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David E Tunkel - One of the best experts on this subject based on the ideXlab platform.

  • surgery for cervicofacial nontuberculous mycobacterial Adenitis in children an update
    Archives of Otolaryngology-head & Neck Surgery, 1999
    Co-Authors: David E Tunkel
    Abstract:

    Objective To assess optimal surgical treatment with excision or curettage techniques in children with cervicofacial nontuberculous mycobacterial (NTM) Adenitis. Design Retrospective case series. Setting Tertiary university-based pediatric referral center. Patients Patients younger than 18 years diagnosed as having cervicofacial NTM Adenitis by positive mycobacterial cultures or stains, or by histopathologic evaluation. Interventions Fine-needle aspiration biopsy for diagnosis, surgical excision and/or curettage of head and neck lesions for treatment. Main Outcome Measures Number of procedures per patient, complications, resolution of mass. Results A total of 32 surgical procedures were performed in 25 children with cervicofacial NTM Adenitis (mean, 1.3 procedures per patient; range, 1-3): 19 excisional and 13 curettage procedures. The 14 children who had excision as an initial procedure required no additional surgery. Of 11 children who had curettage as an initial procedure, 6 (55%) required additional procedures. Three of these children had additional surgery as planned staged procedures. Excisional surgery after initial curettage (5 patients) was simplified by initial debridement and secondary healing. No complications of curettage were noted. Transient marginal mandibular nerve weakness was seen in 4 patients who had excision. Fourteen of 16 fine-needle aspiration biopsy specimens were diagnostic for NTM Adenitis. Conclusions Cervicofacial NTM Adenitis can be treated with excision or curettage. Excision remains the treatment of choice because of the high cure rate with a single procedure. We now consider curettage as a staged procedure for lesions in proximity to the facial nerve or with extensive skin necrosis, with initial curettage simplifying subsequent excision and wound closure. Preoperative counseling should include discussion of planned or unplanned revision surgery after curettage. Fine-needle aspiration biopsy allows early diagnosis of NTM Adenitis.

  • surgical treatment of cervicofacial nontuberculous mycobacterial Adenitis in children
    Laryngoscope, 1995
    Co-Authors: David E Tunkel, Brian K Romaneschi
    Abstract:

    Fifteen children with nontuberculous mycobacterial Adenitis of the head and neck underwent surgical treatment between July 1991 and July 1994. Fine-needle aspiration for biopsy and culture allowed early diagnosis in nine children. Positive cultures grew Mycobacterium avium-intracellulare complex in 12 children and M. chelonei in one child. Total excision was performed in 10 cases with combinations of lymphadenectomy and salivary gland excision. Curettage was used to successfully treat five children. One patient required local flap coverage for primary wound repair. Two patients required more than one surgical procedure. Our approach to early diagnosis and surgical treatment of cervicofacial nontuberculous mycobacterial Adenitis is presented.

Henry M. Feder - One of the best experts on this subject based on the ideXlab platform.

  • periodic fever aphthous stomatitis pharyngitis Adenitis a clinical review of a new syndrome
    Current Opinion in Pediatrics, 2000
    Co-Authors: Henry M. Feder
    Abstract:

    Periodic fevers (fevers that occur predictably at fixed intervals) are unusual in infants and children. The classic periodic fever syndrome is cyclic neutropenia (neutropenia followed by infections and fever that recur every 21 days). A new periodic fever syndrome PFAPA (periodic fever, aphthous stomatitis, pharyngitis, and cervical Adenitis) has been characterized over the past decade. PFAPA is defined clinically, because specific laboratory abnormalities have not been found. The clinical characteristic of PFAPA is high fevers (usually 40.0°C to 40.6°C) recurring at fixed intervals every 2 to 8 weeks. The fevers last for about 4 days, then resolve spontaneously. Associated with the fevers are aphthous stomatitis in 70% of patients, pharyngitis in 72% of patients, and cervical Adenitis in 88% of patients. PFAPA is not familial and begins before the age of 5 years. An episode of PFAPA can be aborted with one or two small doses of prednisone. The episodes of PFAPA may last for years and the patient is well between episodes. The cause of PFAPA is unknown and there are no reported

  • Periodic fever, aphthous stomatitis, pharyngitis, Adenitis: a clinical review of a new syndrome.
    Current opinion in pediatrics, 2000
    Co-Authors: Henry M. Feder
    Abstract:

