Search

Abstract Background Thalidomide based regimen is an effective and well tolerated therapy in multiple myeloma (MM) patients, however, there were a small number of studies written about the results of thalidomide therapy in non-transplant MM patients. We therefore conducted a retrospective study of 42 consecutive patients with newly diagnosed and relapsed/refractory MM treated with thalidomide- based induction regimens followed by thalidomide maintenance therapy. Results Induction regimens with thalidomide and dexamethasone, and the oral combination of melphalan, prednisolone and thalidomide were administrated in 22 and 16 patients, respectively. The remaining 4 patients received other thalidomide- containing regimens. Twenty-nine patients received thalidomide as a salvage regimen. Twenty-three out of 26 patients achieving complete remission (CR) and very good partial remission (VGPR) received thalidomide maintenance. Of the 41 evaluable patients, median time of treatment was 21 months (3- 45 months), ORR was 92.7% with a 63.4% CR/VGPR. With a median follow up of 23 months, 3-year- PFS and 3-year-OS were 58.6 and 72.6%, respectively. Median time to progression was 42 months. While 3-year-PFS and 3-year-OS in non-transplant patients receiving thalidomide maintenance therapy were 67 and 80%, respectively. Conclusions Prolonged thalidomide therapy enhanced survival rate and less frequently developed serious toxicity in non-transplant multiple myeloma patients.

ObjectivesTo study the prevalence of high-risk obstructive sleep apnea (OSA) in attention deficit hyperactivity disorder (ADHD) children in a child and adolescent psychiatry clinic using the Thai version of the Pediatric Obstructive Sleep Apnea Screening Tool (POSAST) questionnaire. The secondary objective was to evaluate the quality of life and identify associated factors for high-risk OSA in ADHD children.Study designProspective cross-sectional study.Material and methodCaregivers of pediatric patients aged 5–18 years old and diagnosed with ADHD by child and adolescent psychiatrists were surveyed about their child's sleeping habits.ResultsTwo hundred and seventy-four subjects were included. The patients' mean age was 10.4 ± 2.6 years, and 82.8% were males. There were 30 children (10.9%) diagnosed with obesity, 46 (16.8%) with chronic rhinitis, and 9 (3.3%) with asthma. The median duration of ADHD symptoms was 22.1 months. The prevalence of high-risk OSA was 18.2% and was associated with significantly reduced quality of life (adjusted OR = 4.46, 95% CI: 2.26–8.81, P < 0.001). A significant association between high-risk OSA and obesity also emerged (adjusted OR = 2.84, 95% CI: 1.17–6.88, P = 0.021).ConclusionAn elevated prevalence of high-risk OSA is present among Thai children with ADHD, and significantly impacts quality of life. A significant association between high-risk OSA and obesity is also detected in patients with ADHD. Therefore, screening for high-risk OSA in ADHD patients may likely facilitate early detection and treatment of OSA, and potentially prevent adverse consequences.

Abstract Objectives Standard treatment with a thiotepa-based regimen in countries with a limited resource is less feasible. Aims of the study were to evaluate the treatment outcome, and identify the prognostic factors in patients with primary central nervous system lymphoma (PCNSL). Methods We conducted a retrospective study of 43 patients diagnosed with PCNSL, DLBCL subtype, who were treated with either HDMTX-based regimen, whole brain radiotherapy (WBRT), or both between 2010 and 2017. Results There were 43 patients with a median age of 65 years (range 34–89 years). Protein expression of CD10, Bcl6, MUM1, Bcl2 and MYC were found in 19, 86, 91, 91 and 23%, respectively. Both germinal center B cell (GCB) and double-expressor (MYC+/Bcl2+) lymphomas were found in 21%. Multiple brain lesions and maximum tumor diameter (MTD) ≥5 cm were seen in 27 and 10 patients, respectively. Chemotherapy combined with WBRT, chemotherapy and WBRT were given to 20, 14 and 9 patients, respectively. Overall complete remission (CR) rate was 55.8%. Those receiving a combined-modality therapy had a higher CR rate than those treated with either chemotherapy (75% versus 36%, p = 0.036) or WBRT (75% versus 44%, p = 0.109). Median follow-up time was 17 months, and a 7-year overall survival (OS) was 40%. Features associated with a prolonged OS were an ECOG score ≤ 2 (p = 0.001), multiple brain lesions (p = 0.010), multiple area of brain involvement (p = 0.023), MTD

