had a relapse of LP. Papilloma of the larynx were more often localized in the glottis. 275 (92%) patients had a widespread form of LP. LP recurrences were significantly more common in women and in patients with an existing cicatricle process in the larynx. The relapse rate was higher in non-smokers (73.5% vs 47.8%; p <0.001). Although the recurrence rate was higher in patients with non-voice occupations (70.6% vs. 52.9%), there was no statistically significant association between relapses and the vocal professions ( p =0.125)., Conclusion: As a result of the study, a number of risk factors for laryngeal papillomatosis recurrent have been identified, and their study should be continued.
- Published
- 2024
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34. Surgery for adult laryngeal papillomatosis.
- Author
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Primov-Fever, Adi and Madgar, Ory
- Abstract
Recurrent laryngeal papillomatosis is a viral (human papillomavirus) disease that causes the growth of epithelial verrucous lesions. Patients with laryngeal papillomatosis undergo multiple surgeries due to the tendency of the lesions to reoccur and cause recurrent voice and breathing problems. The goal of the surgical treatment is to remove the lesions while protecting the delicate layered structure of the vocal folds in order to prevent scarring and permanent damage to the mucosa. This is a review of the currently performed operative procedures for treating recurrent adult laryngeal papillomatosis. They involve the use of cold instruments, lasers, and microdebriders. There is a trend towards preferential use of microdebriders and office-based laser procedures in compliant patients. There is no consensus on any surgical method of choice, and further investigations and long-term results of the ones in current use are warranted to provide more clear-cut guidelines for optimal management. [ABSTRACT FROM AUTHOR]
- Published
- 2019
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35. Therapeutic Use of the Human Papillomavirus Vaccine on Recurrent Respiratory Papillomatosis: A Systematic Review and Meta-Analysis.
- Author
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Rosenberg, Tine, Philipsen, Bahareh B, Mehlum, Camilla S, Dyrvig, Anne-Kirstine, Wehberg, Sonja, Chirilǎ, Magdalena, and Godballe, Christian
- Subjects
- *
META-analysis , *HUMAN papillomavirus vaccines , *PAPILLOMA , *LARYNGEAL diseases , *LARYNGEAL surgery - Abstract
Background Recurrent respiratory papillomatosis is a benign condition caused by human papillomavirus (HPV). Surgery is the mainstay of treatment, but numerous adjuvant therapies have been applied to improve surgical outcome. Recently, HPV vaccination has been introduced, but only smaller studies of its effect have been published. The present meta-analysis is intended as a possible substitute for a proposed but not yet realized multicenter randomized controlled trial. Methods A systematic review and meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. PubMed, Embase, and Cochrane were systematically searched. All retrieved studies (n = 593) were reviewed and qualitatively assessed. In addition, 2 previously unpublished data sets were included. The systematic review included 11 studies, comprising 133 patients, of whom 63 patients from 5 studies were eligible for meta-analysis. A random-effects meta-analysis was conducted for the mean difference in number of surgical procedures per month before and after vaccination. Results The number of surgical procedures per month was significantly reduced after HPV vaccination compared with before vaccination (estimated mean, 0.06 vs 0.35). The mean intersurgical interval increased from 7.02 months (range, 0.30–45 months) before to 34.45 months (2.71–82 months) after HPV vaccination. Conclusion The present study supports the continued use of the HPV vaccine as an adjuvant treatment for recurrent respiratory papillomatosis. [ABSTRACT FROM AUTHOR]
- Published
- 2019
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36. Safe use of systemic bevacizumab for respiratory recurrent papillomatosis in two children.
- Author
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Carnevale, Claudio, Ferrán‐De la Cierva, Luis, Til‐Pérez, Guillermo, Peña‐Zarza, José Antonio, Osona‐Rodriguez, Borja, Martinez‐Lozano, Joaquina, Sarría‐Echegaray, Pedro, Arancibia‐Tagle, Diego, Tomás‐Barberán, Manuel, Ferrán-De la Cierva, Luis, Til-Pérez, Guillermo, Peña-Zarza, José Antonio, Osona-Rodriguez, Borja, Martinez-Lozano, Joaquina, Sarría-Echegaray, Pedro, Arancibia-Tagle, Diego, and Tomás-Barberán, Manuel
- Abstract
Recurrent respiratory papillomatosis can be a devastating condition for a child, with severe consequences. Currently, there is no proven successful medical treatment. We describe the use of systemic bevacizumab to treat two children affected by aggressive recurrent respiratory papillomatosis. Respiratory symptoms and quality of life improved dramatically in both patients, without observing any toxicity. The only complication was mild proteinuria. Systemic bevacizumab is a promising adjuvant treatment in aggressive recurrent respiratory papillomatosis in children. It is effective and well tolerated. Further studies are needed to establish the optimal dosing frequency and duration of therapy. Laryngoscope, 129:1001-1004, 2019. [ABSTRACT FROM AUTHOR]
- Published
- 2019
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37. ANALYSIS OF THE EFFECTIVENESS OF THE COMBINED TREATMENT OF PATIENTS WITH LARYNGEAL PAPILLOMATOSIS.
