B asic life support (BLS) is the foundation for saving lives following cardiac arrest. Fundamenta... more B asic life support (BLS) is the foundation for saving lives following cardiac arrest. Fundamental aspects of BLS include immediate recognition of sudden cardiac arrest (SCA) and activation of the emergency response system, early cardiopulmonary resuscitation (CPR), and rapid defibrillation with an automated external defibrillator (AED). Initial recognition and response to heart attack and stroke are also considered part of BLS. This section presents the 2010 adult BLS guidelines for lay rescuers and healthcare providers. Key changes and continued points of emphasis from the 2005 BLS Guidelines include the following:
Adenotonsillectomy is commonly performed in children with the obstructive sleep apnea syndrome, y... more Adenotonsillectomy is commonly performed in children with the obstructive sleep apnea syndrome, yet its usefulness in reducing symptoms and improving cognition, behavior, quality of life, and polysomnographic findings has not been rigorously evaluated. We hypothesized that, in children with the obstructive sleep apnea syndrome without prolonged oxyhemoglobin desaturation, early adenotonsillectomy, as compared with watchful waiting with supportive care, would result in improved outcomes.
Results: Initial results: 5% of patients were informed of general risks of surgery, 44% received ... more Results: Initial results: 5% of patients were informed of general risks of surgery, 44% received a copy, 70% signed and printed their names, 5% of consent forms were complete in all criteria. Re-audit results: General risks were mentioned 97.5% of the time, 55% received a copy, 100% signed and printed their names, 12.5% of forms were complete in all criteria. Only 2.5% of the forms re-audited used stickers, it was not possible to quantify the value of the website. Conclusions: Although the provision of information relating to general risks improved significantly other improvements were less substantial. This audit highlights the difficulties faced in implementing change to practice and how initially favourable interventions lose support as clinicians revert to previous methods. Whilst the use of information technology is encouraged within the NHS, its effects will only reflect the willingness of doctors prepared to realise its full potential.
A bs tract: Objective: This s tudy was conducted to analyze the underlying bacterial pathogen s i... more A bs tract: Objective: This s tudy was conducted to analyze the underlying bacterial pathogen s in tons illar dis eas e among Egyptian children, to investigate whether there is any difference bet ween tons illar s urface a n d d e e p tis s ue cultures in patients who underwent tons illectomy for recurrent tons illit is a n d a ls o to study the incidence of beta lactamase producing bacteria (âLPB) and Oxacillin resis tant strains . M ethods : Specimens were c o lle c t e d over a period of three months from different tons illar s ites of 72 patients -their ages ranging from 5 to 12 y e ars -s uffering from recurrent tons illitis and undergoing tons illectomy. A erobic bacterial identification and antimicrobial s us ceptibility were carried out through standard procedures. Results: Sixty-five tons ils had pos itive aerobic is olates while the remaining s even cas es had normal flora (9.7%). The total number of pos itive is olates in both s urface and core cultures were 152. S. aureus was the mos t common aerobic organis m (56.9%) is olated from both s urface and core of excis ed to n s ils . M os t of S. aureus is olates (95%) had ß-Lactamase activity, whereas only 11% was Oxacillin resis ta n t S . aureus (ORSA ). H. influenzae was is olated in (44.6%) of cas es, mos tly as core cultu re s with 58% of them s howing ß-Lactamase activity. GA âHS had an incidence of 38.5%, mos tly as surface cultu re s w ith 26% of them showing ß-Lactamas e activity. Streptococcus pneumoniae were is olated in 20% of cas es, mos tly surface is olates . Klebsiella pneumoniae were identified in the core of 5 cas es (7.7%). There was a noticeable difference between s urface and core cultures regard in g a ll t ypes of bacteria except S.aureus . Fifty percent discrepancy between the two sites was found. Co n c lus ion: S. aureus is the main offending pathogen res pons ible for chronic tons illitis nowadays . H. influenzae an d GA âHS had a near equal incidence. Due to the difference between the is olates from tons illar s urfac e a n d c o re , the practice of s urface tons illar s wab may be mis leading. Tons illar dis eas e may s tem from the bacteria w it h in t he s ubs tance of the tons ils rather than the bacteria identified on the surface.