Introduction: The aim of this research is to find the association between the pathogenic bacteria obtained from the adenoid culture and clinical characteristics of adenoid-related diseases in children. Methods: In this retrospective study, we reviewed the medical records of children who had adenoidectomy for adenoid-related diseases. Demographic data, diagnoses, indications for adenoidectomy and bacterial culture results were collected. The adenoid size was measured in the lateral skull X-ray as adenoid–nasopharyngeal ratio. Associations between the culture results and the demographic data, adenoid size, and the diagnoses were analyzed. Results: There were 407 children who had adenoidectomy for obstructive sleep-disordered breathing (75.2%), otitis media with effusion (19.2%), and chronic sinusitis (5.6%). Median age was 5.9 years. Common pathogenic bacteria in the adenoid were Haemophilus influenzae (26.2%), Staphylococcus aureus (23.5%), Streptococcus pneumoniae (18.2%), and Moraxella catarrhalis (12%). The patient’s age had significant association with the prevalence of pathogenic bacteria. S. pneumoniae was most prevalent in young children up to 7 years. S. aureus was more common in children over 7 years. H. influenzae had similar prevalence in all age groups. Size of the adenoid and type of adenoid-related diseases had no association with the outcome of bacterial culture. Conclusion: Age of the patients was the significant factor associated with the bacteriological findings of the adenoid while size and types of adenoid-related diseases were not associated with the outcome of bacterial culture.

This research was aimed to study the association of cleft palate and craniofacial syndromic anomalies with the outcome of the tympanic membrane after tympanostomy tube insertion and time to recovery from recurrent otitis media with effusion. A retrospective cohort study was done in 85 children with cleft palate and 102 non-cleft children who had tympanostomy tube insertion for otitis media with effusion. The desired outcome was the recovery of recurrent otitis media with effusion with intact tympanic membrane. Craniofacial syndromic anomalies were found in 11.8% of the children in both groups. Intact tympanic membrane was found most commonly in noncleft children without craniofacial anomalies (63.7%). Cleft palate was the most significant risk for the non-intact tympanic membrane after adjusting for syndromic anomalies and the number of tympanostomy tube insertion (p = 0.047). Time to recovery from recurrent otitis media with effusion was shortest in the non-cleft children without craniofacial anomalies (4.9 years) with the highest probability of cure (hazard ratio and 95% CI 3.46 (1.62, 7.39)). Children with cleft palate had higher probability of cure than the children with cleft palate and craniofacial syndromic anomalies (hazard ratio and 95% CI 2.59 (1.16, 5.80)). Children with cleft palate and craniofacial syndromic anomalies had highest incidence of otorrhea (59.1%) and repeated tympanostomy tube insertion (86.4%). Craniofacial syndromic anomalies with cleft palate contributed to a longer time to recovery and higher incidence of complications from tympanostomy tube.

Objective: To study the long-term outcome of otitis media with effusion in children with and without cleft palate treated with the same protocol of ventilation tube insertion. Materials and Methods: A retrospective cohort study was conducted in eighty-five children with cleft palate and 80 children without cleft palate who had otitis media with effusion and had follow-up between 2001 and 2019. Both groups were treated with ventilation tube insertion for longstanding middle ear effusion more than 90 days. The main outcome was the cumulative incidence of surgical management, time of the indwelling ventilation tubes, conditions of the tympanic membrane, and the hearing outcome. Results: At 24 months old, 63.5% of children with cleft palate and 11.3% of children without cleft palate had their first ventilation tube insertion. Repeated surgery was done in 81.2% of children with cleft palate and 50% of children without cleft palate (p < 0.001). The median duration of the indwelling tube was 11.3 months in the children with cleft palate and 12.4 months in the non-cleft children (p = 0.82). At the end of the study, 63.7% of children without cleft palate and 43.5% of children with cleft palate had normal tympanic membrane (p = 0.009). The hearing outcomes of children with and without cleft palate were 20.7 dB and 19.3 dB, respectively. Conclusion: Children with and without cleft palate were managed under the same guideline and the hearing outcome was favorable in both groups.