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SVISTUSHKIN, V. M., STAROSTINA, S. V., VOLKOVA, K. B., and AVETISYAN, E. YE.
- Subjects
LARYNGEAL diseases ,PAPILLOMAVIRUSES ,OTOLARYNGOLOGY ,INTERFERONS ,HOARSENESS - Abstract
Laryngeal papillomatosis is one of the most common tumor diseases of the upper respiratory tract, the morphological substrate of which is papilloma, leading to chronic obstruction of the larynx and hoarseness, occurring in both children and adults. The main etiological factor of laryngeal papillomatosis is the human papillomavirus. There are data that about 10%-60% of the population is affected by latent human papillomavirus infection, as evidenced by the detection of human papillomavirus DNA in the externally unchanged mucosa in 78.5% of the examined. Papillomas make up 3.5% of all benign tumors of the ENT organs and from 20 to 45% of all benign tumors of this localization. Laryngeal papillomatosis is characterized by recurrent course and rapid growth, which requires multiple surgical interventions. In order to eliminate laryngeal stenosis for a long period, tracheotomy remained practically the only method of surgical treatment. Up to now, more than 50 different methods of treatment of laryngeal papillomatosis are known, but a radical etiopathogenetic agent has not been found yet. It should be noted that about 70% of patients have a frequent case of the disease. Therefore, the problem of treatment of respiratory papillomatosis is one of the most urgent in modern otorhinolaryngology and currently largely unsolvable. Medical practice is based on three main directions and their different combinations: the improvement of surgical methods, the search for the new drugs (antiviral, immunotropic, etc.) and the development of vaccination methods. At present, there is no single international standard for the treatment of laryngeal papillomatosis, but it is known that it should be comprehensive. The article presents a study of cold plasma surgery application and the use of a fundamentally new drug in otorhinolaryngology i.e. inductor of interferon synthesis. [ABSTRACT FROM AUTHOR]
- Published
- 2018
38. Laryngeal Papillomatosis
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DeMarcantonio, Michael, Derkay, Craig, and Kountakis, Stilianos E., editor
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- 2013
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39. Infantile recurrent respiratory papillomatosis: review of adjuvant therapies
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N Orban and A Patel
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,Human Papilloma Virus Vaccine ,Cetuximab ,Antiviral Agents ,chemistry.chemical_compound ,Pegylated interferon ,medicine ,Humans ,Respiratory Tract Infections ,business.industry ,Papillomavirus Infections ,Infant ,Interferon-alpha ,Cytoreduction Surgical Procedures ,General Medicine ,Debulking ,medicine.disease ,Combined Modality Therapy ,Dermatology ,Treatment Outcome ,Otorhinolaryngology ,chemistry ,Chemotherapy, Adjuvant ,Female ,Interferons ,Recurrent Respiratory Papillomatosis ,Cimetidine ,business ,Adjuvant ,Cidofovir ,medicine.drug ,Laryngeal papillomatosis - Abstract
BackgroundRecurrent respiratory papillomatosis is a potentially life-threatening condition characterised by the growth of exophytic lesions within the larynx and trachea. The principal aim of management is maintenance of an adequate airway by surgical debulking. Several adjuvant therapies have been used to varying effect to reduce the burden of this disease and increase the interval between debulking procedures. The most severe cases present in children aged under three years, who are therefore most likely to need adjuvant therapies. The current evidence base on adjuvant treatments relating to children who present aged under three years has been reviewed.MethodsA literature review of articles in Cochrane, PubMed and Embase databases was carried out. Given the rarity of the condition in this age group, all the literature relates to case reports and case series.Results and conclusionThe following adjuvant therapies have been used in children who presented under three years of age: quadrivalent human papilloma virus vaccine, intralesional cidofovir, pegylated interferon, alpha-interferon, cimetidine and cetuximab.
