Συμβολή στη μελέτη και αντιμετώπιση της οξείας επιγλωττίτιδας σε ενήλικες στην Ελλάδα

Σκοπός: Η παρούσα διδακτορική διατριβή ασχολείται με τη μελέτη της πληθυσμιακής, δημογραφικής, φυλετικής και ηλικιακής κατανομής της οξείας επιγλωττίτιδας σε ενήλικες ασθενείς στην Ελλάδα καθώς και με την κλινικοεργαστηριακή διάγνωση και αντιμετώπιση της νόσου και των δυνητικά θανατηφόρων επιπλοκών της. Μέθοδοι: Μελετήθηκαν αναδρομικά ασθενείς από τρία νοσοκομειακά ιδρύματα, με βάση το εφημερειακό καθεστώς που ισχύει στη χώρα από την έναρξη του 2011 έως το τέλος του 2020 και έγινε αναγωγή των αποτελεσμάτων επί του γενικού συνόλου του πληθυσμού. Όλοι οι ασθενείς αντιμετωπίστηκαν με ενιαίο πρωτόκολλο διαχείρισης. Αποτελέσματα: Μελετήσαμε 308 περιπτώσεις ενήλικων ασθενών που νοσηλεύτηκαν με τη διάγνωση της οξείας επιγλωττίτιδας, 176 άνδρες και 132 γυναίκες. Η διάμεση ηλικία τους ήταν 47,7±16,2 έτη. Η μέση διάρκεια νοσηλείας ήταν 4,6±3,4 ημέρες. Δεν παρατηρήθηκε εποχιακή κατανομή της νόσου, ούτε μεταβολή στην χρονική τάση. Από το σύνολο του δείγματος μελετήθηκαν αναλυτικότερα 140 ασθενείς (82 άντρες και 58 γυναίκες). Συνοδά νοσήματα είχαν 81 ασθενείς ενώ 63 ήταν καπνιστές. Ο μέσος χρόνος έναρξης των συμπτωμάτων πριν την προσέλευση στο νοσοκομείο ήταν 2,6±1.7 μέρες. Τα πιο κοινά συμπτώματα ήταν η οδυνοφαγία και η φαρυγγαλγία ακολουθούμενα από την αλλαγή φωνής, το εμπύρετο, την αναπνευστική δυσχέρεια, τη σιελόρροια και το βήχα. Επιγλωττιδική κύστη είχαν 8 ασθενείς. Επιπλοκές της νόσου εμφάνισαν 32 ασθενείς (αποστηματική επιγλωττίτιδα: 27, απόφραξη αεραγωγού: 17, άλλες: 4). Επιγλωττιδικό απόστημα εμφάνισαν 13 ασθενείς (γλωσσική επιφάνεια της επιγλωττίδας), υπεργλωττιδικό απόστημα 3, ενώ 11 ασθενείς εμφάνισαν εν τω βάθει τραχηλικό απόστημα. Χειρουργική παροχέτευση των αποστημάτων έγινε σε 20 ασθενείς ενώ 7 αντιμετωπίστηκαν με συντηρητική αγωγή. Η διάρκεια νοσηλείας των ασθενών με αποστηματική επιγλωττίτιδα ήταν 8.7±5.5 μέρες (p-value: <.001) ενώ αυτών που χρειάστηκαν διασφάλιση αεραγωγού με χειρουργική τραχειοστομία ήταν 10.8±4.8μέρες (p-value: <.001). Βρέθηκε ότι η ύπαρξη άνω του ενός μικροβίων αυξάνει τη διάρκεια νοσηλείας (p value: <.002). Στατιστικά σημαντικοί προγνωστικοί παράγοντες εκδήλωσης αποστηματικής επιγλωττίτιδας βρέθηκαν να είναι τα συμπτώματα αναπνευστικής δυσχέρειας, η ύπαρξη κύστης και η τιμή της CRP>44 mg/L (p value: <.001, <.001 και <.001 αντίστοιχα). Οι παράγοντες που συνδέονται στατιστικά με την απόφραξη του αεραγωγού είναι τα συμπτώματα της αναπνευστικής δυσχέρειας, ο σακχαρώδης διαβήτης και η τιμή της CRP>50 mg/L (p value: <.013, <.001 και <.001 αντίστοιχα). Η απόφραξη του αεραγωγού συνδέεται στατιστικά με την προΰπαρξη ή την ανάπτυξη αποστήματος και αντίστροφα (p-value: <0.001). Ελήφθησαν συνολικά 100 καλλιέργειες φαρυγγικού επιχρίσματος, πύου και ιστών. Το 90% εμφάνισαν ένα μονό παθογόνο μικρόβιο ενώ το 10% εμφάνισε δύο ή παραπάνω μικρόβια. Ο στρεπτόκοκκος απομονώθηκε στο 64% των καλλιεργειών ενώ ο H.Influenza δεν ανιχνεύτηκε σε καμία καλλιέργεια. Η ύπαρξη άνω του ενός παθογόνου μικροβίου συνδέεται στατιστικά με τη δημιουργία αποστημάτων και με την απόφραξη του αεραγωγού (p value: <.001). Όλοι οι ασθενείς επέζησαν. Συμπεράσματα: Η ετήσια συχνότητα εμφάνισης της οξείας επιγλωττίτιδας ενηλίκων στην Ελλάδα υπολογίστηκε σε 3,2 ασθενείς ανά 100.000 κάτοικοι. Η διάγνωση της νόσου είναι κλινική. Οι εργαστηριακές και απεικονιστικές εξετάσεις είναι επικουρικές αλλά συμβάλουν στην εκτίμηση της βαρύτητας της νόσου. Άνω του 20% των ασθενών αναμένεται να εκδηλώσουν επιπλοκές με συχνότερες τη δημιουργία αποστημάτων και την απόφραξη του αεραγωγού. Προγνωστικοί παράγοντες για την εκδήλωση επιπλοκών είναι τα συμπτώματα αναπνευστικής δυσχέρειας, η ύπαρξη επιγλωττιδικής κύστης, ο ΣΔ και η αυξημένη τιμή της C-αντιδρώσας πρωτείνης με τιμή άνω του 50 mg/L. Σε περίπτωση εμφάνισης επιπλοκών η διάρκεια νοσηλείας διπλασιάζεται. Ο στρεπτόκοκκος εμφανίζεται ως το πιο κοινό παθογόνο μικρόβιο. Τα εμπειρικά σχήματα ενδοφλέβιας αντιβιοτικής αγωγής έχουν συχνά επιτυχή αποτελέσματα ενώ σε περίπτωση επιπλοκών η πολυμικροβιακότητα είναι συχνή. Η κύρια ένδειξη χειρουργικής παροχέτευσης των αποστημάτων είναι η επέκταση τους πέραν της δομής της επιγλωττίδας. Τα ευρήματα της παρούσας μελέτης υποδεικνύουν ότι η οξεία επιγλωττίτιδα