    Periodic fevers (fevers that occur predictably at fixed intervals) are unusual in infants and children. The classic periodic fever syndrome is cyclic neutropenia (neutropenia followed by infections and fever that recur every 21 days). A new periodic fever syndrome PFAPA (periodic fever, aphthous stomatitis, pharyngitis, and cervical Adenitis) has been characterized over the past decade. PFAPA is defined clinically, because specific laboratory abnormalities have not been found. The clinical characteristic of PFAPA is high fevers (usually 40.0 degrees C to 40.6 degrees C) recurring at fixed intervals every 2 to 8 weeks. The fevers last for about 4 days, then resolve spontaneously. Associated with the fevers are aphthous stomatitis in 70% of patients, pharyngitis in 72% of patients, and cervical Adenitis in 88% of patients. PFAPA is not familial and begins before the age of 5 years. An episode of PFAPA can be aborted with one or two small doses of prednisone. The episodes of PFAPA may last for years and the patient is well between episodes. The cause of PFAPA is unknown and there are no reported sequelae.

Alison J. Bruce - One of the best experts on this subject based on the ideXlab platform.

  • Periodic fever, aphthous stomatitis, pharyngitis, and Adenitis (PFAPA) syndrome
    Clinics in Dermatology, 2016
    Co-Authors: Nora S. Ali, Julio C. Sartori-valinotti, Alison J. Bruce
    Abstract:

    Periodic fever, aphthous stomatitis, pharyngitis, and Adenitis (PFAPA) syndrome, the most common periodic disorder of childhood, presents with the cardinal symptoms of periodic fever, aphthous stomatitis, pharyngitis, and Adenitis typically before age 5. This review presents the recent literature on PFAPA and summarizes key findings in the pathogenesis, evaluation, and treatment of the disease. Theories surrounding the pathogenesis of PFAPA include a faulty innate immunologic response in conjunction with dysregulated T-cell activation. A potential genetic link is also under consideration. Mediterranean fever (MEFV) gene variants have been implicated and appear to modify disease severity. In individuals with the heterozygous variant, PFAPA episodes are milder and shorter in duration. Diagnostic criteria include the traditional clinical signs, in addition to the following biomarkers: elevated C-reactive protein in the absence of elevated procalcitonin, vitamin D, CD64, mean corpuscular volume, and other nonspecific inflammatory mediators in the absence of an infectious explanation for fever. Treatment of PFAPA includes tonsillectomy, a single dose of corticosteroids, and, most recently, interleukin 1 blockers such as anakinra, rilonacept, and canakinumab. Tonsillectomy remains the only permanent treatment modality.

Tsukasa Takemura - One of the best experts on this subject based on the ideXlab platform.

R M Warren - One of the best experts on this subject based on the ideXlab platform.

  • danish bacille calmette guerin vaccine induced disease in human immunodeficiency virus infected children
    Clinical Infectious Diseases, 2003
    Co-Authors: A C Hesseling, H S Schaaf, Willem A Hanekom, Nulda Beyers, Mark F Cotton, R P Gie, Ben J Marais, P D Van Helden, R M Warren
    Abstract:

    An analysis of isolates of Mycobacterium tuberculosis complex was performed to determine the prevalence of bacille Calmette-Guerin (BCG) disease among human immunodeficiency virus (HIV)-infected children. Speciation was done with polymerase chain reaction; 183 isolates from mycobacterial cultures for 49 HIV-infected patients were analyzed. The Danish Mycobacterium bovis BCG strain was isolated from 5 patients. No cases of Tokyo M. bovis BCG strain disease were detected. All patients were asymptomatic at birth, <12 months of age, and severely immunodeficient at presentation. Four patients had regional axillary Adenitis ipsilateral to the vaccination site, and 2 had pulmonary BCG disease. Two patients with regional BCG disease had simultaneous pulmonary M. tuberculosis infection. Although chest radiographic features were similar to those seen in patients with tuberculosis, BCG disease should be considered in HIV-infected infants with right axillary Adenitis ipsilateral to the vaccination site. Young, symptomatic, HIV-infected infants are at risk for BCG-related complications. Controlled, population-based studies are needed to assess the risk of BCG in HIV-infected children.