- Published
- 2021
40. Laryngeal Papillomatosis: A Non-traditional Flexible Endoscopic Approach.
- Author
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Gurău P
- Abstract
Objective: To evaluate the efficacy of flexible endoscopic laryngeal surgery (FELS) using unconventional tools in the treatment of laryngeal papillomatosis (LP)., Methods: We applied FELS using forceps, diathermy snare, and Nd:YAG laser for 47 patients with LP. In 38 cases (81%), surgeries were performed under topical anesthesia with spontaneous respiration and in seven cases we used general anesthesia with superimposed high-frequency jet ventilation. In two cases, both types of anesthesia were used in different sessions. In 22 cases (46.8%), the interventions were performed as outpatient procedures. The Nd:YAG laser was used in the majority (89.4%) of cases., Results: The expected result (complete eradication of the visible lesion) was obtained in all treated patients without procedure complications. Disease recurrence was established in 16 cases (34%) that led to repeated surgeries., Conclusions: FELS, using Nd:YAG laser as a main tool, is a safe and effective approach that can be a feasible alternative to the conventional approach in the treatment of LP due to possibility to avoid repeated general anesthesia with its associated risks; applicability for the patients, who have contraindications for general anesthesia and transoral microsurgery; possibility to perform the intervention in an outpatient setting that leads to essential reduction of medical costs; economy of time. Nd:YAG laser ablation, preceded by diathermy snare resection, allows reducing the time of the intervention and thermal injury of the adjacent tissues, compared to using laser alone, and can be used in bulky and obstructive lesions that present a limitation for nonablative techniques., Competing Interests: Declaration of Competing Interest I have no competing interests in relation to the work., (Copyright © 2023 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)
- Published
- 2023
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41. Surgical treatment of laryngeal stenosis with semiconductor laser
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Chernokur A.A.
- Subjects
laryngeal papillomatosis ,laryngeal stenosis ,semiconductor laser ,Medicine - Abstract
The article reflects the current trends in the treatment of diseases of the larynx, accompanied by stenosis and impaired fonatory function, such as laryngeal papillomatosis and double-sided paresis of the recurrent larynx nerve. Actuality of surgical treatment of bilateral paresis of the recurrent larynx nerve is due to the fact that a significant proportion of patients with this disease are persons of vocal professions and functional result of the operation determines the quality of life, professional suitability. Using semiconductor laser causes a good functional outcome in this pathology treatment. The aim of the study was to improve the effectiveness of treatment of patients with laryngeal papillomatosis and with bilateral paresis of the recurrent larynx nerve. All patients underwent surgery with using semiconductor laser "Lika - surgeon." Results of treatment made it possible to draw a conclusion that microlaryngoscopy with laser vaporization of papillomas can reduce frequency of relapses by 15.4% during the first year after surgery as compared to the control group. Using of semiconductor laser in patients with bilateral paresis of the larynx allows to more effectively restore compensated breathing through upper airways as compared with the control group. Application of laser in phonosurgery allow to save a good voice function in 76.9% of patients.
- Published
- 2014
42. THE IMMUNE SYSTEM IN RARE AND FREQUENT RELAPSING LARYNGEAL PAPILLOMATOSIS IN CHILDREN.
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Sobirovna, Sadirova Shakhlo
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- *
IMMUNE system , *LYMPHOCYTES , *CELLULAR immunity , *CD4 antigen , *CD8 antigen , *LARYNGEAL diseases - Abstract
Clinical and immunological examination of 54 children with rare (RRLP) and frequent (FRLP) relapsing laryngeal papillomatosis was carried out. As a control, 15 healthy children in comparable age were examined. A decrease in the number of CD16 +, CD3+ and CD4+ lymphocytes, IgA, IgG, and CD4+/CD8+ ratio, an increase in the number of CD95 + and CD19 + cells was revealed. [ABSTRACT FROM AUTHOR]
- Published
- 2018
43. Laryngeal papillomatosis in Senegal: A ten-year experience.
- Author
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Maïga, S., Ndiaye, C., Diouf, M., Diallo, B.K., Ndiaye, M., Diouf, M.S., Ndiaye, I.C., and Diouf, R.