ενηλίκων αποτελεί διαφορετική κλινική οντότητα από αυτή των παίδων. Η έγκαιρη διάγνωση και αντιμετώπιση μπορεί να εκμηδενίσει τη θνητότητα.Objectives: The purpose of this doctoral dissertation is to examine the population, demographic, gender, and age distributions of acute epiglottitis in adult patients in Greece, as well as to investigate the clinical and laboratory findings and the treatment course of the disease and its potentially fatal complications. Methods: Patients from three hospitals were studied retrospectively, using the hospital's on-call time system in the country from the start of 2011 to the end of 2020, and the results were extrapolated to the general population. All patient were managed according to a single protocol. Results: 308 adult cases with acute epiglottitis were identified, 176 males and 132 females. Patients have a median age of 47.7±16.2 years. The mean length of stay in the hospital was 4.6±3.4 days. There was no seasonal distribution of the disease, and there was no change in the time trend. 140 patients (82 males and 58 females) were studied in greater detail from the entire sample. 81 patients had co-morbid conditions, and 63 were smokers. The mean time from onset of symptoms to hospital admission was 2.6±1.7 days. Odynophagia and pharyngalgia were the most frequently reported symptoms, followed by voice change, fever, respiratory distress, drooling, and cough. Eight patients were diagnosed with epiglottis cyst. In 32 patients, developed complications (abscess: 27, airway obstruction: 17, others: 4). 13 patients developed epiglottic abscess (all on the lingual surface of the epiglottis), 3 patients developed hyperglottic abscess, and 11 patients developed deep cervical abscess. Twenty patients underwent surgical drainage of abscesses, while seven received conservative treatment. The hospitalization duration for patients with abscess was 8.7±5.5 days (p-value: <.001), whereas the hospitalization duration for patients requiring airway management via surgical tracheostomy was 10.8±4.8 days (p-value: <.001). Mixed flora was found to significantly increase the length of hospital stay (p value: <.002). Respiratory distress symptoms, the presence of a cyst, and a CRP value greater than 44 mg/L were found to be statistically significant prognostic factors for the development of abscess (p values: <.001,<.001, and <.001, respectively). Airway obstruction is statistically associated with respiratory distress symptoms, diabetes mellitus, and CRP greater than 50 mg/L (p values <.013,<.001, and <.001, respectively). Airway obstruction is statistically correlated with the presence or development of abscesses and vice versa (p-value: <0.001). We collected a total of 100 pharyngeal, pus, and tissue cultures. 90% developed a single pathogenic germ, while 10% developed two or more pathogenic microrganisms. Streptococcus was isolated as the pathogen in 64% of cultures, while H. influenzae was not isolated in any culture. Mixed flora was statistically associated with the formation of abscesses and airway obstruction (p-value: <.001). All patients survived. Conclusions: In Greece, the annual incidence of acute adult epiglottitis was estimated to be 3.2 patients per 100,000 inhabitants. The diagnosis of the disease is clinical. While laboratory and imaging tests are not required, they aid in determining the severity of the disease. Over 20% of patients are expected to develop complications, the most common of which are abscesses and airway obstruction. Complications are predicted by respiratory distress symptoms, the presence of an epiglottic cyst, SD, and an elevated C-reactive protein level greater than 50 mg/L. In the event of complications, the length of stay is doubled. The most prevalent pathogen appears to be Streptococcus. In most cases, empirical regimens of intravenous antibiotics are successful, while polymicrobial disease is common in the event of complications. The main indication for surgical drainage of abscesses is their progression beyond the epiglottis structure. The findings of this study indicate that acute epiglottitis in adults, is a distinct clinical entity from pediatric acute epiglottitis. Early diagnosis and treatment can virtually eliminate mortality

