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Clinical Investigation: The Presence of Viral Meningitis without Pleocytosis among Pediatric Patients

Open Journal of Pediatrics 2014年第4期4卷 276-282页

作者： adi klein-kremer Vered Nir Kassem Eias Rony-Reuven Nir Renata Yakubov Keren Gershon Department of Pediatrics Hillel-Yaffe Medical Center Hadera Israel Unit of Infectious Diseases Hillel-Yaffe Medical Center Hadera Israel

Background:?Viral meningitis (VM) is mostly common among infants. Its induction by enteroviruses (EVM) is associated with morbidity and is primarily diagnosed by lumbar puncture, which may yield false negatives. We evaluated the frequency of VM by polymerase chain reaction (PCR) among infants with no detected pleocytosis. Furthermore, as literature suggests EVM essentially occurs during summer and fall, we characterized the monthly distribution of EVM cases. Methods:?Infants diagnosed with VM from June 2009 to May 2010 were enrolled in the current prospective study. Following each lumbar puncture, CSF was tested for enteroviruses by PCR. Outcome measures were i) the percentage of EVM cases revealed solely by PCR;and ii) the monthly distribution of EVM cases. Results:Enrolled were 173 VM-diagnosed infants, of whom 75 (43.4%) tested positive in CSF-PCR. Of these, no pleocytosis was indicated in 43 (57%), specifically in 70% and 42% of infants younger than 90 days and older than 1 year, respectively. Furthermore, 119 (69%) infants were admitted during June-November while 54 (31%) during December-May. Conclusions:Current findings stress the high frequency of infants who were tested negative for pleocytosis, yet were diagnosed with VM by PCR. This was especially noticeable among infants younger than 3 months, possibly reflecting their decreased ability to mount a robust inflammatory response to EV infection. CSF-PCR may be warranted in pediatric patients who test negative for pleocytosis. While most EVM cases occurred during the summer and fall, EVM-infants were admitted to the hospital all through the year.

关键词： Cerebrospinal Fluid (CSF) Enteroviral Meningitis Lumbar Puncture Polymerase Chain Reaction (PCR) Viral Meningitis

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Coblation Intracapsular Tonsillectomy and Coblation Complete Tonsillectomy for Obstructive Sleep Apnea

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International Journal of Otolaryngology and Head & Neck Surgery 2015年第5期4卷 350-355页

作者： Itzhak Braverman Alex Nemirovsky adi klein Miriam Sarid Galit Avior Unit of Otolaryngology-Head & Neck Surgery Hadera Israel Pediatric Department Hillel Yaffe Medical Center Hadera and The Faculty of Medicine The Technion Haifa Israel Western Galilee College Acco Israel

Objective: Total tonsillectomy and intracapsular tonsillectomy are common procedures for the treatment of obstructive sleep apnea (OSA) in children. The objective of this study was to compare the effectiveness of coblation intracapsular tonsillectomy (ICT) and coblation complete tonsillectomy (CT) as treatments for OSA. Study design: A retrospective study of all the children ages 2 - 18 years with OSA who underwent coblation intracapsular tonsillectomy (ICT) or coblation complete tonsillectomy (CT) from January 2007 to August 2010 by the same surgeons at one institution. Methods: Data were retrieved from children’s charts and from telephone interviews with children’s parents, regarding pre and postoperative OSA-18 scores, postoperative pain, postoperative complications, use of analgesic drugs, and time to return to a solid food diet. Results: All 43 children who underwent ICT and 37 children who underwent CT suffered from OSA before surgery, and none did postoperatively. There were no minor complications in the ICT group, compared to 13.5% in the CT group (p = 0.01). According to parental report, 72% and 21% suffered a low level of postoperative pain, and 9% and 33% severe pain in the ICT and CT groups, respectively. For these respective groups, 49% and 73% needed analgesic drugs (p < 0.05);and 65% and 35% ate solid food during the first 3 days post surgery. Conclusions: Both ICT and CT were safe, with few complications;however recovery was faster in the ICT group, as demonstrated by less pain, and more rapid return to a solid food diet.

关键词： Obstructive Sleep Apnea Tonsillectomy Coblation Intracapsular Tonsillectomy Pain Adenotonsillectomy Tonsillotomy

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