- Abstract
Objectives The objectives of this study were to describe the epidemiological, clinical and therapeutic characteristics of laryngeal papillomatosis in the Fann teaching hospital ENT department in Dakar, Senegal. Patients and methods We retrospectively reviewed all cases of laryngeal papillomatosis managed in the Fann teaching hospital ENT department between 1st January 2006 and 31st December 2015. Epidemiological, clinical and therapeutic characteristics of laryngeal papillomatosis were studied. Statistical analysis was performed with SPSS 18 software. Results The median age at diagnosis was 11 years and the sex ratio was 1.88. The mean time to consultation was 4.5 years. The predominant symptom was dysphonia, present in all cases, followed by laryngeal dyspnoea in 64.6% of cases. The glottic area was involved in all patients. Tracheostomy was performed in 20.8% of cases. All patients in our study underwent endoscopic excision of the lesions. Conclusion Laryngeal papillomatosis is the most common benign tumor in children, but it can also occur in adults. Treatment has been revolutionized by progress in endoscopy and antiviral therapy. However, tracheostomy still occupies an important place in our practice. [ABSTRACT FROM AUTHOR]
- Published
- 2018
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44. Current and future management of recurrent respiratory papillomatosis.
- Author
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Ivancic, Ryan, Iqbal, Hassan, deSilva, Brad, Pan, Quintin, and Matrka, Laura
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- *
PAPILLOMAVIRUSES , *CHRONIC diseases , *PHARMACOLOGY , *IMMUNE system , *DISEASE incidence - Abstract
Objectives: Recurrent respiratory papillomatosis (RRP) is a chronic disease of the respiratory tract that occurs in both children and adults. It is caused by the human papillomavirus (HPV), in particular low‐risk HPV6 and HPV11, and aggressiveness varies among patients. RRP remains a chronic disease that is difficult to manage. This review provides perspectives on current and future management of RRP. Results: The current standard of care is surgical excision, with adjuvant therapies as needed. Surgical management of RRP has evolved with the introduction of microdebriders and photoangiolytic lasers; the latter can now be used in the office setting. Numerous adjuvant pharmacologic therapies have been utilized with some success. Also, exciting preliminary data show that HPV vaccines may prolong the time to recurrence in the RRP population. There is also optimism that wide‐spread HPV vaccination could reduce RRP incidence indirectly by preventing vertical HPV transmission to newborns. Conclusion: To date, the biology of RRP is not well understood, although it has been noted to become more aggressive in the setting of immune suppression. Additional research is needed to better understand immune system dysfunction in RRP such that immunomodulatory approaches may be developed for RRP management. Level of Evidence: 4 [ABSTRACT FROM AUTHOR]
- Published
- 2018
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45. Manejo anestésico de paciente pediátrico con obstrucción severa de vía aérea causada por Papilomatosis.
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Céspedes Rios, Marcela Rosio
- Abstract
Laryngeal papillomatosis is a viral etiology desease that can be transmitted at birth through vaginal way or maternal blood. A 2-year-old boy with Laryngeal Obstruction III grade was scheduled for fibrolaryngoscopy diagnosis. We discuss the perioperative management of the case with the various ventilation strategies. It is suggested to maintain spontaneous ventilation until intubation, since ventilation with facial or laryngeal mask could be difficult and intubation prevent the passage of the fibrolaryngoscope for a complete laryngeal evaluation. [ABSTRACT FROM AUTHOR]
- Published
- 2018
46. Anesthetic management of severe airway stenosis in laryngeal papillomatosis.
- Author
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Mato-Búa, Rocío, Sampayo-Rodríguez, Lucía, Casas-Reza, Pablo, and Gestal-Vázquez, María
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- *
STENOSIS , *TRACHEOTOMY , *PAPILLOMAVIRUSES , *COMPUTED tomography , *HOSPITAL emergency services - Published
- 2022
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47. Failed fibreoptic intubation: 70° rigid nasendoscope and Frova introducer to the rescue
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Stalin Vinayagam, MVS Satya Prakash, Pankaj Kundra, and Surianarayana Gopalakrishnan
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Airway management ,endoscope ,goitre ,laryngeal papillomatosis ,nasendoscope ,Anesthesiology ,RD78.3-87.3 - Abstract
Endotracheal intubation was successfully accomplished with 70° rigid nasendoscope under video guidance in two patients in whom repeated attempts to secure airway with flexible fibreoptic bronchoscope were unsuccessful. Both patients had compromised airway (laryngeal papillomatosis and a huge thyroid swelling) and were uncooperative. Frova intubating introducer was used along with 70° rigid nasendoscope to accomplish tracheal intubation under video guidance.