It has been debated whether the reported increased risk of Hodgkin's lymphoma (HL) after tonsille... more It has been debated whether the reported increased risk of Hodgkin's lymphoma (HL) after tonsillectomy could be due to some underlying factor rather than the surgery itself. We studied whether not only tonsillectomy but also tonsillitis was associated with HL. This nationwide cohort study included all Danish residents during 1977-2001. Information on a diagnosis of tonsillitis, tonsillectomy, or HL was obtained from national registries. During 124 million person-years we observed 2,988 HL patients of whom 58 were tonsillectomized (most with preceding tonsillitis) and 14 were diagnosed with only tonsillitis at more than 1 year before HL diagnosis. Tonsillectomy was associated with a significantly increased HL risk in persons under 15 years of age as follows: 1-4 years after tonsillectomy, relative risk (RR) 5 3.9 [95% CI: 1.4-11; n 5 4]; >5 years after tonsillectomy, RR 5 3.5 [1.4-8.5; n 5 5]. No young cases of HL occurred among persons diagnosed with only tonsillitis. In contrast, 1-4 years after a hospital diagnosis of tonsillitis without subsequent tonsillectomy we found an increased HL risk in persons aged 15 years or above as follows: 15-34 years of age at HL diagnosis, RR 5 3.5 [1.6-7.7; n 5 6]; 351 years, RR 5 5.9 [2.2-16; n 5 4]. Age at tonsillitis or tonsillectomy did not modify HL risk within the 3 age strata. An increased HL risk was found both after tonsillectomy and after an isolated diagnosis of tonsillitis. These results suggest that tonsillitis is a risk factor for HL and not that, as previously reported, only the surgical removal of tonsils is a risk factor.
The aim of the present study was to explore serological biomarkers which predict the outcome of t... more The aim of the present study was to explore serological biomarkers which predict the outcome of tonsillectomy for chronic tonsillitis. Methods: A case study in a University ENT department of 24 adult patients with chronic tonsillitis (CHT) in comparison to 24 patients with acute peritonsillar abscess (PTA) was performed. Blood samples for clinical routine hematological and serological parameters were assessed prior to surgery (T-1) and five days (T5) after tonsillectomy. Outcome 6 months later (T180) was documented using the Glasgow Benefit Inventory (GBI) and the Specific Benefits from Tonsillectomy Inventory (SBTI). Correlation analyses between CHT and PTA group as well as between the different time points within each group concerning the serological parameters and the outcome parameters were performed. Results: At T-1, patients in the CHT group presented with significantly higher lymphocytes counts (relative and absolute), basophils (relative and absolute) and eosinophils but less white-cells, monocytes, neutrophils (absolute and relative), alpha-1, alpha-2, beta globulins, immunoglobulin and lower C-reactive protein and procalcitonin values than patients in the PTA group (all p < 0.05, respectively). Within each group, different significant changes of the serum parameters (often in opposite direction) were observed between T-1 and T5. SBTI scores at T-1 were significantly lower in the CHT group. In contrast, most GBI scores at T180 were significantly higher in the CHT group. Between T-1 and T180 the SBTI scores improved in three quarters of the CHT patients but only in three fifths of the PTA patients. Higher eosinophil counts and immunoglobulin E levels at T-1 predicted higher GBI scores at T180 in the CHT group. Conclusions: This pilot study showed a specific serological pattern for patients with chronic tonsillitis with a specific pattern of changes after tonsillectomy. But there is no established role for biomarkers currently used in clinical practice to predict the outcome of tonsillectomy for chronic tonsillitis.