Virtual and Augmented Reality in Medical Education

Virtual reality (VR) and augmented reality (AR) are two contemporary simulation models that are currently upgrading medical education. VR provides a 3D and dynamic view of structures and the ability of the user to interact with them. The recent technological advances in haptics, display systems, and motion detection allow the user to have a realistic and interactive experience, enabling VR to be ideal for training in hands-on procedures. Consequently, surgical and other interventional procedures are the main fields of application of VR. AR provides the ability of projecting virtual information and structures over physical objects, thus enhancing or altering the real environment. The integration of AR applications in the understanding of anatomical structures and physiological mechanisms seems to be beneficial. Studies have tried to demonstrate the validity and educational effect of many VR and AR applications, in many different areas, employed via various hardware platforms. Some of them even propose a curriculum that integrates these methods. This chapter provides a brief history of VR and AR in medicine, as well as the principles and standards of their function. Finally, the studies that show the effect of the implementation of these methods in different fields of medical training are summarized and presented

Left Atrial Appendage Closure: Initial Experience with the Watchman Device

We herein present the first left atrial appendage (LAA) percutaneous closure procedure performed in our Institution with use of the Watchman device in an 82-year old woman with atrial fibrillation, unable to continue receiving anticoagulation therapy due to bleeding complications. A propos with this case, we discuss the data related to this therapeutic approach geared to prevent thromboembolism in patients with atrial fibrillation and contraindications to treatment with anticoagulants

Altered mechanisms of protein synthesis in frontal cortex in Alzheimer disease and a mouse model

