Removal Of Papilloma Research Articles

Vacuum-assisted percutaneous removal of breast papillomas and radial scars

Introduction: Image-guided removal of breast lesions has been described. The UK breast screening program pathology sub-group have defined a group of lesions with uncertain malignant potential (B3) when surgical excision is recommended. However large-core vacuum-assisted devices provide an alternative means of removal. We review the Maidstone experience in the vacuum-assisted removal of papillomas and radial scars.

Aktuelle Therapieoptionen bei der rezidivierenden respiratorischen Papillomatose

The purpose of this review is to describe and to critically discuss recent advances in the management of recurrent respiratory papillomatosis (RRP). The goal of surgery in RRP remains the control of symptoms. A curative therapy cannot be expected. The microdebrider and the CO(2)-laser are currently the most widely used surgical options. Literature reports an increase in adjuvant medical therapies of 10-22%. The most common drugs in adjuvant therapy are interferon, cidofovir and indole-3-carbinole/diindolylmethane. The lack of controlled studies limits our ability to accurately assess the antiviral action of the adjuvant therapies. At the moment, therapeutic interventions remain focused on the surgical removal of papillomas when possible, and additional adjuvant therapy is available for the minority of patients for whom surgical management fails to adequately control their disease. Recent advances in immunologic research offer the hope of immune system modulation as potential future treatment modalities to better control this disease process.

Microsurgical management of laryngeal papillomas and prevalence of human papilloma virus infection

The aim of the study was to detect the prevalence of human papillomavirus (HPV) infection in the upper respiratory tract of patients with laryngeal papillomatosis and evaluate outcomes of endolaryngeal microsurgery (EM).A group of 36 patients with laryngeal papillomatosis and a control group of 108 healthy individuals were examined for the presence of DNA of HPV. Viral typing using the polymerase chain reaction (PCR) was performed. DNA of HPV was detected in 35 out of 36 cases of laryngeal papillomatosis (97.22%), and only in 25 persons (23.15%) in the control group. HPV types 6 and 11 were predominant in these cases. A total of 89 patients, comprising of 32 subjects with juvenile papillomatosis (JP) and 57 with adult papillomas (AP), have been undergoing EM at the Department of Otolaryngology of Kaunas University of Medicine for the last 15 years. The recurrence rate in the follow-up period, lasting at least 2 years, was 72% (23 patients) in the JP group and 23% (13 patients) in the AP group. The number of EM for one patient ranged from 1 to 18 (mean 3.2) in the JP group and from 1 to 5 (mean 1.35) in the AP group. EM is a minimally invasive and safe technique, which provides accurate removal of papillomas. However, it remains as primarily palliative method of treatment.

The course of laryngeal papillomatosis treated by endolaryngeal microsurgery.

Surgical excision of papillomas remains the mainstay of the management of laryngeal papillomatosis, as causal therapy is not yet available. Eighty-nine patients -32 with juvenile papillomatosis (JP) and 57 with adult papillomas (AP)-- underwent endolaryngeal microsurgery (EM) in our department during the last 15 years. The ENT-department in Kaunas serves most of the patients with laryngeal papilloma among the 3.85 million inhabitants of Lithuania. Therapeutic outcome was assessed as both the recurrence rate and the length of time between recurrences of papillomas in the follow-up period lasting at least 2 years. The recurrence rate was 71.9% (23 patients) in the JP group and 22.8% (13 patients) in the AP group. The interval between recurrences of papillomas ranged from 1 month to 10 years (mean 1.9 years) in the JP group and from 6 months to 9 years (mean 3.2 years) in the AP group. The number of EMs per patient ranged from 1 to 18 (mean 3.2) in the JP group and from 1 to 5 (mean 1.35) in the AP group. EM is a minimally invasive and safe technique which provides accurate removal of papillomas, although recurrence is often unavoidable. Prognosis for the disease therefore remains rather unpredictable.

Apneic anesthesia with intermittent ventilation for microsurgery of the upper airway.

Apneic anesthesia with intermittent ventilation (AAIV) has been used in 250 procedures on the larynx and trachea at Indiana University Medical Center since October 1989. Initially employed for laryngeal papilloma removal in children, this anesthetic technique is now used for other procedures and in adult patients. The advantages of AAIV include improved visualization of the airway, absence of combustible material, and lack of vocal cord motion during surgery. No significant complications have occurred with AAIV. The high degree of safety for this anesthetic technique relates largely to the constant monitoring of oxygen saturation using pulse oximetry and the periodic measurement of end-tidal carbon dioxide (CO2) levels. Contraindications to AAIV are age less than 2 years, significant cardiopulmonary disease, and any hypermetabolic state. Relevant pulmonary physiology includes the unique aspects of oxygen and CO2 metabolism in children.

Transoral Laser Surgery for Supraglottic Cancer

ABSTRACT Introduction of the CO2 laser by Strong and Jako in 1972 for laryngeal papilloma removal ushered in a new dimension in surgery of the larynx. Because it increases visualization and hemostasis and decreases tissue edema and morbidity, the CO2 laser has enhanced the effectiveness of microlaryngoscopic surgery. Forty patients with squamous cell carcinoma of the supraglottis (T1–T3) underwent transoral CO2 laser resection. Twenty of these patients had a combined neck node dissection and postoperative radiotherapy. Advantages of the laser transoral approach are facility, immediate restoration of swallowing, shortened hospitalization, and avoidance of tracheostomy.