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- 2016
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48. Benign and Potentially Malignant Lesions of the Squamous Epithelium and Squamous Cell Carcinoma
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Gale, N., Zidar, N., Cardesa, Antonio, editor, and Slootweg, Pieter J., editor
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- 2006
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49. Dejavniki, ki vplivajo na pojav in klinični potek papilomatoze grla
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Gluvajić, Daša and Hočevar Boltežar, Irena
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aggressive course ,squamous carcinoma ,ploščatocelični karcinom ,laryngeal papillomatosis ,juvenile papillomatosis ,agresivni potek ,juvenilna papilomatoza ,laringealna papilomatoza - Abstract
Laringealna papilomatoza (LP) je zelo redka bolezen, pri kateri se pojavljajo papilomi v grlu in je etiološko povezana z okužbo s človeškimi papilomavirusi (angl. human papillomavirus, HPV), saj jo v več kot 90% primerov povzročata HPV-6 in -11. Ker način aktivacije virusa še ni bil opredeljen, še ni povsem jasno, zakaj po okužbi s HPV pride do pojava LP in kateri dejavniki vplivajo na klinični potek bolezni. Ta je nepredvidljiv in pri nekaterih bolnikih lahko poteka agresivno s pogostimi ponovitvami in s širjenjem papilomov v distalne dele dihal. Pri manjšem deležu bolnikov lahko v papilomih nastane visoko-rizična intraepitelijska sprememba (VR-IPS), redko pa lahko pride tudi do nastanka ploščatoceličnega karcinoma v papilomih grla (PCC ex-LP). Namen doktorske naloge je bil opredeliti dejavnike, ki so povezani z agresivnim potekom LP, oceniti incidenco VR-IPS v tkivu papilomov in PCC ex-LP ter opredeliti dejavnike tveganja, ki značilno vplivajo na pojav teh epitelijskih sprememb. V prvem delu longitudinalne retrospektivne raziskave smo na podlagi vzorcev 59 bolnikov z LP s časom sledenja več kot 10 let ocenili možne dejavnike tveganja za agresivni potek bolezni, pri čemer smo se osredotočili na klinične dejavnike, histopatološko stopnjo intraepitelijskih sprememb (IPS), imunohistokemično stopnjo izražanja receptorja za epidermalni rastni faktor (angl. epidermal growth factor receptor, EGFR) in število Langerhansovih celic (LC) v tkivu LP, prejeto adjuvantno zdravljenje in cepljenje proti HPV ter pod(tip) in podtipske različice HPV-6 in -11, ki smo jih opredelili z molekularnimi metodami. Tako smo pri 59 bolnikih z LP, z mediano časa sledenja 18 let (IQR: 14–27) in v povprečju 10,4 (standardni odklon (SD) 9,4, razpon: 2–49) kirurškimi posegi, agresivni potek LP opredelili pri 26/59 (44,1%) bolnikov. Adjuvantno zdravljenje je prejelo 26/59 (44,1%) bolnikov, najpogosteje sistemsko protivirusno zdravljenje z aciklovirjem ali valaciklovirjem (16/26, 61,5%), medtem ko je cepljenje proti HPV prejelo 12/59 (20,3%) bolnikov. Izražanje EGFR smo dokazali v vseh tkivnih vzorcih LP, odvzetih pri prvem kirurškem posegu (58/58, 100,0%), najpogosteje v spodnjih 2/3 epitelija (40/58, 67,8%). Stopnja izražanja EGFR v tkivu LP se ni razlikovala glede na kajenje (p=0,453) ali stopnjo IPS v tkivu (p=0,071), prav tako pa se pri posameznem bolniku med prvim in zadnjim posegom ni spremenila glede na sledeče klinične dejavnike: juvenilna ali odrasla oblika LP (p=0,945), agresivni potek bolezni (p=0,143), prejemanje adjuvantnega zdravljenja (p=0,111) in cepljenje proti HPV (p=0,620). Ugotovili smo tudi, da se stopnja izražanja EGFR v LP ni statistično značilno spremenila v tkivu, ki je bilo odvzeto s kirurškim posegom, ki je sledil adjuvantnemu zdravljenju (sistemsko protivirusno zdravljenje (p=0,257), indol-3-carbinol (I-3-C) (p=1,000), cidofovir (p=1,000)), cepljenju proti HPV (p=0,157) ali v tkivu, odvzetem pri posegu, kateremu je nato sledilo klinično poslabšanje zaradi hitrejše rasti papilomov (p=0,317). Mediana števila LC/mm2 v tkivu LP iz prvega kirurškega posega je bila 139,2 (interkvartilni razmik (IQR): 96–176) in se