Expression of the nucleolar chaperones nucleolin (NCL) and nucleophosmin (NPM1), upstream binding transcription factor (UBTF), rRNA18S, rRNA28S, and several genes encoding ribosomal proteins (RPs) is decreased in frontal cortex area 8 at advanced stages of Alzheimer's disease (AD). This is accompanied by reduced protein levels of elongation factors eEF1A and eEF2. Changes are more marked in AD cases with rapid course (rpAD), as initiation factor eIF3η is significantly down-regulated and several RP genes up-regulated in rpAD when compared with typical AD. These changes contrast with those seen in APP/PS1 transgenic mice used as a model of AD-like β-amyloidopathy; Ncl mRNA, rRNA18S, rRNA28S and seven out of fifteen assessed RP genes are up-regulated in APP/PS1 mice aged 20 months; only eEF2 protein levels are reduced in transgenic mice. Our findings show marked altered expression of molecules linked to the protein synthesis machinery from the nucleolus to the ribosome in frontal cortex at terminal stages of AD which differs from that seen in APP/PS1 transgenic mice, thus further suggesting that molecular signals in mouse models do not apply to real human disease counterparts

Primary Percutaneous Coronary Intervention in Acute ST-Elevation Myocardial Infarction: The Experience of "Evagelismos" General Hospital of Athens

BACKROUND: Primary percutaneous coronary intervention (PCI) has been shown to be a better reperfusion strategy in patients with ST-elevation myocardial infarction (STEMI) compared with thrombolysis, particularly when applied early. The objective of the present study was to report our experience from treating patients presenting to the emergency room of our hospital with STEMI with primary PCI. PATIENTS AND METHODS: The population of the study included 100 patients who presented to our hospital with STEMI and underwent primary PCI over a 12-month period. Patients’ clinical and angiographic data were retrospectively collected and patients were followed up for 9 months. Technical details of the primary PCI, including stent implantation, and use of drug eluting stents, thrombus aspiration catheter, or platelet glycoprotein IIb/ΙΙΙa inhibitors were recorded and correlated to clinical and angiographic patient data. RESULTS: Of 196 patients who presented o the emergency room with STEMI during the study period, 100 (51%) patients (85 men and 15 women) underwent primary PCI. PCI was successful with TIMI 3 flow of the infarct-related coronary artery in 79 (79%) patients. Six (6%) patients died during hospitalization and another 4 (4.3%) patients died during the 9-month follow up period. Twenty one (22%) patients required rehospitalization for acute coronary syndrome, of whom 17 needed a repeat PCI and 4 patients were submitted to coronary artery bypass grafting. Left ventricular ejection fraction (LVEF) was <50% in 54 (54%) patients. In 52 patients primary PCI was performed in less than 4 hours from onset of symptoms. In his cohort, 19 patients were thrombolyzed before arriving to the catheterization laboratory. Antithrombotic therapy with platelet glycoprotein IIb/IIIa inhibitors was used in 48 (48%) patients. Univariate analysis showed that the odds of achieving TIMI 3 flow were higher after using IIb/ΙΙΙa inhibitors (odds ratio-OR 6.4) or if the LVEF ≥50% (vs LVEF < 50%) at the beginning of the PCI (OR 6.4). If the time from the onset of symptoms to PCI was >4 hours, the odds of achieving TIMI 3 flow were reduced by 23.4% compared to time from symptoms to PCI <4 hours. The presence of TIMI 3 flow of the infarct-related artery reduced the odds of death by 10.2% compared to the absence of TIMI 3 flow of the infarct-related coronary artery. CONCLUSION: Our results are in keeping with those published by other groups performing primary PCI. We demonstrated the importance of time interval from onset of symptoms until PCI is started. We found that the use of GP IIb/IIIa inhibitors was beneficial and emphasized the predictive value of LVEF >50% and the importance of achieving TIMI 3 flow in the IRA at the end of the procedure

Outcomes of elective liver surgery worldwide: a global, prospective, multicenter, cross-sectional study

