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Presented by:Ahmad Izzudin Af – 01.209.5824

FAKULTAS KEDOKTERANUNIVERSITAS ISLAM SULTAN AGUNG

SEMARANG2015

Peritonsillar Infections: ProspectiveStudy of 100 Consecutive Cases

María Costales-Marcos, Fernando López-Álvarez, Faustino Nú˜nez-Batalla, Carla Moreno-Galindo,∗

César Álvarez Marcos, osé Luis Llorente-!end"sServicio de Otorrinolaringología, Hospital Universitario Central de Asturias, Oviedo, Principado de Asturias,

Spain

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J urna! identityTitle :Peritonsillar Infections: Prospective Study of 100 Consecutive

Cases

Authors:• M r! "ost les#M r$os%& Fer' '(o L)*e+#,l- re+% F usti'o

N./'e+# t ll % " rl More'o#G li'(o% " s r ,l- re+M r$os% os Luis Llore'te#3e'(4s

• Servicio de Otorrinolaringología, Hospital Universitario Central de Asturias, Oviedo, Principado de Asturias, Spain

3u lishe( t:2 January 20123u lishe( 6:"!se#ier "s$a%a&7e site:• '''.e!se#ier.es( t rrin

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I)*+,- /*I,)

• Perit nsi!!ar in e ti ns are the m stmm n in e ti ns dee$ tissues

the head and ne re i n b th inadu!ts and hi!dren& 'ith an in iden e

a$$r 3imate!y 0 ases $er 100 000$ $u!ati n $er year.

• *he natura! hist ry in e ti ns in the

$erit nsi!!ar re i n is re$resented by 2main entities: $h!e m n and$erit nsi!!ar abs ess.

• "a h re e ts a se$arate sta e in thee# !uti n the in ammat ry $r ess

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• 6in e there are n !ini a! uide!ines rthe mana ement this disease&treatment #aries bet'een untries ande#en bet'een h s$ita!s 'ithin the same

untry& in as$e ts su h as treatmentre ime 7 ut$atient r in$atient & meth d draina e and antibi ti thera$y

em$! yed.• I $erit nsi!!ar in e ti ns are n t treated

$r $er!y there is a ris de#e! $inseri us m$!i ati ns su h as thr mb sis

the interna! u u!ar #ein& mediastinitis&$eri arditis& $neum nia& rmati n

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• *he m rta!ity rate $atients 'h de#e! $these m$!i ati ns an rea h 42 in

ases mediastinitis r ser sitis.• m rbidity and m rta!ity are ! ' i it is

treated rre t!y.

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Primary aim•

t re#ie' the dia n stiand thera$eutimana ement 100

nse uti#e ases!!e ted at ur ser#i ebet'een the years 2008and 2010.

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M teri ls '( Metho(s• ;e $er rmed a des ri$ti#e& $r s$e ti#e

study the mana ement $atients 'h'ere dia n sed and treated r $erit nsi!!arin e ti n bet'een A$ri! 2008 and , t ber2010.

• ;e !!e ted the !! 'in !ini a! #ariab!es:a e& ender& hist ry re urrent t nsi!!itis&$re#i us e$is des $h!e m n(abs ess&

e# !uti n& $re#i us antibi ti thera$y and itsdurati n 7the in rmati n 'as $r #ided by$atients r their re!ati#es & sym$t ms at

nset& $hysi a! e3aminati n fndin s and

thera$euti $r edure a$$!ied. ;e a!s

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• = !! 'in the $r t ! used in urde$artment r the mana ement $erit nsi!!ar in e ti ns& a!! $atients attendinthe "mer en y 6er#i e 'ith sym$t ms ande3$! rati n nsistent 'ith the dia n sis

$erit nsi!!ar in e ti n 'ere admitted rintra#en us antibi ti thera$y& ana! esia and$ ssib!e intra#en us rti ster ids.

• a dia n sis $h!e m n r $erit nsi!!ar

abs ess 'as based $rimari!y n thebtenti n $us 'ith need!e as$irati n

$er rmed n $atients u$ n admissi n& inthe re i n ma3imum $erit nsi!!ar bu! in

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resu!t• ;e ana!ysed 100 nse uti#e $atients

dia n sed 'ith $erit nsi!!ar in e ti n atur h s$ita! bet'een A$ri! 2008 and

, t ber 2010.

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• As menti ned $re#i us!y& u$ n admissi n a!!$atients under'ent $un ture>as$irati n in the m st

n#e3 $art the anteri r t nsi!!ar $i!!ar.•

) $uru!ent materia! 'as btained in ?2 ases7?2 & !ea a e $us 'as bser#ed in 2 ases7 2 & in 5 $atients 75 'e n ted a s$ ntane usdraina e $uru!ent materia! and in 1 ase 71$un ture 'as n t $er rmed at the time dia n sis due t trismus.

• @ased n this resu!t 'e !assifed $atients int th se'ith a dia n sis $h!e m n& 'hen there 'as ndis har e $us 7?2 & r abs ess& 'hen $un ture!ed t the !ea a e $uru!ent materia! 7 8 .

• /!ini a! si ns si nif ant!y ass iated 'ith the$resen e $erit nsi!!ar abs ess 'ere the $resen e

trismus 7P .001 & ntra!atera! de#iati n theu#u!a 7P .001 and bu! in the anteri r $i!!ar

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• A!! $atients 'ere h s$ita!ised and treated'ith intra#en us antibi ti s.

•

In a!! ases& antibi ti treatment 'as arriedut em$iri a!!y and durati n intra#en usthera$y #aried bet'een 1 day 7 n!y 1 ase'as treated r 24 h and C days. D st

$atients 782 re ei#ed intra#en usantibi ti treatment r at !east days.• A!! $atients re ei#ed ra! antibi ti thera$y

at dis har e r C days.

