Probiootit ylähengitysteissä : tarttuminen, teho ja turvallisuus

Upper respiratory infections are among the most common ailments in humans. Evidence for mechanisms suggests that specific probiotic bacteria could reduce the risk and symptoms of these infections. However, the clinical evidence of probiotics in the upper respiratory tract, especially when colonization and the etiological effects are considered, is sparse. In addition, the safety of probiotics requires constant assessment. This thesis investigated the recovery of probiotic Lactobacillus rhamnosus GG (L. GG) from the upper respiratory tract and its effects on pathogens in this tract. In addition, the thesis assessed the adverse events of L. GG alone or in combination with other probiotics (Bifidobacterium lactis BB-12 [BB12], or Lactobacillus rhamnosus Lc705 [Lc705], Propionibacterium freudenreichii JS [PJS], and/or Bifidobacterium breve 99 [BB99]). In a randomized, double-blinded, placebo-controlled study, 40 children consumed per oral L. GG or a placebo (1:1) prior to surgery in which their adenoids were removed and a possible middle ear effusion (MEE) was collected. L. GG was recovered from both the adenoid tissue and MEE, but it did not affect the findings of human rhinovirus (HRV) or enterovirus (EV) in the samples compared to the placebo. In addition, the analysis of the bacterial pathogens in the MEE showed similarities in both intervention groups. No differences between the groups emerged in respiratory or gastrointestinal (GI) symptoms prior to the surgery or in pain or bleeding after the surgery. In another randomized, double-blinded, placebo-controlled trial, an experimental HRV infection model was used in 59 healthy adult volunteers to investigate the effects of the oral consumption of live, heat-inactivated L. GG on the HRV load in nasopharyngeal lavage samples. The correlation of the HRV load to the subjects clinical symptom scores was assessed. The use of live or inactivated L. GG did not result in statistical differences in the HRV load, but a tendency to lower loads in the L. GG groups was noted. The HRV load positively correlated with the total symptom scores on day 2 and day 5 after inoculation. In the fourth study, individual participant data from six randomized placebo-controlled probiotic studies were analyzed for adverse events (AEs), as distributed by the Common Terminology Criteria of Adverse Events (CTCAE). Data on 1,909 healthy subjects, including children, young adults, and elderly participants, revealed no statistical differences in AEs between the groups that consumed L. GG alone, L. GG in combination, or the placebo. A detailed analysis of three specific categories (respiratory diseases, gastrointestinal diseases, and infections) did not yield any statistical differences in AEs between the probiotic and placebo groups. Based on the results, we concluded that L. GG was able to colonize the upper respiratory tract, but it had no effects on the levels of viral or bacterial pathogens or on the frequency of clinical symptoms in the subjects during