Background: The outcomes of liver surgery worldwide remain unknown. The true population-based outcomes are likely different to those vastly reported that reflect the activity of highly specialized academic centers. The aim of this study was to measure the true worldwide practice of liver surgery and associated outcomes by recruiting from centers across the globe. The geographic distribution of liver surgery activity and complexity was also evaluated to further understand variations in outcomes. Methods: LiverGroup.org was an international, prospective, multicenter, cross-sectional study following the Global Surgery Collaborative Snapshot Research approach with a 3-month prospective, consecutive patient enrollment within January–December 2019. Each patient was followed up for 90 days postoperatively. All patients undergoing liver surgery at their respective centers were eligible for study inclusion. Basic demographics, patient and operation characteristics were collected. Morbidity was recorded according to the Clavien–Dindo Classification of Surgical Complications. Country-based and hospital-based data were collected, including the Human Development Index (HDI). (NCT03768141). Results: A total of 2159 patients were included from six continents. Surgery was performed for cancer in 1785 (83%) patients. Of all patients, 912 (42%) experienced a postoperative complication of any severity, while the major complication rate was 16% (341/2159). The overall 90-day mortality rate after liver surgery was 3.8% (82/2,159). The overall failure to rescue rate was 11% (82/ 722) ranging from 5 to 35% among the higher and lower HDI groups, respectively. Conclusions: This is the first to our knowledge global surgery study specifically designed and conducted for specialized liver surgery. The authors identified failure to rescue as a significant potentially modifiable factor for mortality after liver surgery, mostly related to lower Human Development Index countries. Members of the LiverGroup.org network could now work together to develop quality improvement collaboratives

The Role of Branched-Chain Amino Acid Supplementation in Combination with Locoregional Treatments for Hepatocellular Carcinoma: Systematic Review and Meta-Analysis

Background: Branched-chain amino acid (BCAA) supplementation has been linked with favorable outcomes in patients undergoing surgical or palliative treatments for hepatocellular carcinoma (HCC). To date, there has been no systematic review investigating the value of BCAA supplementation in HCC patients undergoing locoregional therapies. Materials and methods: A systematic search of the literature was performed across five databases/registries using a detailed search algorithm according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement. The search was conducted on March 23, 2022. Results: Sixteen studies with a total of 1594 patients were analyzed. Most patients were male (64.6%) with a mean age of 68.2 ± 4.1 years, Child-Pugh score A (67.9%) and stage II disease (40.0%). Locoregional therapy consisted of radiofrequency ablation, transarterial chemoembolization or hepatic artery infusion chemotherapy. BCAA supplementation was in the form of BCAA granules or BCAA-enriched nutrient. Most studies reported improved albumin levels, non-protein respiratory quotient and quality of life in the BCAA group. Results pertaining to other outcomes including overall survival, recurrence rate, and Child-Pugh score were variable. Meta-analysis showed significantly higher levels of post-treatment serum albumin in the BCAA group (SMD = 0.54, 95% CI 0.20-0.87) but no significant differences in mortality rate (RR = 0.81, 95% CI: 0.65-1.02) and AST (SMD = -0.13, 95% CI: -0.43-0.18). Conclusion: BCAA supplementation is associated with higher post-treatment albumin levels. There are currently not sufficient data to support additional benefits. Further studies are needed to elucidate their value. Keywords: amino acids; cancer; cirrhosis; hepatocellular carcinoma; interventional radiology; liver cancer; nutrition; supplements

Surgical versus percutaneous catheter placement for peritoneal dialysis: an updated systematic review and meta-analysis