B asic life support (BLS) is the foundation for saving lives following cardiac arrest. Fundamenta... more B asic life support (BLS) is the foundation for saving lives following cardiac arrest. Fundamental aspects of BLS include immediate recognition of sudden cardiac arrest (SCA) and activation of the emergency response system, early cardiopulmonary resuscitation (CPR), and rapid defibrillation with an automated external defibrillator (AED). Initial recognition and response to heart attack and stroke are also considered part of BLS. This section presents the 2010 adult BLS guidelines for lay rescuers and healthcare providers. Key changes and continued points of emphasis from the 2005 BLS Guidelines include the following:
Adenotonsillectomy is commonly performed in children with the obstructive sleep apnea syndrome, y... more Adenotonsillectomy is commonly performed in children with the obstructive sleep apnea syndrome, yet its usefulness in reducing symptoms and improving cognition, behavior, quality of life, and polysomnographic findings has not been rigorously evaluated. We hypothesized that, in children with the obstructive sleep apnea syndrome without prolonged oxyhemoglobin desaturation, early adenotonsillectomy, as compared with watchful waiting with supportive care, would result in improved outcomes.
Results: Initial results: 5% of patients were informed of general risks of surgery, 44% received ... more Results: Initial results: 5% of patients were informed of general risks of surgery, 44% received a copy, 70% signed and printed their names, 5% of consent forms were complete in all criteria. Re-audit results: General risks were mentioned 97.5% of the time, 55% received a copy, 100% signed and printed their names, 12.5% of forms were complete in all criteria. Only 2.5% of the forms re-audited used stickers, it was not possible to quantify the value of the website. Conclusions: Although the provision of information relating to general risks improved significantly other improvements were less substantial. This audit highlights the difficulties faced in implementing change to practice and how initially favourable interventions lose support as clinicians revert to previous methods. Whilst the use of information technology is encouraged within the NHS, its effects will only reflect the willingness of doctors prepared to realise its full potential.
A bs tract: Objective: This s tudy was conducted to analyze the underlying bacterial pathogen s i... more A bs tract: Objective: This s tudy was conducted to analyze the underlying bacterial pathogen s in tons illar dis eas e among Egyptian children, to investigate whether there is any difference bet ween tons illar s urface a n d d e e p tis s ue cultures in patients who underwent tons illectomy for recurrent tons illit is a n d a ls o to study the incidence of beta lactamase producing bacteria (âLPB) and Oxacillin resis tant strains . M ethods : Specimens were c o lle c t e d over a period of three months from different tons illar s ites of 72 patients -their ages ranging from 5 to 12 y e ars -s uffering from recurrent tons illitis and undergoing tons illectomy. A erobic bacterial identification and antimicrobial s us ceptibility were carried out through standard procedures. Results: Sixty-five tons ils had pos itive aerobic is olates while the remaining s even cas es had normal flora (9.7%). The total number of pos itive is olates in both s urface and core cultures were 152. S. aureus was the mos t common aerobic organis m (56.9%) is olated from both s urface and core of excis ed to n s ils . M os t of S. aureus is olates (95%) had ß-Lactamase activity, whereas only 11% was Oxacillin resis ta n t S . aureus (ORSA ). H. influenzae was is olated in (44.6%) of cas es, mos tly as core cultu re s with 58% of them s howing ß-Lactamase activity. GA âHS had an incidence of 38.5%, mos tly as surface cultu re s w ith 26% of them showing ß-Lactamas e activity. Streptococcus pneumoniae were is olated in 20% of cas es, mos tly surface is olates . Klebsiella pneumoniae were identified in the core of 5 cas es (7.7%). There was a noticeable difference between s urface and core cultures regard in g a ll t ypes of bacteria except S.aureus . Fifty percent discrepancy between the two sites was found. Co n c lus ion: S. aureus is the main offending pathogen res pons ible for chronic tons illitis nowadays . H. influenzae an d GA âHS had a near equal incidence. Due to the difference between the is olates from tons illar s urfac e a n d c o re , the practice of s urface tons illar s wab may be mis leading. Tons illar dis eas e may s tem from the bacteria w it h in t he s ubs tance of the tons ils rather than the bacteria identified on the surface.