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• 6e#enty>se#en $er ent $atients had nhist ry re urrent t nsi!!itis and 55'ere re ei#in antibi ti treatment. 6i3ty>t' ases 'ere $erit nsi!!ar abs ess andthe rest 'ere e!!u!itis.

• Trismus & u#u!ar de#iati n and anteri r

$i!!ar bu! in 'ere statisti a!!y ass iated'ith $erit nsi!!ar abs ess 7 P .005 . A!!$atients 'ere admitted t h s$ita! andtreated 'ith $un turedraina e&intra#en us antibi ti s7am 3i i!!in( !a#u!anate in 8 asesand a sin !e d se ster ids. A!! $atients'ere dis har ed n ra! antibi ti thera$y.

*he mean !en th h s$ita! stay 'as

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-is ussi n

• D st studies $ub!ished in urrent !iteratureare based n a retr s$e ti#e ana!ysis

ases.• In rder t redu e the heter eneity

inherent t m st retr s$e ti#e series& 'eha#e h sen t ana!yse $r s$e ti#e!y 100

nse uti#e ases treated at ur h s$ita!a rdin t the same dia n sti andthera$euti $r t !.

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• ,ne the hy$ theses 'hi h 'ensidered at the be innin the study

'as that an ina$$r $riate use antibi ti s in the treatment $haryn itis

a# ured the de#e! $ment m$!i ati ns& s$e if a!!y the use

ma r !ides& due t the hi h rate resistan e am n the 6$anish $ $u!ati n.

• E 'e#er& a!th u h m st $atients 'ereta in antibi ti s at the time dia n sis

$erit nsi!!ar in e ti n& 'e und thatn!y $atients 'h had ta en

antibi ti s $re#i us!y had ta en ama r !ide and m st 'ere bein treatedade<uate!y 'ith am 3i i!!in( !a#u!anate.

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• 'e an n !ude that m st resistan esremain d se>de$endent.

•

;e be!ie#e that a mbinati n !indamy in and entami in may be an

ade<uate a!ternati#e in ases beta>!a tam a!!er y r un a# urab!e e# !uti n'ith the frst $ti n.

• ,ther auth rs ad# ate the use e ta3ime r $eni i!!in a! ne r mbined

'ith metr nidaz !e& 'ith simi!ar resu!ts.• ;e be!ie#e that administrati n a sin !ed se rti ster ids an be #ery use u!&ha#in bser#ed& !i e ther auth rs&

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/riti a! A$$raisa!

• Title 3erito'sill r I'8e$tio's: 3ros*e$ti-e Stu(6 o8 100"o'se$uti-e " ses

• uthorsM r! "ost les#M r$os%& Fer' '(o L)*e+#,l- re+%F usti'o N./'e+# t ll % " rl More'o#G li'(o% " s r,l- re+ M r$os% os Luis Llore'te#3e'(4s

• 3u li$ tor :999 else-ier es

3ositi-e• / nsist #ariab!esstudied• @ !d• ) abbre#iati n

• / nsist !ess than 12' rds : 8 ' rds

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Deth ds

• /!ear sam$!e and in !usi n riteria• /!ear inter#enti n am n r u$s• Ana!yti a! studies 'ere !ear!y menti ned• ,ut me 'ere !ear!y measured

P siti#e

• >)e ati

#e

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Result

• 6tatisti a! #a!ue 'as 'rittenP siti#

e• it 'as n t a m$anied by tab!es $resented ina rdan e 'ith the rmat Internati na! J urna!;rittin 7'ith ut inner #erti a! and h riz nta! !inesand seria! number& tab!e tit!e and des ri$ti n the

ntent

)e ati

#e

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Dis$ussio'• *here are m$aris ns test $re#i us studies and the

the ry• *here menti ned dra'ba s and ad#anta es

resear h resu!ts that ha#e been a hie#ed• *here is an em$hasis i the resu!ts the resear h 'i!!

be a$$!ied

P siti#e

• *here 'as n any su esti ns r uture resear hne ati

#e

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I'ter' l V li(it6

• Patients : 100 $atients 'ith $erit nsi!!arin e ti n r m 2008 t 2010.

• Inter#enti n : treated 'ith

$un turedraina e& intra#en usantibi ti s 7am 3i i!!in( !a#u!anate in 8

ases and a sin !e d se ster ids. A!!$atients 'ere dis har ed n ra!

antibi ti thera$y.• / m$aris n – there is n ntr ! r u$• ,ut me7s >

V li(it s U=i

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"o';t i'ter' l - li(it6<uestio'

1a. +> ;as the assi nment $atients t treatmentsrand misedF

No

1b. +> ;ere the r u$s simi!ar at the start the tria!F Yes

2a. A – Aside r m the a!! ated treatment& 'ere r u$s treated

e<ua!!yF No

2b. A – ;ere a!! $atients 'h entered the tria! a unted rF –and 'ere they ana!ysed in the r u$s t 'hi h they 'ererand misedF

No

. D > ;ere measures b e ti#e r 'ere the $atients and!ini ians e$t Gb!indH t 'hi h treatment 'as bein re ei#edF

No

V li(it s U=i

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E>ter' l V li(it6?A**li$ ilit6<uestio'

Is my $atient s diBerent t th se in the studythat the resu!ts ann t a$$!yF

no

Is the treatment easib!e in my settin F yes

;i!! the $ tentia! benefts treatmentut'ei h the $ tentia! harms treatment r

my $atientFyes

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KESIM3ULAN

• the thera$y study is VALID

1

• the thera$y study is IM3ORTANT

2

• the thera$y study is A33LI"A LE