Children with cleft palate and craniofacial anomalies are more prone to otitis media due to the anatomical defect of the cranial base and the eustachian tube. This prospective study was conducted in the cleft palate patients of the Craniomaxillofacial Clinic from January 2001 to April 2002. Pneumatic otoscopic examination was done monthly in every patient since they registered in the clinic for cleft palate correction. Thirty-eight children were included. Mean age was 21.4 ± 33.7 months and 89.5% of the children were under 24 months old. Mean time for follow up was 150 ± 132 days (mean ± S.D.). Twenty-six patients (68.4%) had ear diseases at least once during the study period. Otitis media with effusion (OME) was the most common ear disease found in this series. Twenty-one percent of the patients had at least one episode of OME by the age of one and 47.5% of the patients had at least one episode of OME by the age of two. The incidence of OME was 3.85 per person per year. Acute otitis media and atelectatic ear drum were found with the incidence of 0.51 and 0.30 per person per year respectively. Tympanogram type B was found in 47.4% and type C was found in 10.5%. Periodical ear examination in cleft palate children is recommended for early detection of otitis media in order to prevent irreversible middle ear damage or hearing loss in the future.

Obstructive sleep apnea in children is most commonly caused by adenotonsillar hypertrophy. Chronic longstanding hypoxia at night can lead to cardiovascular complications such as pulmonary hypertension and cor pulmonale. We reported a case of a four-year-old boy who had suffered from adenotonsillar hypertrophy and obstructive sleep disturbance for 3 years, resulting in right ventricular hypertrophy. Adenotonsillectomy was performed. Pre-operative awareness of potential complications, good co-operation between pediatric cardiologist and pediatric anesthesiologist with post-operative monitoring in intensive care unit were essential for the success of surgical treatment.

We present a 14 year-old girl with a history of chronic rhinorrhoea and nasal obstruction. Physical findings showed huge nasal polyp with broadening of the nasal bridge, perforation of the left ear drum and a right middle ear effusion. Despite a strict program of nasal saline toilet, broad-spectrum antibiotics covering beta-lactamase producing organisms, and meticulous technique of endoscopic sinus surgery, the patient's symptoms and nasal polyp reappeared very quickly. A set of investigations had been done in order to confirm and rule out suspected diseases. The electron microscopic study of the patient's nasal mucosa revealed partial absence of inner dynein arms and extra singlet at the center in some axoneme compatible with Primary ciliary dyskinesia.

Objective: The adenoid is an important contributing factor for otitis media with effusion by serving as the reservoir for patho- genic bacteria. Adenoidectomy is suggested in the guidelines as an adjunctive surgical treatment for otitis media with effusion. Recurrence of otitis media after adenoidectomy should be evaluated and concomitant adenoidal diseases should be taken into consideration. The objective of this study was to evaluate the outcome of the patients who had simultaneous adenoidectomy and tympanostomy tube insertion, in terms of recurrence of otitis media, adenoid-related diseases and repeated surgery. Methods: A retrospective study was performed in those patients who had adenoidectomy with tympanostomy tube insertion during 1994-2003. Medical records were reviewed from the time of surgery until the last contact of each patient. Data col- lection included indications for surgery, culture results, post-operative recurrence of otitis media, adenoid-related diseases and additional operations. Results: There were sixty-six patients with 47 boys and 19 girls. The mean age was 6.27 ± 3.05 years. Co-existing adenoidal diseases consisted of rhinosinusitis (54.5%), obstructive sleep disorder (42.4%), and adenotonsillitis (3%). Nine cases (13.6%) had no associated adenoidal disease. and adenoidectomy was done in conjunction with the insertion of their second set of tym- panostomy tubes. The predominant bacteria from the adenoid cultures were Streptococcus pneumoniae (21.7%), Pseudomonas aeruginosa (21.7%) and Streptococcus viridans (17.4%). The mean period of follow up was 23.8 months. Forty-one patients (62.1%) had no recurrence of otitis media. Nine cases (13.6%) had repeated myringotomy and tube insertion. Significant correlation was found between recurrent rhinosinusitis and recurrent otitis media (p = 0.001). The relative risk of recurrent otitis media in patients with recurrent rhinosinusitis was 3.63 (95% CI 1.4 to 9.4). Conclusion: Simultaneous adenoidectomy with tympanostomy tube insertion produced satisfactory results in reducing the recurrence of otitis media during the follow-up period. Recurrent rhinosinusitis was correlated with recurrent otitis media and repeated myringotomy and tube insertion.

