Do laryngoscopic findings reflect the characteristics of reflux in patients with laryngopharyngeal reflux?

OBJECTIVE

To analyse the association between 24-hour multichannel intraluminal impedance-pH (24-h MII-pH) parameters and each item of the reflux finding score (RFS) to determine whether the laryngoscopic findings of the RFS could reflect the characteristics of reflux in patients with laryngopharyngeal reflux (LPR).

STUDY DESIGN

Prospective cohort study.

SETTINGS

Tertiary care referral medical centre.

PARTICIPANTS

Patients complaining of LPR symptoms were evaluated via a 24-hour MII-pH. Among them, 99 patients whose LPR was confirmed via 24-hour MII-pH were enrolled in this study.

MAIN OUTCOME MEASURES

Correlations between RFS ratings and 24-hour MII-pH parameters were evaluated and compared between patients with or without each laryngoscopic finding used in the RFS.

RESULTS

Subglottic oedema had a statistically significant positive correlation with number of non-acid LPR and non-acid full column reflux events. Ventricular obliteration and posterior commissure hypertrophy showed a significant correlation with non-acid exposure time and total reflux exposure time. We also found a significant correlation between granuloma/granulation score and number of acid LPR events. The numbers of non-acid LPR and full column reflux events in patients with subglottic oedema were significantly higher than those without subglottic oedema.

CONCLUSION

Among the laryngoscopic findings used in the RFS, subglottic oedema is specific for non-acid reflux episodes, and granuloma/granulation is specific for acid reflux episodes.

A Fas-associated via death domain promoter polymorphism (rs10898853, -16C/T) as a risk factor for papillary thyroid cancer

PURPOSE

To determine whether a Fas-associated via death domain (FADD) promoter single-nucleotide polymorphism (SNP) is associated with susceptibility to papillary thyroid cancer (PTC) and clinicopathological features of PTC.

METHODS

To identify a possible association with PTC, 94 patients with PTC and 346 healthy controls were recruited. One promoter SNP (rs10898853, -16C/T) was analyzed by direct sequencing. Multiple logistic regression models (co-dominant, dominant, recessive, and log-additive models) were applied, and odds ratios (ORs), 95% confidence intervals (CIs), and p values were calculated.

RESULTS

The genotype of the promoter SNP (rs10898853) of FADD was found to be significantly associated with PTC in the co-dominant model 2 (T/T vs. C/C; p = 0.002, OR = 2.80, 95% CI = 1.39-5.65), the recessive model (p = 0.003, OR = 2.21, 95% CI = 1.31-3.71), and the log-additive model (p = 0.002, OR = 1.71, 95% CI = 1.20-2.44). Allele frequency analysis showed that the C allele of rs10898853 was significantly associated with an increased risk of PTC (p = 0.002, OR = 1.67, 95% CI = 1.21-2.32).

CONCLUSIONS

Our results suggest that the FADD promoter polymorphism is associated with susceptibility to PTC.

Routine computerised tomography in patients with acute supraglottitis for the diagnosis of epiglottic abscess: is it necessary?--a prospective, multicentre study

OBJECTIVES

To evaluate the predictive factor of epiglottic abscess and to investigate whether routine computerised tomography (CT) in patients with acute supraglottitis are necessary.

DESIGN

A prospective and multicentre study.

SETTINGS

Tertiary care referral medical centre.

PARTICIPANTS

A total of 202 patients with suspected acute supraglottitis were enrolled. All patients underwent CT to confirm the presence of abscess.

MAIN OUTCOME MEASURES

The patients' characteristics, symptoms at presentation, laryngoscopic findings of epiglottic swelling and arytenoid swelling by scope classification and initial laboratory finding were analysed.

RESULTS

Of 202 patients, 158 (78%) had acute supraglottitis and 44 (22%) had epiglottic abscess. There was no significant difference in age between the acute supraglottitis group and the epiglottic abscess group. Men were significantly more frequent in the epiglottic abscess group than females (P = 0.042). When comparing the symptom at presentation, the patients with epiglottic abscess complained of voice change more frequently (P = 0.003). Moderate or severe epiglottic swelling in scope classification was significantly associated with epiglottic abscess (P < 0.001). In logistic regression analysis, voice change [OR = 2.64, 95% CI = 1.29-5.40, P = 0.008] and moderate or severe epiglottic swelling in laryngoscopic findings [OR = 3.94, 95% CI = 1.63-9.53, P = 0.002] were independent predictive factors for epiglottic abscess. The positive predictive values of voice change and moderate or severe epiglottic swelling were 33% and 30%, respectively. The negative predictive values of voice change and moderate or severe epiglottic swelling were 15% and 9%, respectively.

CONCLUSIONS

Routine CT might be suggested for diagnosis of epiglottic abscess in the patients with acute supraglottitis, because of the poor predictive values of symptoms and signs.

Interleukin 22 polymorphisms and papillary thyroid cancer

BACKGROUND

IL22RA1 (Interleukin 22 receptor-alpha 1), a member of the class II cytokine receptor family, mediates diverse biologic activities and appears to be important in pathogen defense, wound healing, and tissue reorganization. Polymorphisms in genes encoding inflammatory cytokines are associated with increased cancer risk.

AIM

The aim of this study was to evaluate the association between the single nucleotide polymorphisms (SNP) in the IL22 and IL22RA1 and papillary thyroid cancer (PTC), and to assess the relationship between the SNP in the IL22 and IL22RA1 and the clinical parameters of PTC.

MATERIAL AND METHODS

Study enrolled experimental group of 94 PTC patients and 213 controls. PTC patients were grouped and compared for clinical PTC parameters. One promoter SNP of IL22, -429C/T (rs2227485), and one SNP of IL22RA1, Arg518Gly (rs3795299) were analyzed using direct sequencing. Genetic data were analyzed using Helixtree, SNPAnalyzer Pro, SNPStats, and Haploview.

RESULTS

A SNP in IL22 (rs2227485) was significantly associated with PTC (codominant2 model [C/C vs T/T], odds ratio (OR) 2.39, 95% confidence interval (CI) 1.21-4.71, p=0.012; dominant model, OR 1.89, 95% CI 1.08-3.31, p=0.022). The allele T frequency of rs2227485 in IL22 was also associated with PTC (OR 1.59, 95% CI 1.13-2.25, p=0.009). According to clinical parameters, rs2227485 of IL22 was associated with number of cancers (dominant model, OR 3.03, 95% CI 1.02-9.01, p=0.035). By haplotype analysis, TG was associated with PTC (codominant model, OR 1.52, 95% CI 1.07-2.16, p=0.019; dominant model, OR 1.91, 95% CI 1.13- 3.24, p=0.015). Genotype and allele analysis of rs3795299 in IL22RA1 showed no significant differences between PTC patients and controls.

CONCLUSION

The rs2227485 SNP in IL22 might be associated with the risk and the multifocality of PTC.