ni statistično značilno razlikovala glede na kajenje (p=0,951) ali stopnjo IPS (p=0,103). Po prejetem adjuvantnem zdravljenju (sistemsko protivirusno zdravljenje (p=0,173), cidofovir (p=0,327), I-3-C (p=0,225)), cepljenju proti HPV (p=0,142) in poslabšanju poteka s pogostimi ponovitvami LP (p=1,000) se pri posameznemu bolniku število LC/mm2 ni statistično značilno spremenilo. Smo pa v tkivu LP iz zadnjega posega ugotovili statistično značilno višje število LC/mm2 v primerjavi z vzorci, odvzetimi pri prvem posegu: mediana 180,8 (IQR: 123,2–260,8) proti 142,8 (IQR: 96–187,2) (p=0,019). HPV DNA smo v tkivu LP dokazali pri 58/59 (98,3%) bolnikov, najpogosteje genotip HPV-6 (40/58, 68,9%) in (pod)tip HPV-6a (27/40, 67,5%). V dveh ločenih tkivnih vzorcih istega preiskovanca smo pri 96,5% (56/58) bolnikov dokazali enak (pod)tip HPV-6 in -11 in dodatno pri izbranih 15/15 (100,0%) bolnikov enako podtipsko različico HPV v tkivu iz prvega in zadnjega kirurškega posega (mediana 17 let, IQR: 12–24). Pri HPV-6 smo sicer najpogosteje opredelili podtipsko različico linije A (6/12, 50,0%), pri HPV-11 pa podtipsko različico podlinije A2 (7/8, 87,5%). Med naslednjimi preiskovanimi dejavniki: (pod)tip (p=0,544) in podtipska različica HPV (p=0,217), moški spol (p=0,127), kajenje (p=0,356), VR-IPS (p=0,405), višja stopnja izražanja EGFR (p=0,060) in višje število nezrelih LC (p=0,205) v tkivu LP pri prvem kirurškem posegu smo kot statistično značilni dejavnik tveganja za agresivni potek LP opredelili le juvenilno obliko LP, pri kateri so bili relativni obeti za agresivni potek bolezni dvanajstkrat višji v primerjavi z odraslo obliko LP (p0,005), visoko-rizični HPV (VR-HPV) (p=0,123), odrasla oblika LP (p=0,684), moški spol (p=0,403), agresivni klinični potek LP (p=0,738), višje število posegov (p=0,754), subglotisna rast papilomov (p=0.066), traheotomija (p=0,499), kajenje (p=0,698) in adjuvantno zdravljenje s cidofovirjem (p=0,100)) niso imeli statistično značilnega vpliva na stopnjo epitelijske spremembe v LP. Pri obeh (2/7) bolnikih s HPV-pozitivnim PCC ex-LP smo z in situ hibridizacijo dokazali integracijo HPV v genom gostiteljeve celice, dodatno pa smo pri bolniku z integrirano okužbo HPV-6b v PCC ex-LP dokazali tudi patogeno različico gena TP53. Na podlagi naših rezultatov smo zaključili, da najpomembnejši dejavnik tveganja za agresivni potek LP predstavlja juvenilna oblika LP. Kljub temu, da smo ugotovili, da se EGFR izraža v vseh tkivih LP in da so v papilomih pogoste LC, nismo uspeli opredeliti, kateri dejavniki vplivajo na stopnjo izražanja EGFR in na spremembo števila LC v tkivu LP. Dokazali smo, da pri posameznem bolniku v dveh časovno ločenih tkivnih vzorcih LP vztraja enak genotip HPV in dodatno da pri vseh bolnikih vztraja enaka podtipska različica HPV-6 in -11, ne glede na prejeto adjuvantno zdravljenje, klinični potek bolezni in več kot 10-letni čas sledenja. Nadalje smo ugotovili, da sta najpomembnejša dejavnika tveganja za nastanek VR-IPS v LP in PCC ex-LP višja starost ob diagnozi LP in odsotnost dokazljive HPV DNA v tkivu ter da prisotnost VR-IPS v LP poveča tveganje za nastanek PCC ex-LP. Nenazadnje smo zaključili, da je integracija HPV v gostiteljev genom možna tako pri VR-HPV kot tudi pri NR-HPV, vendar pri slednji na rakavo preobrazbo celic najverjetneje vplivajo še dodatni dejavniki tveganja. Laryngeal papillomatosis (LP) is a very rare disease of the larynx caused by human papillomaviruses (HPV), mainly HPV-6 and 11 in more than 90% of cases. It is not entirely clear what activates the virus to cause papillomas and which are the factors that influence the clinical course of the disease, that is typically unpredictable and can take an aggressive course with numerous recurrences and distal spread in the respiratory system. High-grade squamous intraepithelial lesion (HG-SIL) is found upon histopathological examination of LP in a minority of patients, while squamous cell carcinoma in LP (PCC ex-LP) occurs rarely. Therefore, the goal of this study was to identify