It has been debated whether the reported increased risk of Hodgkin's lymphoma (HL) after tonsille... more It has been debated whether the reported increased risk of Hodgkin's lymphoma (HL) after tonsillectomy could be due to some underlying factor rather than the surgery itself. We studied whether not only tonsillectomy but also tonsillitis was associated with HL. This nationwide cohort study included all Danish residents during 1977-2001. Information on a diagnosis of tonsillitis, tonsillectomy, or HL was obtained from national registries. During 124 million person-years we observed 2,988 HL patients of whom 58 were tonsillectomized (most with preceding tonsillitis) and 14 were diagnosed with only tonsillitis at more than 1 year before HL diagnosis. Tonsillectomy was associated with a significantly increased HL risk in persons under 15 years of age as follows: 1-4 years after tonsillectomy, relative risk (RR) 5 3.9 [95% CI: 1.4-11; n 5 4]; >5 years after tonsillectomy, RR 5 3.5 [1.4-8.5; n 5 5]. No young cases of HL occurred among persons diagnosed with only tonsillitis. In contrast, 1-4 years after a hospital diagnosis of tonsillitis without subsequent tonsillectomy we found an increased HL risk in persons aged 15 years or above as follows: 15-34 years of age at HL diagnosis, RR 5 3.5 [1.6-7.7; n 5 6]; 351 years, RR 5 5.9 [2.2-16; n 5 4]. Age at tonsillitis or tonsillectomy did not modify HL risk within the 3 age strata. An increased HL risk was found both after tonsillectomy and after an isolated diagnosis of tonsillitis. These results suggest that tonsillitis is a risk factor for HL and not that, as previously reported, only the surgical removal of tonsils is a risk factor.
The aim of the present study was to explore serological biomarkers which predict the outcome of t... more The aim of the present study was to explore serological biomarkers which predict the outcome of tonsillectomy for chronic tonsillitis. Methods: A case study in a University ENT department of 24 adult patients with chronic tonsillitis (CHT) in comparison to 24 patients with acute peritonsillar abscess (PTA) was performed. Blood samples for clinical routine hematological and serological parameters were assessed prior to surgery (T-1) and five days (T5) after tonsillectomy. Outcome 6 months later (T180) was documented using the Glasgow Benefit Inventory (GBI) and the Specific Benefits from Tonsillectomy Inventory (SBTI). Correlation analyses between CHT and PTA group as well as between the different time points within each group concerning the serological parameters and the outcome parameters were performed. Results: At T-1, patients in the CHT group presented with significantly higher lymphocytes counts (relative and absolute), basophils (relative and absolute) and eosinophils but less white-cells, monocytes, neutrophils (absolute and relative), alpha-1, alpha-2, beta globulins, immunoglobulin and lower C-reactive protein and procalcitonin values than patients in the PTA group (all p < 0.05, respectively). Within each group, different significant changes of the serum parameters (often in opposite direction) were observed between T-1 and T5. SBTI scores at T-1 were significantly lower in the CHT group. In contrast, most GBI scores at T180 were significantly higher in the CHT group. Between T-1 and T180 the SBTI scores improved in three quarters of the CHT patients but only in three fifths of the PTA patients. Higher eosinophil counts and immunoglobulin E levels at T-1 predicted higher GBI scores at T180 in the CHT group. Conclusions: This pilot study showed a specific serological pattern for patients with chronic tonsillitis with a specific pattern of changes after tonsillectomy. But there is no established role for biomarkers currently used in clinical practice to predict the outcome of tonsillectomy for chronic tonsillitis.
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