Cases reported "Papilloma"

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11/14. Double-barreled (diversionary) tracheostomy in the management of juvenile laryngeal papillomatosis.

    A two-year-old female presented to the author with a 11/2 year history of multiple recurrences of juvenile laryngeal papillomatosis which when first seen had progressed to and below the tracheotomy site. The entire supraglottic larynx, glottis, and subglottic area were completely filled with exuberant papillomata. There was active growth of papilloma at and below the tracheotomy site and the tube had to be inserted through papilloma in order to reach a clear area in the trachea. In hopes of preventing further spread of papilloma below the area already involved and in order to control the airway and provide access to the subglottic area for laser removal, a double-barreled tracheostomy was performed. Laser treatment and/or spontaneous resolution ultimately resulted in complete clearing of all papillomata from the upper and lower tracheal segments. Four years and nine months after the initial procedure it was felt safe to attempt reconstruction. Her postoperative course was uneventful and she was successfully extubated three months later. Both vocal cords are normally mobile and her voice is quite clear although slightly hoarse as a result probably of slight changes in the edges of the cords because of the repeated surgical interventions. There has been no recurrence of papilloma now, over one year since reconstruction of the trachea. This somewhat radical approach to a life-threatening growth of endotracheal papilloma was successful in preventing further spread below the level of tracheostomy and ultimately permitted total reconstruction of an intact tracheal bronchial tree in the case reported.
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12/14. Bronchogenic squamous cell carcinoma complicating localized recurrent respiratory papillomatosis.

    Bronchogenic squamous cell carcinoma has been reported in patients with recurrent respiratory papillomatosis (RRP) extending into the tracheobronchial tree even in the absence of a history of radiation therapy or smoking. We present a case of bronchogenic squamous cell carcinoma developing in a patient with RRP localized to the larynx for 45 years.
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13/14. adult type squamous papillomatosis of larynx with extension to trachea and bronchial tree: a report of two cases.

    We describe 2 rare cases of adult type squamous papillomatosis of larynx with spread to the trachea and bronchial tree that occurred at the age of 72 and 42, respectively. They were treated with laser therapy for laryngeal and tracheal lesions; the first case also received surgical resection. However, due to the extent of papilloma involvement, the outcomes were completely different between both. The first patient had all lesions successfully removed by combined surgical resection and laser photoresection, and the patient remained asymptomatic up to 7 years after the operation. The second patient, however, had been bothered by recurrent tumors with associated repeated secondary infections, despite treatment, for 6 years and 3 months before his death.
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14/14. ribavirin treatment for juvenile respiratory papillomatosis.

    Juvenile respiratory papillomatosis involving the tracheo-bronchial tree imposes a significant management problem and is sometimes life threatening. The mainstay of treatment is repeated vapourization with a CO2 laser. To date, adjunctive medical treatments have been of limited value. A tracheostomized child with extensive laryngo-tracheo-bronchial papillomatosis who has required bronchoscopic lasering at two-weekly intervals for three years was treated with ribavirin, a broad spectrum anti-viral agent. The drug was administered in nebulized form using a small particle aerosol generator (S.P.A.G.) to the lower respiratory tract (6 gm/150 ml over nine hours) on three consecutive nights every two weeks over seven weeks and also administered orally (15 mg/kg/day). Endoscopic assessments were made every two weeks. At 14 days the papillomata were regressing and far less lasering was required. No further lasering was required up to 56 days. One month after stopping the ribavirin, however, a few sessile papillomata in the tracheo-bronchial tree had recurred and were treated with the laser. No adverse reactions were encountered. During the treatment period there was a significant reduction in the frequency of therapeutic endoscopies. This promising response requires further evaluation to define the role of ribavirin in the treatment of juvenile respiratory papillomatosis.
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