either the intervention or the follow-up period. The nasopharyngeal HRV load was positively correlated with the subjects total symptom score. The use of L. GG alone or in combination did not result in AEs in the population of healthy children, young adults, and elderly participants.Ylähengitystieinfektiot ovat yleisimpiä ihmiskunnan sairauksia. Tutkimuksissa on saatu viitteitä tiettyjen probioottisten bakteerien vähentävän sairastumisriskiä ylähengitystieinfektioihin ja toisaalta myös vähentävän infektion oireita. Probioottien tarttumisesta ylähengitysteiden limakalvolle sekä niiden vaikutuksista taudinaiheuttajiin on vain vähän tietoa. Lisäksi probioottivalmisteiden käytön turvallisuus on tarpeen arvioida. Tässä väitöskirjassa tutkittiin probiootti Lactobacillus rhamnosus GG:n (L. GG) tarttumista ylähengitysteiden limakalvoille ja sen vaikutuksia ylähengitysteiden taudinaiheuttajiin. Lisäksi tutkittiin L. GG:n ja neljän muun probiootin mahdollisia haittavaikutuksia verrattuna plaseboon. Satunnaistetussa, kaksoissokkoutetussa plasebo-kontrolloidussa tutkimuksessa tutkittiin 40 lasta, jotka käyttivät suun kautta L. GG- tai plasebo-valmistetta ennen kitarisan poistoleikkausta. Samalla mahdollinen välikorvaerite kerättiin talteen. L. GG:tä löydettiin sekä kitarisakudoksesta että välikorvaeritteestä, mutta L. GG:n käyttö ei vaikuttanut kitarisan tai välikorvaeritteen rinovirus- tai enteroviruslöydöksiin verrattuna plaseboon. Myös välikorvaeritteen bakteerilöydökset olivat samanlaiset molemmissa ryhmissä. Lasten kokemissa oireissa ei myöskään havaittu eroja ryhmien välillä tutkimuspäiväkirjojen mukaan. Toisessa satunnaistetussa, kaksoissokkoutetussa plasebo-kontrolloidussa tutkimuksessa aiheutettiin rinovirus-infektio 59 tutkimushenkilölle, joiden nenänielunäytteistä tutkittiin L. GG:n vaikutusta rinoviruksen pitoisuuteen. Lisäksi tutkittiin tutkimushenkilön kokemien flunssaoireiden verrannollisuutta viruspitoisuuteen. Elävällä tai kuolleella L. GG:llä ei havaittu tilastollisesti merkitsevää eroa nenänielun rinoviruspitoisuuteen verrattuna plaseboon. Positiivinen verrannollisuus löydettiin virusmäärän ja oireiden välillä: mitä korkeampi virusmäärä, sitä voimakkaammat oireet. Neljännessä osatyössä tutkimusryhmämme kuuden aiemman satunnaistetun ja plasebo-kontrolloidun probioottitutkimuksen alkuperäisaineistot avattiin ja tutkittiin niistä probioottien ja plasebovalmisteen haittavaikutukset. Kaikki havaitut vaikutukset jaoteltiin tunnettujen haittavaikutuskriteereiden mukaisesti. Otoskoko oli 1909 tervettä lasta, nuorta aikuista ja vanhusta, jotka käyttivät L. GG:tä, probioottiyhdistelmää tai plaseboa. Tutkimushenkilöiden kokemissa haittavaikutuksissa ei havaittu eroja ryhmien välillä. Johtopäätöksenä todetaan, että L. GG tarttui ylähengitysteiden limakalvoille, mutta sillä ei ollut vaikutusta ylähengitysteiden virus- tai bakteerilöydöksiin, eikä kliinisten oireiden esiintyvyyteen. Nenänielun rinovirusmäärä oli positiivisesti verrannollinen flunssan oireiden hankaluuteen. Tutkittujen probioottivalmisteiden käyttö todettiin turvalliseksi