Background: No consensus currently exists regarding the optimal approach for peritoneal dialysis catheter placement. We aimed to compare the outcomes of percutaneous and surgical peritoneal dialysis catheter placement. Methods: A systematic review of the literature was performed using the MEDLINE, Cochrane Library, and Scopus databases (end-of-search date: August 29th, 2020). We included studies comparing percutaneous (blind, under fluoroscopic/ultrasound guidance, and half-perc ) and surgical peritoneal dialysis catheter placement (open and laparoscopic) in terms of their infectious complications (peritonitis, tunnel/exit-site infections), mechanical complications (leakage, inflow/outflow obstruction, migration, hemorrhage, hernia, bowel perforation) and long-term outcomes (malfunction, removal, replacement, surgery required, and mortality). Results: Thirty-four studies were identified, including thirty-two observational studies (twenty-six retrospective and six prospective) and two randomized controlled trials. Percutaneous placement was associated with significantly lower rates of tunnel/exit-site infection [relative risk (RR) 0.72, 95% confidence interval (CI) 0.56-0.91], catheter migration (RR 0.68, 95% CI 0.49, 0.95), and catheter removal (RR 0.73, 95% CI 0.60-0.88). The 2-week and 4-week rates of early tunnel/exit-site infection were also lower in the percutaneous group (RR 0.45, 95% CI 0.22-0.93 and RR 0.41, 95% CI 0.27-0.63, respectively). No statistically significant difference was observed regarding other outcomes, including catheter survival and mechanical complications. Conclusion: Overall, the quality of published literature on the field of peritoneal dialysis catheter placement is poor, with a small percentage of studies being randomized clinical trials. Percutaneous peritoneal dialysis catheter placement is a safe procedure and may result in fewer complications, such as tunnel/exit-site infections, and catheter migration, compared to surgical placement. Protocol registration: PROSPERO CRD42020154951. Keywords: Laparoscopic catheter placement; Open surgical catheter placement; Percutaneous catheter placement; Peritoneal dialysis catheter

The role of liver transplantation for colorectal liver metastases: A systematic review and pooled analysis

Background: Liver transplantation (LT) has gained interest in the treatment of unresectable colorectal liver metastases (CRLM) over the last two decades. Despite the initial poor outcomes, recent reports from countries with graft abundance have provided further insights in the potential of LT as a treatment for unresectable CRLM. Methods: A systematic literature search was conducted in the MEDLINE (PubMed), Embase, Scopus, Cochrane Library, Google Scholar, Virtual Health Library, Clinicaltrials.gov, and Web of Science databases (end-of-search date: January 27th, 2020) to identify relevant studies. Pooled overall and recurrence-free survival analysis at 6 months, 1, 2, 3, and 5 years was conducted with the Kaplan-Meier (Product Limit) method. Results: Eighteen studies comprising 110 patients were included. The population consisted of 59.8% males with a mean age of 52.3 ± 9.3 years. CRLM diagnosis was synchronous in 83%, while 99% received chemotherapy, and 39% received liver resection prior to LT. The mean time from primary tumor resection to LT was 39.5 ± 32.5 months, the mean post-LT follow-up was 32.1 ± 22.2 months, and the mean time to recurrence was 15.0 ± 11.3 months. The pooled 6-month, 1-, 2-, 3-, and 5-year overall survival rates were 95.7% (95%CI: 89.1%-98.4%), 88.1% (95%CI: 79.6%-93.2%), 74.6% (95%CI: 64.2%-82.3%), 58.4% (95%CI: 47.2%-62.0%), and 50.5% (95%CI: 39.0%-61.0%), respectively. The pooled 6-months, 1-, 2-, 3-, and 5-year recurrence-free survival rates were 77.2% (95%CI: 67.2%-84.5%), 59.9% (95%CI: 49.0%-69.2%), 42.4% (95%CI: 31.8%-52.6%), 30.7% (95%CI: 20.9%-41.1%), and 25.6% (95%CI: 16.2%-36.0%), respectively. Conclusion: LT should be considered in patients with unresectable liver-only CRLM under strict selection criteria and only under well-designed research protocols. Ongoing studies are expected to further elucidate the indications and prognosis of patients undergoing LT for unresectable CRLM. Keywords: Colon cancer; Colorectal liver metastasis; Liver transplantation; Transplant oncology; Unresectable