喉頭乳頭腫に対する喉頭顕微鏡下レーザー手術

There are many kinds of therapeutic methods for laryngeal papilloma. However, it is even now exceedingly difficult to eradicate lesions completely. Recurrences after surgery occur frequently. One of the causes of recurrences is considered to be an incomplete removal. We believe an incomplete removal of papilloma is caused by lack of precise visualization of the lesion during surgery. Bleeding, coagulated blood and/or carbonized tissue produced by laser obscures the image of remaining papilloma. We have developed a new surgical method, called “tow-stage operation”. Two successive surgeries are conducted with an interval of 10 days. At the second operation, bleeding, coagulated blood and carbonized tissue of the first operation disappear and the laryngeal image is much clearer. When some lesions are still found, they are removed at the second operation. This paper presents a case of 26-year-old male with laryngeal papilloma who had been operated one month before at another hospital. A laryngeal endoscopic examination revealed multiple papillomas especially at the glottis. The first surgery was performed with carbon dioxide laser on 16th Apr. 1990. Visible lesions appeared to be removed completely. The second operation was carried out 10 days after the first operation and small remaining lesions was removed with CO2 laser. The patient has been disease free for eight months.

Histopathologic and Virologic Study in Squamous Carcinoma Arising From Established Benign Papillomata

Haskins Kashima and coworkers at Johns Hopkins University School of Medicine, Baltimore, recently reported a case of squamous cell carcinoma arising in a laryngeal papilloma in an adult who had had irradiation 14 years previously. Further investigation of this case, presented at the Southern Section of the Triological Society in Birmingham, Ala, disclosed widespread distribution of human papillomavirus in the laryngectomy specimen. Of the 17 previously reported cases of carcinoma in laryngeal papilloma, ten cases had had radiation therapy for treatment of the papillomas. The latency between the diagnosis of papilloma and the development of carcinoma was approximately 30 years in the nonirradiated cases, but it was only ten years in the irradiated cases. Careful histologic examination of the specimen was urged after any papilloma removal for early detection of carcinoma.

Aerodigestive tract papillomatosis: Bacille calmette‐guérin (BCG) immunotherapy

Aerodigestive tract papillomatosis (ADTP) remains a distinct challenge for the otolaryngologist. None of the myriads of therapies utilized to date offers a distinctly improved prognosis with less frequent clinical recurrences or absolute cure rates. Significant complications are avoided by withholding tracheotomy whenever possible and avoiding overly aggressive papilloma removal. Laser technology seems to offer a distinct benefit as regards the latter. Despite much activity in this area, little new knowledge has actually influenced the outcome of patients afflicted with papillomatosis. The disorder remains one of long-term morbidity in those acquiring it early in life and one with a significant rate of mortality for those with involvement of the lower airway. A review and selected discussion of our experience at The Milton S. Hershey Medical Center of The Pennsylvania State University with ADTP from 1974 to 1981 is presented. Nineteen patients ranging in age at the time of presentation from 1.5 to 68 years old have been diagnosed and treated. For the most part, therapy consisted of repeated microendoscopies with forceps removal of papillomas until recurrences ceased. However, in four adult patients with either rapidly recurring laryngeal and/or tracheobronchial papillomas, bacille Calmette-Guérin (BCG) immunotherapy has been administered. Two of these patients are evaluable for greater than 12 months. The rationale and efficacy of the treatment of a high risk group in this fashion are discussed.

Laryngeal papilloma: results of treatment with the CO2 laser and podophyllum.

From 1976 to 1982, 109 patients with recurrent laryngeal papillomas were treated with a total of 548 CO2 laser excisions followed by podophyllum painting. There was high incidence of multiple sites of involvement, especially the tracheobronchial tree (18.3%) and palate (8.3%). Four patients had pulmonary parenchymal involvement. Patients were treated at 2-month intervals until they entered remission. Thereafter, microdirect laryngoscopies were advised at longer intervals. Remission was achieved in 41%; it occurred at all ages although it was most common during adolescence and rarest in the very young and very old. Many patients obtained remission with the CO2 laser after multiple prior cup forceps removals had not achieved remission. Only two tracheotomies (1.8%) were required and no deaths occurred. When compared with mechanical methods of papilloma removal, CO2 laser excision with podophyllum painting represents a clear advance in terms of preservation of laryngeal physiology and avoidance of life-threatening complications.

Autogenous vaccine treatment of juvenile laryngeal papillomatosis

Seventeen cases of juvenile laryngeal papillomatosis have been seen and treated with microlaryngoscopy, removal of papillomas, and administering of autogenous vaccine. Holinger's original findings could be confirmed. The operation frequency of 9 patients was significantly reduced, 5 were improved, and 3 unchanged. In no case was an undesirable reaction to the vaccine observed. Electron microscopy showed no virus-like particles in the papilloma but a section of a vulvar wart did show the virus.

Persistent hydrocephalus following the removal of papillomas of the choroid plexus of the lateral ventricles. Report of two cases.

Persistent hydrocephalus following the removal of papillomas of the choroid plexus of the lateral ventricles. Report of two cases.

Transurethral Removal of Papilloma of the Bladder

Transurethral Removal of Papilloma of the Bladder

Removal of Papillomas from the Larynx of Infants by the Direct Method

Removal of Papillomas from the Larynx of Infants by the Direct Method