Probiotics and Upper Respiratory Tract - a Review

Peer reviewe

Syvä kaulapaise - diagnostinen haaste?

Vertaisarvioitu.Syvän kaulapaiseen hoito edellytti laajaa leikkausta ja usean vuorokauden sairaalahoitoa. Kuvaamme potilaan, jonka hyvä yleistila hämärsi hänen infektionsa vakavuuden havaitsemista. Infektion syynä oli yleinen syvän kaulapaiseen aiheuttaja - hampaan juurialueen tulehdus. Suun ja nielun alueen infektiot voivat toisinaan levitä kaulan syviin kudoksiin. Kudosvälitiloissa etenevä paise voi olla hengenvaarallinen. Paise voi johtaa hengitystien tukkeutumiseen, vaikeaan yleistyneeseen infektioon tai aiheuttaa hankalia komplikaatioita levitessään muualle elimistöön. Syvän kaulapaiseen taustalla on valitettavan usein viive varhaisessa diagnostiikassa ja tehokkaassa hoidossa, vaikka tauti voi edetä tuntien kuluessa

Tracheostomy complications in otorhinolaryngology are rare despite the critical airway

Purpose To identify complications of surgical tracheostomies in otorhinolaryngologic patients and adjust our processes to be properly prepared in the future. Methods We reviewed retrospectively all surgical tracheostomies (n = 255) performed by otolaryngologist-head and neck surgeons at Helsinki University Hospital between Jan 2014 and Feb 2017. Patient demographics, surgical details, surgical and medical complications, and tracheostomy-related mortality were recorded from the hospital charts. Risk factors for complications were assessed. Results Altogether, 55 (22%) complications were identified in 39 (15%) patients, with pneumonia, accidental decannulation, and bleeding being the most common. No patient or surgery-related factor reached significance in overall complication risk factor analysis. Medical complications were more common after elective tracheostomies compared to emergency procedures (10.6% vs. 3.5%, p <0.05). Majority of complications (78%) were classified as mild or moderate according to Clavien-Dindo. Only 2 (0.8%) tracheostomy-related deaths were recorded. Conclusion In otorhinolaryngologists service, severe complications and tracheostomy-related deaths are very rare. Reducing their prevalence even further with careful planning is possible.Peer reviewe

Accuracy of preoperative MRI to assess lateral neck metastases in papillary thyroid carcinoma

Primary treatment of papillary thyroid carcinoma (PTC) with lateral lymph node metastasis is surgery, but the extent of lateral neck dissection remains undefined. Preoperative imaging is used to guide the extent of surgery, although its sensitivity and specificity for defining the number and level of affected lymph nodes on the lateral neck is relatively modest. Our aim was to assess the role of preoperative magnetic resonance imaging (MRI) in predicting the requisite levels of neck dissection in patients with regionally metastatic PTC, with a focus on Levels II and V. All patients with PTC and lateral neck metastasis who had undergone neck dissection at the Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Hospital, Helsinki, Finland from 2013 to 2016 and had a preoperative MRI available were retrospectively reviewed. A head and neck radiologist re-evaluated all MRIs, and the imaging findings were compared with histopathology after neck dissection. In the cohort of 39 patients, preoperative MRI showed concordance with histopathology for Levels II and V as follows: sensitivity of 94 and 67%, specificity of 20 and 91%, positive predictive value of 56 and 75%, and negative predictive value of 75 and 87%, respectively. In PTC, MRI demonstrated fairly high specificity and negative predictive value for Level V metastasis, and future studies are needed to verify our results to omit prophylactic dissection of this level. Routine dissection of Level II in patients with regionally metastatic PTC needs to be considered, as MRI showed low specificity.Peer reviewe

Analysis of 255 tracheostomies in an otorhinolaryngology-head and neck surgery tertiary care center : a safe procedure with a wide spectrum of indications

PurposeTo review indications, patient characteristics, frequency, and safety for surgical tracheostomies performed by otolaryngologist-head and neck surgeons in a single tertiary care center.MethodsSurgical tracheostomies performed by otolaryngologist-head and neck surgeons at Helsinki University Hospital between January 2014 and February 2017 were retrospectively reviewed. Patient demographics, surgical data, and peri- and postoperative mortality information were collected from the hospital charts. Minimum follow-up was 18months.ResultsThe total population was 255, with a majority (n=181; 71%) of males. The majority of patients (n=178; 70%) were classified as ASA 3 or 4. A total of 198 (78%) patients suffered from head and neck cancer. Multiple (14 altogether) indications for tracheostomy were identified, and simultaneous major head and neck tumor surgery was common (in 58%). Altogether, 163 (64%) patients were decannulated during follow-up with a median cannulation period of 9days (range 1-425). The surgical mortality was 0.4%.ConclusionSimultaneously performed major tumor surgery was the most common indication for a tracheostomy. A notable number of patients had impaired physical status, but relatively insignificant comorbidities. Almost two-thirds of the patients were decannulated during follow-up, although some patients remained tracheostomy dependent for a prolonged period. Tracheostomy was found to be a safe procedure.Level of evidence2b.Peer reviewe