the factors that influence the aggressive clinical course of LP, to define the incidence of HG-SIL in LP and PCC ex-LP, and to determine the risk factors for dysplastic and malignant epithelial changes of the mentioned disease. In the first part of the longitudinal retrospective study, risk factors for the aggressive clinical course of LP were analyzed in a cohort of 59 patients with LP and more than a 10-year-long follow-up. An aggressive clinical course was identified in 26/59 (44.2%) patients with an average of 10.4 (standard deviation (SD) 9.4, range: 2–49) surgical procedures for LP and a median follow-up time of 18 years (interquartile range (IQR): 14–27). The investigated factors were clinical data, grade of dysplasia in LP, grade of epidermal growth factor receptor (EGFR) expression and the number of Langerhans cells (LC) in LP, evaluated by immunohistochemistry staining, previously prescribed adjuvant therapy, vaccination against HPV and the (sub)type and genomic variants of HPV-6 and -11, identified using molecular methods. Adjuvant therapy was prescribed to 26/59 (44.1%) patients, most commonly antiviral systemic therapy with acyclovir or valacyclovir (16/26, 61.5%), while 12/59 (20.3%) patients were vaccinated against HPV. EGFR expression was confirmed in all tested LP tissue samples obtained during the first surgical procedure (58/58, 100%), in the majority of LP samples (40/58, 67.8%) in the lower 2/3 of the epithelium. Based on the smoking status of the patients (p=0.453) and grade of SIL in LP (p=0.071), statistically significant difference of EGFR expression in LP was not identified. Compared to the first surgical procedure, no statistically significant change in EGFR expression was identified in the last surgical procedure, considering the following clinical factors: juvenile or adult LP (p=0.945), aggressive clinical course (p=0.143), adjuvant therapy (p=0.111) and vaccination against HPV (p=0.620). Furthermore, EGFR expression did not change in the LP tissue samples surgically obtained after receiving adjuvant therapy (systemic antiviral therapy (p=0.257), indol-3-carbinol (I-3-C) (p=1.000), cidofovir (p=1.000)), vaccination against HPV (p=0.157) or at the beginning of a period with more recurrences of LP (p=0.317). A median of 139.2 (IQR: 96–176) LC/mm2 were detected in the LP tissue samples from the first surgical procedure and no statistically significant difference in LC number was identified based on smoking status (p=0.951) or grade of dysplasia in LP (p=0.103). Similarly, no statistically significant change in the number of LC/mm2 was identified after adjuvant therapy (systemic antiviral therapy (p=0.173), cidofovir (p=0.327), I-3-C (p=0.225)), vaccination against HPV (p=0.142) or at the beginning of a period with more recurrences of LP (p=1.000). Nonetheless, a statistically significant higher number of LC/mm2 was detected in the LP tissue sample from the last surgical procedure compared with the first one (median 180.8 (IQR: 123.2–260.8) versus 142.8 (IQR: 96–187.2) (p=0.019)). HPV DNA was isolated in LP tissue samples of 58/59 (98.3%) patients, most commonly HPV-6 (40/58, 68.9%) and subtype HPV-6a (27/40, 67.5%). In 96.5% (56/58) of patients the same HPV genotype was identified in two different LP tissue samples and in all 15/15 (100%) patients the same genomic variant of HPV-6 or -11 was identified in the tissue samples from the first and last surgical procedure (median 17 years, IQR: 12–24). HPV-6 lineage A (6/12, 50%) and HPV-11 sublineage A2 (7/8, 87.5%) were the most commonly identified genomic variants in LP. The analysis of risk factors for the aggressive clinical course of LP included: HPV (sub)type (p=0.544), genomic variants of HPV-6 and -11 (p=0.217), male gender (p=0.127), smoking status (p=0.356), HR-SIL (p=0.405), higher EGFR expression (p=0.060) and a higher number of LC (p=0.205) in LP tissue samples from the first surgical procedure. However, the only statistically significant risk factor identified was juvenile