Brain heterotopia is a benign tumor composed of differentiated neural tissue that is located outside the cranial vault. This condition is uncommon and presents as a congenital pharyngeal mass. Here, we report a case of neuroepithelial heterotopia in the nasopharyngeal area of a six-month-old boy who presented with cleft palate and stridor. The tumor demonstrated aggressive growth with oropharyngeal involvement. Radiologic finding revealed a large heterogeneous enhancement on the left side of the nasopharynx, involving the uvula, left lateral pharyngeal wall, and left tonsil. No connection to the brain or spinal cord was apparent on imaging. Histologic features included presence of neuroglial heterotopias, composed predominately of glial cells in a surrounding neurofibrillary matrix. Surgery was the selected intervention, with wide excision performed via cleft palate. Previously published literature relevant to this case were reviewed and discussed. Recurrence is common in incomplete resection, although there was no evidence of recurrence at the two-year follow-up in this patient.

Brain heterotopia is a benign tumor composed of differentiated neural tissue that is located outside the cranial vault. This condition is uncommon and presents as a congenital pharyngeal mass. Here, we report a case of neuroepithelial heterotopia in the nasopharyngeal area of a six-month-old boy who presented with cleft palate and stridor. The tumor demonstrated aggressive growth with oropharyngeal involvement. Radiologic finding revealed a large heterogeneous enhancement on the left side of the nasopharynx, involving the uvula, left lateral pharyngeal wall, and left tonsil. No connection to the brain or spinal cord was apparent on imaging. Histologic features included presence of neuroglial heterotopias, composed predominately of glial cells in a surrounding neurofibrillary matrix. Surgery was the selected intervention, with wide excision performed via cleft palate. Previously published literature relevant to this case were reviewed and discussed. Recurrence is common in incomplete resection, although there was no evidence of recurrence at the two-year follow-up in this patient.

Children with cleft palate and craniofacial anomalies are more prone to otitis media due to the anatomical defect of the cranial base and the eustachian tube. This prospective study was conducted in the cleft palate patients of the Craniomaxillofacial Clinic from January 2001 to April 2002. Pneumatic otoscopic examination was done monthly in every patient since they registered in the clinic for cleft palate correction. Thirty-eight children were included. Mean age was 21.4 ± 33.7 months and 89.5% of the children were under 24 months old. Mean time for follow up was 150 ± 132 days (mean ± S.D.). Twenty-six patients (68.4%) had ear diseases at least once during the study period. Otitis media with effusion (OME) was the most common ear disease found in this series. Twenty-one percent of the patients had at least one episode of OME by the age of one and 47.5% of the patients had at least one episode of OME by the age of two. The incidence of OME was 3.85 per person per year. Acute otitis media and atelectatic ear drum were found with the incidence of 0.51 and 0.30 per person per year respectively. Tympanogram type B was found in 47.4% and type C was found in 10.5%. Periodical ear examination in cleft palate children is recommended for early detection of otitis media in order to prevent irreversible middle ear damage or hearing loss in the future.