Prognostic Value of Apparent Diffusion Coefficient in Oropharyngeal Carcinoma

Purpose To investigate clinical and radiological factors predicting worse outcome after (chemo)radiotherapy ([C]RT) in oropharyngeal squamous cell carcinoma (OPSCC) with a focus on apparent diffusion coefficient (ADC). Methods This retrospective study included 67 OPSCC patients, treated with (C)RT with curative intent and diagnosed during 2013-2017. Human papilloma virus (HPV) association was detected with p16 immunohistochemistry. Of all 67 tumors, 55 were p16 positive, 9 were p16 negative, and in 3 the p16 status was unknown. Median follow-up time was 38 months. We analyzed pretreatment magnetic resonance imaging (MRI) for factors predicting disease-free survival (DFS) and locoregional recurrence (LRR), including primary tumor volume and the largest metastasis. Crude and p16-adjusted hazard ratios were analyzed using Cox proportional hazards model. Interobserver agreement was evaluated. Results Disease recurred in 13 (19.4%) patients. High ADC predicted poor DFS, but not when the analysis was adjusted for p16. A break in RT (hazard ratio, HR = 3.972, 95% confidence interval, CI 1.445-10.917, p = 0.007) and larger metastasis volume (HR = 1.041, 95% CI 1.007-1.077, p = 0.019) were associated with worse DFS. A primary tumor larger than 7 cm(3) was associated with increased LRR rate (HR = 4.861, 1.042-22.667, p = 0.044). Among p16-positive tumors, mean ADC was lower in grade 3 tumors compared to lower grade tumors (0.736 vs. 0.883; p = 0.003). Conclusion Low tumor ADC seems to be related to p16 positivity and therefore should not be used independently to evaluate disease prognosis or to choose patients for treatment deintensification.Peer reviewe

Reply to "Do not de-escalate oncology care in oropharyngeal cancer routinely"

Non peer reviewe

Complications in lymph node excision in the head and neck area

Background Although needle biopsy is widely used in work-up of lymphadenopathy, lymph node excision (LNE) is often required especially in lymphoma diagnostics. LNE is an invasive procedure, which carries a potential risk of complications. However, comprehensive studies evaluating the spectrum and occurrence of complications are lacking. Aims/Objectives This study addresses the role of preoperative needle biopsies in patients who underwent LNE. Furthermore, surgical complications related to LNE are analyzed. Materials and methods Altogether 321 patients, who underwent LNE in two-year period in 2018-19, and fulfilled our study criteria, were included. Patients' data were retrieved from the electronic patient records. Results The surgical complication rate was 5.9%. Most of the complications (n = 16; 84.2%) were categorized as minor (I-II) according to the Clavien-Dindo scale. The remaining three (15.8%), all hemorrhages, were categorized as major complications and required intervention. Preoperative needle biopsy might have avoided the need for LNE in some patients, which we discuss in this study. Conclusions and significance Surgical complications after LNE in the head and neck area are rare and mostly minor. Needle biopsy is often recommended preoperatively to avoid unnecessary operations and to refrain performing LNE for patients with non-lymphatic malignancy.Peer reviewe

A Prospective Observational Study of Complications in 140 Sialendoscopies

Objectives. To evaluate the incidence and nature of complications associated with diagnostic and interventional sialendoscopies and to report intervention failures in a prospective setup. Study Design. Prospective observational study. Setting. Academic tertiary care university hospital. Subjects and Methods. Patients who underwent diagnostic or interventional sialendoscopy between October 2015 and December 2016 were prospectively enrolled. Patient data, operation-related factors, treatment failures, and complications were recorded into a database and analyzed. Results. A total of 140 sialendoscopies were attempted or performed on 118 patients; 67 (48%) were for a parotid gland and 73 (52%) for a submandibular gland. The sialendoscopy was interventional in 81 cases (58%), diagnostic in 56 (40%), and not possible to perform in 3 (2.1%). A total of 21 complications were registered for 21 sialendoscopies (15%) and 21 patients (18%). The most common complication was infection, in 9 cases (6.4%). Other observed complications were salivary duct perforation (4 cases), prolonged glandular swelling (3 cases), transient lingual nerve analgesia (2 cases), basket entrapment (2 cases), and transient weakness in the marginal branch of the facial nerve (1 case). All complications were related to interventional procedures or papilla dilatation. Failure to treat occurred in 21 (15%) sialendoscopies: sialendoscopy itself was unsuccessful in 3 cases, and an intended intervention failed in 18 cases. Conclusion. Complications in sialendoscopy are usually related to interventional procedures. The complications are mainly minor and temporary but lead to additional follow-up visits, further treatments, and sometimes hospitalization. Sialendoscopic procedures are safe but not free of complications.Peer reviewe