LP, in which relative odds for the aggressive clinical course were twelve times higher in comparison to the adult LP (p0.005), high-risk HPV (HR-HPV) (p=0.123), adult LP (p=0.684), male gender (p=0.403), aggressive clinical course of LP (p=0.738), higher number of surgical procedures (p=0.754), subglottic spread of LP (p=0.066), tracheotomy (p=0.499), smoking status (p=0.698) and therapy with cidofovir (p=0.100)), did not have a statistically significant influence on the occurrence of epithelial changes in LP. Using ISH, a transcriptionally active HPV infection was identified in both (2/7) patients with HPV-positive PCC ex-LP and additionally genotyping has identified a mutation of the TP53 gene in the patient with a transcriptionally active HPV-6b infection in PCC ex-LP. Based on the results of our research, we can conclude that juvenile LP is the most important risk factor for the aggressive clinical course of LP. We have confirmed that in LP tissue the EGFR is expressed and LC are common, but we have failed to identify the factors that influence the grade of EGFR expression and the change in the number of LC. In the majority of patients, we have found that the same HPV genotype persists in two different LP tissue samples of the same patient. Furthermore, in a selected group of patients, the same HPV-6 and -11 genomic variants in the LP tissue samples from the first and last surgical procedure were confirmed. The identified genomic variants did not change based on clinical course, adjuvant therapy and long-term follow-up of more than 10 years. Our study has identified older age at LP diagnosis and HPV negativity in LP as the most important risk factors for HG-SIL in LP and PCC ex-LP. Moreover, HG-SIL in LP is an important risk factor for malignant transformation in LP. We have identified integration in the host genome of both HR- and LR-HPV DNA in PCC-ex LP, but most probably in cases of LR-HPV infection, malignant transformation is dependent on additional carcinogenic factors.
- Published
- 2022
50. NBI and Laryngeal Papillomatosis: A Diagnostic Challenge: A Systematic Review
- Author
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Salvatore GALLINA, Barbara Verro, Carmelo Saraniti, Saraniti C., Gallina S., and Verro B.
- Subjects
larynx ,Laryngoscopy ,Papilloma ,diagnosis ,Health, Toxicology and Mutagenesis ,Public Health, Environmental and Occupational Health ,laryngeal papillomatosis ,Sensitivity and Specificity ,Narrow Band Imaging ,Settore MED/31 - Otorinolaringoiatria ,differential diagnosis ,Humans ,Laryngeal Neoplasms ,narrow-band imaging - Abstract
Narrow-band imaging (NBI) represents a valid aid in laryngeal squamous cell carcinoma (LSCC) diagnosis for detecting vascular changes. However, LSCC and laryngeal papillomatosis (LP) show similar vascular patterns that may lead to misdiagnosis and improper treatment. This review aims to deepen this NBI limit in order to stress a careful preoperative evaluation of laryngeal lesions. The research was carried out on PubMed, Web of Science and Scopus databases using specific keywords. The topic of research was assessed by these parameters: accuracy, sensitivity, specificity, and positive and negative predictive values. This review included only five articles: they demonstrated that NBI is better than white-light endoscopy in detecting LSCC and LP. They also reported that LP is frequently mistaken for LSCC, resulting in high rates of false positives using NBI. This is the first review that emphasized this NBI limitation in distinguishing between LP and LSCC in cases of a type V pattern of intraepithelial papillary capillary loop. Although NBI application increased the rate of early cancer detection, LP reduces NBI accuracy. This drawback may lead to misdiagnosis and improper treatment. Our advice is to be careful in cases of type V pattern on NBI and to research LP epithelial and clinical features because it could be a pitfall.
- Published
- 2022
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