Contribution to the study and treatment of adult acute epiglottitis in Greece

Objectives: The purpose of this doctoral dissertation is to examine the population, demographic, gender, and age distributions of acute epiglottitis in adult patients in Greece, as well as to investigate the clinical and laboratory findings and the treatment course of the disease and its potentially fatal complications.Methods: Patients from three hospitals were studied retrospectively, using the hospital's on-call time system in the country from the start of 2011 to the end of 2020, and the results were extrapolated to the general population. All patient were managed according to a single protocol.Results: 308 adult cases with acute epiglottitis were identified, 176 males and 132 females. Patients have a median age of 47.7±16.2 years. The mean length of stay in the hospital was 4.6±3.4 days. There was no seasonal distribution of the disease, and there was no change in the time trend. 140 patients (82 males and 58 females) were studied in greater detail from the entire sample. 81 patients had co-morbid conditions, and 63 were smokers. The mean time from onset of symptoms to hospital admission was 2.6±1.7 days. Odynophagia and pharyngalgia were the most frequently reported symptoms, followed by voice change, fever, respiratory distress, drooling, and cough. Eight patients were diagnosed with epiglottis cyst. In 32 patients, developed complications (abscess: 27, airway obstruction: 17, others: 4). 13 patients developed epiglottic abscess (all on the lingual surface of the epiglottis), 3 patients developed hyperglottic abscess, and 11 patients developed deep cervical abscess. Twenty patients underwent surgical drainage of abscesses, while seven received conservative treatment. The hospitalization duration for patients with abscess was 8.7±5.5 days (p-value: 44 mg/L (p value: 50 mg/L (p value: <.013, <.001 και <.001 αντίστοιχα). Η απόφραξη του αεραγωγού συνδέεται στατιστικά με την προΰπαρξη ή την ανάπτυξη αποστήματος και αντίστροφα (p-value: <0.001). Ελήφθησαν συνολικά 100 καλλιέργειες φαρυγγικού επιχρίσματος, πύου και ιστών. Το 90% εμφάνισαν ένα μονό παθογόνο μικρόβιο ενώ το 10% εμφάνισε δύο ή παραπάνω μικρόβια. Ο στρεπτόκοκκος απομονώθηκε στο 64% των καλλιεργειών ενώ ο H.Influenza δεν ανιχνεύτηκε σε καμία καλλιέργεια. Η ύπαρξη άνω του ενός παθογόνου μικροβίου συνδέεται στατιστικά με τη δημιουργία αποστημάτων και με την απόφραξη του αεραγωγού (p value: <.001). Όλοι οι ασθενείς επέζησαν.Συμπεράσματα: Η ετήσια συχνότητα εμφάνισης της οξείας επιγλωττίτιδας ενηλίκων στην Ελλάδα υπολογίστηκε σε 3,2 ασθενείς ανά 100.000 κάτοικοι. Η διάγνωση της νόσου είναι κλινική. Οι εργαστηριακές και απεικονιστικές εξετάσεις είναι επικουρικές αλλά συμβάλουν στην εκτίμηση της βαρύτητας της νόσου. Άνω του 20% των ασθενών αναμένεται να εκδηλώσουν επιπλοκές με συχνότερες τη δημιουργία αποστημάτων και την απόφραξη του αεραγωγού. Προγνωστικοί παράγοντες για την εκδήλωση επιπλοκών είναι τα συμπτώματα αναπνευστικής δυσχέρειας, η ύπαρξη επιγλωττιδικής κύστης, ο ΣΔ και η αυξημένη τιμή της C-αντιδρώσας πρωτείνης με τιμή άνω του 50 mg/L. Σε περίπτωση εμφάνισης επιπλοκών η διάρκεια νοσηλείας διπλασιάζεται. Ο στρεπτόκοκκος εμφανίζεται ως το πιο κοινό παθογόνο μικρόβιο. Τα εμπειρικά σχήματα ενδοφλέβιας αντιβιοτικής αγωγής έχουν συχνά επιτυχή αποτελέσματα ενώ σε περίπτωση επιπλοκών η πολυμικροβιακότητα είναι συχνή. Η κύρια ένδειξη χειρουργικής παροχέτευσης των αποστημάτων είναι η επέκταση τους πέραν της δομής της επιγλωττίδας. Τα ευρήματα της παρούσας μελέτης υποδεικνύουν ότι η οξεία επιγλωττίτιδα ενηλίκων αποτελεί διαφορετική κλινική οντότητα από αυτή των παίδων. Η έγκαιρη διάγνωση και αντιμετώπιση μπορεί να εκμηδενίσει τη θνητότητα